Investigating the phenomenology of Borderline Personality Disorder with the States Description Procedure: clinical implications

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Abstract

Patients with Borderline Personality Disorder (BPD) manifest major discontinuities in their experience and behaviour, and these contribute to the difficulties of clinicians seeking to treat them. The underlying problem is one of structural dissociation of self processes into a small range of distinct states, the switches between which can be abrupt and evidently unprovoked.

A method of guided introspection, the States Description Procedure (Revised) (SDP-R), is described. The SDP-R provides a list of commonly used titles and brief profiles of borderline states on which subjects indicate those that they experience. Descriptions of possible subjective experiences, of possible relationships between self and other and of a range of other features are provided, and respondents describe each of their states in turn by underlining those descriptions that apply.

The procedure (which is not a psychometric test) was completed by 17 patients with BPD. The patients identified and characterized from 4 to 10 states from the provided titles. On the basis of their face value, the descriptions of subjective experiences were classified as positive or negative and the presence of somatic or dissociative experiences was noted. Four states were described as predominantly positive and seven were described as predominantly negative; about half of the latter were accompanied by somatic or dissociative symptoms. Subjects reported harsh relationship patterns in association with the subjectively negative states. These findings are consistent with the Multiple Self States Model of BPD. This was developed as part of Cognitive Analytic Therapy theory, but it is suggested that clinicians working with other therapy models or with pharmacotherapy could find the procedure helpful in understanding and managing this difficult and often disruptive patient group. Copyright © 2007 John Wiley & Sons, Ltd.

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