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.J.Clin.Psychiatry, 48: 155 157.12.Perugi G., Akiskal H.S., Lattanzi L., Cecconi D., Mastrocinque C., Patronelli A.,Vignoli S., Bemi E.(1998) The high prevalence of soft bipolar (II) features inatypical depression.Compr.Psychiatry, 39: 1 9.13.Gunderson J.G., Phillips K.A.(1991) A current view of the interface betweenborderline personality disorder and depression.Am.J.Psychiatry, 148: 967 975.14.Perugi G., Akiskal H.S.(in press) Are bipolar II, atypical depression andborderline personality overlapping manifestations of a common cyclothymic-sensitive diathesis? J.Clin.Psychiatry.15.Henry C., Mitropoulou V., New A., Koenigsber H., Silverman J., Siever L.(2001) Affective instability and impulsivity in borderline personality andbipolar II disorders: similarities and differences.J.Psychiatr.Res., 35: 307 312.16.Perugi G., Toni C., Travierso M.C., Akiskal H.S.(2003) The role of cyclothymiain atypical depression: toward a data-based reconceptualization of theborderline-bipolar II connection.J.Affect.Disord., 73: 87 98.3.12Borderline and Histrionic Personality Disorders:Implications for Health ServicesBrian Martindale1This WPA volume on personality disorders will have been most worthwhile ifit makes a contribution to overcoming the common finding that   Manyclinicians and mental health practitioners are reluctant to work with peoplewith personality disorder because they believe that they have neither theskills, training or resources to provide an adequate service, and becausemany believe there is nothing that mental health services can offer  [1].Michael Stone s review achieves the important tasks of delineating thephenomena encountered within contemporary definitions of borderline andhysteroid personality disorders and gives grounds for cautious optimismabout treatment possibilities.However, in Western societies, it is a sad butrealistic fact that we will only see greater investment on behalf of thesetroubled persons when there is much harder evidence of financial costs tothe community when untreated and financial benefits from therapeuticinterventions.The societal, psychological and practical problems that willbe encountered in achieving this necessary research are considerable.1Psychotherapy Department, West London Mental Health Trust, Uxbridge Road, Southall,Middlesex UB1 3EU, UK264 __________________________________________________________________ PERSONALITY DISORDERSAmongst many factors, major obstacles include the professional and socialstigma against this clinical population, the predominant medical model inpsychiatry that focuses on symptoms and current state disorders ratherthan underlying traits and developmental issues (with the excessivedependence on the pharmaceutical industry for research money), and notleast the problematic fact that any worthwhile research needs to be longterm when we are talking about personality disorders.There is one essential point that follows from Stone s description of thesetwo personality disturbances that is in keeping with everyday clinicalexperience.All persons who engage over time with these persons willinevitably be subject to stress and distress, because these particularpersonality disturbances manifest themselves in disturbing relations withothers, and clinicians are not spared this consequence.This  clinical fact isprobably the main underlying reason for the frequent rejection of thesepersons from services other than emergency care.The rejection often onlyleads to more frequent, often escalating, contact across a spectrum ofservices including mental health, social services, general practitioners andthe criminal justice system.On the other hand, it is this same effect onothers that is the source of the cautious optimism expressed by those whosetraining equips them to engage with the patient and with those sameinterpersonal stress and distress, and to manage it in a therapeutic manner,whatever the theoretical model being used [ Pobierz całość w formacie PDF ]