In this article the authors discuss the patient with borderline personality disorder, milieu issues, and an alternative therapeutic approach: a contingency contract developed to manage self-mutilating behavior in a cost-effective manner. This contract was created as a quality improvement project on a locked unit to decrease self-destructive behavior in the patient with borderline personality disorder. The goal was to assist patients in developing more adaptive coping mechanisms, resulting in decreased self-destructive behaviors. Since implementation in February 1992, there has been an 84% decrease in self-destructive behavior in patients with borderline personality disorder in the population.
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References
1.
American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., revised). Washington, DC: Author.
2.
Burnham, D.L. (1966) The special problem patient: Victim or agent of splitting. Psychiatry, 29, 105-122.
3.
Caroll, J., Schaffer, C., Spenskley, J., & Abramowitz, S. (1980). Family experiences of self-mutilating patients. American Journal of Psychiatry, 137, 852-853.
4.
Cook, D., & Skeldon, I. (1980). The use of contract admission procedure on an acute psychiatric admission ward. British Journal of Psychiatry, 136, 463-468.
5.
Herman, J.L., Perry, J.C., & van der Kolk, B.A. (1989). Childhood Trauma in Borderline Personality Disorder. American Journal of Psychiatry, 146, 490-495.
6.
Hickey, B. (1985). The borderline experience: Subjective impressions. Journal of Psychosocial Nursing, 23(4), 24-29.
7.
Kaplan, H.I., Sadock, BJ., & Grebb, J.A. (1994). Kaplan and Sadock's synopsis ofpsychiatry, 7th Ed.Baltimore: Williams and Wilkins.
8.
Kernberg, O. (1976). Object relations theory and clinical psycho-analysis (pp. 19-54). New York. Jason Aronson, Inc.
9.
Mahler, M.S. (1971). A study of the separation-individuation process. Psychoanalytic Study of the Child, 26, 403-424.
10.
McEnany, G.W., & Tescher, B.E. (1985). Contracting for care. Journal of Psychosocial Nursing, 23(4), 11-18.
11.
O'Brien, P., Caldwell, C., & Transeau, G. (1985). Destroyers: written treatment contracts can help cure self-destructive behaviors of the borderline patient. Journal of Psychosocial Nursing, 12(4),21-21, 22-22.
12.
Pattison, E., & Kahan, J. (1983). The deliberate self-harm syndrome. American Journal of Psychiatry, 140, 867-872.
13.
Platt-Koch, L. (1983). Borderline personality disorder: A therapeutic approach. American Journal of Nursing,83, 1666-1671.
14.
Russ, M.J., Shearin, E.N., Clarkin, J.F., Harrison, K., & Hull, J. (1993). Subtypes of self-injurious patients with borderline personality disorder. American Journal of Psychiatry, 150, 1869-1871.
15.
Sadavoy, J., Silver, T., & Book, E. (1978). Staff countertransference to borderline patients on an inpatient unit. American Journal of Psychotherapy32, 521-532.
16.
Silver, D., Book, H.E., Hamilton, J.E., Sadavoy, J., & Slonim, R. (1983). The characterologically difficult patient: A hospital treatment model. Canadian Journal of Psychiatry28, 91-96.
17.
Simpson, M. (1975). The phenomonology of self mutilation in a general hospital setting. Canadian Psychiatric Association journal, 20, 429-434.
18.
Smoyak, S. (1985). Borderline personality disorder. Journal Psychosocial Nursing Mental health Service, 12(4), 5-5.
19.
Stone, M.H. (1990). The fate of borderline patients. Abnormalities of personality: Within and beyond the realm of treatment (pp. 4-6). New York, W.W. Norton and Co.
20.
Yeomans, F.E., Hull, J.W., & Clarkin, J.C., (1994). Risk factors for self-damaging acts in a borderline population. journal of Personality Disorders, 8(1), 10-16.
