ranoid ideation" (APA, 1994:654). A person with BPD will exhibit several of the criteria mentioned above. Characteristically a patient with BPD is recognized as having extreme mood swings and a poor sense of self-image that may lead to suicidal tendencies.
Because borderline personality disorder is complex in nature and difficult to label, differential diagnostic criteria and theoretical orientations have been established for assessing the disorder (Cottrell & Jones, 2000). Thus a therapist might encounter differing behavioral, symptomatic and psychodynamic formulations and findings that form the basis of diagnostic categorization of BPD (Cottrell & Jones, 2000). Differential diagnostic criteria may include: identity diffusion, contradictory aspects of self and others, splitting defenses, projective identification, idealization and omnipotence as well as denial and de-valuation of the self (Cottrell & Jones, 2000). The specificity of borderline personality disorder remains in question however because patients vary in symptomology and personality despite fitting into diagnostic criteria (Cottrell & Jones, 2000).
Some researchers have in fact suggested that dimensional rather than diagnostic measures of behavior might be more appropriate for BPD patients, including analysis of differential characteristics and dimensions such as cognition, impulsivity, emotional liability and anxiety (Silk, 2002). Patients with BPD might also meet differential criteria for disorders including anti-social and shizotypal personality disorders (Cottrell & Jones, 2000; Silk, 2002). In fact as many as half of BPD patients exhibit the criteria for these other disorders (Silk, 2002). What differentiates BPD patients include the impulsive feelings, self-deprecating behaviors and suicide attempts common in BPD patients (Cottrell & Jones, 2000). Scales useful for determining the patient include the Gunderson Diagnostic Interview and Perry Borderline Personality Scale (Cottrell & Jones, 2000).
Traditional therapy has focused on pharmacological interventions for treating certain criteria of the disorder including depression and traditionally psychotherapeutic interventions. Psychotherapy while perhaps beneficial is often not backed by empirical data supporting this treatment approach. This is because traditional psychotherapy often fails and patients often drop out of treatment. Psychotherapists have even expressed some resistance toward treating BPD patients.
Cognitive Behavioral Perspective
There are other ways to view borderline personality disorder including from a cognitive behavioral perspective. Beck & Freeman (1990) suggest that borderline personality disorder may be addressed via cognitive behavioral techniques that address the expressions "of early maladaptive schemas" (p. 185). They suggest that the cognitive effects of the disorder cause a patient to believe that other people are responsible for satisfying their needs, and represent themselves as helpless in "a hostile world without security" (Beck & Freeman, 1990).
Cognitive behavioral therapy may be useful in treating and preparing patients for transference focused psychotherapy (Appelibaum, et. al, 2000). The CBT treatment approach aims to reduce behaviors that are harmful and life threatening first and foremost and those that interfere with the quality of life (Beck & Freeman, 2000). A cognitive behavioral approach requires that patients are taught to be aware of how their thinking is fundamentally instable, as well as recognize their emotional responses and interpersonal behavior. The goal of therapy is to help the patient develop coping mechanisms that will assist them in dealing with thoughts and feelings (Appelibaum, et. al, 2000).
A critical component of cognitive therapy involves individualized case conceptualization, which may help therapists organize information about a patient (Stenhouse & Van Kessel, 2002). The components of a cognitive treatment model will include analysis of core beliefs, intermediate beliefs and automatic beliefs (cognitive content) with information process