Magazine article Clinical Psychiatry News

Families of Borderline Patients Need Support Rather Than Blame. (Mixed Message from Psychiatrists)

Magazine article Clinical Psychiatry News

Families of Borderline Patients Need Support Rather Than Blame. (Mixed Message from Psychiatrists)

Article excerpt

NEW YORK -- Families of borderline patients need support from mental health professionals in coping with a most demanding illness. But what they hear often has an accusatory tone, Harriet P. Lefley, Ph.D., said at a conference on borderline personality disorder sponsored by Columbia University.

"Families get a mixed, inconsistent message from clinicians ... an overt attempt to help along with covert blame," said Dr. Lefley, professor of psychiatry and behavioral sciences at the University of Miami.

To judge by recent literature on the role of families in borderline personality disorder, the prevailing view resembles beliefs that were held about schizophrenia a half-century ago, when the talk was of schizophregenic mothers and the double bind.

Today, if the family is cited as an etiologic factor in schizophrenia, the context is likely to be genetics or prenatal exposure to influenza or malnutrition. But in the borderline literature, at least 90% of articles on the subject of families deal with childhood abuse as an antecedent, trigger, or cause of the disorder.

"The assumption of trauma is built into most therapeutic models," Dr. Lefley said at the meeting, which was also sponsored by the National Education Alliance for Borderline Personality Disorder.

A chapter on the subject in a book that appeared in 2001 emphasized overprotectiveness and parental pathology, as well as physical and sexual abuse. It suggested an etiologic role for the "chaotic" family environment in which many borderline patients live, and the noted that they "describe their parents as less caring," she said. …

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