With the book Borderline Personality Disorder in Older Adults:
Emphasis on Care in Institutional Settings, Drs. Hategan,
Bourgeois, and Xiong address an often underappreciated clinical
problem that is likely increasing with the aging of the population.
Geriatric patients with borderline personality disorder, like their
younger counterparts, experience social and relationship
challenges, comorbid psychiatric illness (including but not limited
to substance use disorders), comorbid systemic illness, and are
high utilizers of medical and social services. With the aging of
the population worldwide, more older patients with
chronic/progressive illnesses are to be found in various
institutional settings such as skilled nursing facilities,
rehabilitation units, and residential care, as well as in the
general hospital. However, these patients' habitual patterns of
behavior (including affective dyscontrol, externalizing of blame,
"splitting" the external world into groups who are "all good" and
"all bad") make the compromises and need for collectivity in
institutional settings more challenging than for any other easily
defined and demarcated patient group. The Editors have assembled a
large team of authors and co-authors to produce a clinical handbook
that addresses the clinical, social, and administrative needs of
this particular group of patients. They include an overview of the
development of the diagnosis of borderline personality disorder
over several issues of the Diagnostic and Statistical Manual of
Mental Disorders classification system; the epidemiology and
comorbidity, personality and aging, clinical diagnosis and
productive use of psychometrics; clinical interventions including
psychotherapy, psychopharmacology and advanced somatic treatments;
and chapters devoted to medical-legal matters, systems of care,
therapeutic alliance, and palliative care approaches. In all
chapters, the authors have endeavored to focus specifically on the
challenges posed for the patient, the clinician, and the larger
system for geriatric patients with borderline personality disorder.
The authors and the editors hope that this volume summarizes the
current clinical literature pertinent to the care of this
population, with a focus on clinical encounters, clinical decision
making, and techniques for interventions with patients and clinical
systems of care to enhance the opportunities for favorable clinical
outcomes for these patients, who typically have difficulty coping
with the major existential challenges of old age, infirmity, and
mortality. Greater awareness of borderline personality disorder in
this population and greater clinician attunement to its
understanding and management may serve the patient and the care
system in this regard.
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