ABSTRACT
Patients with Borderline Personality Disorder (BPD) commonly present to mental health clinicians, accounting for approximately 15–25 per cent of inpatient and 10 per cent of outpatient presentations (Leichsenring et al., 2011). Although multiple factors contribute to the development of BPD, the most robust predictor is chronic attachment trauma in early childhood (Agrawal et al., 2004), frequently compounded by later traumatic experiences, for example, emotional neglect, violence or sexual abuse (Zanarini et al., 1997). Patients with BPD present with a marked intolerance of being alone, chaotic and overwhelming emotional instability, and desperate attempts to stave off unbearable negative feelings. Deliberate self-harm, impulsive acts, dissociation and suicide attempts may all be involved (American Psychiatric Association, 2013), and when these do not reduce overwhelmingly unbearable feelings, the patient may be left with chronic despair and hopelessness, overwhelming anger, and a feeling of deadness, often alternating with unbearable anxiety (Meares, 2004). Up until the 1990s, therapeutic nihilism with respect to the treatment of BPD was pervasive, as the usual mental health interventions were mostly unhelpful (National Institute for Health and Care Excellence, 2009).
