Chapter 2.Overall Principles
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Clinicians, families, and patients often do not know how to understand the moment-to-moment shifts in the symptomatic states of patients with borderline personality disorder (BPD). Good psychiatric management (GPM) makes sense of BPD as a disorder of interpersonal hypersensitivity (Gunderson 2007; Gunderson and Lyons-Ruth 2008). Genetic vulnerability, endocrinological alterations, and neuroimaging findings suggest a biological vulnerability for BPD, which has been characterized as a stress-sensitive disorder (Crick et al. 2005; Fossati 2015; Kendler et al. 2011; Zanarini et al. 1990). BPD has a unifying latent genetic core (Distel et al. 2008; Gunderson et al. 2011b; Kendler et al. 2011), and interpersonal features are the most discriminating (Zanarini et al. 1990). The desire for exclusivity in relationships, insecure attachments, separation problems, and hypersensitivity predict adolescent BPD (Agrawal et al. 2004; Crick et al. 2005; Fossati 2015; Grant et al. 2008). These scientific findings suggest that individuals who develop BPD symptoms have innate predispositions for interpersonal hypersensitivity.
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