Mechanisms For The Impact Of Bpd On Depression Outcomes

Why does BPD have such adverse impacts on outcomes of depression? Shea, Widiger, and Klein (1992) discussed a number of possibilities, upon which we expand here. One is that depression with BPD may be biologically distinct. No good data directly support this position, although poorer outcomes for biological treatments, at least in uncontrolled studies, are consistent with it.

A second possibility is that, compared to patients with depression only, there are differences in cognitive content and style variables associated with depressed patients with BPD, such as dysfunctional beliefs and biased information-processing mechanisms. For example, Abela, Payne, and Moussaly (2003) found that individuals with both BPD and MDD had more dysfunctional attitudes and hopelessness than those with only MDD. This suggests greater cognitive vulnerability to depression in patients with BPD.

A third factor may be the adverse influence on psychotherapy of BPD behavior patterns, such as being underassertive or aggressive, or fluctuating between the two. Shea et al. (1992) speculated that because cognitive therapy (CT) is "technique-oriented," it might be less adversely affected by the interpersonal deficits patients with BPD than psychotherapies that give a more central role to the therapeutic relationship. In our opinion, this is a mischaracterization of CT, which always requires a well-functioning relationship. The cognitive-behavioral treatments for BPD discussed in this chapter all emphasize the importance of maintaining a strong working alliance.

A fourth factor that may lead to poorer outcomes is the increased incidence of stressful life events in the patient's life, which is at least partially self-generated due to his/her poor interpersonal skills; deficits in tolerating distress; associated impulsive behaviors, such as self-injury or substance abuse; and a tendency to avoid situations that need to be addressed. Helping the patient to deal with frequent situational crises necessarily shifts the focus of therapy away from the development of cognitive and behavioral skill sets that he/she can apply to reduce depressive symptoms and, more generically, to improve quality of life and reduce recurrences.

Natural Depression Cures

Natural Depression Cures

Are You Depressed? Heard the horror stories about anti-depressants and how they can just make things worse? Are you sick of being over medicated, glazed over and too fat from taking too many happy pills? Do you hate the dry mouth, the mania and mood swings and sleep disturbances that can come with taking a prescribed mood elevator?

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