Cognitive-behavioral treatment of depression with comorbid borderline personality traits

Personality dysfunction can influence the onset and maintenance of depressive symptoms. When both depression and personality dysfunction are present, it is important to develop an integrated treatment plan that addresses both conditions. A case example is used to illustrate how features of borderline personality disorder can influence the assessment and treatment of major depression. Specific challenges encountered by the therapist include: 1) differentiating borderline personality from depressive symptoms, 2) maintaining the therapeutic alliance, 3) managing impulsivity and self-destructive tendencies, 4) staying focused on long-term therapeutic goals, and 5) coping with noncompliance. Over the course of 27 sessions, the client was able to make positive changes in mood, self-image, and impulsive tendencies. Although the client's borderline personality traits complicated the course of treatment for depression, neglecting these personality problems would have left the client vulnerable to depressive relapse. © 2004 Human Sciences Press, Inc.