Psychiatric Quarterly, Vol. 72, No. 1, 2001
CLINICAL CHARACTERISTICS OF OLDER
PSYCHIATRIC INPATIENTS WITH
BORDERLINE PERSONALITY DISORDER
Brian Trappler, M.D., and Jill Backﬁeld, Ph.D.
This case study investigation considers typical and potentially unique charac-
teristics of older (Ͼ 50 years) Borderline Personality Disorder (BPD) patients
and describes their impact on an inpatient psychiatric unit encompassing a
therapeutic milieu setting and multidisciplinary treatment teams. The somat-
ization of symptoms, in particular, and the associated therapeutic, medical,
and psychopharmacological interventions, result in prolonged and elaborate
treatments that undermine clinical and personal boundaries, clash with man-
aged care directives, and engender frustrating and elusive transferential and
countertransferential reactions. Moreover, the guilt-inducing nature of so-
matization and physical frailty in older individuals, combined with the well-
documented ability of BPD patients, regardless of age, to incite stormy and
‘split’ relationships, are linked characteristics that may describe a diagnostic
subtype of BPD. Rather than suggesting a diminution of psychopathology as
BPD patients age, the results of this investigation indicate that their persis-
tent difﬁculties may only be altering in content and in pathological adapta-
tion to changing needs.
KEY WORDS: Borderline Personality Disorder; older patients; inpatients.
Brian Trappler, M.D., is an Attending Psychiatrist and Assistant Clinical Professor
of Psychiatry, State University of New York, Health Science Center at Brooklyn, NY.
Jill Backﬁeld, Ph.D., is a Clinical Psychologist and Adjunct Associate Professor of
Psychology, Teachers College, Columbia University, New York, NY; Director of Psycho-
logical and Clinical Consulting, P.C., NY; and was a Postdoctoral Clinical Psychology
and Research Fellow and Clinical Instructor in the Inpatient Service and Psychology
Unit, Department of Psychiatry, State University of New York, Health Science Center
at Brooklyn from 1994 to 1997.
Address correspondence to Dr. Trappler at the Department of Psychiatry, State Uni-
versity of New York, Health Science Center at Brooklyn, Box 1203, 450 Clarkson Ave-
nue, Brooklyn, NY 11203.
0033-2720/01/0300-0029$19.50/0 2001 Human Sciences Press, Inc.