By and large, psychiatrists aren’t terribly comfortable when it comes to diagnosing and treating borderline personality disorder (BPD). Fortunately, diagnosing BPD is relatively easy and can often be done in 20–30 minutes. The key is to have a systematic approach, to ask high-yield questions, and to know how to efficiently follow up on responses.

While benzodiazepines are effective anti-anxiety workhorses for many patients, most guidelines tell us to avoid prescribing them to substance abusers. The concern is that the benzo high will remind patients of their substances of choice, and that benzo withdrawal symptoms will lead to old substance abuse habits.

A recent issue of the Journal of Anxiety Disorders (Vol. 21, 2007) focused on the troubling possibility that the PTSD (posttraumatic stress disorder) construct is not nearly as valid as has been assumed. The articles are both fascinating and provocative and are well worth reading.

At least in Britain, it’s official: psychotherapy works better than medication for PTSD. You shouldn’t be too surprised. The last time we covered PTSD (TCPR April 2004) we reviewed the SSRIs and found them to have evidence of only modest efficacy.