Abstract
In this article the authors discuss the patient with borderline personality disorder, milieu issues, and an alternative therapeutic approach: a contingency contract developed to manage self-mutilating behavior in a cost-effective manner. This contract was created as a quality improvement project on a locked unit to decrease self-destructive behavior in the patient with borderline personality disorder. The goal was to assist patients in developing more adaptive coping mechanisms, resulting in decreased self-destructive behaviors. Since implementation in February 1992, there has been an 84% decrease in self-destructive behavior in patients with borderline personality disorder in the population.
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