Experts Offer Guidance for Treating Patients with Borderline Personality Disorder
Abstract
An IPS expert panel discusses some ways that non-specialists can support people with BPD, who can be challenging patients given their erratic behaviors and strong responses to perceived rejections.
Individuals with borderline personality disorder—who are prone to mood swings, impulsiveness, and inappropriate public behavior—can be challenging patients to treat. This difficulty can be amplified in health settings where trained personality disorder specialists may not be readily available.
Victor Hong, M.D., tells attendees that people with borderline personality disorder often make multiple visits to the emergency department, but that physicians and staff should not show any signs of anger or frustration.
At a session held at this year’s IPS: The Mental Health Services Conference, experts in borderline personality disorder (BPD) were on hand to provide some guidance on how mental health professionals working in primary care settings, emergency departments, or college health centers can best support the needs of patients with BPD.
Dan Price, M.D., a psychiatrist at Maine Medical Center, told the audience that the first step when treating a BPD patient is to properly frame the care. “Many doctors avoid using a BPD diagnosis since they worry about offending the patient or believe that a patient won’t get better,” he said. “They instead focus on other comorbidities thinking that might improve their behavior.”
Price believes this approach just feeds into the negative perception among the public and some in the medical community that people with BPD are overly sensitive, melodramatic, and crave attention. Properly framed discussions about the illness can lead to better communication with the patient and may speed up the recovery of symptoms. Price said that focusing on the BPD can also reduce the use of unnecessary medications for ancillary symptoms.
When treating a patient with BPD, it is important for the physician to validate the patient’s feelings of distress, Price continued.
When a person with BPD comes to a doctor’s office or emergency room, it usually is the result of some interpersonal trigger event, such as a breakup with a boyfriend or girlfriend, he said. “Rejection in particular makes people with BPD feel threatened,” he said.
If a patient then perceives further rejection from the doctor, that can shift their mindset from one of help-seeking to help-avoidance, which could spiral into despair and potentially even self-harm or suicide.
If a patient is angry or hostile, it is important that the mental health professional remain calm and remind the patient that such behavior can prevent optimal care, he said.
“Patients with BPD are repeat visitors for health services, especially at the emergency department,” explained Victor Hong, M.D., the medical director for psychiatry emergency services at the University of Michigan.
In order to provide the best care to these patients, it is important for staff to remember that “each visit involves a fresh new stressor for the patient,” Hong said. He suggested that for repeat visitors, it might be worthwhile to have staff reach out to a patient after he or she is discharged to make sure the patient knows “We are here for you.” Providing this assurance can help BPD patients feel more secure, Hong said.
Creating a structure of support around the patient can also be helpful in nonemergency settings, Price said. “Try and schedule visits that are frequent, brief, and predictable,” he said. Doing so helps further destigmatize the illness and may help the patient recognize that every situation is not an emergency. ■
