Borderline Personality Disorder in Primary Care

Abstract

The prevalence of BPD in primary care is high, about 4-fold higher than that found in general community studies. Despite availability of various pharmacological and psychological interventions that are helpful in treating symptoms of BPD, and despite the association of this disorder with suicidal ideation, comorbid psychiatric disorders, and functional impairment, BPD is largely unrecognized and untreated. These findings are also important for the primary care physician, because unrecognized BPD may underlie difficult patient-physician relationships and complicate medical treatment.

Mood instability versus bipolar disorder: what to look for

“…Patients with EUPD present frequently to GPs, not only with mood instability but with other complaints that can require significant investment of resources. 7 The adverse impact of EUPD on the sufferer's quality of life has been well established. 8 Although mood instability can be a symptom of an illness or exist on its own, it is also a part of normal human experience, for example in times of grief.…”

Difficult ("heartsink") patients and clinical communication difficulties

“…They may have unrecognized pathological disorders, especially personality disorders, or have an exaggerated feeling that they deserve more care or attention. [13][14][15][16] They are often excessive consumers of medical services. Indeed, their clinical records evidence an increased number of consultations and visits to various medical facilities and free emergency services with poor adherence to both treatment and medical recommendations.…”

Prescribing and borderline personality disorder

“…4 The disorder has a fourfold higher prevalence among primary care patients than among the general population. 5 It affects around one-quarter of primary care patients with depression 6 and one in five psychiatric outpatients. 7,8 In these settings females outnumber males by a ratio of up to 4:1.…”