Borderline personality disorder, therapeutic privilege, integrated care: is it ethical to withhold a psychiatric diagnosis?

2021 ◽  
pp. medethics-2021-107216
Author(s):  
Erika Sims ◽  
Katherine J Nelson ◽  
Dominic Sisti
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Integrated Care ◽  
Clinical Psychiatry ◽  
Psychiatric Diagnosis ◽  
Patient Population ◽  
Borderline Personality ◽  
Prognostic Information ◽  
Diagnostic Disclosure ◽  
Therapeutic Privilege

Once common, therapeutic privilege—the practice whereby a physician withholds diagnostic or prognostic information from a patient intending to protect the patient—is now generally seen as unethical. However, instances of therapeutic privilege are common in some areas of clinical psychiatry. We describe therapeutic privilege in the context of borderline personality disorder, discuss the implications of diagnostic non-disclosure on integrated care and offer recommendations to promote diagnostic disclosure for this patient population.

Bedside Stuffed Animals and Borderline Personality

1996 ◽  
Vol 79 (2) ◽  
pp. 624-626 ◽  
Author(s):  
Lawrence A. Labbate ◽  
David M. Benedek
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Adult Female ◽  
Psychiatric Diagnosis ◽  
Psychiatric Inpatients ◽  
Borderline Personality ◽  
Female Patients ◽  
Clinical Clue ◽  
The Relationship

We explored the relationship between psychiatric diagnosis and the presence of stuffed animals at the bedside in a population of adult female psychiatric inpatients. One of the authors made approximately weekly surveys of the wardrooms of adult psychiatric inpatients over twelve months for the presence of displayed stuffed animals. The observer was blind to the diagnosis of 80% of the patients, and the study or its hypothesis was not known to other physicians. The discharge diagnoses of patients displaying stuffed animals were recorded and compared with those of the ward population in general. Among 36 female patients who displayed stuffed animals in their rooms, Borderline Personality Disorder was diagnosed in 22 (61%) of these patients. Of 447 adult female patients admitted to the same unit over the same period, only 17% were noted to be diagnosed Borderline Personality Disorder. Stuffed animals as a bedside clinical clue may suggest evaluation for Borderline Personality Disorder.

Pharmacological Interventions for Borderline Personality Disorder

2017 ◽  
Author(s):  
Kenneth R. Silk
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Systematic Reviews ◽  
Patient Population ◽  
Randomized Trials ◽  
Borderline Personality ◽  
Pharmacological Interventions ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Meta Analyses

Although no medication is indicated to specifically treat symptoms of borderline personality disorder (BPD), medications are used frequently in the treatment of patients with BPD. This chapter reviews a number of reasons why medications are frequently prescribed in this patient population, then goes on to discuss eight systematic reviews or meta-analyses of 23 double-blind placebo-controlled randomized trials of the psychopharmacologic treatment of patients with BPD. The author attempts to make some sense of these reviews, which at times come to different conclusions despite examining essentially the same dataset. The chapter also addresses how to proceed with and manage the psychopharmacologic treatment of patients with BPD.

scholarly journals The case for retaining borderline personality disorder as a psychiatric diagnosis

2009 ◽  
Vol 3 (2) ◽  
pp. 96-100 ◽  
Author(s):  
Joel Paris ◽  
Kenneth R. Silk ◽  
John Gunderson ◽  
Paul S. Links ◽  
Mary Zanarini
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Psychiatric Diagnosis ◽  
Borderline Personality

Emotion-Oriented Coping Style Predicts Self-Harm in Response to Acute Psychiatric Hospitalization

Crisis ◽  
2020 ◽  
pp. 1-7
Author(s):  
Jacqueline M. Frei ◽  
Vladimir Sazhin ◽  
Melissa Fick ◽  
Keong Yap
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Psychiatric Hospitalization ◽  
Coping Styles ◽  
Psychiatric Inpatients ◽  
Borderline Personality ◽  
Self Report ◽  
Therapeutic Interventions ◽  
Coping Behaviors ◽  
Self Harm

Abstract. Psychiatric hospitalization can cause significant distress for patients. Research has shown that to cope with the stress, patients sometimes resort to self-harm. Given the paucity of research on self-harm among psychiatric inpatients, a better understanding of transdiagnostic processes as predictors of self-harm during psychiatric hospitalization is needed. The current study examined whether coping styles predicted self-harm after controlling for commonly associated factors, such as age, gender, and borderline personality disorder. Participants were 72 patients (mean age = 39.32 years, SD = 12.29, 64% male) admitted for inpatient treatment at a public psychiatric hospital in Sydney, Australia. Participants completed self-report measures of coping styles and ward-specific coping behaviors, including self-harm, in relation to coping with the stress of acute hospitalization. Results showed that younger age, diagnosis of borderline personality disorder, and higher emotion-oriented coping were associated with self-harm. After controlling for age and borderline personality disorder, higher levels of emotion-oriented coping were found to be a significant predictor of self-harm. Findings were partially consistent with hypotheses; emotion-oriented but not avoidance-oriented coping significantly predicted self-harm. This finding may help to identify and provide psychiatric inpatients who are at risk of self-harm with appropriate therapeutic interventions.

Comparison of Three Questionnaires to Screen for Borderline Personality Disorder in Adolescents and Young Adults

2017 ◽  
Vol 33 (2) ◽  
pp. 123-128 ◽  
Author(s):  
Anne van Alebeek ◽  
Paul T. van der Heijden ◽  
Christel Hessels ◽  
Melissa S.Y. Thong ◽  
Marcel van Aken
Keyword(s):  
Young Adults ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Borderline Personality ◽  
Adolescents And Young Adults ◽  
Patient Questionnaire ◽  
Statistical Manual ◽  
Axis Ii ◽  
Diagnostic And Statistical Manual ◽  
Dsm Iv

Abstract. One of the most common personality disorders among adolescents and young adults is the Borderline Personality Disorder (BPD). The objective of current study was to assess three questionnaires that can reliably screen for BPD in adolescents and young adults (N = 53): the McLean Screening Instrument for BPD (MSI-BPD; Zanarini et al., 2003 ), the Personality Diagnostic Questionnaire 4th edition – BPD scale (PDQ-4 BPD; Hyler, 1994 ), and the SCID-II Patient Questionnaire – BPD scale (SCID-II-PQ BPD). The nine criteria of BPD according to the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV; APA, 1994 ) were measured with the Structural Clinical Interview for DSM-IV Axis II disorders – BPD scale (SCID-II; First, Spitzer, Gibbon, Williams, & Benjamin, 1995 ). Correlations between the questionnaires and the SCID-II were calculated. In addition, the sensitivity and specificity of the questionnaires were tested. All instruments predicted the BPD diagnosis equally well.

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