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Psychiatry Grand Rounds: Ethics of Diagnosing Borderline Personality Disorder (BPD): Focus on Adolescents

Activity
post test

Ethics of Diagnosing Borderline Personality Disorder (BPD): Focus on Adolescents

Presented by:
Michael Shapiro, MD
Associate Professor, Department of Psychiatry

Faculty Disclosure:

Dr. Shapiro has disclosed that he has no relevant financial relationship(s). No one else in a position to control content has any financial relationships to disclose. Conflict of interest information for the CME Advisory Committee members can be found on the following website: https://cme.ufl.edu/disclosure/. All relevant financial relationships have been mitigated.

Release Date: October 18, 2023
Expiration Date: October 17, 2025

Target Audience: All physicians

Learning Objectives:

As a result of participation in this activity, participants should be able to:

  1. Describe how the name and classification of BPD can lead to misunderstandings and stigma associated with the diagnosis.
  2. Identify common reasons why psychiatrists/psychologists do not diagnose BPD in patients, particularly adolescents.
  3. Identify positive reasons why the diagnosis of BPD could be given to patients, including adolescents.
  4. Discuss ways that the diagnosis of BPD can be ethically and compassionately discussed with patients and families.

Requirements for successful completion: Certificates are awarded upon successful completion (80% proficiency) of the post-test.

Accreditation: The University of Florida College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit: The University of Florida College of Medicine designates this enduring material for a maximum of 2 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Resource(s) for further study:

  1. Sisti D, Segal AG, Siegel AM, Johnson R, Gunderson J. Diagnosing, Disclosing, and Documenting Borderline Personality Disorder: A Survey of Psychiatrists’ Practices. J Pers Disord. 2016;30(6):848-856. doi:10.1521/pedi_2015_29_228
  2. Laurenssen, E.M.P., Hutsebaut, J., Feenstra, D.J. et al. Diagnosis of personality disorders in adolescents: a study among psychologists. Child Adolesc Psychiatry Ment Health 7, 3 (2013). https://doi.org/10.1186/1753-2000-7-3
  3. Paris J. Why Psychiatrists are Reluctant to Diagnose: Borderline Personality Disorder. Psychiatry (Edgmont). 2007;4(1):35-39.
  4. Sims E, Nelson KJ, Sisti D. Borderline personality disorder, therapeutic privilege, integrated care: is it ethical to withhold a psychiatric diagnosis? Journal of Medical Ethics 2022;48:801-804.
  5. https://code-medical-ethics.ama-assn.org/ethics-opinions/withholding-information-patients
  6. Kaess M, Brunner R, Chanen A. Borderline personality disorder in adolescence. Pediatrics. 2014;134(4):782-793. doi:10.1542/peds.2013-3677
  7. Miller AL, Muehlenkamp JJ, Jacobson CM. Fact or fiction: diagnosing borderline personality disorder in adolescents. Clin Psychol Rev. 2008;28(6):969-981. doi:10.1016/j.cpr.2008.02.004
  8. Nakar O, Brunner R, Schilling O, et al. Developmental trajectories of self-injurious behavior, suicidal behavior and substance misuse and their association with adolescent borderline personality pathology. J Affect Disord. 2016;197:231-238. doi:10.1016/j.jad.2016.03.029
  9. Hutsebaut J, Clarke SL and Chanen AM (2023) The diagnosis that should speak its name: why it is ethically right to diagnose and treat personality disorder during adolescence. Front. Psychiatry 14:1130417.  doi: 10.3389/fpsyt.2023.1130417
  10. https://dsm.psychiatryonline.org/doi/10.1176/appi.books.9780890425787.x18_Personality_Disorders
  11. Caspi, A., Harrington, H., Milne, B., Amell, J., Theodore, R., & Moffitt, T. (2003). Children’s behavioral styles at age 3 are linked to their adult personality traits at age 26. Journal of Personality, 71(4), 495−513.
  12. Chanen AM, Jackson HJ, McGorry PD, Allot KA, Clarkson V, Yuen HP. Two-year stability of personality disorder in older adolescent outpatients. J Pers Disord. 2004;18(6):526-541. doi:10.1521/pedi.18.6.526.54798
  13. Chanen AM, McCutcheon L. Prevention and early intervention for borderline personality disorder: current status and recent evidence. Br J Psychiatry Suppl. 2013;54:s24-s29. doi:10.1192/bjp.bp.112.119180
  14. Aleva, A., Laceulle, O. M., Denissen, J. J., Hessels, C. J., & van Aken, M. A. (2022). Adolescence as a peak period of borderline personality features? A meta-analytic approach. European Journal of Personality, 0(0). https://doi.org/10.1177/08902070221134652
  15. Catthoor K, Feenstra DJ, Hutsebaut J, Schrijvers D, Sabbe B. Adolescents with personality disorders suffer from severe psychiatric stigma: evidence from a sample of 131 patients. Adolesc Health Med Ther. 2015;6:81-89. Published 2015 May 4. doi:10.2147/AHMT.S76916
  16. “How SAD” Stigma and Discrimination of People with BPD (bpdcommunity.com.au)
  17. Lewis G, Appleby L. Personality Disorder: The Patients Psychiatrists Dislike. Br J Psychiatry. 1988:153:44-9. Doi: 10.1192/bjp.153.1.44. PMID: 3224249.
  18. Gunderson JG, Stout RL, McGlashan TH, et al. Ten-year course of borderline personality disorder: psychopathology and function from the Collaborative Longitudinal Personality Disorders study. Arch Gen Psychiatry. 2011;68(8):827-837. doi:10.1001/archgenpsychiatry.2011.37
  19. Paris J. The nature of borderline personality disorder: multiple dimensions, multiple symptoms, but one category. J Pers Disord. 2007;21(5):457-473. doi:10.1521/pedi.2007.21.5.457
  20. https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425787.x07_Trauma_and_Stressor_Related_Disorders#BABJAEHE
  21. https://www.tandfonline.com/doi/abs/10.1080/21674086.1938.11925367
  22. Gunderson JG. Borderline personality disorder: ontogeny of a diagnosis. Am J Psychiatry. 2009;166(5):530-539. doi:10.1176/appi.ajp.2009.08121825
  23. Lasiuk GC, Hegadoren KM. Posttraumatic stress disorder part I: historical development of the concept. Perspect Psychiatr Care. 2006;42(1):13-20. doi:10.1111/j.1744-6163.2006.00045.x
  24. Oredsson, A. F. (2023). Women ‘out of order’: inappropriate anger and gender bias in the diagnosis of borderline personality disorder. Journal of Psychosocial Studies, 16(2), 149-162. Retrieved Oct 13, 2023, from https://doi.org/10.1332/147867323X16863891304659
  25. https://www.mdedge.com/psychiatry/article/246381/personality-disorders/trust-key-treating-borderline-personality-disorder
  26. Miller JD, Sleep CE, Lamkin J, Vize C, Campbell WK, Lynam DR. Personality disorder traits: Perceptions of likability, impairment, and ability to change as correlates and moderators of desired level. Personal Disord. 2018;9(5):478-483. doi:10.1037/per0000263
  27. Sleep CE, Lamkin J, Lynam DR, Campbell WK, Miller JD. Personality disorder traits: Testing insight regarding presence of traits, impairment, and desire for change. Personal Disord. 2019;10(2):123-131. doi:10.1037/per0000305
  28. Hart, W., Cease, C. K., Lambert, J. T., & Witt, D. E. (2023). Revisiting the ego-syntonic assumption: Investigating neuroticism and harmony with thoughts of negative emotions. Personality Disorders: Theory, Research, and Treatment, 14(5), 501–511. https://doi.org/10.1037/per0000620
  29. Courtney DB, Makinen J. Impact of Diagnosis Disclosure on Adolescents with Borderline Personality Disorder. J Can Acad Child Adolesc Psychiatry. 2016 Fall;25(3):177-184. Epub 2016 Nov 1. PMID: 27924148; PMCID: PMC5130091.
  30. https://www.nimh.nih.gov/health/topics/borderline-personality-disorder

If you have any questions please feel free to contact Nancy Boyd at (352) 594-4298 or at nancy.boyd@ufl.edu