Assessing Borderline Personality Disorder
in the Primary Care Setting
Presented by: Jonathan Betlinski, MD
Date: 11/13/2014
Disclosures and Learning Objectives
• Learning Objectives
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Be able to list the diagnostic criteria for
Borderline Personality Disorder
Know at least 3 mental health
comorbidities of BPD
Know at least 3 physical health
comorbidities of BPD
Disclosures: Dr. Jonathan Betlinski has nothing to disclose.
Assessing Borderline Personality Disorder
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Review epidemiology
Review mental health comorbidities
Review physical health comorbidities
Review Prognosis
Review diagnostic criteria
• Next Week's Topic
Borderline Personality Disorder
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1-4% of the general population
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8-27% in outpatient mental health (15-51% inpatient)
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6% of a primary care clinic population (or 26%???)
– 21% current suicidal ideation
– 21% Bipolar Disorder
– 36% Major Depressive Disorder
– 57% Anxiety Disorder
– 50% had no mental health treatment that year
– 43% not recognized by PCP has having any
emotional or mental health problems.
http://archinte.jamanetwork.com/article.aspx?articleID=210746
Borderline Personality Disorder Co-Occurs
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60% have MDD
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70% have Dysthymic Disorder
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25% have Eating Disorders
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35% meet criteria for Substance Abuse
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15% Bipolar Disorder
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25% Antisocial Personality Disorder
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25% Narcissistic Personality Disorder
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Up to 80% have suicidal behaviors
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4-9% die from suicide
http://www.nimh.nih.gov/health/publications/borderline-personalitydisorder/Borderline_Personality_Disorder_508_141959.pdf
http://www.nami.org/Template.cfm?Section=By_Illness&Template=/TaggedPage/TaggedPageDisplay.cfm&TPLID=54&
Borderline Personality Disorder
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Higher rates of common health problems
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Diabetes
Hypertension
Chronic Back Pain
Arthritis
Fibromyalgia
May be due to medication-induced
obesity
http://www.nimh.nih.gov/health/publications/borderline-personalitydisorder/Borderline_Personality_Disorder_508_141959.pdf
Borderline Personality Disorder
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Fewer PCP visits per year
Lower mental/emotional health ratings
Similar physical health self-rating
Much higher rates of hospitalization
Much higher rates of mental health care
Much higher rates of psychiatric
medications
http://archinte.jamanetwork.com/article.aspx?articleID=210746
Borderline Personality Disorder, Prognosis
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First five years are most crisis-ridden
60% readmitted within the first 6 months
35% readmission in 18-24 months
40-50% remission in 2 years
85% remission in 10 years
After remission, only 6% relapse
25% achieve social stability
http://www.borderlinepersonalitydisorder.com/documents/A_BPD_Brief_REV2011.pdf
http://www.nimh.nih.gov/health/publications/borderline-personalitydisorder/Borderline_Personality_Disorder_508_141959.pdf
Borderline Personality Disorder, DSM-IV TR
A pervasive pattern of instability of interpersonal relationships, self
image, and affects, and marked impulsivity beginning by early
adulthood and present in a variety of contexts, as indicated by 5 (or
more) of the following:
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Frantic efforts to avoid abandonment
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A pattern of unstable, intense relationships
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Identity disturbance
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Impulsivity in potentially damaging areas
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Recurrent suicidal behaviors
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Chronic feelings of emptiness
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Inappropriate intense anger or difficulty controlling anger
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Transient paranoia or severe dissociative symptoms
http://www.psi.uba.ar/academica/carrerasdegrado/psicologia/sitios_catedras/practicas_profesionales/820_clinica_tr_pe
rsonalidad_psicosis/material/dsm.pdf
Borderline Personality Disorder, DSM-5
Impairments in personality (self and interpersonal) functioning AND the
presence of pathological personality traits. These criteria must be met:
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Significant impairments in personality functioning
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Impairments in self functioning (a or b)
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Identity (unstable self image, chronic emptiness, dissociative states, self-criticism)
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Self-direction (instability in goals, aspirations, values or career plans)
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AND Impairments in interpersonal functioning (a or b)
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Empathy (and hypersensitivity)
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Intimacy (intense, unstable, and conflicted close relationships, alternating extremes)
Pathological Personality Traits in the following domains
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Negative Affectivity, characterized by
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Emotional lability
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Anxiousness
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Separation insecurity
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Depressivity
http://www.psi.uba.ar/academica/carrerasdegrado/psicologia/sitios_catedras/practicas_profesionales/820_clinica_tr_pe
rsonalidad_psicosis/material/dsm.pdf
Borderline Personality Disorder, DSM-5
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Disinhibition, characterized by
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Impulsivity
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Risk-taking
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Antagonism, characterized by
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Hostility
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These impairments are relativity stable across time and
consistent across situations
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The impairments are not better understood as normative for
developmental stage or socio-cultural environment
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The impariments are not solely due to the direct physiologic
effects of a substance or a general medical condition
http://www.psi.uba.ar/academica/carrerasdegrado/psicologia/sitios_catedras/practicas_profesionales/820_clinica_tr_pe
rsonalidad_psicosis/material/dsm.pdf
Summary
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Borderline Personality Disorder
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More common in Primary Care settings
Commonly misunderstood
Can disrupt care
Borderline Personality Disorder
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Gets better!
Accurate recognition increases chances
for recovery
http://www.nami.org/Template.cfm?Section=Borderline_Personality_Disorder_(BPD)&Template=/ContentManagement/
ContentDisplay.cfm&ContentID=81017
The End!
Next Week's
Topic:
Treatment of
Borderline
Personality
Disorder