Management of patients with borderline personality disorder in primary care

Abstract

Background: Borderline personality disorder (BPD) is a severe and chronic psychiatric disorder characterized by marked impulsivity, instability of affect and interpersonal relationships, and suicidal behavior. The study was designed to explore the general practitioners experiences and management of patients with BPD and to study the prevalence, comorbidity, associated impairment, and health care utilization.

Material and methods: The survey consisted on personal interviews and was conducted on a sample from three urban primary care practices during the spring 2004. The interviews were transcribed into text and a qualitative, comparative method was used for the analysis which was carried out after the data collection.

Results: All the general practitioners included in the survey experienced their patients with BPD to be challenging and demanding, but were comfortable dealing with them. They did not experience conflicts, suicidal behavior and boundary violations. The prevalence of diagnosed BPD among the primary care patients in this study was low compared to population studies.

Interpretation: Although the material is too small to be representative, there are surprising and interesting findings suggesting that general practitioners to a lesser extent than expected, experience the typical problems associated with handling BPD patients, as described in the literature. The low prevalence of patients with BPD in the primary care population can suggest that the disorder is underdiagnosed and unrecognized.