Borderline Personality Disorder: What do psychiatrists really think?

1. BorderlinePersonalityDisorder:What do psychiatristsreally think? Everett Julyan Rajeev Krishnadas Michael Götz

2. Personality disorders Importance • Predispose to mental illness • Pathoplasticity • Response to treatment • Substance misuse • Risks

4. Personality disorder • Historically • Prognostic pessimism • Therapeutic nihilism • Recently • Evidence-based optimism • Scottish Personality Disorder Network • ICPs • NICE

5. Borderline Personality Disorder

6. Methods • Postal survey • All psychiatrists in Scotland (on RCPsych list) • Grades, specialities, years of experience • 12 statements about BPD • Diagnosis & prognosis • Management • Ethico-legal

9. Results • 300 responses (28%) • 4432 years experience • Diverse views

10. Results

11. Results

12. Results Diagnosis & prognosis • BPD is a mental illness • BPD is a valid diagnosis • BPD has a good prognosis • Patients with BPD should have their diagnosis explained to them

13. Results Diagnosis & prognosis • BPD is a mental illness • BPD is a valid diagnosis • BPD has a good prognosis • Patients with BPD should have their diagnosis explained to them

14. Results Diagnosis & prognosis • BPD is a mental illness • BPD is a valid diagnosis • BPD has a good prognosis • Patients with BPD should have their diagnosis explained to them

15. Results Diagnosis & prognosis • BPD is a mental illness • BPD is a valid diagnosis • BPD has a good prognosis • Patients with BPD should have their diagnosis explained to them

16. Results Diagnosis & prognosis • BPD is a mental illness • BPD is a valid diagnosis • BPD has a good prognosis • Patients with BPD should have their diagnosis explained to them

17. Results Management • Patients with BPD benefit from hospital admission • Patients with BPD benefit from medication • Patients with BPD benefit from psychotherapy • ICPs are helpful in managing patients with BPD

18. Results Management • Patients with BPD benefit from hospital admission • Patients with BPD benefit from medication • Patients with BPD benefit from psychotherapy • ICPs are helpful in managing patients with BPD

19. Results Management • Patients with BPD benefit from hospital admission • Patients with BPD benefit from medication • Patients with BPD benefit from psychotherapy • ICPs are helpful in managing patients with BPD

20. Results Management • Patients with BPD benefit from hospital admission • Patients with BPD benefit from medication • Patients with BPD benefit from psychotherapy • ICPs are helpful in managing patients with BPD

21. Results Management • Patients with BPD benefit from hospital admission • Patients with BPD benefit from medication • Patients with BPD benefit from psychotherapy • ICPs are helpful in managing patients with BPD

22. Results Ethico-legal • Patients with BPD are responsible for their behaviour • Patients with BPD are in control of their behaviour • Patients with BPD should have the same healthcare rights as those with schizophrenia • The Mental Health Act should recognise BPD as a mental disorder (as it currently does)

23. Results Ethico-legal • Patients with BPD are responsible for their behaviour • Patients with BPD are in control of their behaviour • Patients with BPD should have the same healthcare rights as those with schizophrenia • The Mental Health Act should recognise BPD as a mental disorder (as it currently does)

24. Results Ethico-legal • Patients with BPD are responsible for their behaviour • Patients with BPD are in control of their behaviour • Patients with BPD should have the same healthcare rights as those with schizophrenia • The Mental Health Act should recognise BPD as a mental disorder (as it currently does)

25. Results Ethico-legal • Patients with BPD are responsible for their behaviour • Patients with BPD are in control of their behaviour • Patients with BPD should have the same healthcare rights as those with schizophrenia • The Mental Health Act should recognise BPD as a mental disorder (as it currently does)

26. Results Ethico-legal • Patients with BPD are responsible for their behaviour • Patients with BPD are in control of their behaviour • Patients with BPD should have the same healthcare rights as those with schizophrenia • The Mental Health Act should recognise BPD as a mental disorder (as it currently does)

27. Results

28. Results Years • Less experience • Trend towards “optimism” • Illness • Responsibility • Admission

29. Results

30. Results

31. Results

32. Results Grade • Juniors • Agree re: illness • Neutral re: admission • Strongly agree re: psychotherapy • Agree re: ICPs

33. Results Speciality • Psychotherapy • Strongly agree re: psychotherapy • Strongly agree re: rights

34. Discussion • Illness vs disorder? • Prognosis? • Responsibility vs control? • Admission, medication, & psychotherapy? • Rights? • Experience? • Speciality?