Text adapted from: "The adult patient with a personality disorder," in Psychiatry in primary care by Michael Rosenbluth, Matthew Boyle & Lucille Schiffman (CAMH, 2019).
Patients with borderline personality disorder (BPD) are often seen in primary care settings. Treating personality disorders can be challenging, as well as a source of frustration for both clinicians and patients. Yet clinical experience and research evidence indicate that careful assessment and treatment can result in more positive outcomes than previously assumed, and that most people with borderline personality disorder, a particularly stigmatized personality disorder, improve with time (Biskin, 2015; Zanarini et al., 2004).
Primary care practitioners are on the front line in treating patients with personality disorders. Recent research indicates better outcomes than were previously assumed. Carefully considering key assessment and treatment issues can help to optimize the outcome and lead to more satisfaction among patients and their families, as well as among primary care practitioners.
The Primary Care Practitioner Role
Primary care practitioners are in an ideal position to provide validation and negotiate treatment plans for patients with personality disorders. All patients with a personality disorder should be screened for comorbid Axis I diagnoses, and these diagnoses should be treated robustly. For primary care practitioners, the main issue is often whether they have the time, interest or training to do psychotherapy. Optimal care requires coordinating treatment provided by multiple clinicians. If possible, it is always best if psychiatrists can be involved in the care of patients with personality disorders, either to manage the comorbid Axis I diagnosis or to facilitate psychotherapeutic involvement.