Borderline personality disorder can be treated and achieve ‘good response’

Borderline personality disorder continues to be a very stigmatised condition but it can be treated with talking therapies of which psychiatrists need to be better informed, according to a clinician specialising in the treatment of these patients.

This article was written by Priscilla Lynch and was published in the Medical Independent on 26/04/19

During a special workshop at the 2019 College of Psychiatrists of Ireland Spring Conference, Dr Evelyn McCabe, Consultant Psychiatrist, Community Mental Health Centre, Ballina, Co Mayo, explained how borderline personality disorder is associated with high morbidity and mortality: It has a lifetime prevalence of up to 6 per cent in the general population; is associated with 10-to-30 per cent of psychiatric outpatient visits; 20 per cent of psychiatric inpatient stays; and 14-to-23 per cent of prison populations. It is highly comorbid with addiction, eating disorders and recurrent depressive disorders — 70 per cent will make at least one attempt at suicide and 8-to-10 per cent will die by suicide; 50 times the rate in the general population. However, about 40 per cent of personality disorder patients are misdiagnosed, she noted.

Futhermore, despite growing awareness of the condition, borderline personality disorder has long been stigmatised and is often considered untreatable, by both clinicians and the public.

Dr McCabe acknowledged that people with personality disorders are often hard to reach and can be “very challenging” for clinicians to work with and there are no specialist services in the Republic.

Treatment-wise, she discussed the psychotherapeutic evidenced-based approach to personality disorder. Dr McCabe explained that people with personality disorders are poor at “mentalising themselves and others” and she promoted the benefits of mentalisation-based therapy (MBT).

She quoted data showing MBT significantly reduced outpatient presentations, psychiatric inpatient bed days and episodes of self-harm in personality disorder patients.

Chair of the workshop Dr Alyson Lee noted that the HSE has set up a working group looking at models of care for delivering talking therapies in specialist mental health services. She said the College has set up its own working group on developing a position paper on treating personality disorders, which it hopes to publish by the end of the year or early in 2020. Both Dr Lee and Dr McCabe said psychiatrists need to deliver psychotherapy to their patients, and not just leave it to psychotherapists.

Meanwhile, also discussing the treatment of personality disorders during the conference, UK speaker Prof Anthony Bateman outlined the benefits of talking therapies in treating these patients. He maintained that they should not be routinely prescribed pharmacological treatments (except for comorbid conditions which need to be carefully considered), as they provide no benefit.