Trending Clinical Topic: Borderline Personality Disorder

Ryan Syrek


October 08, 2021

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Doctors questioning whether the condition needs a new name and a study showing that omega-3 fatty acids may be a promising add-on therapy (see Infographic below) helped make borderline personality disorder (BPD) this week's top trending clinical topic. Michael A. Cummings, MD, is one of several experts who don't care for the term. "What is it bordering on? It's not bordering on something, it's a disorder on its own," said Cummings, of the department of psychiatry at the University of California, Riverside. In his view, what is now BPD should be categorized as a mood dysregulation disorder. Transitioning from a pejorative to a more neutral label could make it easier for people to say, "This is just a type of mood disorder. It's not necessarily easy, but it's workable," said Cummings.

Another thing that may help individuals with BPD is improved clinician training. Experts suggest that the condition is underdiagnosed in part because not enough clinicians are informed on critical clinical information. Psychiatry training in residency tends to emphasize biomedical treatments and does not focus enough on learning psychotherapy and other psychosocial treatments, according to Eric M. Plakun, MD, medical director/CEO of the Austen Riggs Center in Stockbridge, Massachusetts. "This is where I see the need for a greater psychotherapy teaching focus in residency, along with teaching of general principles for working with patients with BPD," said Plakun.

News of actor/comedian Pete Davidson expressing relief after finally receiving a diagnosis of BPD prompted a Twitter discussion earlier this year among physicians regarding the ongoing debate on whether or not to tell a patient they have this diagnosis. "I've heard from [many] trainees that they were told never to tell a patient they had BPD, but I can hardly think of anything more paternalistic and stigmatizing," Amy Barnhorst, MD, vice chair of community psychiatry at University of California Davis, tweeted. Although BPD is a "hard diagnosis, we would never withhold a diagnosis of cancer or liver disease or something else we knew patients didn't want but that we were going to try and treat them for," said Barnhorst.

Many who work with patients with BPD stress that trust is key in treating the disorder. John M. Oldham, MD, MS, recalls one patient he almost lost, a woman who was struggling with aggressive behavior. Initially cooperative and punctual, the patient gradually became distrustful. "She slipped from being very cooperative to being enraged and attacking me," said Oldham, distinguished emeritus professor in the Menninger department of psychiatry and behavioral sciences at Baylor College in Houston. Oldham eventually drew her back in by earning her trust. "There's no magic to this," he acknowledged. "You try to be as alert and informed and vigilant for anything you say that produces a negative or concerning reaction in the patient." This interactive approach to BPD treatment has been gaining traction in a profession that often looks to medications to alleviate specific symptoms. It's so effective that it sometimes even surprises the patient, Oldham noted.

In regard to more traditional treatment approaches, a meta-analysis of four randomized controlled trials published this summer found that adjunctive omega-3 fatty polyunsaturated fatty acids were beneficial in reducing key BPD symptoms (see Infographic below). The four studies had a total of 137 patients. Omega-3 fatty acids were used as monotherapy in one study. In the others, they were used as add-on therapy to other agents, such as antidepressants, benzodiazepines, and/or valproic acid. None of the studies included patients who were taking antipsychotics. The omega-3 fatty acids were derived from marine rather than plant sources.

From overall concerns about terminology and clinician training to a specific treatment study, a focus on BPD resulted in this week's top trending clinical topic.

Read more clinical information on BPD.


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