Table 1

Treating people with BPD: some potentially difficult dynamics, underlying explanations and possible solutions

Examples of perceived behaviour of people with BPD50 Possible explanations for this behaviourPossible solutions for the doctor
High use of healthcareHigh burden of psychiatric and physical comorbidities, coupled with health anxiety and fear of abandonmentAllowing enough time during the consultation to make the patient feel understood
Avoiding ‘bouncing’ patients between specialties where possible
Apparent intentional sabotage of carePart of self-destructive behaviour due to low self-worth
Fear of abandonment by health professionals
Maintaining an open and validating approach
Organising follow-up
Difficulty establishing trustHistories of being repeatedly let down or taken advantage of in the pastWorking towards a collaborative, transparent approach with careful explanations
Sticking to appointment times and agreements
Organising follow-up
Misunderstandings and angry reactionsNegative interpretative bias to ambiguous faces in people with BPDA genuinely compassionate approach from the physician will often instil greater patient confidence
‘Splitting’ in clinical teamsEmotional dysregulation in patients can provoke strong reactions in clinicians which can become polarisedRecognising the pattern and using it informatively
Effective teamwork and adequate supervision
  • BPD, borderline personality disorder.