![]() Research spanning twenty years suggests providers continue to find clients with Borderline Personality Disorder more difficult than other mentally ill populations, including patients with schizophrenia (see Gallop, Lancee & Garfinkel 1989 Treloar 2009). Manning (2000) has even argued that the category of “Borderline” emerged as a label to group patients perceived as difficult. All of these descriptors have been applied to patients with BPD (See Luhrmann 2000 Nehls 1998, Nehls 1999). The very symptoms and behaviors associated with BPD are linked with how providers define the “difficult patient.” Kelly & May (1982) found that behaviors such as mutilation, chronic illness, rule-breaking behavior, aggressive, uncooperative or won’t accept care, or need too much care, and are destructive, willful, attention-seeking and manipulative have been linked with negative attitudes toward patients. Several more have indicated that almost all difficult patients have “borderline personality organization” (See Koekkoek, Meijel & Hutschemalkers 2006, Group for advancement of psychiatry 1987 Fiore 1988 Schwartz & Goldfinger 1981). One study found that “psychiatrists mentioned the diagnosis of Borderline Personality Disorder up to four times more often than any other diagnosis when asked about the characteristics of difficult patients” ( Koekkoek, Meijel & Hutschemalkers 2006:797). This process creates a functional form of demedicalization where the actual diagnosis of BPD remains de jure medicalized, but the treatment component of medicalization is harder to secure for patients.īorderline Personality Disorder (BPD) and “difficult patient” status are intimately linked. My findings suggest patients with BPD are routinely labeled “difficult,” and subsequently routed out of care through a variety of direct and indirect means. While patients who are deemed difficult are often dispreferred for care, does this have an impact on their overall status as medicalized patients who have successfully achieved a sick role? This study relies on (n=22) in-depth interviews with mental health clinicians in the United States from 2012 to evaluate how they describe patients with BPD, how the diagnosis of BPD affects the treatment clinicians are willing to provide, and the implications for patients. A diagnosis of Borderline Personality Disorder (BPD) often signals the quintessential “difficult patient” status to clinicians, with at least one scholar arguing the condition itself was created to name and group difficult patients.
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