"Good Psychiatric Management" Effective in Borderline Personality Disorder Treatment, Dr Mark Zimmerman Says

Ahead of his Psych Congress Elevate session "Navigating Personality Disorders: Understanding Borderline Personality Disorder and Differential Diagnosis" in Las Vegas, Nevada, on Thursday, Mark Zimmerman, MD, professor of psychiatry and human behavior at Brown University, caught up with Psych Congress Network in this Q&A. Dr Zimmerman shares why borderline personality disorder (BPD) is often underdiagnosed, how clinicians can screen for it, and psychopharmacological treatment of the disorder.

Keep checking back to our Psych Congress Elevate newsroom for more updates and insights from this year's meeting.

Meagan Thistle, Psych Congress Network (PCN): In your session, you discussed the fact that borderline personality disorder (BPD) is often underdiagnosed in clinical settings. What factors lead to that underdiagnosis?

Mark Zimmerman, MD: Patients with BPD typically present for the treatment of other disorders, such as mood, anxiety, and substance use disorders; they rarely present with chief complaints that directly reflect the diagnostic criteria of BPD, such as identity disturbance or fears of abandonment.

PCN: What key steps need to be taken to improve the rates of diagnosis?

Dr Zimmerman: As part of the initial diagnostic evaluation, clinicians routinely screen for disorders that are comorbid to the primary diagnosis. In a similar way, clinicians can screen for BPD by assessing the BPD criterion affective instability, which is present in more than 90% of patients with BPD and when absent almost always indicates that the patient does not have BPD.

PCN: What advice do you have for clinicians communicating a BPD diagnosis to their patients?

Patients should be told about the diagnosis of BPD in the same way that they are told about other diagnoses. Satisfaction with the initial evaluation is as high in patients with BPD as in patients without BPD.

PCN: In your session, you shared that there are no FDA-approved medications for the treatment of BPD. What medication is most often used to treat BPD, and why is it effective or ineffective?

Dr Zimmerman: Antidepressants are most frequently used in the treatment of patients with BPD because major depressive disorder is the most common comorbidity. While treatment guidelines recommend the use of antidepressants in patients with BPD and major depressive disorder there are no placebo controlled studies of antidepressants in this group of patients.

PCN: Are there any misconceptions about this topic that you’d like to clarify?

Dr Zimmerman: The long-term course of patients with BPD is favorable. The vast majority of patients with BPD no longer meet diagnostic criteria for the disorder and significantly improve in treatment. Moreover, one need not be an expert in a particular form of therapy. Good psychiatric management is effective in the treatment of BPD.

PCN: Is there anything else you would like to share with our audience of clinicians treating BPD?

Even more so than other psychiatric disorders BPD is stigmatized. A major source of the stigma comes from mental health providers. Providing a steady presence for patients, and not overreacting (or medicating) crises they might be experiencing is therapeutic and stabilizing to patients whose world is often characterized by instability.

Mark Zimmerman, MD, is a professor of psychiatry and human behavior at Brown University and chief of ambulatory psychiatry and behavioral health at South County Psychiatry. Dr Zimmerman received his undergraduate degree from Columbia University, and his medical degree from Chicago Medical School. He completed his postgraduate training at the Medical College of Pennsylvania, and held an academic appointment as assistant professor at the same time he was a resident in psychiatry. He is principal investigator of the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project. The goal of the MIDAS project has been to integrate research methodology into routine clinical practice in order to improve clinical practice. Dr Zimmerman is the author of more than 450 articles published in peer-reviewed journals, and serves on the editorial board of 10 journals. He is the associate editor of the Journal of Personality Disorders. Dr Zimmerman was the Personality Disorders section editor for DSM-5-TR. He has developed several measures of psychiatric disorders for use in clinical practice. He is the author of the Interview Guide to Diagnose DSM-5-TR Psychiatric Disorders and the Mental Status Examination.