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Borderline Personality Disorder in Primary Care
Raz Gross, MD, MPH;
Mark Olfson, MD, MPH;
Marc Gameroff, MA;
Steven Shea, MD;
Adriana Feder, MD;
Milton Fuentes, PsyD;
Rafael Lantigua, MD;
Myrna M. Weissman, PhD
Arch Intern Med. 2002;162:53-60.
Background Borderline personality disorder (BPD) is a severe and chronic psychiatric
disorder characterized by marked impulsivity, instability of affect and interpersonal
relationships, and suicidal behavior that can complicate medical care. Few
data are available on its prevalence or clinical presentation outside of specialty
mental health care settings.
Methods We examined data from a survey conducted on a systematic sample (N =
218) from an urban primary care practice to study the prevalence, clinical
features, comorbidity, associated impairment, and rate of treatment of BPD.
Psychiatric assessments were conducted by mental health professionals using
structured clinical interviews.
Results Lifetime prevalence of BPD was 6.4% (14/218 patients). The BPD group
had a high rate of current suicidal ideation (3 patients [21.4%]), bipolar
disorder (3 [21.4%]), and major depressive (5 [35.7%]) and anxiety (8 [57.1%])
disorders. Half of the BPD patients reported not receiving mental health treatment
in the past year and nearly as many (6 [42.9%]) were not recognized by their
primary care physicians as having an ongoing emotional or mental health problem.
Conclusions The prevalence of BPD in primary care is high, about 4-fold higher than
that found in general community studies. Despite availability of various pharmacological
and psychological interventions that are helpful in treating symptoms of BPD,
and despite the association of this disorder with suicidal ideation, comorbid
psychiatric disorders, and functional impairment, BPD is largely unrecognized
and untreated. These findings are also important for the primary care physician,
because unrecognized BPD may underlie difficult patient-physician relationships
and complicate medical treatment.
From the Division of Clinical and Genetic Epidemiology, Department
of Psychiatry (Drs Gross, Olfson, Feder, Fuentes, and Weissman and Mr Gameroff),
the Division of General Medicine, Department of Medicine (Drs Shea, Feder,
and Lantigua), College of Physicians and Surgeons, and the Department of Epidemiology,
Mailman School of Public Health (Drs Gross, Shea, and Weissman), Columbia
University, and New York State Psychiatric Institute (Drs Olfson and Weissman),
New York, NY.
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