Navigating Ethical and Clinical Dilemmas in the Treatment of Borderline Personality Disorder: Challenges for Mental Health Professionals
Recently, in my clinic, I encountered a middle-aged married woman who is a housewife with two children. The initial session focused on gathering her medical history, during which I observed signs of irritation on her face. Towards the end of the session, I recommended some diagnostic tests to determine a proper diagnosis. Following the entire session, there was a noticeable shift in her expression, and she eagerly asked, will you be informing me about my condition? Her voice conveyed excitement, being slightly loud and shaky. I responded affirmatively, expressing the importance of identifying the condition to initiate an appropriate treatment. However, she abruptly interrupted me, saying, Okay, when should I come for the next session? Even though she mentioned previous appointments with psychiatrists and psychologists in her treatment history but I focused on gathering more details about her medications and the therapeutic process. It became evident that she lacked awareness of her diagnosis. Having consulted with two mental health professionals, including both psychiatrists and psychologists, she remains uninformed about the diagnosis she has been given. At that particular moment, a cascade of thoughts rushed through my mind. Over my decade-long career, a recurring question has persistently emerged from my patients: “What is my diagnosis?” This inquiry isn’t confined to visits to general practitioners; it seems to be a universal instinct to seek clarity about our health conditions. Every patient holds a fundamental right to be acquainted with information about their illness. The question then becomes why certain patients are not provided with information about their diagnosis. Each professional holds a distinct rationale for their approach.
A few years back, I came across an article authored by Howe (2013), addressing the five ethical and clinical challenges that psychiatrists might encounter while treating individuals with borderline personality disorder who are at risk of or prone to suicidal tendencies. This article highlights a fundamental question that arises early in the course of treatment what information mental health professionals should convey to patients regarding a diagnosis of borderline personality disorder. The author shared psychiatrists’ perspectives on hesitation to disclose the diagnosis of Borderline Personality Disorder (BPD) to their patients. This hesitation stems from concerns about potential adverse reactions, especially in situations where patients with BPD might feel abandoned. Some professionals are apprehensive that sharing this diagnosis could contribute to stigma, hinder the ongoing relationship between patients and professionals, and possibly undermine the patient’s sense of hope.
Among the four ethical principles in healthcare –autonomy serves as a foundational concept; that emphasizes an individual’s right to make their own decisions regarding their treatment and care. An independent patient has the right to be informed about their diagnosis and prognosis. Professional has the ethical responsibility to provide clear and comprehensive information before obtaining consent for treatment to the practice of truthfully disclosing diagnoses and prognoses to patients.
From my observations, individuals with mental health conditions frequently achieve better results when we transparently discuss their diagnosis. It not only streamlines the treatment process but also assists patients in comprehending the source of their distress. Various professionals and ethical frameworks offer differing perspectives on whether disclosing a BPD diagnosis is advisable. The decision involves weighing potential benefits and risks. While one major benefit is that it can help patients understand their condition, fostering self-awareness and potentially reducing the stigma associated with mental health disorders, disclosure may also inadvertently contribute to stigma. Patients might internalize negative expectations associated with the BPD diagnosis, potentially hindering their motivation for change or growth, and it may alter the dynamics of the therapeutic relationship.Careful consideration of each case is essential for mental health professionals, considering the specific needs, preferences, and circumstances of the patient. Open communication and collaboration between professionals and patients are crucial for addressing potential benefits and risks in a way that prioritizes the well-being of the individual. Creating a safe space for dialogue allows patients to express their concerns, questions, and feelings about potential disclosure. The decision-making process should be collaborative, with professionals and patients working together to weigh the potential benefits and risks based on the individual’s circumstances. Recognizing each person’s uniqueness, professionals should tailor their approach to suit the patient’s needs and preferences, considering their comfort with information disclosure and readiness to engage in discussions about their diagnosis.
The decision-making process should be guided by ethical principles, including respect for autonomy, and a commitment to fostering a positive therapeutic environment. By incorporating these principles, mental health professionals can navigate the complexities of disclosing a BPD diagnosis in an ethical, patient-centered manner that promotes the well-being and progress of the individual seeking treatment.
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