title: Improving patient-centered communication of the borderline personality disorder diagnosis.
abstract: BACKGROUND
  Borderline personality disorder (BPD) has historically been difficult to diagnose, and laden with stigma, leading to a variety of clinical responses to patients who present with symptoms.
  
  
  OBJECTIVE
  (1) To understand how clinicians communicate the diagnosis of BPD with patients. (2) To compare these practices with patient communication preferences. (3) To use patient preferences to evaluate clinician practices.
  
  
  METHODS
  Semi-structured interviews with mental health care providers and experts (n = 32) were compared with patients (n = 10) and primary patient-written accounts (n = 22). Grounded theory was used to explore causal pathways between clinical practice and patient responses.
  
  
  RESULTS
  The majority of clinicians sampled did not actively share the BPD diagnosis with their patients, even when they felt it was the most appropriate diagnosis. The majority of patients wanted to be told that they had the disorder, as well as have their providers discuss the stigma they would face. Patients who later discovered that their diagnosis had been withheld consistently left treatment.
  
  
  CONCLUSIONS
  Clinicians believed that by not using the BPD label they were acknowledging or sidestepping the stigma of the condition. However, from the perspective of patients, open communication was essential for maintaining a therapeutic relationship.
authors.affiliation: a Department of Family Medicine , University of Wisconsin-Madison , Madison , WI , USA .
authors.forename: Sandra H
authors.initials: SH
authors.lastname: Sulzer
authors.affiliation: b National Alliance on Mental Illness , Minneapolis , MN , USA , and.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Muenchow
authors.affiliation: b National Alliance on Mental Illness , Minneapolis , MN , USA , and.
authors.forename: Annabelle
authors.initials: A
authors.lastname: Potvin
authors.affiliation: c University of North Carolina at Chapel Hill, Cecil G. Sheps Center for Health Services Research , Chapel Hill , NC , USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Harris
authors.affiliation: a Department of Family Medicine , University of Wisconsin-Madison , Madison , WI , USA .
authors.forename: Grant
authors.initials: G
authors.lastname: Gigot
mesh_terms: D000328:Adult; D000368:Aged; D001883:Borderline Personality Disorder / Q000175:diagnosis* / Q000523:psychology; D003142:Communication; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care / Q000379:methods; D010817:Physician-Patient Relations; D055815:Young Adult
keywords: Borderline personality disorder; clinician-patient communication; diagnosis; patient-centered