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How do you reconcile an attachment to mood disorder diagnoses in borderlines whose actual consolidating diagnosis is that of borderline PD? What strategies do you incorporate to manage these patients? I find it to be a nightmare in the outpatient setting when inheriting such patients.
I have many colleagues who offer an alleged unspecified mood disorder or bipolar spectrum illness diagnosis to borderlines. Sometimes they want it on paper to substantiate use of atypicals (liability)...or else to appease patients who might ask for records and find borderline PD as pejorative. Another reason is if they are a borderline with a hx of distant SA's or parasuicidal behavior, some colleagues get incentivized to pile on 10 meds and call it a mood disorder.
In the long run it harms those borderlines who indulge in the sick role, some of whom end up treated with LAI's. I think of it as an intersecting area between two circles, borderline PD and factitious disorder. I'm not dismissing the view that bipolar d/o and borderline PD can exist on a spectrum. How do you manage such patients when they are maxed out on a billion meds, want a med change at the first and every subsequent visit, claim nothing works for their bipolar d/o, and get offended when you tell them they have borderline PD? I tell them at this point I can more reliably diagnose borderline PD. Sometimes they want to go back to their previous psychiatrist who dumped them, but sometimes they want to stick around.
I have many colleagues who offer an alleged unspecified mood disorder or bipolar spectrum illness diagnosis to borderlines. Sometimes they want it on paper to substantiate use of atypicals (liability)...or else to appease patients who might ask for records and find borderline PD as pejorative. Another reason is if they are a borderline with a hx of distant SA's or parasuicidal behavior, some colleagues get incentivized to pile on 10 meds and call it a mood disorder.
In the long run it harms those borderlines who indulge in the sick role, some of whom end up treated with LAI's. I think of it as an intersecting area between two circles, borderline PD and factitious disorder. I'm not dismissing the view that bipolar d/o and borderline PD can exist on a spectrum. How do you manage such patients when they are maxed out on a billion meds, want a med change at the first and every subsequent visit, claim nothing works for their bipolar d/o, and get offended when you tell them they have borderline PD? I tell them at this point I can more reliably diagnose borderline PD. Sometimes they want to go back to their previous psychiatrist who dumped them, but sometimes they want to stick around.