Responding to stigma: Clinician diagnostic practices and patient responses in Borderline Personality Disorder

Mental health care providers lack systematic information about patient experiences with diagnosis, and are left to guess about the effectiveness of their practices. By examining how different practitioners handle the diagnostic encounter, this project documented how diagnosing patients with Borderline Personality Disorder (BPD) happens in clinical settings. Additionally, we incorporated much-needed research on patient perspectives. Primary data included in-depth interviews of mental health care providers and persons diagnosed with BPD. Interviews were coded using grounded theory and institutional ethnography. Secondary patient reports of diagnostic encounters from memoirs and online message boards were used to augment primary data collection. Clinicians used a variety of strategies to communicate the BPD diagnosis such as using euphemisms, symptom-based language or naming the diagnosis, usually with critical commentary on the category itself. Patients responded differently to the encounter depending on the kind of language used to describe the disorder and when they found out in the trajectory of their care. Generally, patient responses did not line up with clinician expectations, suggesting that hearing the patient point of view might inform how providers discuss diagnosis. What patients with BPD are told and how they are told affects their desire to stay in treatment, as well as their relationships with their providers. This research can lead to better clinical outcomes in the most prevalent personality disorder in the U.S. by helping clinicians to retain their patients through effective diagnostic communication.