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Dealing with disclosure in patients with borderline personality traits

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To the Editor: Mental health patients with borderline personality traits are frequently not informed of their diagnosis, both in the inpatient ward and in the outpatient clinic. Often, however, this axis II finding (according to the Diagnostic and statistical manual of mental disorders) is clearly documented in their file. Why the disparity?

Perhaps this is because the decision to disclose the psychiatric opinion to the patient is arbitrary, owing to the fact that the diagnosis may be made in just one sitting and personality traits are arguably within the spectrum of normal. Often the patient is left in the dark and only sees light when a brave but irate psychiatrist decides that their current presentation warrants a revision of the existing diagnosis to the personality disorder.

Is it fair to the patient with borderline personality traits that we should, as colleagues in health care, collude in keeping the truth away from the unsuspecting person walking through the door?

One problem in disclosure is that the personality attributes of patients with borderline traits are often considered egosyntonic.