PsychEd: educational psychiatry podcast PsychEd Episode 32: Diagnosing Borderline Personality Disorder with Dr. Robert Biskin and Dr. Ronald Fraser
50:09
Misdiagnosed BPD
- Dr. Fraser recounts diagnosing many patients with treatment-resistant depression who actually had BPD.
- This highlights the frequent misdiagnosis of BPD and the importance of recognizing it.
Caution in BPD Diagnosis
- Be cautious when diagnosing BPD, especially in the ER, without sufficient history.
- Consider BPD as a rule-out and reflect this in consultations.
BPD Stigma and Diagnosis
- Diagnosing BPD doesn't require absolute certainty, unlike other diagnoses.
- The stigma around BPD makes clinicians reluctant to diagnose it, delaying care.
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Introduction
00:00 • 3min
The DSM-5 and Borderline Personality Disorder
03:11 • 3min
How to Differentiate a Cool Morbid Condition From Other Conditions
06:20 • 4min
The Role of Chronicity in PTSD
10:41 • 2min
The Epidemiology of BPD
12:29 • 3min
The Diversity of the City of Montreal
15:00 • 3min
The Prognosis of Waterline Personality Disorder
18:17 • 4min
The Genetic Risk of Emotional Dysregulation in Children With BPD
22:25 • 4min
Different Presentations for Borderline Personality Disorder
26:02 • 5min
The Importance of Disclosed Borderline Personality Disorder
31:05 • 4min
How to Diagnosis BPD Effectively and Compassionately
34:40 • 3min
The Importance of Disclosed Diagnosis
37:42 • 5min
The Role of Emptiness in the Diagnosis of BPD
43:00 • 3min
How to Diagnosis PPD
46:21 • 4min
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners.
This episode covers the diagnosis of borderline personality disorder with expert guests:
- Dr. Robert Biskin, Associate Professor in the Department of Psychiatry at McGill University, psychiatrist at the Borderline Personality Disorder Clinic at the McGill University Health Centre, as well as inpatient psychiatrist at the Jewish General Hospital.
- Dr. Ronald Fraser, Associate Professor in the Department of Psychiatry at McGill University, Adjunct Professor at Dalhousie University, head of the Inpatient Detoxification Services and Addictions Unit, as well as director of the Extended Care Borderline Personality Disorder Clinic at the McGill University Health Centre.
By the end of this episode, you should be able to…
- List the DSM-5 diagnostic criteria of borderline personality disorder.
- Recall the epidemiology of borderline personality disorder.
- Consider the risk factors and posited causal mechanisms for borderline personality disorder, including developmental and neurobiological mechanisms.
- Discuss the clinical presentation of borderline personality in different clinical settings, including the Emergency and Outpatient settings.
- Recognize the differential diagnoses for patients presenting with borderline personality disorder.
- List the common comorbid psychiatric and general medical conditions with borderline personality disorder.
- Discuss the common diagnostic challenges and pitfalls.
- Explore the stigma surrounding the diagnosis of borderline personality disorder, and discuss a therapeutic approach to providing psychoeducation to patients with this diagnosis.
Guests: Dr. Robert Biskin and Dr. Ronald Fraser.
Hosts: Dr. Sarah Hanafi (PGY3), Dr. Nima Nahiddi (PGY3), Audrey Le (CC4).
Audio editing by Audrey Le.
Show notes by Dr. Nima Nahiddi.
Interview Content:
- Introduction – 0:00
- Learning objectives – 2:03
- DSM-5 definition of personality disorder, and borderline personality disorder (BPD) – 3:00
- Other associated features of BPD – 4:36
- Distinguishing BPD from other psychiatric and co-morbid conditions – 5:55
- Epidemiology of BPD – 13:48
- BPD over the lifecycle – 18:05
- Explanatory models for the development of BPD – 21:20
- Differences in the presentation of BPD – 26:00
- Approach to a BPD diagnosis in the emergency department – 31:05
- Stigma surrounding BPD diagnosis and disclosure of diagnosis – 33:51
- Clinical pearls for screening of BPD – 41:11
- Evidenced based screening tools or scales for BPD diagnosis – 46:22
- Closing – 48:40
Resources:
- MSI-BDP: MacLean Screening Index for BPD
- Diagnostic Interview for BPD – Revised (DIB-R): https://psycnet.apa.org/record/1990-11356-001
Articles: Diagnosing borderline personality disorder | CMAJ
References:
- Biskin, R.S., Paris, J. (2012). Diagnosing borderline personality disorder. CMAJ. 184 (16), 1789-1794.
- Zanarini, M. C., Gunderson, J. G., Frankenburg, F. R., & Chauncey, D. L. (1989). The revised Diagnostic Interview for Borderlines: Discriminating BPD from other Axis II disorders. Journal of Personality Disorders, 3(1), 10–18.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
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