Letters
Mental health
Volume 197 - Issue 11

Depression and borderline personality disorder

Author:  Darryl L Lacey

Med J Aust 2012; 197 (11): 620. || doi: 10.5694/mja12.11591
Published online: 10 December 2012
To the Editor: Beatson and Rao’s article1 appeared in the MJA Open supplement subtitled “A guide to management in primary care”. Despite acknowledging that it “can be difficult to distinguish between [borderline personality disorder] and [major depressive disorder]”, the authors offer no specific guidance for general practitioners on how to do this. Beatson and Rao cite no primary care research, although admittedly there is a dearth ...
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To the Editor: Beatson and Rao’s article1 appeared in the MJA Open supplement subtitled “A guide to management in primary care”. Despite acknowledging that it “can be difficult to distinguish between [borderline personality disorder] and [major depressive disorder]”, the authors offer no specific guidance for general practitioners on how to do this.

Beatson and Rao cite no primary care research, although admittedly there is a dearth of literature. In a 1-year study of psychiatric morbidity in 358 general practice patients, GPs diagnosed personality disorder in 5.3%, but this increased to 28% when patients were assessed using a structured interview.2 It seems likely that the GPs did take “a longitudinal history, with careful examination of depressive symptoms”,1 as the study psychiatrist also diagnosed personality disorder in 5.6%, although not in the same patients.

It has been noted in the Journal that “Primary care psychiatry is not specialist psychiatry in general practice”,3 and that a dimensional approach can be more appropriate in general practice than a categorical one. Since 2010, I have used the Dimensional Assessment of Personality Pathology – Basic Questionnaire (DAPP-BQ)4 as an integral part of assessing every patient presenting for initial management of a mental health problem. Over 25 assessments, I have found it to efficiently provide relevant, clinically valuable information about dysfunctional personality traits. Online administration costs under $15, requires minimal practitioner time and has proven acceptable to most patients. The DAPP-BQ can alert the GP to important dysfunctional traits before commencing treatment, enabling appropriate choice of management. Reproducibility and correlation with personality disorders are well established.4,5 I commend the DAPP-BQ to academic GPs for consideration of formal demonstration in primary care.

Author

  • Darryl L Lacey1
  • 1. Cockburn Medical Centre, Perth, WA.

Correspondence: darryl.lacey@gmail.com

Competing interests

No relevant disclosures.

References

View this article on Wiley Online Library

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