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
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 ...
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.
Competing interests
No relevant disclosures.
References
- Beatson JA, Rao S. Depression and borderline personality disorder. MJA Open 2012; 1 Suppl 4: 24-27. 0_CHDGIAJF
- Casey PR, Tyrer P. Personality disorder and psychiatric illness in general practice. Br J Psychiatry 1990; 156: 261-265. 0_CBBBFECC
- Hickie IB. Primary care psychiatry is not specialist psychiatry in general practice. Med J Aust 1999; 170: 171-173. 0_i1142874
- Livesley WJ, Jackson DN. Dimensional Assessment of Personality Pathology – Basic Questionnaire technical manual. Port Huron, Mich: Sigma Assessment Systems Inc, 2009. 0_i1142876
- Clark LA, Livesley WJ, Schroeder ML, Irish SL. Convergence of two systems for assessing specific traits of personality disorder. Psychol Assess 1996; 8: 294-303. 0_CBBIFIBE