Letters
Mental health
Volume 197 - Issue 11

Depression and borderline personality disorder

Authors:  Josephine A Beatson and Sathya Rao

Med J Aust 2012; 197 (11): 620-621. || doi: 10.5694/mja12.11646
Published online: 10 December 2012
In reply: Lacey suggests that the Dimensional Assessment of Personality Pathology - Basic Questionnaire (DAPP-BQ)1 can be a useful tool for the assessment of personality problems by academic general practitioners. We agree. Significant elevations on the DAPP-BQ’s affective lability, identity problems, insecure attachment, and self-harm scores would alert the practitioner to the probable - if not certain - presence of borderline personality disorder (BPD). However, the ...
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In reply: Lacey suggests that the Dimensional Assessment of Personality Pathology – Basic Questionnaire (DAPP-BQ)1 can be a useful tool for the assessment of personality problems by academic general practitioners. We agree. Significant elevations on the DAPP-BQ’s affective lability, identity problems, insecure attachment, and self-harm scores would alert the practitioner to the probable — if not certain — presence of borderline personality disorder (BPD).

However, the DAPP-BQ will not help the GP differentiate depressive symptoms that are part of BPD from co-occurring depressive illness, which requires treatment in its own right. Substantiating the presence of depressive illness requires a longitudinal history establishing the presence of depressive symptoms sufficient to meet criteria for depressive disorder, sustained for at least 2 weeks.2

GPs who lack the time or inclination to use the DAPP-BQ or similar instrument should consider referring any patient presenting with repeated self-harm, persistent risk-taking behaviour or marked emotional instability to a psychiatrist for diagnostic evaluation. Confirmation of a diagnosis of BPD would then alert the GP to the importance of collaborative, cooperative engagement with the patient in planning ongoing treatment.

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