During inpatient hospitalizations, do you inform patients you are diagnosing them with a personality disorder?

It would be a bit presumptuous to diagnose a personality disorder based on a brief hospital stay. I generally try to avoid labeling people as much as possible. I usually discuss their presentation's symptoms and how they affect them and their well-being. Whenever possible, I discuss their experiences and how they may contribute to their difficulties. For example, childhood trauma is often connected to mood instability and interpersonal disruption. If they ask specifically about diagnosis, I will generally speak about them in general terms and identify how certain things they are experiencing are consistent with a particular diagnostic category. I approach Borderline PD in much the same way.

I find this to be an important and complicated question.

I think it is imperative that psychiatrists provide their patients with their diagnosis and prognosis. Insight into their illness is very important and we cannot ask individuals to challenge this insight if they do not know their diagnosis. This may be one of the few times, if not the only time, that physicians withhold the diagnosis from their patients. Another issue is informed consent for treatment. For patients to consent to treatment, they should understand the indication along with the risks and benefits. Finally, not informing the patient can present challenges for future physicians when the patient is under the belief they have some other diagnosis (given by you or a previous ...

Yes, almost always. I trained with the Gunderson BPD materials and prioritize thoughtful disclosure and education that I believe all patients deserve. Only if the patient is very resistant to working together in general, won't be on my service past a day or two, or some other extenuating circumstance, would I document it in the differential but not disclose it. In that case, it would be to help as much as possible inform other providers and shape future care, hoping the patient will be able to hear it effectively at the next encounter.

As psychiatrists, we have a profound opportunity to help patients more effectively by assertively and swiftly identifying underlying personality structures that shape and inform clinical presentations. There has often been a reluctance to do this out of a fear of appearing judgmental, which inadvertently contributes to labels like treatment-resistant conditions. In reality, what is frequently masked behind treatment resistance is a maladaptive personality structure that may not meet full criteria for a formal disorder, yet remains crucial for both the clinician and the patient to recognize. Bringing these patterns to light in a non-judgmental and motivational environment allows us to foster true insight and significantly improve therapeutic...