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Does “difficult patient” status contribute to de facto demedicalization? The case of borderline personality disorder

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  • Sulzer, Sandra H.

Abstract

A diagnosis of Borderline Personality Disorder (BPD) often signals the quintessential “difficult patient” status to clinicians, with at least one scholar arguing the condition itself was created to name and group difficult patients. While patients who are deemed difficult are often dispreferred for care, does this have an impact on their overall status as medicalized patients who have successfully achieved a sick role? This study relies on (n = 22) in-depth interviews with mental health clinicians in the United States from 2012 to evaluate how they describe patients with BPD, how the diagnosis of BPD affects the treatment clinicians are willing to provide, and the implications for patients. My findings suggest patients with BPD are routinely labeled “difficult,” and subsequently routed out of care through a variety of direct and indirect means. This process creates a functional form of demedicalization where the actual diagnosis of BPD remains de jure medicalized, but the de facto or treatment component of medicalization is harder to secure for patients.

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  • Sulzer, Sandra H., 2015. "Does “difficult patient” status contribute to de facto demedicalization? The case of borderline personality disorder," Social Science & Medicine, Elsevier, vol. 142(C), pages 82-89.
    • Handle: RePEc:eee:socmed:v:142:y:2015:i:c:p:82-89
    DOI: 10.1016/j.socscimed.2015.08.008
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    1. Charles, Cathy & Gafni, Amiram & Whelan, Tim, 1997. "Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango)," Social Science & Medicine, Elsevier, vol. 44(5), pages 681-692, March.
    2. Koekkoek, B. & Hutschemaekers, G. & van Meijel, B. & Schene, A., 2011. "How do patients come to be seen as 'difficult'?: A mixed-methods study in community mental health care," Social Science & Medicine, Elsevier, vol. 72(4), pages 504-512, February.
    3. Bonnington, Oliver & Rose, Diana, 2014. "Exploring stigmatisation among people diagnosed with either bipolar disorder or borderline personality disorder: A critical realist analysis," Social Science & Medicine, Elsevier, vol. 123(C), pages 7-17.
    4. Nuckolls, Charles W., 1992. "Toward a cultural history of the personality disorders," Social Science & Medicine, Elsevier, vol. 35(1), pages 37-47, July.
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    Cited by:

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    2. Turowetz, Jason, 2022. "Interaction order and the labeling of disorder: How parents mobilize personal knowledge in the clinic to resist medicalization of their children's behavior," Social Science & Medicine, Elsevier, vol. 294(C).
    3. Claire Warrington, 2019. "Repeated Police Mental Health Act Detentions in England and Wales: Trauma and Recurrent Suicidality," IJERPH, MDPI, vol. 16(23), pages 1-15, November.
    4. Madden, Erin Fanning, 2019. "Intervention stigma: How medication-assisted treatment marginalizes patients and providers," Social Science & Medicine, Elsevier, vol. 232(C), pages 324-331.
    5. Ayuandini, Sherria, 2017. "Finger Pricks and Blood Vials: How doctors medicalize ‘cultural’ solutions to demedicalize the ‘broken’ hymen in the Netherlands," Social Science & Medicine, Elsevier, vol. 177(C), pages 61-68.

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