Borderline Personality Disorder and Diabetes: A Potentially Ominous Mix

N o psychological characteristic arouses as much interest and frustration as borderline personality disorder (BPD). While complex and richly symptomatic on one hand, it is, on the other hand, difficult to treat effectively with any current techniques.1 People with BPD bring with them the promise of unstable personal and therapeutic relationships, growing demands for service and support, and, in the end, the strong likelihood of failure to achieve any defined goals.2-4When seen in the health care setting, patients with BPD are often a challenge to provider organizations.5,6 They arouse intense emotional reactions from medical staff and others. They can pit care providers against each other. They often occupy substantial amounts of time and resources in frequently futile attempts to help them solve either their medical conditions or their recurrent dissatisfactions with the care process. And usually, but not always, they end their stormy course with a health care organization with a negative termination of the therapeutic relationship, complete with a vigorous litany of the many failings of the health care group. They are more apt to litigate against health care providers than are other patients.7,8Although there is only a modicum of specific data on the care of diabetic patients with BPD, these issues may apply to the treatment of those patients, as well as to all other BPD patients. Having BPD tendencies may be associated with poor glycemic control and other stresses in the therapeutic process.9-11 It may also influence how patients respond to specific clinical situations, such as insulin-induced hypoglycemia.12For provider organizations, BPD represents a potentially serious problem of financial and legal risk management. Patients with BPD usually occupy a disproportionate amount of staff time and resources. Their demands for service and …