The advice comes in new draft NHMRC guidelines, which aim to promote early diagnosis and management of a condition branded one of the “most difficult and troubling problems in psychiatry”.
The guidelines recommend that 12-18-year-olds with frequent self-harming behaviour, suicidal ideation, marked emotional instability, or high levels of functional impairment be assessed for the condition. They also recommend disclosing the diagnosis to the patient.
Associate Professor Andrew Chanen, a Melbourne psychiatrist who helped develop the guidelines, told Australian Doctor they would promote early intervention and legitimise the use of treatments with proven efficacy. He estimated about 120,000 Australian adolescents and 200,000 adults had borderline personality disorder, a condition associated with high suicide rates.
Professor Chanen said the diagnostic criteria for adolescents were just as “reliable, valid and stable” as in adults, yet currently most patients only received treatment years later.
“People wait for the eggs to be well and truly scrambled, then try and unscramble them. [We’re trying to] prevent the eggs from being cracked in the first place,” said Professor Chanen, a consultant psychiatrist at Orygen Youth Health Research Centre.
The guidelines recommend the use of structured psychological therapies for a minimum of three months.
However, there is already scepticism about whether the suggested approaches will prove helpful to patients, given the scarcity of appropriate mental health services.
Dr Andrew Gunn, a Brisbane GP who works at a clinic for home-less youth, said it was a constant challenge to secure specialist care for patients with the condition.
He was concerned about diagnosing the condition at such a young age, especially given the scarcity of services.
“You get teenagers thinking, ‘I’ve got this personality disorder that’s never going to go away and I’m going to be a bit stuffed for life’. That’s unhelpful,” he said.
Associate Professor Chanen acknowledged GPs had often been left “holding the baby”, and that many psychiatric services practised an almost “bureaucratic self-deception” to avoid taking on patients with borderline personality disorder.
“The big risk is the guideline will promise a great deal and GPs might well be disappointed,” he said.
As first appeared in Psychiatry Update, 12 April, 2012