Why do Australians with borderline personality disorder return to hospital frequently?

Key points:

• Borderline personality disorder is the most common personality disorder in Australia, affecting up to five percent of the population

• Borderline personality disorder is a Cluster B personality disorder, like antisocial personality disorder and histrionic personality disorder

• Borderline personality disorder primarily affects women, however, gender differences among people with BPD indicated that men with the condition may be more likely to end up in prison settings, whereas women may be more likely to wind up in hospital settings

Patients with BPD were at higher risk of returning to hospital when compared to patients with any other type of mental disorder, according to a new study from Flinders University.

The study reviewed a South Australian cohort of 86,740 emergency department and inpatient episodes of care for 25,619 mental patients presenting to SA public hospitals between 2014 and 2019.

Researchers assessed how frequently people with BPD attended the hospital along with the length of their inpatient stay, finding that they present with other co-occurring problems, including substance abuse, depression, anxiety and bipolar affective disorder.

The study found that BPD was also associated with considerable psychosocial impairment, including poor social functioning, unemployment and loss of income.

Lead author Dr David Smith from the College of Medicine and Public Health said further research was needed to determine other determinants.

“We found that approximately four percent of all mental health patients were discharged from an emergency department or inpatient admission with a primary diagnosis of BPD recorded as the primary discharge diagnosis,” Dr Smith said.

“Those patients were then at higher risk of hospital re-admission compared to other mental health diagnostic groups in this study cohort.

“Of particular interest is the association between initial inpatient length of stay in hospital and the number of days before they sought hospital treatment again.

“Those patients whose initial stay in hospital was up to 14 days returned to hospital on average 58 days sooner than those patients who stayed for two days or less.”

These findings open up new avenues for research, including whether any overnight stay and stays of less or greater than two days were associated with harm or benefit to people with BPD.

“There is no doubt that more needs to be done to provide better healthcare pathways for patients with BPD,” Dr Smith explained.

“We need to get more accurate recordings of BPD patients and related presentations, more in-depth investigations of care pathways and identifications of individuals who may benefit from a specific inpatient length of stay.

“We’d like to trace the patient’s journey in hospital from the patient’s perspective which would allow clinicians and managers to see and understand patients’ experience by separating the management of a specific psychiatric condition and treatment into a series of consecutive events or steps — for example, activities, interventions, or staff interactions.

“This approach would also need to address BPD-related questions about sex and gender, such as how sex and gender intersect with age, race and ethnicity and other sociocultural factors as well as determine outcomes.

“The synthesis of this type of information with data, such as from the current study, would provide deeper insights into patient journeys, including when things went right and when they did not.

The Diagnostic and Statistical Manual, Fifth Edition, has indicated that up to 75 percent of those with BPD are female and personality disorders are often lifelong and without a cure, however, treatment may include psychodynamic therapy.

Personality disorders are not covered by the National Disability Insurance Scheme, as per NDIS guidelines surrounding the difference between mental health conditions and psychosocial disability.

“We believe that building on existing resources would improve health and community-based services and staff training and not only boost the health and well-being of all Australians but significantly contribute to a reduction in emergency department presentations and hospital admissions,” Dr Smith added.

Previous breakdowns of BPD prevalence across countries have indicated that the condition may be subject to ‘Western’ diagnostic criteria or ‘socially sensitive’ conditions.

Do you suspect that you or someone you know may have borderline personality disorder? Please refer to the following resources:

• Lifeline 13 11 14 — for anyone in crisis
• ReachOut — youth mental health service — online help
• SANE Australia — call 1800 187 263
• Mental Illness Fellowship of Australia — call 1800 985 944

Do you think that you attend the hospital more or less frequently than the average Australian and why? Let the team at Talking Disability know and subscribe to the newsletter for more information, news and industry updates.

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