Borderline personality disorder. Interpersonal and behavioral problems that sabotage treatment success.

Patients with borderline personality disorder may be the most psychologically challenging patients a primary care physician ever encounters. Early diagnosis is important to avoid interpersonal enmeshment and personalization in dealings with these patients, who often appear intact initially. The acronym PISIA is useful in recalling the major characteristics of the disorder: psychotic episodes, impulsivity, superficially intact social adaptation, interpersonal-relationship problems, and affective disorders. Specific techniques (eg, setting limits, separating medical and psychological issues, consulting a psychiatrist to determine a psychotropic drug regimen) promote effective treatment of these difficult patients.