4.7 Article

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

期刊

SOCIAL SCIENCE & MEDICINE
卷 142, 期 -, 页码 82-89

出版社

PERGAMON-ELSEVIER SCIENCE LTD
DOI: 10.1016/j.socscimed.2015.08.008

关键词

USA; Borderline personality disorder; Medicalization; Difficult patient; Mental health; Access to care; Doctor/patient communication

资金

  1. Holtz Center for Science and Technology Studies at the University of Wisconsin
  2. National Research Service Award Post-doctoral Traineeship from the Agency for Health Care Research and Quality
  3. Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill [5T32 HS000032]
  4. National Research Service Award Post-doctoral Traineeship from the National Center for Complementary and Alternative Medicine, at the National Institutes of Health
  5. Department of Family Medicine at the University of Wisconsin-Madison [T32 AT006956]

向作者/读者索取更多资源

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. (C) 2015 Elsevier Ltd. All rights reserved.

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