Emergency Department Management

Abstract

When clinicians encounter patients with borderline personality disorder (BPD) in the emergency department (ED) setting, challenges include managing acute self-injurious and suicidal behavior, intoxication, anger, interpersonal hypersensitivity, diagnostic confusion, and requests for medication changes. It is imperative to approach the BPD patient in an active, genuinely concerned manner while keeping one’s emotional reactions in check. Determining interpersonal stressors may help the provider expeditiously locate the trigger point for the crisis and can improve the safety risk assessment, which must be guided by the principle of acute-on-chronic risk. Psycho-education about BPD assists the patient in understanding their reactions and provides a useful framework for identifying which interventions are likely to be helpful (psychosocial) or not (medications). Communication with colleagues, the patient’s social supports, and outpatient providers is paramount in reaching the most appropriate disposition.