CBSSM Seminar: Therapeutic Privilege in Psychiatry? The Case of Borderline Personality
Borderline personality disorder is a serious mental illness that effects 2-3% of the population, is highly stigmatized, and is often comorbid with other mental disorders. Although no pharmaceutical interventions exist, long-term psychotherapy has been shown to alleviate the symptoms of BPD. Nonetheless, behavioral health care professionals often hesitate to discuss this disorder with their patients even when it is clear they have this disorder. Why do psychiatrists, in particular, fall silent? In this talk, I will sketch the history of BPD and describe ethical arguments for and against of therapeutic nondisclosure. I will summarize empirical data regarding psychiatrist nondisclosure of BPD, including recent research conducted by my team at Penn. I will argue that diagnostic nondisclosure, while well-intentioned, can have long-term negative consequences for patients, caregivers, and the health system more generally. As a form of therapeutic privilege, nondisclosure of BPD is ethically inappropriate.
Dominic Sisti, PhD
Director, The Scattergood Program for Applied Ethics of Behavioral Health Care
Assistant Professor, Department of Medical Ethics & Health Policy
Assistant Professor, Department of Psychiatry