Therapeutic Privilege in Psychiatry? The Case of Borderline Personality Disorder

Dominic A. 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 
Perelman School of Medicine at the University of Pennsylvania 
Recorded September 19, 2018 

Borderline personality disorder (BPD) 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 BPD with their patients even when it is clear they have this disorder. Why do psychiatrists, in particular, fall silent? In this talk, Dr. Sisti will sketch the history of BPD and describe ethical arguments for and against therapeutic nondisclosure. Dr. Sisti will summarize empirical data regarding psychiatrist nondisclosure of BPD, including recent research conducted by his team at Penn. Dr. Sisti 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.

This lecture was part of the 2018-2019 Bioethics Brownbag & Webinar Series, presented by the Center for Ethics.