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Borderline personality disorder, therapeutic privilege, integrated care: is it ethical to withhold a psychiatric diagnosis?
  1. Erika Sims1,
  2. Katharine J Nelson2,
  3. Dominic Sisti3
  1. 1Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
  2. 2Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
  3. 3Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Dominic Sisti, Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA; sistid{at}upenn.edu

Abstract

Once common, therapeutic privilege—the practice whereby a physician withholds diagnostic or prognostic information from a patient intending to protect the patient—is now generally seen as unethical. However, instances of therapeutic privilege are common in some areas of clinical psychiatry. We describe therapeutic privilege in the context of borderline personality disorder, discuss the implications of diagnostic non-disclosure on integrated care and offer recommendations to promote diagnostic disclosure for this patient population.

  • ethics
  • psychiatry
  • applied and professional ethics
  • clinical ethics
  • informed consent

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Footnotes

  • Correction notice This paper has been updated since first published to amend author name 'Katharine J Nelson'.

  • Contributors ES, KJN and DS all contributed to the development, writing and revision of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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