Set boundaries for the relationship with BPD patients: This is a skill that needs to be taught and may take some practice, for both the GP and patient with BPD [4].
Use “management contracting”: a negotiation between GP and patient about the expectations during treatment, and also makes clear that responsibility for management is shared by both parties; this encourages accountability and independence in the patient [3].
Discuss and identify short-term and long-term goals with the patient, encouraging them to reduce inpatient admissions and reliance on health services, as well as practicing self-regulation in their non-clinical interpersonal encounters [4].
Schedule regular structured appointments for check-ins and avoiding only crisis presentations [2,3,4], and addressing perceived abandonment [2].
Develop a “crisis management plan”: agreed upon by the GP, patient, and other care providers; this may reduce excessive reliance on GP services and facilitate self-management skills [3,4]. “Crisis plans” also aim to minimise emergency department admissions, which occur frequently among individuals with BPD [3,4].
De-escalate any possible emotionally intense confrontations with a calm and neutral demeanour [4].
Ensure that frequent communication is maintained between various care providers: important for preventing patients from “playing one practitioner against another” through the process of splitting and devaluation–idealization [3].
Management goals should be realistic and take into account the fluctuating and long-term course of BPD symptomatology: GPs must bear in mind that although significant improvements and remission are possible, they occur over the long-term [28].
While boundary-setting and management contracting are emphasised, management plans should also allow a degree of flexibility to accommodate changing circumstances [4].
