Low compliance to pharmacological treatment of severe chronic illness: Passive suicide ideation in borderline personality disorder?

Abstract

IntroductionThe core features of Borderline Personality Disorder (BPD), such as deliberate self-harm, suicide attempts and demandingness in interpersonal relationships persist with age, even though impulsivity decreases. Impairing progressive disease combined with affective instability and chronic feelings of emptiness can lead to a desire for death.ObjectivesTo present a case of BPD with severe chronic endocrine pathology and liver cirrhosis who refused to take his treatment as prescribed.MethodsA case report is presented and discussed.ResultsWe report the case of a 61-year-old man with BPD and liver cirrhosis, complex endocrine pathology (pituitary adenoma, diabetes insipidus and primary hypothyroidism), type 2 diabetes mellitus with insulin therapy, essential hypertension and alcohol use disorder. He had a history of 5 suicide attempts caused by marked feelings of rejection and emptiness and a pattern of unstable relationships and lack of commitment, thus his marriage lasted only 2 years. He idealized and was extremely familiar with his clinician and displayed marked affective instability (dysphoria, periods of anger and despair, affective ambivalence towards his parents and recurrent depressive symptoms). Because of his liver disease, the psychotropic medication was ceased by his physician. The patient refused to follow the rest of his treatment plan and diet as prescribed, resulting in the deterioration of his somatic status. The patient denied an active suicidal ideation, but did not explain his non-compliance.ConclusionThe impairment from BPD and the risk of suicide persist even in older age affecting the outcome of co-morbid somatic conditions.Disclosure of interestThe authors have not supplied their declaration of competing interest.