Borderline personality disorder in residential care facilities

Personality disorders in the geriatric population have scarcely received any attention in the literature, particularly on how they manifest and their management. The authors provide two case scenarios of long-term care (LTC) residents who formally received a diagnosis of borderline personality disorder (BPD) in late-life and outline the treatment approach that was used. These cases serve to demonstrate that BPD may manifest differently in geriatric patients than in younger persons, rendering current diagnostic criteria and assessment tools inadequate for making the diagnosis in this population. These cases also serve to show how BPD may be managed using validation therapy with limit-setting, a nonpharmacological intervention that yielded good results in the case patients. Although there is a paucity of data on the use of validation therapy in LTC facilities, the authors' experience and the successful use of this therapy in other settings indicate that this may be a viable treatment strategy to curtail problematic behaviors among residents with BPD, while also maximizing empathy and reducing burden among staff and caregivers. Research in this arena is warranted.