Abstract

MARTINS, Cátia Priscila; CAETANO, Filipa; ALMEIDA, Hugo  and  CARVALHO, Serafim. Comorbidity of borderline personality disorder and irritable bowel syndrome: case report on the importance of the medical biopsychosocial model and the integration of care. Rev Port Med Geral Fam [online]. 2020, vol.36, n.5, pp.416-423. ISSN 2182-5173.  https://doi.org/10.32385/rpmgf.v36i5.12655.

Introduction: Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder in occidental countries, with symptoms including abdominal pain and/or bloating and alteration of bowel transit, such as diarrhea and/or constipation (Rome IV Criteria). Borderline Personality Disorder (BPD) is driven by interpersonal instability and affective and behavioral dysregulation. Somatic complaints are frequent in patients with BPD and the coexistence of gastrointestinal symptoms and BPD seems to represent an additional risk in terms of suicide and poorer quality of life. The overlap of these symptoms and the associated risks require an integrative clinical approach, in order to grant a more effective and less iatrogenic treatment. Case description: Woman, 31 years old, followed-up in psychology since childhood, without personal relevant medical history and with a family history of IBS. She started psychiatry appointments for a depressive episode at the age of 28 and was then medicated with mirtazapine 30mg id, lamotrigine 100mg 2id, and clobazam 20mg id, with total remission of depressive symptoms. Around two years later, she started having recurrent abdominal pain and diarrhea, at a time when she was experiencing bullying in the workplace. The diagnostic tests showed no alterations and her symptoms improved after psychotherapy and after she changed her workplace, with episodes then limited to times after she ingested specific food. IBS was diagnosed. Comment: The biopsychosocial framing of the symptoms is fundamental not only to find a relationship between the beginning of the physical symptoms and the aversive events and to the starting of a problem-solving plan and adequate life changes but also to establish the diagnosis of IBS. The multidisciplinary dialogue and a better care discussion between the general physician and psychiatrists are central steps to the optimization of the biopsychosocial model and a more humanized medicine.

Keywords : Borderline Personality Disorder; Irritable bowel syndrome; Psychological stress; Workplace bullying.

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