Dominic A. Sisti, Ph.D.
Director, The Scattergood Program for Applied Ethics of Behavioral Health Care
Assistant Professor, Department of Medical Ethics & Health Policy
Assistant Professor, Department of Psychiatry
Perelman School of Medicine at the University of Pennsylvania
“Therapeutic Privilege in Psychiatry? The Case of Borderline Personality Disorder”
Borderline personality disorder is a serious mental illness that effects 2-3% of the population, is highly stigmatized, and is often comorbid with other mental disorders. Although no pharmaceutical interventions exist, long-term psychotherapy has been shown to alleviate the symptoms of BPD. Nonetheless, behavioral health care professionals often hesitate to discuss this disorder with their patients even when it is clear they have this disorder. Why do psychiatrists, in particular, fall silent? In this talk, I will sketch the history of BPD and describe ethical arguments for and against of therapeutic nondisclosure. I will summarize empirical data regarding psychiatrist nondisclosure of BPD, including recent research conducted by my team at Penn. I will argue that diagnostic nondisclosure, while well-intentioned, can have long-term negative consequences for patients, caregivers, and the health system more generally. As a form of therapeutic privilege, nondisclosure of BPD is ethically inappropriate.
Dominic Sisti, PhD is director of the Scattergood Program for the Applied Ethics of Behavioral Health Care and assistant professor in the Department of Medical Ethics & Health Policy at the University of Pennsylvania. He holds secondary appointments in the Department of Psychiatry, where he directs the ethics curriculum in the residency program, and in the Department of Philosophy. Dominic’s research examines the ethics of mental health care services and policies, including long-term psychiatric care for individuals with serious mental illness and ethical challenges in correctional mental health care. He also studies how mental disorders are defined, categorized, and diagnosed with a focus on personality disorders. Dr. Sisti's writings have appeared in peer-reviewed journals such as JAMA, JAMA Psychiatry, Psychiatric Services, and the Journal of Medical Ethics. His work has been featured in popular media outlets such as the New York Times, NPR, Slate, and The Atlantic. Dr. Sisti received his PhD in Philosophy at Michigan State University. A native of Philadelphia, Dominic received his Master’s degree in bioethics from the University of Pennsylvania and his bachelor’s degree from Villanova University.