Insights From Our Editors

Why an OD Needs to Understand Personality Behavior Disorders

By Mark Wright, OD, FCOVD,
and Carole Burns, OD, FCOVD

Oct. 26, 2022

Have you ever had a patient who loved you and your practice, but had nothing good to say about any doctor who had seen them before? If so, beware. They may be suffering from a personality behavior disorder and your treatment plan may need to include more than just glasses, contact lenses and eye health. Eyecare professionals have a role in the overall health and well-being of the patients we see. This includes mental health.

We know that mental health disorders have an impact on systemic and ocular conditions such as myokymia, blur, binocular vision, headaches, herpes zoster and dry eye. Looking at the general population, the chance that the average person has a mental health illness is 21 percent (women, 25.8 percent, and men, 15.8 percent). It is important to know that over half (about 56 percent) of adults with mental illness do not receive treatment.

Personality disorders are a type of mental illness. These disorders may cause serious problems with relationships. The cause of personality disorders is unknown. Treatment may require medication and and years of talk therapy to become manageable. The severity, frequency and duration of symptoms of people with personality disorders depends on the person and their illness.

People with borderline personality disorder may experience intense mood swings and their feelings for others often change quickly, swinging from extreme closeness to extreme dislike. People with borderline personality disorder tend to view things in extremes, such as all good or all bad. These changing feelings often lead to unstable relationships and emotional pain.

People with borderline personality disorder have a higher rate of self-harming and suicidal behavior than the general population.

People with borderline personality disorder who are thinking of harming themselves or attempting suicide need help right away. If you have a patient who is in immediate distress or is thinking about hurting themselves,

Borderline personality disorder often occurs with other mental illnesses, such as post-traumatic stress disorder (PTSD)  depressionbipolar disorderanxiety disorderssubstance abuse or eating disorders.

Management Keys For Mental Health Issues For Eyecare Professionals

  • Do not ignore signs and symptoms.
  • Demonstrate good listening skills and empathetic responding skills.
  • Don’t over-promise and under-deliver
  • The hardest part is how to suggest to the patient that problems of concern exist and the need for a consult. The discussion of stress may be a good “entry point.” ii

 Key Thoughts

There are key thoughts you need to have:

  • These people are sick.
  • These people are often not rational, so they may not respond well to logical discussions. Don’t get upset at what they say to you.
  • Set boundaries, otherwise you may begin getting phone calls at home.

Further Information

Here is a list of further information on this topic if you’d like to read more.

i. NIMH » Borderline Personality Disorder (

ii. Fraser Horn, OD, East-West, Keynote Lecture – Optometry’s Role in Mental Health

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