When children and adolescents cycle repeatedly through hospital emergency rooms and inpatient units—misdiagnosed with anxiety or depression that never seems to improve—they're often struggling with a condition that's frequently missed: borderline personality disorder (BPD).
Mollie Gurley, PMHNP-BC, MSN, has made it her mission to change that reality.
“I think this population is often overlooked or misunderstood,” she says. “Sometimes they’re called difficult, which isn’t the case. This is a mental health condition.”
Understanding Borderline Personality Disorder
Gurley is talking about children and adolescents who have borderline personality disorder (BPD), a complex mental health condition characterized by intense emotional experiences, difficulty regulating emotions, unstable relationships, impulsivity, and a fragile sense of self.
While BPD is often associated with adults, research shows that early identification and intervention in adolescence can dramatically improve long-term outcomes. Yet many young patients go years without proper diagnosis or treatment.
“A lot of times, these patients have been cycling in and out of hospitals because they’ve been told they have anxiety or depression. But a lot of times, that anxiety or depression won’t get better until you’re diagnosed with BPD and can get treatment for that,” she says.
Creating a Solution
That’s why she created a tool for better screening and intervention techniques as part of her Doctor of Nursing Practice (DNP) project at the University of Colorado Anschutz College of Nursing. Gurley implemented her project at Children’s Hospital Colorado, where she holds multiple roles at the hospital’s Pediatric Mental Health Institute and is an Assistant Professor in the Department of Psychiatry at the School of Medicine.
“This tool can be the answer for a lot of families and patients who have been struggling for a long time, who haven’t had any answers.”
Her tool is based on Harvard’s General Psychiatric Management for Adolescents (GPM-A), which focuses on giving patients and their families information and skills to better understand and manage mental health conditions.
“I’m able to help parents understand their child’s brain better so they can help their child get better,” she says. “It makes a big difference in families, because some may not be able to understand that their child is not just a difficult teenager – they have a real diagnosis or traits with BPD.”
Training Other Providers
Part of Gurley’s role at Children’s Hospital is training other healthcare providers, so she’s been able to integrate the tool into the hospital’s Advanced Practice Provider Fellowship program.
“All of this starts with providers – when we give better care, our patients get better care,” she says. “I’m able to teach them about working more effectively with these patients in an evidence-based way, so it’s actually going to make a difference in these patients’ lives and help them get better.
Making a Measurable Impact
Gurley says her tool has already made a big impact – allowing providers to feel more confident in making diagnoses while making sure patients get the treatment they need.
“BPD is a costly diagnosis in our healthcare system because these patients use the ER and inpatient services frequently,” she says. “These interventions help patients from being unsafe and help them get treatment sooner.”
Children’s Hospital will continue using Gurley’s intervention tool once she graduates, and the hope is to train other providers and hospital units.
“I’m passionate about this patient population, and it’s been great seeing people’s views on these patients change,” she says. “Earning my DNP is helping me implement change in a structured, measurable way. I’m able to assess outcomes and implement evidence-based practice to improve patient care.”
