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To examine how clinicians navigate providing treatment to Borderline Personality Disorder (BPD) in the context of the DSM 5, deinstitutionalization, and the biomedical model.

We conducted 39 interviews with mental health providers in the United States in a two-year period preceding and following the release of the DSM 5. Using Constructivist Grounded Theory, we analyzed the data for themes that emerged.

Clinicians faced pressures from insurance companies, the DSM categories, and their professional training to focus on biomedical treatments. These treatments, which emphasized pharmaceuticals and short courses of care, were ill-suited to BPD, which has a strong evidence base recommending long-term therapeutic interventions. We term this contradiction a “biomedical mismatch” and use Gidden’s concept of structuration to better understand how clinicians navigate the system of care. Providers ranged in their responses to the mismatch: some championed biomedicine, others were complicit, and a final group behaved as activists, challenging the paradigm. The sum of the strategies had downstream effects which included crisis reinstitutionalization and a discourse of untreatability. Ultimately, we discuss how social factors such as gender bias, stigma, and trauma are insufficiently represented in the biomedical model of care for BPD.

BPD fits poorly within the biomedical underpinnings of the current system. Accordingly, it illuminates the structuration of health care and where the rules of care break down. More precisely, deinstitutionalization was designed to remove patients from long courses of inpatient care. Many patients with BPD have failed to experience this outcome, with some patients now cycling through long courses of short-term crisis reinstitutionalization instead of having effective outpatient care over long periods. This unintended consequence of deinstitutionalization calls for a more biopsychosocial response to BPD.

Literature regarding recovery has focussed on diagnoses such as schizophrenia, with few papers focussing on borderline personality disorder (BPD). This is a significant area in need of change because a lack of research concentrating on recovery from BPD could be seen to perpetuate the view that recovery from this condition may not be possible. Recovery Colleges (RCs) in the UK began in 2009and aim to offer co-produced and co-facilitated psychoeducational courses to encourage recovery and enable people to develop skills and knowledge so they become experts in the self-management of their difficulties. Given the gaps within the recovery literature, it is unclear how Recovery Colleges can support recovery for people diagnosed with BPD. The purpose of this study was to explore the impact of a Recovery College course for people diagnosed with BPD.

Using participatory methods, this paper aims to explore the question of what personal recovery looks like for people with BPD and how this may prove useful in developing future practice in RCs. Qualitative feedback data was collected from 51 managing intense emotions courses delivered to 309 students using a patient reported experience measure between Autumn 2015 and Autumn 2021.

The results of this study indicate that people with BPD can experience recovery, whilst still experiencing symptoms, as long as they receive appropriate co-produced, recovery-orientated support and services.

Further research in this area could help shape future clinical practice by embedding a recovery-focussed programme into community services.

Literature regarding recovery has focussed on diagnoses such as schizophrenia withfew papers focussing on BPD. This is an area in need of change because a lack of research on recovery from BPD could be seen to perpetuate the view that recovery from this condition may not be possible. RCs offer co-produced and co-facilitated psychoeducational courses around recovery, enabling people to develop skills and knowledge to become experts in the self-management of their difficulties. Given the gaps within the recovery literature it is unclear how RCs can support recovery for this group of service users.

Borderline personality disorder (BPD) is a controversial psychiatric diagnosis. Despite an increasing amount of research looking at the BPD diagnosis when applied to young people, there is limited understanding of the key viewpoints of mental health professionals working with young people in the UK. This research aims to use Q-methodology to contribute to understanding the multiple views of the diagnosis.

Q-statements about views of the BPD diagnosis were selected from relevant journals, internet sites and social media platforms and were validated by a Q-methodology research group, the research supervisors and an online group of individuals with BPD. Q-sorts were then used to explore the viewpoints of 27 mental health professionals in the UK working with children and adolescents. Analysis of the data was completed using Q-methodology analysis software.

Three main factors emerged from the data, explaining 66% of the variance. Of the 27 participants, 24 loaded onto these three factors, defined as: harmful not helpful; language and optimism; and caution and specialist services. Three Q-sorts did not load significantly onto any one factor.

There appears to be at least three ways of understanding the BPD diagnosis for young people. It may be useful for clinicians to consider and share their own viewpoint, be open to difference and formulate difficulties from an individual perspective.

Borderline personality disorder (BPD) is a complex condition characterized by a number of psychosocial difficulties that typically involve considerable suffering for individuals with the condition. Recovery from BPD may involve specific processes such as work on how the self is perceived by the individual with BPD and his or her relationships which differ from those common to recovery from other mental health conditions. The details of the processes that may best promote changes within the self and relationships are yet to be established. The paper aims to discuss these issues.

In total, 17 consumers from a specialist BPD service were interviewed to identify factors they have experienced that contribute to recovery from BPD. Thematic analysis within a grounded theory framework was used to understand key themes within the interview data. The emphasis was on specific conditions of change rather than the more global goals for recovery suggested by recent models.

Key themes identified included five conditions of change: support from others; accepting the need for change; working on trauma without blaming oneself; curiosity about oneself; and reflecting on one’s behavior. To apply these conditions of change more broadly, clinicians working in the BPD field need to support processes that promote BPD-specific recovery identified by consumers rather than focusing exclusively on the more general recovery principles previously identified within the literature.

The specific factors identified by consumers as supporting recovery in BPD are significant because they involve specific skills or attitudes rather than aspirations or goals. These specific skills may be constructively supported in clinical practice.

The purpose of this paper is to explore the lived experience of having a diagnosis of Borderline Personality Disorder (BPD) in a forensic setting.

Semi-structured interviews were conducted with eight women with a diagnosis of BPD in private secure units. The interview data were analysed using interpretative phenomenological analysis (IPA).

Four main themes emerged: identity, power, protection and containment, and confusion. The themes of identity, power and protection and containment represented polarised positions which in turn contributed to the theme of confusion.

There are limitations to this study mainly the heterogeneous nature of the sample. However, good quality control and the similarities with previous findings indicate that this study makes a valuable contribution to the understanding of BPD in a forensic setting. In addition it has implications for further research; exploring sense of self and the differences between a sample from a community and a sample from a forensic setting with a diagnosis of BPD.

For practitioners to acknowledge power dynamics and to be able to formulate and address these with patients with a diagnosis of BPD.

This is the first IPA study to ask women with a diagnosis of BPD in a forensic setting what their experience is. It is a qualitative study due to the need to genuinely explore the topic and to provide a basis for others to conduct further research.

Borderline personality disorder (BPD) is a debilitating illness characterised by a pervasive pattern of emotional instability, interpersonal difficulties and impulsive behaviour in association with repeated self-injury and chronic suicidal ideation. People diagnosed with BPD also have high rates of co-occurring psychopathology, including disorders associated with disturbed impulse control, such as substance use disorder (SUD) and disordered eating behaviours. The co-occurrence of BPD and impulse control disorders contributes to the severity and complexity of clinical presentations and negatively impacts the course of treatment and recovery. This study qualitatively documents aspects of the lived experience and recovery journeys of people diagnosed with BPD and co-occurring SUD and/or disordered eating. This study aims to identify similarities with respect to themes reported at different stages of the recovery process, as well as highlight important factors that may hinder and/or foster recovery.

In-person, in-depth, semi-structured interviews were conducted with 12 specialist service consumers within a clinical setting. Ten women and two men (22–58 years; mean: 35.5 years) were recruited. Interview transcripts were analysed using thematic analysis principles.

As expected, participants with co-occurring disorders experienced severe forms of psychopathology. The lived experience descriptions aligned with the proposition that people with BPD engage in impulsive behaviours as a response to extreme emotional states. Key emergent themes and sub-themes relating to recovery comprised three domains: factors hindering adaptive change; factors assisting adaptive change and factors that constitute change. An inability to regulate negative affect appears to be an important underlying mechanism that links the three disorders.

This study highlights the potential shortcomings in the traditional approach of treating co-occurring disorders of BPD, SUD and eating disorders as separate diagnoses. The current findings strongly support the adoption of an integrative approach to treating complex mental health issues while concurrently emphasising social connection, support and general health and lifestyle changes.

The findings of this study contribute to the burgeoning BPD recovery literature. A feature of the current study was its use of in-depth face-to-face interviews, which provided rich, many layered, detailed and nuanced data, which is a major goal of qualitative research (Fusch and Ness, 2015). Furthermore, the interviews were conducted within a safe clinical setting with engagement facilitated by a clinically trained professional. There was also a genuine willingness among participants to share their stories in the belief that doing so would inform effective future clinical practice. Their willingness and engagement as participants may reflect their progress along the path to recovery in comparison to others with similar diagnoses. Finally, most of the interviewees were engaging in dialectical behavioural therapy (DBT)-style therapies; two were receiving mentalisation-based therapy treatment, and most had previously engaged in cognitive behavioural therapy or acceptance and commitment therapy-based approaches. The predominance of DBT-style therapy may have influenced the ways that themes were articulated. Future studies could supplement this area of research by interviewing participants receiving therapeutic interventions other than DBT for the treatment of BPD and heightened impulsivity.

This paper aims to examine the ways in which the criminal justice system has evolved to accommodate mental illness. Mental health courts are one such alternative; these courts actively seek rehabilitative and therapeutic outcomes for participants. However, current literature suggests that these courts are ineffective for offenders who have been diagnosed with borderline personality disorder (BPD).

The aim of the current inquiry was to determine the degree to which participation in the Assessment and Referral Court (ARC) List in the Magistrates’ Court of Victoria reduced re-offending rates for offenders diagnosed with BPD by providing a comparative analysis of pre and post ARC List offending.

The results of a two-year recidivism study suggest that successful completion of the ARC List reduces recidivism for 50% of offenders diagnosed with BPD.

To the authoring team’s knowledge, this is the second paper to explore the efficacy of the Assessment of Referral Court List (Magistrates’ Court of Victoria) in reducing recidivist behaviours for programme participants; however, it is the first paper to look specifically at the recidivist behaviours of participants of the Assessment of Referral Court List (Magistrates’ Court of Victoria) who have been diagnosed with BPD.

This study aims to identify and critically appraise literature exploring the effectiveness of psychological interventions in improving borderline personality disorder (BPD) symptomatology for individuals who misuse substances.

Systematic searches across six databases (PsycINFO, Embase, Scopus, Medline, CINAHL and ProQuest), hand searching and citation chaining were conducted between June and August 2021. Key search terms included BPD, substance use, therapy and effect. Study and sample characteristics, interventions, outcome measures and key findings were extracted. Quality assessment and a narrative synthesis approach were used to explore strengths, limitations and relationships between and within studies.

Seven eligible reports were included and showed mostly adequate quality. Mixed samples, designs, outcomes, definitions and implementation varied. Treatment completion did not differ significantly between those who did and did not misuse substances. Interventions demonstrated effectiveness in relation to psychiatric symptoms, hospital admissions, self-efficacy and impulsive and self-mutilating (cutting, burning, etc.) behaviours. No effects were found for suicidal or parasuicidal (threats, preparation and attempts) behaviours.

This review only considers individuals with diagnoses of BPD who are not accessing substance misuse treatment. Radically open dialectical behaviour therapy (DBT), therapeutic communities and other interventions are available as interventions for substance misuse (Beaulieu et al., 2021). Based on the findings of this review, it should not be assumed that such interventions affect substance misuse rather than BPD symptomatology. Therefore, future research might explore the effectiveness of these interventions on BPD symptomatology despite this not being the primary target for intervention.

Despite McCrone et al. (2008) noting the cost of this population’s difficulties to both themselves and services, the limited number of studies in this area is astonishing. Despite a lack of quality in the data available, there i some evidence to support the use of DBT and general psychiatric management (GPM) interventions for those with BPD and concurrent substance misuse. It is therefore of principal importance that health and social care services action Public Health England’s (2017) recommendations. Individuals with coexisting BPD and substance misuse would then receive support from any professional they see, who could then refer for psychological therapies.

Although the reports appear to show that DBT, integrated therapies and GPM may be effective for this population, conclusions cannot be drawn with high levels of confidence due to heterogeneity among studies. The findings indicate that future, high-quality research is needed to test the effects of interventions on BPD symptomatology for those who misuse substances. Randomised controlled trials with sufficient statistical power, homogeneous outcomes and standardised methodological approaches are needed.

People with a borderline personality disorder (BPD) diagnosis can require support from mental health services for managing risk behaviour. Current routine inpatient and community treatment can be unhelpful for this group. Positive risk taking has been developed to help community teams manage risk with people with a BPD. This study aims to explore experiences of risk management in an NHS Trust where positive risk taking is being implemented with people with a BPD.

Interpretative phenomenological analysis is the methodology of transcripts from semi-structured interviews. Nine adults with a diagnosis of BPD and current or previous experiences of risk management approaches were sampled from one NHS Trust.

Limited resources and interpersonal barriers had a negative impact on experiences of Positive risk taking. Participants experienced one-off risk assessments and short-term interventions such as medication which they described as “meaningless”. Traumatic experiences could make it difficult to establish therapeutic relationships and elicit unhelpful responses from professionals. Participants could only feel “taken seriously” when in crisis which contributed towards an increase in risky behaviour. Positive risk taking was contingent upon collaborative and consistent professional relationships which created a “safety net”, enabling open communication and responsibility taking which challenged recovery-relapse patterns of service use.

Positive risk taking approaches to risk management may benefit people with a BPD. Findings complement those from other studies emphasising the importance of compassion and empathy when working with personality disorder. Training and increased resources are required to implement effective risk management with this group.

Findings expand upon the sparse existing research in the area of risk management using the Positive risk taking approach with people with a BPD diagnosis, and provide idiographic understanding which is clinically meaningful. Participants’ experiences suggest Positive risk taking may provide a framework for improving quality of life and decreasing service use for people diagnosed with BPD engaging in risk management with Community Mental Health Teams, which facilitates recovery and other benefits.