Borderline Personality Disorder: To diagnose or not to diagnose? That is the question

Campbell, Katrina; Clarke, Karen-Ann; Massey, Debbie; Lakeman, Richard

doi:10.1111/inm.12737

Cited by 46 publications

(45 citation statements)

References 66 publications

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“…One programme entailed a weekly 90 minute faceto-face skills group over 30 weeks (10-week modules) and weekly therapy but did not include telephone coaching. By November 2019, programmes were available and operational across the district in all large towns and the involvement of so many clinicians, inevitably began to erode the therapeutic nihilism associated with a diagnosis of BPD that often pervades services which primarily respond to crisis (Campbell et al, 2020). However, in March 2020 with COVID-19 declared a pandemic and social distancing mandated, all group encounters immediately ceased and services refocused their attention on responding to crisis and meeting the basic needs of clients who were now 'locked down' and encouraged only to access health services if absolutely necessary.…”

Section: Local Contextmentioning

confidence: 99%

The Impact of Social Distancing on People with Borderline Personality Disorder: The Views of Dialectical Behavioural Therapists

Lakeman

Crighton

2020

Issues in Mental Health Nursing

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Dialectical Behavioural Therapy (DBT) is an evidence-based treatment for borderline personality disorder and other problems associated with emotional dysregulation. It has traditionally been deployed as a face-to-face programme comprised of attendance at group skills training, individual therapy and phone coaching. Social distancing measures arising from the COVID-19 pandemic led to a cessation of therapeutic programmes in many places. This survey of DBT clinicians in a regional State mental health service in Australia explored the impact of the cessation of DBT programmes in the region and obstacles to engaging with people via online platforms. Clinicians have been able to engage in DBT informed care, but it was perceived that many people have experienced a clinical deterioration or have increased their use of crisis services, which is entirely appropriate, as group skills programmes have ceased. Movement to online platforms of delivery poses problems, as some people do not have the access to internet or privacy in their home environments to engage in online therapy. Ideally, clinicians need to be supported through education, supervision and coaching in the use of telehealth interventions. Social distancing requirements has enabled an opportunity to carefully consider how programmes can be adapted to enable the extension of these programmes to those who have traditionally been unable to access them.

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Section: Local Contextmentioning

confidence: 99%

The Impact of Social Distancing on People with Borderline Personality Disorder: The Views of Dialectical Behavioural Therapists

Lakeman

Crighton

2020

Issues in Mental Health Nursing

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“…Despite such significant levels of potential need and help-seeking, many concerns remain about the quality and accessibility of services for people given this diagnosis [2]. Stigmatising attitudes among clinical professionals in both health and mental health settings and a lack of therapeutic optimism are identified as some of the significant obstacles to the development and delivery of effective services [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

“…Given the seriousness of critiques of diagnostic labels, we have chosen in this paper to use an alternative term-complex emotional needs (CEN) to describe needs often associated with a diagnosis of "personality disorder". Nonetheless, the literature that we have reviewed largely refers to "personality disorder" [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Service user experiences of community services for complex emotional needs: A qualitative thematic synthesis

et al. 2021

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Background There is a recognised need to develop clear service models and pathways to provide high quality care in the community for people with complex emotional needs, who may have been given a “personality disorder” diagnosis. Services should be informed by the views of people with these experiences. Aims To identify and synthesise qualitative studies on service user experiences of community mental health care for Complex Emotional Needs. Methods We searched six bibliographic databases for papers published since 2003. We included peer reviewed studies reporting data on service user experiences and views about good care from community-based mental health services for adults with CEN, including generic mental health services and specialist “personality disorder” services. Studies using any qualitative method were included and thematic synthesis used to identify over-arching themes. Results Forty-seven papers were included. Main themes were: 1) The need for a long-term perspective on treatment journeys; 2) The need for individualised and holistic care; 3) Large variations in accessibility and quality of mental health services; 4) The centrality of therapeutic relationships; 5) Impacts of ‘personality disorder’ diagnosis. Themes tended to recur across studies from different countries and years. Discussion Recurrent major themes included wanting support that is individualised and holistic, provides continuity over long journeys towards recovery, and that is delivered by empathetic and well-informed clinicians who are hopeful but realistic about the prospects of treatment. Care that met these simple and clearly stated priorities tended to be restricted to often limited periods of treatment by specialist “personality disorder” services: generic and primary care services were often reported as far from adequate. There is an urgent need to co-design and test strategies for improving long-term support and treatment care for people with “personality disorders” throughout the mental health care system.

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“…Many service users report negative consequences as a result of being diagnosed with a ‘personality disorder’, including stigmatisation and exclusion from services [11]. Stigmatising attitudes among mental health professionals and a lack of therapeutic optimism are viewed by service users as significant barriers to the delivery of best practice care [9, 12, 13]. With these issues in mind, in this paper we use the working term CEN to refer to the needs experienced by people who are likely to be diagnosed with a ‘personality disorder’.…”

Section: Introductionmentioning

confidence: 99%

“…With these issues in mind, in this paper we use the working term CEN to refer to the needs experienced by people who are likely to be diagnosed with a ‘personality disorder’. We use this term CEN in preference to ‘personality disorder’, recognising that many view – and experience – the latter as pejorative and stigmatising [13, 14].…”

Section: Introductionmentioning

confidence: 99%

Clinician views on best practice community care for people with complex emotional needs and how it can be achieved: a qualitative study

Foye

Stuart

Trevillion

et al. 2021

Preprint

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Background Service provision for people with complex emotional needs (CEN) is recurrently identified as needing to be transformed: there are serious concerns about quality, accessibility, fragmentation of the service system and the stigma and therapeutic pessimism service users say they encounter. We use the term CEN as a working description to refer to the needs experienced by people who may have been diagnosed with a "personality disorder". Understanding clinician perspectives is vital for service transformation, as their views and experiences shed light on potential barriers to achieving good care, and how these might be overcome. In this study, we aimed to explore these views. Methods We used a qualitative interview design. A total of fifty participants from a range of professions across specialist and generic community mental health services across England who provide care to people with CEN took part in six focus groups and sixteen one-to-one interviews. We analysed the data using a thematic approach. Findings Main themes were: 1) Defining Best Practice, 2) Facilitators of Best Care, 3) Barriers to Best Care, 4) Systemic Challenges. Across these themes, staff highlighted in particular the need for care that was person-centred, relational, empathic, and trauma informed. However, major barriers to achieving this are stigmatising attitudes and behaviour towards people with CEN, especially in generic mental health services, lack of development of coherent service systems offering clear long-term pathways and ready access to high quality treatment, and lack of well-developed structures for staff training and support. Discussion Overall, the findings point towards clinician views as generally congruent with those of service users, reinforcing the need for priorities towards systemwide change to ensure that we can provide the best practice care for these individuals. Particularly prominent is the need to put in place system-wide training and support for clinicians working with CEN, encompassing generic as well as specialist services, and to challenge the stigma still experienced throughout the system. Conclusions Staff working with this service user group report that delivering best practice care services to be flexible, integrated, and sustainably funded, and for staff to be supported through ongoing training and supervision.

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Borderline Personality Disorder: To diagnose or not to diagnose? That is the question

Cited by 46 publications

References 66 publications

The Impact of Social Distancing on People with Borderline Personality Disorder: The Views of Dialectical Behavioural Therapists

The Impact of Social Distancing on People with Borderline Personality Disorder: The Views of Dialectical Behavioural Therapists

Service user experiences of community services for complex emotional needs: A qualitative thematic synthesis

Clinician views on best practice community care for people with complex emotional needs and how it can be achieved: a qualitative study

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