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Broadbear JH, Bhagwandas MG, Crowley S, Cheney L, Rao S. Exploring the Pathways to Diagnosis for Men With Borderline Personality Disorder: A Qualitative Study. Int J Ment Health Nurs 2024. [PMID: 39225121 DOI: 10.1111/inm.13413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 08/09/2024] [Accepted: 08/18/2024] [Indexed: 09/04/2024]
Abstract
Borderline personality disorder (BPD) is often perceived as being more common in females, since women are more likely to seek help and be diagnosed. However, epidemiological studies have reported no sex differences in community prevalence. The purpose of this study was to learn from the narrative journeys of men who have received a diagnosis of BPD. Eight men participated, mean age 45.9 years (range 27-73 years). Recruitment was through clinician referrals at the study site and via social media and website advertising. Participants consented to a 60-90-min semi-structured interview via an audio-visual digital platform. Audio recordings were transcribed and analysed using Interpretative Phenomenological Analysis (IPA). Three themes were identified: (i) The Emergence of Symptoms, (ii) Reaching Crisis Point and (iii) Receiving a Diagnosis. Participants reported many adverse experiences during childhood and adolescence. Early symptoms were often exacerbated by emotionally invalidating caregiving. Participants reported seeking mental health support only after reaching a crisis point, which often arose following an employment-related stressor. Participants typically initiated help-seeking by consulting a General Practitioner. Long delays were reported from initial help-seeking to being diagnosed with BPD; all expressed relief upon diagnosis. The findings highlight the deleterious consequences of emotional invalidation in participants' mental health and their capacity to access timely support. General Practitioners play a critical role in identifying probable symptoms of BPD in men and are the gateway to referral to psychiatrists and psychologists. It is vital that education is provided to assist their important work.
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Affiliation(s)
- J H Broadbear
- Spectrum, Personality Disorder and Complex Trauma Service, Richmond, Victoria, Australia
- Centre for Personality Disorder & Complex Trauma Research, Richmond, Victoria, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - M G Bhagwandas
- Spectrum, Personality Disorder and Complex Trauma Service, Richmond, Victoria, Australia
- Centre for Personality Disorder & Complex Trauma Research, Richmond, Victoria, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - S Crowley
- Spectrum, Personality Disorder and Complex Trauma Service, Richmond, Victoria, Australia
- Centre for Personality Disorder & Complex Trauma Research, Richmond, Victoria, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - L Cheney
- Spectrum, Personality Disorder and Complex Trauma Service, Richmond, Victoria, Australia
- Centre for Personality Disorder & Complex Trauma Research, Richmond, Victoria, Australia
| | - S Rao
- Spectrum, Personality Disorder and Complex Trauma Service, Richmond, Victoria, Australia
- Centre for Personality Disorder & Complex Trauma Research, Richmond, Victoria, Australia
- School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
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Constantine A, Krishnathasan K, Dimopoulos K. Understanding the interface between physical and mental health in adults with congenital heart disease. Eur J Prev Cardiol 2024; 31:1333-1335. [PMID: 38484174 DOI: 10.1093/eurjpc/zwae108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Affiliation(s)
- Andrew Constantine
- Department of Cardiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Kaushiga Krishnathasan
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, Sydney Street, SW3 6NP London, UK
- National Heart and Lung Institute, Imperial College London, UK
| | - Konstantinos Dimopoulos
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, Sydney Street, SW3 6NP London, UK
- National Heart and Lung Institute, Imperial College London, UK
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van Schie CC, Lewis K, Barr KR, Jewell M, Malcolmson N, Townsend ML, Grenyer BFS. Borderline personality disorder and stigma: Lived experience perspectives on helpful and hurtful language. Personal Ment Health 2024; 18:216-226. [PMID: 38482732 DOI: 10.1002/pmh.1609] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 12/06/2023] [Accepted: 02/18/2024] [Indexed: 08/13/2024]
Abstract
Borderline personality disorder (BPD) is a severe mental health disorder that is subject to significant stigmatisation. With language being a key reinforcer of stigma, this co-produced study aims to explore the language use regarding BPD and its effect on those with BPD and carers. Recommendations to reduce stigmatisation are provided for both clinicians and researchers. Participants with BPD (consumer n = 33) and those supporting someone with BPD (carer n = 30) discussed their experience of hurtful and helpful language. Reflexive thematic analysis was used to analyse written and verbal responses into core conflictual relationship themes (CCRT) reflecting how different words were heard and experienced. All consumers and carers in the study reported experiences with stigmatising language. Feelings of inadequacy and frustration were common amongst consumers, specifically when they perceived others as trivialising their needs or not seeing them as a unique individual. Carers often reported feelings of frustration when they perceived others as blaming them or not acknowledging their needs. Both consumers and carers reported helpful language as being connecting, validating and accepting. Unhelpful communication patterns have negative consequences for the person's self-understanding (i.e., self-stigma) and their relationships with others, including the therapeutic alliance. A consideration of these communication patterns may foster the use of reflective positive language that is compassionate and hopeful.
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Affiliation(s)
| | - Kate Lewis
- School of Psychology and School of Education, University of Wollongong, Wollongong, NSW, Australia
| | - Karlen R Barr
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Mahlie Jewell
- Project Air Strategy Consumer and Carer Advisory Committee, Wollongong, NSW, Australia
| | - Natalie Malcolmson
- Project Air Strategy Consumer and Carer Advisory Committee, Wollongong, NSW, Australia
| | - Michelle L Townsend
- School of Psychology and School of Health and Society, University of Wollongong, Wollongong, NSW, Australia
| | - Brin F S Grenyer
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
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Cha Y, Links PS, Ba D, Kazi A. Systematic Review of the Effectiveness and Experiences of Treatment for Men With Borderline Personality Disorder. Am J Mens Health 2024; 18:15579883241271894. [PMID: 39215612 PMCID: PMC11367612 DOI: 10.1177/15579883241271894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 06/16/2024] [Accepted: 06/24/2024] [Indexed: 09/04/2024] Open
Abstract
In clinical settings, among individuals diagnosed with borderline personality disorder (BPD), typically 75% are female and 25% male, although this discrepancy is not reported in the community. In the literature, little is known of the effectiveness and experiences of treatment of men with BPD. We aimed to review the effectiveness and experiences of treatment for men with BPD and outline future research priorities to promote better recovery. We searched Ovid MEDLINE and PsycINFO for eligible studies from inception until July 29, 2022. Peer-reviewed primary research articles on treatment effectiveness or experience for men with BPD were included. Data from eligible studies were synthesized in a narrative review. The protocol of our review was pre-registered on PROSPERO (CRD42022351908). Seventeen studies met the inclusion criteria, and men with BPD from eight countries were represented. Psychological therapies included Dialectical Behavioral Therapy, Systems Training for Emotional Predictability and Problem Solving, Mentalization Based Therapy, and psychoanalytic therapy. Pharmacologic treatment included topiramate, divalproex Extended-Release, and high-dose baclofen. Five studies investigated the service utilization of men with BPD. Compared to women, men were less likely to access treatment for BPD or find treatment helpful. Our findings demonstrated the potential efficacy of psychotherapy and pharmacologic interventions in reducing anger, aggression, and rule-breaking behavior, with limited evidence for reduction in suicide-related outcomes. Our findings are limited by inadequate power and heterogeneity of the included studies. Further research with larger sample sizes and qualitative studies is needed to better understand the treatment experience for men with BPD.
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Affiliation(s)
- Yevin Cha
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Paul S. Links
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Dong Ba
- Michael G Degroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ayman Kazi
- Michael G Degroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
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Nordkamp A, Roed K, Videbech P, Midtgaard J. 'Throw me a life buoy, please': A systematic review and thematic synthesis of qualitative evidence regarding nurses' experiences of caring for inpatients with borderline personality disorder and/or non-suicidal self-injury. J Psychiatr Ment Health Nurs 2024. [PMID: 38940193 DOI: 10.1111/jpm.13077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 06/11/2024] [Accepted: 06/14/2024] [Indexed: 06/29/2024]
Abstract
AbstractIntroductionNon‐suicidal self‐injury (NSSI) is prevalent in individuals diagnosed with borderline personality disorder (BPD), particularly in inpatient settings. This poses challenges, leading to frustration and powerlessness among healthcare professionals. This, in turn, puts mental health nurses at risk of compassion fatigue (CF), impacting treatment quality.AimWe conducted a systematic review and meta‐synthesis to investigate the experiences of mental health nurses caring for people with BPD and/or NSSI in inpatient settings.MethodLiterature search was performed in MEDLINE, CINAHL, PsychINFO and Web of Science. The Critical Appraisal Skills Programme (CASP) was used to critically appraise each study. For synthesis of findings from original studies, Thomas and Harden's thematic synthesis was used.ResultsIn total 1492 studies were screened of which seven met the inclusion criteria. We identified four main analytical themes: ‘Notions on nursing’, ‘Reality calls’, ‘Fall of ideals’ and ‘Throw me a lifebuoy, please’, with each two subthemes included.DiscussionDespite nurses' strong motivations for positive change and assistance, unexpected demands lead to emotional exhaustion, affecting their care provision.Implications for PracticeThe study underscores the necessity of addressing nurses' emotional strain through education and skill‐oriented training, enhancing their resilience and reducing CF risk, ultimately securing adequate care, and improving patient outcomes.
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Affiliation(s)
- Annika Nordkamp
- Centre for Applied Research in Mental Health Care (CARMEN), Mental Health Centre Glostrup, Glostrup, Denmark
- Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kickan Roed
- Centre for Applied Research in Mental Health Care (CARMEN), Mental Health Centre Glostrup, Glostrup, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Poul Videbech
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Center for Neuropsychiatric Depression Research (CNDR), Mental Health Centre Glostrup, Glostrup, Denmark
| | - Julie Midtgaard
- Centre for Applied Research in Mental Health Care (CARMEN), Mental Health Centre Glostrup, Glostrup, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Seal EL, Kokanović R, Flore J, Borovica T, Broadbear JH, McCutcheon L, Lawn S. Talking about borderline personality disorder, shaping care: The multiple doings of narratives. SOCIOLOGY OF HEALTH & ILLNESS 2024. [PMID: 38838130 DOI: 10.1111/1467-9566.13804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 05/22/2024] [Indexed: 06/07/2024]
Abstract
This article focuses on the narratives that circulate about borderline personality disorder (BPD) in health-care settings in Australia and the effects such narratives can have on how people practice and seek out care. People with a BPD diagnosis frequently access health-care services, often encountering stigma and discrimination. Drawing on narrative theory, we critically unpack the circulation and capacities of BPD narratives and the ways they can often contribute to poor and troubling experiences. This article is based on qualitative interviews with people living with a BPD diagnosis, as well as health practitioners who work with people with a BPD diagnosis. Our findings identified insidious and powerful BPD narratives that circulate in health-care settings, particularly in short-term, acute, or non-specialist contexts, such as emergency departments and in-patient units. These narratives influenced the ways that participants both practiced and sought out care. To improve health service quality for people with a BPD diagnosis, or those experiencing mental distress, it is important to challenge the sociocultural-political norms and relations that can influence approaches to care and practice. Disrupting and reframing negative BPD narratives and raising awareness about the impact of stories that are told about BPD have the potential to generate social change.
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Affiliation(s)
- Emma-Louise Seal
- School of Global, Urban and Social Studies, RMIT University, Melbourne, Victoria, Australia
| | - Renata Kokanović
- School of Global, Urban and Social Studies, RMIT University, Melbourne, Victoria, Australia
| | - Jacinthe Flore
- School of Historical and Philosophical Studies, University of Melbourne, Melbourne, Victoria, Australia
| | - Tamara Borovica
- School of Global, Urban and Social Studies, RMIT University, Melbourne, Victoria, Australia
| | - Jillian H Broadbear
- Spectrum Personality Disorder and Complex Trauma Service, Eastern Health, Richmond, Victoria, Australia
- Eastern Health Clinical School, Monash University, Clayton, Victoria, Australia
- Personality Disorder and Complex Trauma Research and Innovation Centre, Richmond, Victoria, Australia
| | | | - Sharon Lawn
- Discipline of Behavioural Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Lived Experience Australia Ltd, South Australia, South Australia, Australia
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Brousseau-Paradis C, Genest C, Maltais N, Séguin M, Rassy J. Emergency department care experience of suicidal patients: A qualitative analysis of patients' perspectives. Int Emerg Nurs 2024; 74:101449. [PMID: 38669791 DOI: 10.1016/j.ienj.2024.101449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/24/2024] [Accepted: 04/06/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION Individuals experiencing suicidal ideation or behavior frequently seek assistance at the emergency department (ED), yet the care they receive does not consistently align with their needs. This study explores the ED care experience of suicidal patients from their own perspective and offers recommendations to improve ED care for this population. METHOD This qualitative study uses a descriptive interpretative design. Semi-structured interviews were conducted with 7 individuals who sought care in an ED due to suicidal ideation or behavior. Transcripts were analyzed using thematic analysis. FINDINGS Participants' experiences were marked by an unsuited physical environment described as uncomfortable, noisy, and depressing. The organization of care was perceived as inadequate as patients complained about limited front-line access to mental health expertise, long waiting times, overworked staff, and inequities between patients with physical injuries and those with mental health concerns. Participants reported feelings of being trapped, left on their own and mistreated during their ED stay. Most found their care experience unhelpful or distressing, leaving them reluctant to reconsult. Specific recommendations based on patients' testimonials and literature are provided to enhance the ED care experience of suicidal patients. CONCLUSION This study highlights several areas for improvement of the ED care experience of suicidal patients. Changes in current practices are needed to offer suicidal patients the satisfying care experience they deserve.
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Affiliation(s)
- Camille Brousseau-Paradis
- Department of Psychiatry and Addictology, Faculty of Medicine, University of Montreal, Pavillon Roger-Gaudry, 2900 boul. Édouard-Montpetit, bureau S-750, H3T 1J4 Montreal, QC, Canada; Research Center of the University Institute in Mental Health of Montreal, 7331 Hochelaga Street, Montreal H1N 3V2, QC, Canada.
| | - Christine Genest
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada; Research Center of the University Institute in Mental Health of Montreal, Trauma Study Center, Montreal, QC, Canada; Center for Research and Intervention on Suicide, Ethical Issues and End-of- Life Practices, Montreal, QC, Canada.
| | - Nathalie Maltais
- Department of Health Sciences, University of Quebec at Rimouski, Rimouski, QC, Canada; Department of Psychoeducation and Psychology, University of Quebec at Outaouais, Gatineau, QC, Canada.
| | - Monique Séguin
- Department of Psychoeducation and Psychology, University of Quebec at Outaouais, Gatineau, QC, Canada; Douglas Mental Health University Institute, Montreal, QC, Canada.
| | - Jessica Rassy
- Research Center of the University Institute in Mental Health of Montreal, 7331 Hochelaga Street, Montreal H1N 3V2, QC, Canada; Quebec Network on Suicide, Mood Disorders and Associated Disorders, Montreal, QC, Canada; Quebec Network on Nursing Intervention Research, Montreal, QC, Canada; School of Nursing, University of Sherbrooke, Longueuil, QC, Canada.
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Dahlenburg SC, Bartsch DR, Giles JA, Koehne KA, O'Sullivan J. Experiences of a peer group for people diagnosed with borderline personality disorder: A qualitative interview study. Personal Ment Health 2024; 18:166-176. [PMID: 38311730 DOI: 10.1002/pmh.1604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 11/23/2023] [Accepted: 01/09/2024] [Indexed: 02/06/2024]
Abstract
There is a notable lack of literature evaluating peer support for people with a diagnosis of borderline personality disorder (BPD). Peer-led groups have been shown to positively impact outcomes related to empowerment, hope, and self-efficacy beliefs for consumers diagnosed with serious mental illness and may also be a helpful option for those experiencing personality disorder symptoms. We outline the coproduction of a peer group for people with a lived experience of BPD and a qualitative analysis of feedback post-group participation. Twenty-two consumers participated in post-group interviews and described their experiences of peer support. Interview transcripts were coded, and three main themes were identified: growth and change, connection and feeling understood, and creating safety. The findings suggested that participation in a coproduced peer support group for people with a diagnosis of BPD facilitated positive personal transformation as well as opportunities to develop connection through shared experiences in a safe environment grounded in mutuality. These themes were particularly powerful for participants because they countered previous experiences of not feeling safe, understood, or equal when seeking treatment. These findings support the acceptability of implementing a coproduced group for people diagnosed with BPD in a community mental health setting.
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Affiliation(s)
- Sophie C Dahlenburg
- Borderline Personality Disorder Collaborative, SA Health, 1/100 Greenhill Road, Unley, South Australia, 5061, Australia
- School of Psychology, The University of Adelaide, Hughes Building, North Terrace, Adelaide, South Australia, 5005, Australia
| | - Dianna R Bartsch
- Borderline Personality Disorder Collaborative, SA Health, 1/100 Greenhill Road, Unley, South Australia, 5061, Australia
- School of Psychology, The University of Adelaide, Hughes Building, North Terrace, Adelaide, South Australia, 5005, Australia
| | - Jessica A Giles
- Borderline Personality Disorder Collaborative, SA Health, 1/100 Greenhill Road, Unley, South Australia, 5061, Australia
| | - Kristy A Koehne
- Borderline Personality Disorder Collaborative, SA Health, 1/100 Greenhill Road, Unley, South Australia, 5061, Australia
| | - Judy O'Sullivan
- Borderline Personality Disorder Collaborative, SA Health, 1/100 Greenhill Road, Unley, South Australia, 5061, Australia
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Bartsch DR, McLeod Everitt C, Bednarz J, Ludbrook C, Cammell P. A State-Wide Initiative to Improve Health System Responses to People With Borderline Personality Disorder Symptoms in Crisis: A Retrospective Audit. J Pers Disord 2024; 38:87-108. [PMID: 38324250 DOI: 10.1521/pedi.2024.38.1.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Gold Card SA is a four-session structured psychological intervention offered soon after an acute crisis presentation to people with symptoms characteristic of borderline personality disorder. This study describes individual and system-level outcomes from a large-scale health-care improvement initiative to implement Gold Card SA across South Australia. An uncontrolled pre-post study design was utilized examining service user (n = 332) patient-reported outcome measures and hospital service utilization records (6 months before and after Gold Card SA). Mixed-effects negative binomial regression analysis revealed a significant decrease in rates of service utilization across emergency department presentations (63%), mental health-related inpatient admissions (65%), and bed days (82%). Linear mixed-effect regression indicated large reductions in borderline symptoms and nonspecific psychological distress, and small to moderate improvements in psychosocial functioning. People presenting with or experiencing borderline personality disorder symptoms may benefit from a brief crisis intervention embedded within a stepped care model.
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Affiliation(s)
- Dianna R Bartsch
- Borderline Personality Disorder Collaborative, Barossa Hills Fleurieu Local Health Network, SA Health, Adelaide, South Australia, Australia
- School of Psychology, The University of Adelaide, Adelaide, South Australia
| | - Cathy McLeod Everitt
- Borderline Personality Disorder Collaborative, Barossa Hills Fleurieu Local Health Network, SA Health, Adelaide, South Australia, Australia
| | - Jana Bednarz
- SAHMRI Women and Kids Theme, South Australia Health and Medical Research Institute, Adelaide, South Australia
- School of Public Health, The University of Adelaide, South Australia
| | - Cathy Ludbrook
- Borderline Personality Disorder Collaborative, Barossa Hills Fleurieu Local Health Network, SA Health, Adelaide, South Australia, Australia
| | - Paul Cammell
- Borderline Personality Disorder Collaborative, Barossa Hills Fleurieu Local Health Network, SA Health, Adelaide, South Australia, Australia
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Balmer A, Sambrook L, Roks H, Ashley-Mudie P, Tait J, Bu C, McIntyre JC, Shetty A, Nathan R, Saini P. Perspectives of service users and carers with lived experience of a diagnosis of personality disorder: A qualitative study. J Psychiatr Ment Health Nurs 2024; 31:55-65. [PMID: 37526302 DOI: 10.1111/jpm.12959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 06/23/2023] [Accepted: 07/04/2023] [Indexed: 08/02/2023]
Abstract
WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Personality disorder is a serious mental health condition affecting up to 52% of psychiatric outpatients and 70% of inpatients and forensic patients. People with a diagnosis of personality disorder have higher morbidity and mortality than those without. Service users and carers reported a lack of training for staff in the management of individuals with a diagnosis of personality disorder, particularly with regard to self-harm and suicidal behaviours. Staff burnout creates barriers to compassionate person-centred care for individuals with a diagnosis of personality disorder as staff struggled to accommodate the nature of the presentation when under significant emotional, psychological and professional strain caused by understaffing and lack of support. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This paper adds new knowledge by informing services of ways to improve care provision from the perspectives of both carers and service users. A more holistic and less medicalised approach to the treatment of problems associated with a diagnosis of a personality disorder should be adopted, and personality disorder training introduced for all healthcare practitioners, to improve patient outcomes. ABSTRACT INTRODUCTION: There is limited understanding of the experience of people with complex mental health (CMH) needs, including those with a diagnosis of personality disorder (PD) and carers of those individuals. Little is known about carers of those in inpatient forensic settings, yet it has been identified that they may have additional needs when compared to general carers. Research highlights that community carer support services were perceived as inadequate and out-of-area placements were described as putting an added strain on ability to support loved ones. Understanding PD within a population of people with CMH needs and how a diagnosis described as PD impacts on care and treatment experience is vital to providing high-quality care. AIM To evaluate the care experience of service users and carers with lived experience of a diagnosis of PD and out-of-area placements. METHOD Semi-structured interviews were conducted with six service users and four carers to explore the experiences and perspectives of people with a diagnosis of PD. Interviews were audio recorded and thematically analysed. RESULTS Four interrelated themes were developed; Influence of a diagnosis of PD on Staff, Early and Appropriate Intervention, Recognition of the Individual and Training and Knowledge of people with a diagnosis of PD. DISCUSSION Anti-stigma interventions for staff, research on care provision and structural changes to services including more evidence-based therapy for individuals with a diagnosis of PD may help reduce disparate treatment and improve prognosis for recovery. IMPLICATIONS FOR PRACTICE This paper informs services of ways to improve care provision from the perspective of carers and service users. A more holistic and less medicalised approach to the treatment of problems associated with diagnoses of PD should be adopted, and PD training for all healthcare practitioners to improve patient outcomes.
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Affiliation(s)
- Anna Balmer
- Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Laura Sambrook
- Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Hana Roks
- Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | | | - Jackie Tait
- Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Christopher Bu
- Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
| | - Jason C McIntyre
- Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Amrith Shetty
- Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
| | - Rajan Nathan
- Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
| | - Pooja Saini
- Faculty of Health, Liverpool John Moores University, Liverpool, UK
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McIntosh JT, Jacobowitz W. Attitudes of Emergency Nurses toward Clients with Mental Illness: A Descriptive Correlational Study in a Nationwide U.S. Sample. Issues Ment Health Nurs 2024; 45:105-113. [PMID: 38190395 DOI: 10.1080/01612840.2023.2278773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
Introduction: Individuals with mental illness often experience stigma from healthcare professionals, including emergency nurses. The purpose of this study was to identify personal and professional attributes of emergency nurses that may be related to their level of stigma toward people with mental illness in the U.S. Methods: Secondary analysis of a cross-sectional study to analyze emergency nurses' characteristics against their perceptions of stigma toward mental illness as measured by the Mental Illness: Clinicians' Attitudes Scale-4 (MICA v4). Data analyses consisted of descriptive statistics; stepwise linear regression; and analysis of the internal consistency of the MICA v4 in the current sample. Results: The mean MICA v4 scores for this sample were 53.4. The linear regression analysis revealed a significant model explaining 23.5% of the variance of MICA v4 scores (F[34] = 6.4, p < 0.001, R2 = 0.235). Many attributes were found to have a strong association with lower stigmatizing attitudes. Discussion: The results of this study indicated high levels of stigma toward individuals with mental illness. Findings from this study can inform nursing education and research, and ultimately improve the health outcomes of individuals with mental illness.
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Affiliation(s)
- Jennifer T McIntosh
- Yale School of Nursing, Orange, Connecticut, USA
- Adelphi University, Garden City, New York, USA
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12
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Lehtinen M, Voutilainen L, Peräkylä A. 'Is it in your basic personality?' Negotiations about traits and context in diagnostic interviews for personality disorders. Health (London) 2023; 27:1033-1058. [PMID: 35608173 PMCID: PMC10588267 DOI: 10.1177/13634593221094701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
What does it mean to claim that somebody's personality is disordered? The aim in this paper is to examine how the process of diagnosing personality disorders (PD) unfolds on a practical level. We take an in-depth look at PD interviews, paying close attention to the occasional discrepancies in the clinicians' and the patients' approaches to generalising the behaviour of patients to describe their personality. Clinicians are guided by the medical model and structured interviews in their approach. We regard the interview situation as interplay between the institution, the clinician and the patient - and the final diagnosis as an interactional construction between them. Our data consists of video-recorded interviews in Finland with 10 adult patients and three psychiatric nurses. The collection was compiled from 22 excerpts in which the participants orient differently to the generalisability of personality traits. Our observations show that, in these interviews, patients frequently make sense of their behaviour differently from what is expected - not as a reflection of their personality traits, but as an outcome of many situational factors. Our understanding leads us to emphasise the importance of making visible the practices that shape the diagnostic process in psychiatry.
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Affiliation(s)
| | | | - Anssi Peräkylä
- University of Helsinki, Finland; Freiburg Institute for Advanced Studies, Germany
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Bergen C, Bortolotti L, Temple RK, Fadashe C, Lee C, Lim M, McCabe R. Implying implausibility and undermining versus accepting peoples' experiences of suicidal ideation and self-harm in Emergency Department psychosocial assessments. Front Psychiatry 2023; 14:1197512. [PMID: 37711424 PMCID: PMC10499316 DOI: 10.3389/fpsyt.2023.1197512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/01/2023] [Indexed: 09/16/2023] Open
Abstract
Background Patients seeking emergency care for self-harm and suicidality report varying experiences from being believed and taken seriously to not being believed and taken seriously. Epistemic injustice provides a conceptual framework to explore how peoples' experiences of self-harm and suicidality are believed or not. We use an empirical method -conversation analysis - to analyze epistemics in clinical communication, focusing on how knowledge is claimed, contested and negotiated. In courtroom, police and political interaction, conversation analysis has identified communication practices implying implausibility in a person's story to contest and recharacterize their accounts. Aims To investigate communication practices in Emergency Department (ED) biopsychosocial assessments that may (1) undermine, imply implausibility and recharacterize or (2) accept peoples' experiences of suicidal ideation and self-harm. Methods Using conversation analysis, we micro-analyzed verbal and non-verbal communication in five video-recorded biopsychosocial assessments with people presenting to the ED with self-harm or suicidal ideation, and conducted supplementary analysis of participants' medical records and post-visit interviews. We present three cases where experiences were not accepted and undermined/recharacterized and two cases where experiences were accepted and validated. Results When peoples' experiences of suicidality and self-harm were not accepted or were undermined, questioners: did not acknowledge or accept the person's account; asked questions that implied inconsistency or implausibility ("Didn't you tell your GP that you were coping okay?"); juxtaposed contrasting information to undermine the person's account ("You said you were coping okay before, and now you're saying you feel suicidal"); asked questions asserting that, e.g., asking for help implied they were not intending to end their life ("So when you called 111 what were you expecting them to do"); and resistinged or directly questioned the person's account. Multiple practices across the assessment built on each other to assert that the person was not suicidal, did not look or act like they were suicidal; that the person's decision to attend the ED was not justified; that an overdose was impulsive and not intended to end life; asking why the person didn't take a more harmful medication to overdose; that self-harming behaviors were not that serious and should be in the person's control. Alternative characterizations were used to justify decisions not to provide further support or referrals to specialist services. At times, these practices were also delivered when speaking over the patient. When peoples' experiences were accepted, practitioners acknowledged, accepted, validated suicidality/self-harm and introduced a shared understanding of experiences that patients found helpful. Non-verbal feedback such as nodding and eye contact was central in acceptance of patients' accounts. Conclusion These findings advance our understanding of how peoples' experiences of suicidality or self-harm are undermined or accepted in mental health encounters in the ED. They have important clinical implications: patients report that when their experiences are not accepted or undermined, this makes them more distressed, less hopeful about the future and discourages future help-seeking when in crisis. Conversely, acknowledging, accepting and validating suicidality/self-harm and introducing a new ways of understanding peoples' experiences may make people less suicidal and more hopeful, generates shared understanding and encourages future help-seeking.
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Affiliation(s)
- Clara Bergen
- School of Health and Psychological Sciences, City, University of London, London, United Kingdom
| | - Lisa Bortolotti
- Department of Philosophy, University of Birmingham, Birmingham, United Kingdom
| | | | | | - Carmen Lee
- Department of Psychology, University of Exeter, Exeter, United Kingdom
| | - Michele Lim
- Department of Psychology, University College London, London, United Kingdom
| | - Rose McCabe
- School of Health and Psychological Sciences, City, University of London, London, United Kingdom
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Sheppard H, Bizumic B, Calear A. Prejudice toward people with borderline personality disorder: Application of the prejudice toward people with mental illness framework. Int J Soc Psychiatry 2023; 69:1213-1222. [PMID: 36794515 PMCID: PMC10338706 DOI: 10.1177/00207640231155056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND People living with borderline personality disorder (BPD) face high levels of prejudice and discrimination from both the community and medical professionals, but no measure of prejudice toward people living with BPD exists. AIMS The current study aimed to adapt an existing Prejudice toward People with Mental Illness (PPMI) scale and investigate the structure and nomological network of prejudice toward people with BPD. METHODS The original 28-item PPMI scale was adapted to create the Prejudice toward People with Borderline Personality Disorder (PPBPD) scale. The scale and related measures were completed by three samples: 217 medical or clinical psychology students, 303 psychology undergraduate students, and 314 adults from the general population. RESULTS The original four-factor structure of the PPMI was supported in the PPBPD scale. Reported prejudice toward people with BPD was more negative than prejudice toward people with mental illness in general. The association of the PPBPD scale with antecedents and consequences was assessed, including social dominance orientation, right-wing authoritarianism, ethnocentrism, personality traits, empathy, prior contact, and feelings toward other stigmatized groups and mental illnesses. CONCLUSIONS This study provided evidence for the validity and psychometric properties of the PPBPD scale across three samples and investigated anticipated relationships with theoretically related antecedents and consequences. This research will help improve understanding of the expressions underlying prejudice toward people with BPD.
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Affiliation(s)
- Hannah Sheppard
- Research School of Psychology, the Australian National University, Canberra, ACT, Australia
| | - Boris Bizumic
- Research School of Psychology, the Australian National University, Canberra, ACT, Australia
| | - Alison Calear
- Research School of Psychology, the Australian National University, Canberra, ACT, Australia
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15
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Sauer-Zavala S, Southward MW, Hood CO, Elhusseini S, Fruhbauerova M, Stumpp NE, Semcho SA. Conceptual development and case data for a modular, personality-based treatment for borderline personality disorder. Personal Disord 2023; 14:369-380. [PMID: 35084872 PMCID: PMC9748867 DOI: 10.1037/per0000520] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Borderline personality disorder (BPD) is a heterogenous condition, and variations in its presentation may be accounted for by individual differences in personality dimensions. Extant treatments for BPD are long term and intensive; it is possible that prioritizing the personality-based difficulties that underlie an individual's symptoms may improve the efficiency of care. This article describes the conceptual background for the development of a novel, personality-based intervention for BPD (BPD Compass), which was informed by recent research on personality mechanisms maintainin this condition, and was designed to address gaps left by existing treatments and to be maximally efficient and disseminable. BPD Compass is a comprehensive, short-term package with a fully modular design that allows for personalization (e.g., all skills can be presented in isolation or in any order based on pretreatment assessment). We discuss the theoretical background for its development, an overview of the skills included in the treatment, as well as preliminary efficacy data. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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16
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McIntosh JT. Emergency department nurses' perceptions of caring behaviors toward individuals with mental illness: A secondary analysis. Int Emerg Nurs 2023; 68:101271. [PMID: 37003054 DOI: 10.1016/j.ienj.2023.101271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 01/20/2023] [Accepted: 02/01/2023] [Indexed: 04/03/2023]
Abstract
AIM The aim of this study was to determine emergency department (ED) nurses' caring behaviors toward individuals with mental illness; and the influence of stigma on their caring behaviors. METHOD This is a secondary analysis of a cross-sectional study with (n = 813) ED nurses working in the United States from March 2021 to April 2021. The Caring Behaviors Inventory-24 item (CBI-24) and the Mental Illness: Clinicians' Attitudes Scale-4 (MICA v4) were used to collect data. RESULTS The mean CBI-24 score was 4.6 (SD = 0.8).The MICA v4 had an overall sum of 53.4 (SD = 9.2). Caring behaviors and stigma were found to have significant weak inverse relationship (r = - 0.23, p <.001). Age and level of education had a significant inverse relationship with caring behaviors (r = - 0.12; r = -. 19, p <.01 respectively). CONCLUSION The results of this study may contribute to the quality, equity, and safety of the emergency nursing care of individuals with mental illness, thereby improving health outcomes. It is recommended that the diversity of nurses and the characteristics of the ED be taken into consideration when designing trainings, providing leadership support, and managing resources to support the care of individuals with mental illness.
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Affiliation(s)
- Jennifer T McIntosh
- Adelphi University, College of Nursing and Public Health, One South Street, Garden City, NY 11530, USA; Yale University School of Nursing, 400 West Campus Drive, Orange, CT 06477, USA.
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17
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Masland SR, Victor SE, Peters JR, Fitzpatrick S, Dixon-Gordon KL, Bettis AH, Navarre KM, Rizvi SL. Destigmatizing Borderline Personality Disorder: A Call to Action for Psychological Science. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2023; 18:445-460. [PMID: 36054911 DOI: 10.1177/17456916221100464] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite recognition that borderline personality disorder (BPD) is one of the most stigmatized psychological disorders, destigmatization efforts have thus far focused on the views and actions of clinicians and the general public, neglecting the critical role that psychological science plays in perpetuating or mitigating stigma. This article was catalyzed by recent concerns about how research and editorial processes propagate stigma and thereby fail people with BPD and the scientists who study BPD. We provide a brief overview of the BPD diagnosis and its history. We then review how BPD has been stigmatized in psychological science, the gendered nature of BPD stigma, and the consequences of this stigmatization. Finally, we offer specific recommendations for researchers, reviewers, and editors who wish to use science to advance our understanding of BPD without perpetuating pejorative views of the disorder. These recommendations constitute a call to action to use psychological science in the service of the public good.
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Affiliation(s)
| | - Sarah E Victor
- Department of Psychological Sciences, Texas Tech University
| | - Jessica R Peters
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | | | | | - Alexandra H Bettis
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center
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18
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Cavelti M, Sharp C, Chanen AM, Kaess M. Commentary: Commentary on the Twitter comments evoked by the May 2022 debate on diagnosing personality disorders in adolescents. Child Adolesc Ment Health 2023; 28:186-191. [PMID: 36478638 DOI: 10.1111/camh.12618] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 12/12/2022]
Abstract
The debate about the value and utility of personality disorder (PD) diagnosis in adolescence published in the May 2022 issue of CAMH generated fervent Twitter discussion. This commentary addresses some points raised in the Twitter discussion that represent important social and/or cultural beliefs that are often presented in day-to-day practice but are rarely tested in the context of scientific evidence. This includes, in particular, the assertion that symptoms used to diagnose personality disorder are better described as sequelae of trauma, and the assertion that effective treatment for PD is possible without a diagnosis. The call for a fundamental transformation of mental health services that currently do not meet the needs of people with PD and for the involvement of people with lived experience as equal partner in this process is supported by evidence and might represent common ground among those clinician-scientist advocating for early intervention for PD and those expressing their concerns about this issue.
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Affiliation(s)
- Marialuisa Cavelti
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Andrew M Chanen
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
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19
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Qian X, Townsend ML, Tan WJ, Grenyer BFS. Sex differences in borderline personality disorder: A scoping review. PLoS One 2022; 17:e0279015. [PMID: 36584029 PMCID: PMC9803119 DOI: 10.1371/journal.pone.0279015] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 11/28/2022] [Indexed: 12/31/2022] Open
Abstract
Borderline Personality Disorder (BPD) is often perceived to be a female-predominant disorder in both research and clinical contexts. Although there is growing recognition of possible sex differences, the current literature remains fragmented and inconclusive. This scoping review aimed to synthesize available research evidence on potential sex differences in BPD. PsycINFO, PubMed, Scopus and Web-of-Science were searched from January 1982 to July 2022 surrounding the key concepts of sex and BPD. Data searching and screening processes followed the Joanna Briggs Institute methodology involving two independent reviewers, and a third reviewer if necessary, and identified 118 papers. Data regarding BPD symptoms, comorbid disorders, developmental factors, biological markers, and treatment were extracted. Data was summarized using the vote counting method or narrative synthesis depending on the availability of literature. Males with BPD were more likely to present externalizing symptoms (e.g., aggressiveness) and comorbid disorders (e.g., substance use), while females with BPD were more likely to present internalizing symptoms (e.g., affective instability) and comorbid disorders (e.g., mood and eating disorders). This review also revealed that substantially more research attention has been given to overall sex differences in baseline BPD symptoms and comorbid disorders. In contrast, there is a dearth of sex-related research pertaining to treatment outcomes, developmental factors, and possible biological markers of BPD. The present scoping review synthesized current studies on sex differences in BPD, with males more likely to present with externalizing symptoms in contrast to females. However, how this might change the prognosis of the disorder or lead to modifications of treatment has not been investigated. Most studies were conducted on western populations, mainly North American (55%) or European (33%), and there is a need for future research to also take into consideration genetic, cultural, and environmental concomitants. As the biological construct of 'sex' was employed in the present review, future research could also investigate the social construct 'gender'. Longitudinal research designs are needed to understand any longer-term sex influence on the course of the disorder.
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Affiliation(s)
- Xinyu Qian
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Michelle L. Townsend
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Wan Jie Tan
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Brin F. S. Grenyer
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
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20
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Sims E, Nelson KJ, Sisti D. Borderline personality disorder, therapeutic privilege, integrated care: is it ethical to withhold a psychiatric diagnosis? JOURNAL OF MEDICAL ETHICS 2022; 48:801-804. [PMID: 34261801 DOI: 10.1136/medethics-2021-107216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/22/2021] [Indexed: 06/13/2023]
Abstract
Once common, therapeutic privilege-the practice whereby a physician withholds diagnostic or prognostic information from a patient intending to protect the patient-is now generally seen as unethical. However, instances of therapeutic privilege are common in some areas of clinical psychiatry. We describe therapeutic privilege in the context of borderline personality disorder, discuss the implications of diagnostic non-disclosure on integrated care and offer recommendations to promote diagnostic disclosure for this patient population.
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Affiliation(s)
- Erika Sims
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Katharine J Nelson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - Dominic Sisti
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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21
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Broadbear JH, Rotella J, Lorenze D, Rao S. Emergency department utilisation by patients with a diagnosis of borderline personality disorder: An acute response to a chronic disorder. Emerg Med Australas 2022; 34:731-737. [PMID: 35352872 PMCID: PMC9790754 DOI: 10.1111/1742-6723.13970] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/03/2022] [Accepted: 03/07/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Patients with borderline personality disorder (BPD) are likely to attend the ED while experiencing crises and associated self-injury and suicidality. Our study describes the prevalence, features, and outcomes associated with ED presentations by patients diagnosed with BPD in Outer Eastern Melbourne, Australia. METHODS A retrospective electronic audit of 157 364 ED attendances identified 700 unique BPD-related ED presentations between May 2015 and April 2016. For the purpose of comparison, 583 (81% female) of these 700 cases were matched with 'depression only' cases. ED re-presentation data were also extracted. RESULTS The 583 matched BPD patients attended ED a total of 2807 times during the audit year compared with 1092 attendances for matched depression-only patients. BPD patients were more likely to: arrive by ambulance (50%); have comorbid substance abuse (44%); have a psychotic (15%) or bipolar disorder (17%); be under the care of a psychiatrist (31%); be case-managed (42%); and be admitted to an inpatient unit (21%). ED doctors saw 38% of BPD or depression patients within the recommended time according to their triage category. The majority (73%) of BPD patients attended ED more than once during the audit year (average 4.81 ± 6.63 times; range 2-78). CONCLUSION Repeated ED attendance of a subset of patients diagnosed with BPD highlights both the severity of their presentation and the inadequacy of community mental health services for meeting their complex needs. Development of effective ED referral pathways with follow-up to engage patients in BPD-appropriate treatment will reduce the likelihood of crises and reliance on hospital EDs for acute episodic care.
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Affiliation(s)
- Jillian H Broadbear
- Spectrum Personality Disorder ServiceMelbourneVictoriaAustralia,Faculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneVictoriaAustralia
| | | | - Donna Lorenze
- School of Nursing, Midwifery and Social SciencesCentral Queensland UniversityMackayQueenslandAustralia
| | - Sathya Rao
- Spectrum Personality Disorder ServiceMelbourneVictoriaAustralia,Faculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneVictoriaAustralia
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22
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Larcombe E, Müller A. The relationship between borderline personality disorder and occupational participation: An integrative review. Int J Ment Health Nurs 2022; 31:1141-1150. [PMID: 35536729 DOI: 10.1111/inm.13014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 11/29/2022]
Abstract
This integrative review explores the impact of borderline personality disorder (BPD) symptomology and behaviours on occupational capacity, participation, and sustainability. The disorder has also been associated with lower education levels, higher levels of attrition in tertiary education populations, and low occupational participation and employment rates. Personality traits and symptomology have been found to substantially detract from employability. Articles were identified from CINAHL (Cumulative Index to Nursing and Allied Health Literature), PsycINFO/Ovid, ProQuest, and PubMed databases. The Joanna Briggs' Institute (JBI) critical appraisal tools were used to evaluate the quality of evidence, and inductive thematic analysis used to extract main themes. Four themes regarding 'barriers', 'enablers', 'treatment', and 'benefits' emerged amongst the 11 eligible articles. The negative symptomology was a barrier to occupational participation, and people with BPD engaged in self-stigmatizing and non-disclosure. However, the positive symptomology such as boldness and honesty were enablers. Treatment was found to be a key element, and occupational engagement was also found to have positive effectives. The evidence indicates that employment improved the symptoms, and a long-term treatment plan is a key element. Some upskilling of mental health workers may be required, including a focus on possible positive symptomology as a way of dealing with the stigmatization. Some awareness raising of the disorder, including for employers, may be needed, with education programmes that deal with the stigmatization. Future funding should focus on specialized programmes targeting unemployment for this group.
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Affiliation(s)
- Enara Larcombe
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Amanda Müller
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
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23
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Klein P, Fairweather AK, Lawn S. Structural stigma and its impact on healthcare for borderline personality disorder: a scoping review. Int J Ment Health Syst 2022; 16:48. [PMID: 36175958 PMCID: PMC9520817 DOI: 10.1186/s13033-022-00558-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/05/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND People with Borderline Personality Disorder (BPD) and their carers/families continue to experience structural stigma when accessing health services. Structural stigma involves societal-level conditions, cultural norms, and organizational policies that inhibit the opportunities, resources, and wellbeing of people living with attributes that are the object of stigma. BPD is a serious mental illness characterized by pervasive psychosocial dysfunction including, problems regulating emotions and suicidality. This scoping review aimed to identify, map, and explore the international literature on structural stigma associated with BPD and its impact on healthcare for consumers with BPD, their carers/families, and health practitioners. METHODS A comprehensive search of the literature encompassed MEDLINE, CINAHL, PsycINFO, Scopus, Cochrane Library, and JBI Evidence-Based databases (from inception to February 28th 2022). The search strategy also included grey literature searches and handsearching the references of included studies. Eligibility criteria included citations relevant to structural stigma associated with BPD and health and crisis care services. Quality appraisal of included citations were completed using the Mixed Methods Appraisal Tool 2018 version (MMAT v.18), the Joanna Briggs Institute (JBI) Checklist for Systematic Reviews and Research Syntheses Tool, and the AGREE II: advancing guideline development, reporting, and evaluation in health care tool. Thematic Analysis was used to inform data extraction, analysis, interpretation, and synthesis of the data. RESULTS A total of 57 citations were included in the review comprising empirical peer-reviewed articles (n = 55), and reports (n = 2). Studies included quantitative, qualitative, mixed methods, and systematic review designs. Review findings identified several extant macro- and micro-level structural mechanisms, challenges, and barriers contributing to BPD-related stigma in health systems. These structural factors have a substantial impact on health service access and care for BPD. Key themes that emerged from the data comprised: structural stigma and the BPD diagnosis and BPD-related stigma surrounding health and crisis care services. CONCLUSION Narrative synthesis of the findings provide evidence about the impact of structural stigma on healthcare for BPD. It is anticipated that results of this review will inform future research, policy, and practice to address BPD-related stigma in health systems, as well as approaches for improving the delivery of responsive health services and care for consumers with BPD and their carers/families. REVIEW REGISTRATION Open Science Framework ( https://osf.io/bhpg4 ).
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Affiliation(s)
- Pauline Klein
- Discipline of Population Health, College of Medicine and Public Health, Flinders University, Adelaide, SA 5001 Australia
| | - A. Kate Fairweather
- Discipline of Population Health, College of Medicine and Public Health, Flinders University, Adelaide, SA 5001 Australia
| | - Sharon Lawn
- Discipline of Behavioural Health, College of Medicine and Public Health, Flinders University, Adelaide, SA 5001 Australia
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Acres K, Loughhead M, Procter N. From the community to the emergency department: A study of hospital emergency department nursing practices from the perspective of carers of a loved one with Borderline Personality Disorder. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1789-1797. [PMID: 34469029 DOI: 10.1111/hsc.13558] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/20/2021] [Accepted: 08/09/2021] [Indexed: 06/13/2023]
Abstract
Carers of loved ones with Borderline Personality Disorder (BPD) often present to Emergency Departments (ED) during acute crisis situations. The initial contact for the carer and consumer in distress is often an emergency nurse. By gaining a greater understanding of carers (18+) perspectives on ED nursing practices when consumers with BPD are requiring crisis support, knowledge about preferred and best practice can be gained. To obtain this knowledge, four semi-structured focus group interviews were undertaken with a purposive sample of 13 carers through existing carer networks. Transcripts were analysed thematically to identify shared experiences and perspectives across interviews. Four key themes emerged: challenges in accessing crisis support, the need for communication, stigmatising practices, and different levels of care. Findings highlight the ED is viewed as a frontline service which has the capacity to link with another specialist supports when in crisis. Despite this; Communication, confidentiality issues and stigmatising practices continue. The results of this study have implications for nursing practice in the ED, providing important insights that can potentially benefit the carer, consumer and the ED to improve the quality of care offered for people in crisis.
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Affiliation(s)
- Kristy Acres
- Mental Health and Suicide Prevention Research and Education Group, University of South Australia, , Clinical and Health Sciences, Adelaide, Australia
| | - Mark Loughhead
- Mental Health and Suicide Prevention Research and Education Group, University of South Australia, , Clinical and Health Sciences, Adelaide, Australia
| | - Nicholas Procter
- Mental Health and Suicide Prevention Research and Education Group, University of South Australia, , Clinical and Health Sciences, Adelaide, Australia
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25
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Klein P, Fairweather AK, Lawn S. The impact of educational interventions on modifying health practitioners' attitudes and practice in treating people with borderline personality disorder: an integrative review. Syst Rev 2022; 11:108. [PMID: 35637499 PMCID: PMC9150362 DOI: 10.1186/s13643-022-01960-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 04/11/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The rising prevalence of Borderline Personality Disorder (BPD) and suicidality represents substantial health burden worldwide. People with BPD experience high rates of crisis presentations and stigma when accessing health services. Educational interventions designed to modify health practitioners' attitudes and practice in treating people with BPD may assist in addressing this stigma. The current review aimed to identify and explore existing educational interventions designed to modify health practitioners' attitudes and practice in BPD; and determine what impact educational interventions have on improving health practitioners' responses towards people with BPD. METHODS A comprehensive search of the literature was undertaken in MEDLINE, CINAHL, PsycINFO, Scopus, Cochrane Library, and JBI Evidence-Based databases (from inception to February 2022). Secondary sources of literature included grey literature searches and handsearching the references of included studies as part of the comprehensive search strategy. The eligibility criteria included peer-reviewed empirical studies examining BPD-related educational interventions aimed at modifying health practitioners' attitudes and practice in treating people with BPD. Quality appraisal of the included studies were completed using the Mixed Methods Appraisal Tool 2018 version (MMAT v.18) or the Joanna Briggs Institute (JBI) Checklist for Systematic Reviews and Research Syntheses Tool. Thematic Analysis informed data extraction, analysis, interpretation, and narrative synthesis of the data. RESULTS A total of nine papers containing 991 participants across a diverse range of studies including, quantitative, qualitative, mixed methods, and a systematic review were included in this integrative review. Several BPD-related educational interventions designed to modify health practitioners' attitudes and practice in BPD exist. Findings suggest that training health practitioners in BPD-related educational interventions can enhance positive attitudes and change practice towards people with BPD; however, more high-quality studies are needed to confirm these conclusions. CONCLUSIONS This review collated and summarized findings from studies examining the impact of BPD-related educational interventions on changing health practitioners' attitudes and practice in treating this population. Results from this review may help inform future research, policy, and practice in stigma-reduction strategies which would improve the delivery of responsive health services and care for people with BPD. SYSTEMATIC REVIEW REGISTRATION Open Science Framework ( https://osf.io/7p6ez/ ).
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Affiliation(s)
- Pauline Klein
- Discipline of Public Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, 5001, Australia.
| | - A Kate Fairweather
- Discipline of Public Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, 5001, Australia
| | - Sharon Lawn
- Discipline of Behavioural Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, 5001, Australia
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Romeu-Labayen M, Tort-Nasarre G, Rigol Cuadra MA, Giralt Palou R, Galbany-Estragués P. The attitudes of mental health nurses that support a positive therapeutic relationship: The perspective of people diagnosed with BPD. J Psychiatr Ment Health Nurs 2022; 29:317-326. [PMID: 33938079 DOI: 10.1111/jpm.12766] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 03/19/2021] [Accepted: 04/23/2021] [Indexed: 01/29/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Some nurses develop positive relationships with people diagnosed with borderline personality disorder (BPD), while others have negative emotional reactions to people diagnosed with this disorder. The therapeutic relationship is key in the practice of mental health nursing. Enhanced knowledge of BPD allows mental health nurses to develop improved self-awareness, knowledge and understanding of the individuals and insight into the therapeutic challenges, which can improve attitudes towards people with this diagnosis. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: We are lacking knowledge about the perspective of people diagnosed with BPD on the attitudes of mental health nurses that facilitate a positive therapeutic relationship. The perspective of people with a BPD diagnosis on the therapeutic relationship offers key information about the attitudes that they credit with supporting their recovery. The participants-people diagnosed with BPD-perceived that the following attitudes of mental health nurses reinforced the therapeutic relationship: confidence in the person's recovery, non-judgement, sense of humour, availability and humanity. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The study highlights mental health nurses' attitudes that participants perceived as having a positive effect on the therapeutic relationship. The recognition among people diagnosed with BPD of the constructive attitudes of mental health nurses may improve nurses' motivation to improve care for these patients. This study will allow mental health nurses to increase their awareness of the importance of attitude in the therapeutic relationship with people diagnosed with BPD. ABSTRACT: Introduction The therapeutic relationship between mental health nurses and people diagnosed with borderline personality disorder (BPD) is essential to successful treatment, and nurses' attitudes are a key component of this relationship. Some nurses develop positive therapeutic relationships with people diagnosed with BPD, while others have negative emotional reactions which in turn limit their ability to develop a positive therapeutic relationship. There is a gap in the literature with respect to how people diagnosed with BPD perceive the attitudes of mental health nurses that foster a positive therapeutic relationship. Aim To describe how people diagnosed with BPD who have experienced an improvement perceive the role of the attitudes of mental health nurses in building a positive therapeutic relationship. Method Qualitative descriptive design with 12 interviews; thematic content analysis. Results Participants identified five attitudes of mental health nurses as contributing to a positive therapeutic relationship: confidence in their ability to recover, non-judgement, humour, availability and humanity. Discussion Nurses' attitudes are key to the therapeutic relationship. It may be possible for nurses to improve their attitudes towards patients diagnosed with BPD through self-reflection. Implications for practice Mental health nurses should incorporate methods that explore attitudes and attitudinal development of the workforce.
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Affiliation(s)
- Maria Romeu-Labayen
- Adult Mental Health Center Horta Guinardó, Barcelona, Spain.,Department of Public Health, Mental Health and Mother-Infant Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, L'Hospitalet del Llobregat, Spain.,AFIN Research Group, Autonomus University of Barcelona, Bellaterra, Spain
| | - Glòria Tort-Nasarre
- GREpS. Health Education Research Group, University of Lleida, Lleida, Spain.,Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
| | - M Assumpta Rigol Cuadra
- Department of Public Health, Mental Health and Mother-Infant Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, L'Hospitalet del Llobregat, Spain.,AFIN Research Group, Autonomus University of Barcelona, Bellaterra, Spain
| | - Rosa Giralt Palou
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Division of Mental Health, CNS, MSN, Althaia Foundation, Manresa, Spain
| | - Paola Galbany-Estragués
- AFIN Research Group, Autonomus University of Barcelona, Bellaterra, Spain.,Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain
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DeLeo K, Maconick L, McCabe R, Broeckelmann E, Sheridan Rains L, Rowe S, Johnson S. Experiences of crisis care among service users with complex emotional needs or a diagnosis of 'personality disorder', and other stakeholders: systematic review and meta-synthesis of the qualitative literature. BJPsych Open 2022; 8:e53. [PMID: 35197131 PMCID: PMC8935933 DOI: 10.1192/bjo.2022.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 11/18/2021] [Accepted: 12/20/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Mental health crises are common in people with complex emotional needs (our preferred working term for people diagnosed with a 'personality disorder'), yet this population is often dissatisfied with the crisis care they receive. Exploring their experiences and views on what could be improved, and those of carers and healthcare staff, is key to developing better services. AIMS We aimed to synthesise the relevant qualitative literature. METHOD Five databases were searched. Eligible studies included service users with a diagnosis of personality disorder and their carers or relevant staff, focused on crisis responses and used a qualitative design. Data were analysed with thematic synthesis. RESULTS Eleven studies were included, most focusing on emergency departments. Four meta-themes emerged: (a) acceptance and rejection when presenting to crisis care: limited options and lack of involvement of carers; (b) interpersonal processes: importance of the therapeutic relationship and establishing a framework for treatment; (c) managing recovery from a crisis: clear recovery plan and negotiating collaboration; and (d) equipping and supporting staff: training and emotional support. CONCLUSIONS Our findings suggest that emergency departments have major limitations as settings to provide crisis care for people with complex emotional needs, but there is a lack of research exploring alternatives. The quality of the therapeutic relationship was central to how care was experienced, with collaborative and optimistic staff highly valued. Staff reported feeling poorly supported in responding to the needs of this population. Research looking at experiences of a range of care options and how to improve these is needed.
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Affiliation(s)
| | - Lucy Maconick
- Division of Psychiatry, University College London, UK; and Camden and Islington NHS Foundation Trust, UK
| | - Rose McCabe
- School of Health Sciences, City University of London, UK
| | - Eva Broeckelmann
- Health Service and Population Research Department, NIHR Mental Health Policy Research Unit Complex Emotional Needs Lived Experience Working Group, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | | | - Sarah Rowe
- Division of Psychiatry, University College London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, UK; and Camden and Islington NHS Foundation Trust, UK
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Sekharan L, Jagadheesan K, Das P, Lakra V, West K, Baldwin M. Short-term and 1-year outcome of patients' with borderline personality admitted to a short-term recovery-oriented residential service. Australas Psychiatry 2021; 29:581-585. [PMID: 33026842 DOI: 10.1177/1039856220961646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Given the paucity of literature, this study investigated whether a prevention and recovery care (PARC) service supported recovery in patients with borderline personality disorder (BPD). METHOD This retrospective study included patients with BPD who had their first (index) admission to North West PARC between 2011 and 2016. Patient medical records and the state-wide database were the sources of information. RESULTS Of the 67 patients included, over 70% attended group activities. All patients achieved their recovery goals, either fully or partially. Compared to admission, the frequency of substance use and the Health of the Nation Outcome Scale (HoNOS) scores at discharge were significantly less. A significantly smaller number of patients needed inpatient treatment during the 12 months following their PARC admission. CONCLUSION The PARC service appears to promote clinical and psychosocial recovery in patients with BPD.
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Affiliation(s)
| | | | - Partha Das
- North West Area Mental Health Service, Melbourne, Australia.,The University of Melbourne, Melbourne, Australia
| | - Vinay Lakra
- North West Area Mental Health Service, Melbourne, Australia
| | - Kim West
- North West Area Mental Health Service, Melbourne, Australia
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29
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Kavanagh BE, Gwini SM, Pasco JA, Stuart AL, Quirk SE, Gaston J, Holloway-Kew KL, Turner A, Berk M, Dean OM, Chanen AM, Koivumaa-Honkanen H, Moran P, Borschmann R, Williams LJ. The Added Burden of Personality Disorder on Subsidized Australian Health Service Utilization Among Women With Mental State Disorder. Front Glob Womens Health 2021; 2:615057. [PMID: 34816186 PMCID: PMC8593946 DOI: 10.3389/fgwh.2021.615057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/23/2021] [Indexed: 11/25/2022] Open
Abstract
This study aimed to investigate health service utilization among women with mental state disorder only (MSD-PD), mental state disorder plus personality disorder (MSD+PD), and controls in a population-based sample. Women (n = 635) from the Geelong Osteoporosis Study completed mental health assessments and were categorized into groups (MSD-PD, MSD+PD, controls). General practitioner (mental and non-mental health encounters) and specialized mental health service utilization was ascertained from data linkage to the Medicare Benefits Schedule, Australia (01/09/2008-31/12/2012). Negative binomial and binary logistic regression models were employed to assess health service utilization differences between groups. Results indicated that women with MSD+PD had more encounters of non-mental health service utilization than women with MSD-PD and controls. Age significantly modified these relationships: women with MSD+PD and MSD-PD had more encounters of health service utilization at midlife and in the seventh decade of life. No significant differences were found in the frequency of general practitioner mental health service utilization or specialized mental health service utilization between groups. These data suggest that the presence of co-occurring PD is associated with increased health service utilization among women with other common mental health problems. Healthcare providers should be vigilant to the presence of PD when establishing management plans with patients presenting with common mental health problems.
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Affiliation(s)
- Bianca E Kavanagh
- School of Medicine, Institute for Physical and Mental Health and Clinical Translation, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Stella M Gwini
- School of Medicine, Institute for Physical and Mental Health and Clinical Translation, Barwon Health, Deakin University, Geelong, VIC, Australia.,University Hospital Geelong, Barwon Health, Geelong, VIC, Australia
| | - Julie A Pasco
- School of Medicine, Institute for Physical and Mental Health and Clinical Translation, Barwon Health, Deakin University, Geelong, VIC, Australia.,University Hospital Geelong, Barwon Health, Geelong, VIC, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Department of Medicine-Western Health, University of Melbourne, St. Albans, VIC, Australia
| | - Amanda L Stuart
- School of Medicine, Institute for Physical and Mental Health and Clinical Translation, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Shae E Quirk
- School of Medicine, Institute for Physical and Mental Health and Clinical Translation, Barwon Health, Deakin University, Geelong, VIC, Australia.,Institute of Clinical Medicine/Psychiatry, University of Eastern Finland, Kuopio, Finland.,Institute of Clinical Medicine, Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio, Finland
| | - James Gaston
- School of Medicine, Institute for Physical and Mental Health and Clinical Translation, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Kara L Holloway-Kew
- School of Medicine, Institute for Physical and Mental Health and Clinical Translation, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Alyna Turner
- School of Medicine, Institute for Physical and Mental Health and Clinical Translation, Barwon Health, Deakin University, Geelong, VIC, Australia.,Faculty of Health and Medicine, School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
| | - Michael Berk
- School of Medicine, Institute for Physical and Mental Health and Clinical Translation, Barwon Health, Deakin University, Geelong, VIC, Australia.,Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia.,Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia.,Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Olivia M Dean
- School of Medicine, Institute for Physical and Mental Health and Clinical Translation, Barwon Health, Deakin University, Geelong, VIC, Australia.,University Hospital Geelong, Barwon Health, Geelong, VIC, Australia.,Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Andrew M Chanen
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Heli Koivumaa-Honkanen
- Institute of Clinical Medicine/Psychiatry, University of Eastern Finland, Kuopio, Finland.,Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland
| | - Paul Moran
- Population Health Sciences Department, Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Rohan Borschmann
- Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom.,Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Lana J Williams
- School of Medicine, Institute for Physical and Mental Health and Clinical Translation, Barwon Health, Deakin University, Geelong, VIC, Australia
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Zifkin C, Montreuil M, Beauséjour MÈ, Picard S, Gendron-Cloutier L, Carnevale FA. An exploration of youth and parents' experiences of child mental health service access. Arch Psychiatr Nurs 2021; 35:549-555. [PMID: 34561072 DOI: 10.1016/j.apnu.2021.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/12/2021] [Accepted: 06/12/2021] [Indexed: 11/28/2022]
Abstract
Youth experience an increased prevalence of mental health issues, while access to timely and quality services remains problematic. This study examined the experiences of adolescents and their parents surrounding mental health care access. A 4-month focused ethnography was conducted at a mental health clinic for adolescents experiencing difficulties with emotional regulation. Findings revealed major barriers to service access, including a lack of knowledge, information, and guidance, long wait times, and stigma. Facilitators to access included social support, having a contact person, and good rapport with healthcare providers. The study highlights the importance of timely mental health service access for adolescents and provides insights for the improvement of service accessibility.
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Affiliation(s)
- Cleo Zifkin
- Ingram School of Nursing, McGill University, 680, rue Sherbrooke Ouest, Montreal, Quebec H3A 2M7, Canada
| | - Marjorie Montreuil
- Ingram School of Nursing, McGill University, 680, rue Sherbrooke Ouest, Montreal, Quebec H3A 2M7, Canada; Douglas Hospital Research Centre, 6875 boul. LaSalle, Verdun, Québec H4H 1R3, Canada.
| | - Marie-Ève Beauséjour
- Douglas Mental Health University Institute, 6875 boul. LaSalle, Verdun, Québec H4H 1R3, Canada
| | - Stéphane Picard
- Douglas Mental Health University Institute, 6875 boul. LaSalle, Verdun, Québec H4H 1R3, Canada
| | - Lauranne Gendron-Cloutier
- Ingram School of Nursing, McGill University, 680, rue Sherbrooke Ouest, Montreal, Quebec H3A 2M7, Canada
| | - Franco A Carnevale
- Ingram School of Nursing, McGill University, 680, rue Sherbrooke Ouest, Montreal, Quebec H3A 2M7, Canada; Douglas Mental Health University Institute, 6875 boul. LaSalle, Verdun, Québec H4H 1R3, Canada; Department of Pediatrics, McGill University, Montreal, Quebec, Canada; Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada; Counselling Psychology, McGill University, Montreal, Quebec, Canada
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31
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Woo J, Shahid H, Hillmer A, Abdullah A, Deshpande S, Panesar B, Sanger N, Samaan Z. Factors affecting participant recruitment and retention in borderline personality disorder research: a feasibility study. Pilot Feasibility Stud 2021; 7:178. [PMID: 34544490 PMCID: PMC8450701 DOI: 10.1186/s40814-021-00915-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 09/07/2021] [Indexed: 12/03/2022] Open
Abstract
Background Previous studies have shown that stigma is a major barrier to participation in psychiatric research and that individuals who participate in psychiatric research may differ clinically and demographically from non-participants. However, few studies have explored research recruitment and retention challenges in the context of personality disorders. Aim To provide an analysis of the factors affecting participant recruitment and retention in a study of borderline personality disorder among general psychiatric inpatients. Methods Adult inpatients in a tertiary psychiatric hospital were approached about participating in a cross-sectional study of borderline personality disorder. Recruitment rates, retention rates, and reasons for declining participation or withdrawing from the study were collected. Demographic characteristics were compared between participants and non-participants and between patients who remained in the study and those who withdrew. Results A total of 71 participants were recruited into the study between January 2018 and March 2020. Recruitment and retention rates were 45% and 70%, respectively. Lack of interest was the most commonly cited reason for non-participation, followed by scheduling conflicts and concerns regarding mental/physical well-being. Age and sex were not predictors of study participation or retention. Conclusions More research is needed to explore patients’ perspectives and attitudes towards borderline personality disorder diagnosis and research, determine effects of different recruitment strategies, and identify clinical predictors of recruitment and retention in personality disorder research.
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Affiliation(s)
- Julia Woo
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, Canada
| | - Hamnah Shahid
- Department of Psychology, Brock University, St. Catharines, ON, Canada
| | - Alannah Hillmer
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, Canada.,Dapartment of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON, Canada
| | - Alamna Abdullah
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Sarah Deshpande
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Balpreet Panesar
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, Canada.,Dapartment of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON, Canada
| | - Nitika Sanger
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, Canada.,Medical Sciences Graduate Program, McMaster University, Hamilton, ON, Canada
| | - Zena Samaan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, Canada.
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Pickard JA, Finch A, Huxley E, Townsend ML, Deuchar S, Lewis KL, Pratt J, Grenyer BFS. Assessing the efficacy of a stepped-care group treatment programme for borderline personality disorder: study protocol for a pragmatic trial. Trials 2021; 22:383. [PMID: 34099033 PMCID: PMC8183092 DOI: 10.1186/s13063-021-05327-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 05/17/2021] [Indexed: 11/12/2022] Open
Abstract
Background Borderline personality disorder (BPD) is a high prevalence and serious mental health disorder that has historically challenged the finite resources of health services. Despite empirical evidence supporting structured psychological therapy as the first line of treatment, there remains significant barriers in providing timely access to evidence-based treatment for this population. The primary aim of this study is to evaluate the effectiveness of providing a stepped-care structured psychological group treatment to individuals with BPD within local mental health services. The secondary aims of the study are to identify the variables that predict the need to step up or down in care and the effectiveness of treatment on psychosocial functioning. Methods Participants seeking treatment at two community mental health services will be invited to participate. Randomised controlled trial assignment will be to either (i) group skills treatment or (ii) treatment as usual. Group treatment will be offered via a stepped-care pathway with participants initially attending a 12-week group with the option of a subsequent 16-week group. The criteria for inclusion in continuing treatment includes meeting > 4 BPD diagnostic criteria or severity on GAF (< 65) at the completion of the 12-week group. Data will be collected at baseline and at five follow-up time points over a 12-month period. Discussion This pragmatic trial will provide valuable information regarding the effectiveness of a progressive stepped-care group treatment for individuals with BPD in the real-world setting of a community mental health service. It will further the current understanding of variables that predict treatment dose and duration. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12618000477224. Registered on 3 April 2018
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Affiliation(s)
- Judy A Pickard
- School of Psychology, University of Wollongong, Wollongong, Australia.
| | - Adam Finch
- Illawarra Shoalhaven Local Health District, Wollongong, Australia
| | - Elizabeth Huxley
- School of Psychology, University of Wollongong, Wollongong, Australia
| | | | | | - Kate L Lewis
- School of Psychology, University of Wollongong, Wollongong, Australia
| | - Jason Pratt
- Illawarra Shoalhaven Local Health District, Wollongong, Australia
| | - Brin F S Grenyer
- School of Psychology, University of Wollongong, Wollongong, Australia
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Warrender D, Bain H, Murray I, Kennedy C. Perspectives of crisis intervention for people diagnosed with "borderline personality disorder": An integrative review. J Psychiatr Ment Health Nurs 2021; 28:208-236. [PMID: 32367638 DOI: 10.1111/jpm.12637] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/30/2020] [Accepted: 04/02/2020] [Indexed: 12/22/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: People diagnosed with "BPD" often experience crisis and use services "BPD" is a controversial diagnosis, and the experience of crisis and crisis intervention is not well understood WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: People diagnosed with "BPD" have different experiences of crisis, and using the diagnosis alone as a basis for deciding care and treatment is not appropriate There are many human factors which can influence how professionals deliver care to people diagnosed with "BPD" WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The education of staff, views on responsibility, team conflicts and access to clinical supervision can have an impact on how care is delivered, and should be addressed by organizations providing crisis care. Access to care often occurs when a person is self-harming or suicidal, but does not address underlying distress. Crisis care should go beyond managing behaviour and address any underlying needs. ABSTRACT: Introduction "Borderline personality disorder" ("BPD") is associated with frequent use of crisis intervention services. However, no robust evidence base supports specific interventions, and people's experiences are not well understood. Aim To explore the experiences of stakeholders involved in the crisis care of people diagnosed with "BPD." Method Integrative review with nine databases searched January 2000 to November 2017. The search filtered 3,169 titles and abstracts with 46 full-text articles appraised and included. Results Four themes were constructed from thematic analysis: crisis as a recurrent multidimensional cycle, variations and dynamics impacting on crisis intervention, impact of interpersonal dynamics and communication on crisis, and balancing decision-making and responsibility in managing crisis. Discussion Crisis is a multidimensional subjective experience, which also contributes to distress for family carers and professionals. Crisis interventions had limited and subjective benefit. They are influenced by accessibility of services, different understandings of "BPD" and human dynamics in complex decision-making, and can be experienced as helpful or harmful. Implications for practice Subjectivity of crisis experiences shows limitations of the diagnostic model of "BPD," emphasizing that interventions should remain person-centred. While thresholds for intervention are often met after self-harm or suicidality, professionals should review approaches to care and support people with underlying distress.
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Affiliation(s)
- Dan Warrender
- School of Nursing and Midwifery, Robert Gordon University, Aberdeen, UK
| | - Heather Bain
- School of Nursing and Midwifery, Robert Gordon University, Aberdeen, UK
| | - Ian Murray
- School of Nursing and Midwifery, Robert Gordon University, Aberdeen, UK
| | - Catriona Kennedy
- School of Nursing and Midwifery, Robert Gordon University, Aberdeen, UK
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Lanfredi M, Elena Ridolfi M, Occhialini G, Pedrini L, Ferrari C, Lasalvia A, Gunderson JG, Black DW, Rossi R. Attitudes of Mental Health Staff Toward Patients With Borderline Personality Disorder: An Italian Cross-Sectional Multisite Study. J Pers Disord 2021; 35:41-56. [PMID: 30785861 DOI: 10.1521/pedi_2019_33_421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Negative attitudes toward borderline personality disorder (BPD) can present a barrier to those seeking care. We explored caring attitudes toward BPD among 860 mental health professionals, including psychiatrists, psychologists, social health educators, nurses, and social workers. The results showed that social workers and nurses scored significantly lower on caring attitudes than psychiatrists, social health educators, and psychologists. Our analysis showed that the more BPD patients treated in the past year, more years of experience in mental health, and having prior BPD training were positively associated with caring attitudes scores. For all professional subgroups, except for social health educators, the caring attitudes score is higher in those who have had prior BPD training, and for professionals with low and medium level of experience in mental health. This result shows that training on BPD should target less experienced clinicians and those professional groups who had less opportunity to receive such education.
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Affiliation(s)
- Mariangela Lanfredi
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | | | | | - Laura Pedrini
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Clarissa Ferrari
- Service of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Antonio Lasalvia
- UOC di Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | | | - Donald W Black
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Roberta Rossi
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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Klein P, Fairweather AK, Lawn S, Stallman HM, Cammell P. Structural stigma and its impact on healthcare for consumers with borderline personality disorder: protocol for a scoping review. Syst Rev 2021; 10:23. [PMID: 33423674 PMCID: PMC7798332 DOI: 10.1186/s13643-021-01580-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 01/02/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Structural stigma in health systems experienced by consumers diagnosed with Borderline Personality Disorder (BPD) is a widespread phenomenon that causes major health inequities and harm for this population. Structural stigma in this context relates to institutional policies, cultural norms, and organizational practices that limit consumers' access to health services, quality of care, and capacity to achieve optimal health and well-being. BPD is a serious mental illness with high morbidity and mortality, characterized by instability in interpersonal relationships, self-image, and emotional and behavioral deregulation, which stem from significant traumatic childhood/life events, and/or biological etiologies. The objectives of this scoping review are to explore the international literature on structural stigma in healthcare systems specific to BPD, and to provide an overview of the impact of structural stigma on health services for BPD consumers and their carers/families. METHODS This scoping review will follow the Joanna Briggs Institute (JBI) scoping review guidelines. We will search the following electronic databases (from inception onwards): MEDLINE, CINAHL, PsycINFO, Scopus, Cochrane Library, and JBI-Evidence databases. Grey literature will be identified through the Google search engine. We will include all types of literature in English, published and unpublished, including any study design, reviews, clinical practice guidelines, policy reports, and other documents. No restrictions on publication date of sources of evidence will be applied. International literature should examine structural stigma associated with BPD in any healthcare setting such as, outpatients, inpatients, primary health care, or community-based facilities. Two reviewers will independently screen all titles, abstracts, and full-text citations. Quality appraisal of the included sources of evidence will be assessed using the Mixed Methods Appraisal Tool (MMAT) 2018 version. Data analysis will involve quantitative (e.g., frequencies) and qualitative (e.g., thematic analysis) methods. DISCUSSION This review is anticipated to enhance both identification and understanding of those structures in health systems (i.e., institutional policies, cultural norms, and practices) that manifest and perpetuate stigma experienced by consumers with BPD and their carers/families. The findings can be used to inform future research, policy, and practice relating to stigma reduction strategies that can be adopted to improve the provision of BPD-responsive services and care for this population. SYSTEMATIC REVIEW REGISTRATION Open Science Framework ( https://osf.io/bhpg4 ).
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Affiliation(s)
- Pauline Klein
- Discipline of Behavioural Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia 5001 Australia
| | - Alicia Kate Fairweather
- Discipline of Behavioural Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia 5001 Australia
| | - Sharon Lawn
- Discipline of Behavioural Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia 5001 Australia
| | - Helen Margaret Stallman
- Thompson Insititute, University of the Sunshine Coast, 12 Innovation Pkwy, Birtinya, Queensland 4575 Australia
| | - Paul Cammell
- The Royal Melbourne Hospital, Parkville, Victoria 3050 Australia
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36
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Carrotte E, Hartup M, Blanchard M. “It's very hard for me to say anything positive”: A qualitative investigation into borderline personality disorder treatment experiences in the Australian context. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12400] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Elise Carrotte
- SANE Australia, Anne Deveson Research Centre, Melbourne, Victoria, Australia
| | - Michael Hartup
- SANE Australia, Anne Deveson Research Centre, Melbourne, Victoria, Australia
| | - Michelle Blanchard
- SANE Australia, Anne Deveson Research Centre, Melbourne, Victoria, Australia
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37
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Romeu-Labayen M, Rigol Cuadra MA, Galbany-Estragués P, Blanco Corbal S, Giralt Palou RM, Tort-Nasarre G. Borderline personality disorder in a community setting: service users' experiences of the therapeutic relationship with mental health nurses. Int J Ment Health Nurs 2020; 29:868-877. [PMID: 32304273 DOI: 10.1111/inm.12720] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/07/2020] [Accepted: 03/04/2020] [Indexed: 01/03/2023]
Abstract
People with borderline personality disorder (BPD) suffer from severe symptoms and crises that put their lives at risk. BPD's symptoms make it difficult for nurses to establish good therapeutic relationships with people who suffer from it, thus hindering their recovery and contributing to stigma. We explored the experiences of people with BPD who were under the care of mental health nurses at a community mental health centre and who reported a reduction in distress. Our goal was to identify the actions and psychotherapeutic factors of the therapeutic relationship that people with BPD considered to be useful in their recovery. Our qualitative approach made it possible for us to learn about individual experiences and meanings and describe the perception of participants. Our sample included 12 participants. Data consisted of qualitative interviews with all participants and nursing records for six of the participants. We conducted an inductive thematic content analysis, resulting in a hierarchical system of subthemes and themes. We found that participants considered the following psychotherapeutic actions to be useful in recovery: learning about the disorder, building trust, and being empowered through validation.
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Affiliation(s)
- Maria Romeu-Labayen
- Adult Mental Health Center Horta Guinardó, Barcelona, Spain.,Department of Public Health, Mental Health and Mother-Infant Nursing, University of Barcelona, L'Hospitalet del Llobregat, Spain.,AFIN Research Group at, Autonomus University of Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Maria Assumpta Rigol Cuadra
- Department of Public Health, Mental Health and Mother-Infant Nursing, University of Barcelona, L'Hospitalet del Llobregat, Spain.,AFIN Research Group at, Autonomus University of Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Paola Galbany-Estragués
- AFIN Research Group at, Autonomus University of Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.,Faculty of Health Science and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Barcelona, Spain
| | | | - Rosa Maria Giralt Palou
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Division of Mental Health, Althaia Foundation, Manresa, Spain
| | - Glòria Tort-Nasarre
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
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38
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Eckerström J, Flyckt L, Carlborg A, Jayaram-Lindström N, Perseius KI. Brief admission for patients with emotional instability and self-harm: A qualitative analysis of patients' experiences during crisis. Int J Ment Health Nurs 2020; 29:962-971. [PMID: 32406168 DOI: 10.1111/inm.12736] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/16/2020] [Accepted: 04/22/2020] [Indexed: 12/11/2022]
Abstract
Previous studies report that individuals diagnosed with borderline personality disorder have been met by negative attitudes from healthcare professionals and their care needs have often been neglected during hospitalizations. When symptoms of emotional instability are combined with self-harm, the resulting crisis often becomes difficult to handle for patients and healthcare professionals. To meet their care needs during these crises, an intervention called 'brief admission' (BA) has been developed. The purpose of BA is to provide a timeout, in situations of increased stress and threat, in order to foster self-management in a safe environment. In the present study, we explored the following research questions: What are patients' experiences with BA? What do patients consider to be the key components of BA? What improvements are considered relevant by patients? A qualitative design was employed, and 15 patients (13 females, 2 males; mean age 38.5 ± 12.9, range 20-67 years) were interviewed using a semi-structured interview guide. Thematic analyses were performed, which yielded four themes related to the patients' experiences: 'a timeout when life is tough', 'it is comforting to know that help exists', 'encouraged to take personal responsibility', and 'it is helpful to see the problems from a different perspective'. Four themes also described the key components: 'a clear treatment plan', 'a smooth admission procedure', 'a friendly and welcoming approach from the staff', and 'daily conversations'. Lastly, three themes described areas for improvements: 'feeling guilty about seeking BA', 'room occupancy issues', and 'differences in staff's competence'. Collectively, the findings indicate that BA constructively supports patients with emotional instability and self-harm during a period of crisis.
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Affiliation(s)
- Joachim Eckerström
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.,Department of Health Sciences, The Swedish Red Cross University College, Stockholm, Sweden
| | - Lena Flyckt
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Andreas Carlborg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.,Northern Stockholm psychiatry, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Nitya Jayaram-Lindström
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Kent-Inge Perseius
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.,Department of Health Sciences, The Swedish Red Cross University College, Stockholm, Sweden
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39
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Relationships Among Structures, Team Processes, and Outcomes for Service Users in Quebec Mental Health Service Networks. Int J Integr Care 2020; 20:12. [PMID: 32565762 PMCID: PMC7292103 DOI: 10.5334/ijic.4718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Few studies have identified and compared profiles of mental health service networks (MHSN) in terms of structures, processes, and outcomes, based on cluster analyses and perceptions of team managers, MH professionals and service users. This study assessed these associations in Quebec metropolitan, urban and semi-urban MHSN. Methods: A framework adapted from the Donabedian model guided data management, and cluster analyses were used to identify categories. Study participants included team managers (n = 45), MH professionals (n = 311) and service users (n = 327). Results: For all three MHSN, a common outcome category emerged: service users with complex MH problems and negative outcomes. The Metropolitan network reported two categories for structures (specialized MH teams, primary care MH teams) and processes (senior medical professional, psychosocial professionals), and outcomes (middle-age men with positive outcomes, older women with few MH problems). The Urban and Semi-urban networks revealed one category for structures (all teams) and service user (young service users with drug disorders), but two for processes (psychosocial professionals: urban, all professionals: semi-urban). Conclusion: The Metropolitan MHSN showed greater heterogeneity regarding structures and team processes than the other two MHSN. Service user outcomes were largely associated with clinical characteristics, regardless of network configurations for structures and team processes.
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40
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Fleury MJ, Grenier G, Farand L, Ferland F. Use of Emergency Rooms for Mental Health Reasons in Quebec: Barriers and Facilitators. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 46:18-33. [PMID: 30074113 DOI: 10.1007/s10488-018-0889-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study explored barriers and facilitators in mental health (MH) patient management in four Quebec (Canada) emergency rooms (ERs) that used different operational models. Forty-nine stakeholders (managers, physicians, ER and addiction liaison team members) completed semi-structured interviews. Barriers and facilitators affecting patient management emanated from health systems, patients, organizations, and from professionals themselves. Effective management of MH patients requires ER access to a rich network of outpatient, community-based MH services; integration of general and psychiatric ERs; on-site addiction liaison teams; round-the-clock ER staffing, including psychiatrists; ER staff training in MH; and adaptation to frequent and challenging ER users.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada. .,Douglas Mental Health University Institute Research Centre, 6875 LaSalle Blvd., Montreal, QC, H4H 1R3, Canada.
| | - Guy Grenier
- Douglas Mental Health University Institute Research Centre, 6875 LaSalle Blvd., Montreal, QC, H4H 1R3, Canada
| | - Lambert Farand
- Department of Health Administration, Policy and Evaluation School of Public Health, University of Montreal, Montreal, QC, Canada
| | - Francine Ferland
- School of Social Work, Laval University, Quebec City, QC, Canada
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41
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McDonagh T, Higgins A, Archer J, Galavan E, Sheaf G, Doyle L. Lived experiences of adults with borderline personality disorder: a qualitative systematic review protocol. JBI Evid Synth 2020; 18:583-591. [PMID: 32197018 DOI: 10.11124/jbisrir-2017-004010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objectives of this review are: to explore the lived experiences of individuals with a diagnosis of borderline personality disorder (BPD) and to present recommendations for policy, practice, education and research. INTRODUCTION Borderline personality disorder is a mental disorder characterized by poor capacity to engage in effective relationships, intense and sudden mood changes, poor self-image and emotion regulation, significant impulsivity and severe functional impairment. Studies estimate the prevalence of BPD at 15% to 22% and identify a predominantly negative attitude among health professionals towards individuals with BPD. This review will examine the lived experiences of people with a diagnosis of BPD in order to better understand this condition. INCLUSION CRITERIA This review will include peer-reviewed qualitative studies on adults with a diagnosis of BPD in all settings and from any geographical location. METHODS A three-step search strategy will be used. A search strategy has been developed for MEDLINE. A second search using all identified keywords and index terms will be conducted across MEDLINE, CINAHL, PsycINFO and Embase. Studies will be screened by title and abstract by two independent reviewers against the review inclusion criteria. The full text of selected citations will be assessed against the inclusion criteria and for methodological quality. Qualitative data will be extracted from included papers using a standardized data extraction tool. Qualitative research findings will be pooled using the meta-aggregation approach. The final synthesized findings will be graded according to the ConQual approach and presented in a Summary of Findings. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42019141098.
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Affiliation(s)
- Teresa McDonagh
- School of Nursing and Midwifery, Faculty of Health Sciences, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Agnes Higgins
- School of Nursing and Midwifery, Faculty of Health Sciences, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | | | - Eoin Galavan
- School of Psychology, Faculty of Arts, Humanities and Social Sciences, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Greg Sheaf
- The Library of Trinity College Dublin, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Louise Doyle
- School of Nursing and Midwifery, Faculty of Health Sciences, Trinity College Dublin, The University of Dublin, Dublin, Ireland.,The Trinity Centre for Practice and Healthcare Innovation: a Joanna Briggs Institute Affiliated Group
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42
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Garland J, Miller S. Borderline personality disorder: part 1 – assessment and diagnosis. BJPSYCH ADVANCES 2020. [DOI: 10.1192/bja.2019.76] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
SUMMARYGeneral adult psychiatrists are largely responsible for the care of patients with personality disorders in community and in-patient settings, and this can be associated with diagnostic and management challenges. In the first of two articles focusing specifically on borderline personality disorder (BPD), we summarise the core clinical features of the disorder and discuss appropriate diagnostic practice.
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43
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Swart S, Wildschut M, Draijer N, Langeland W, Hoogendoorn AW, Smit JH. The course of (comorbid) trauma-related, dissociative and personality disorders: two year follow up of the Friesland study cohort. Eur J Psychotraumatol 2020; 11:1750171. [PMID: 32489522 PMCID: PMC7241467 DOI: 10.1080/20008198.2020.1750171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 03/20/2020] [Accepted: 03/23/2020] [Indexed: 11/25/2022] Open
Abstract
Background: There is substantial comorbidity between trauma-related disorders (TRDs), dissociative disorders (DDs) and personality disorders (PDs), especially in patients who report childhood trauma and emotional neglect. However, little is known about the course of these comorbid disorders, despite the fact that this could be of great clinical importance in guiding treatment. Objective: This study describes the two-year course of a cohort of patients with (comorbid) TRDs, DDs and PDs and aims to identify possible predictors of course. Possible gender differences will be described, as well as features of non-respondents. Method: Patients (N = 150) referred to either a trauma treatment program or a PD treatment program were assessed using five structured clinical interviews for diagnosing TRDs, DDs, PDs and trauma histories. Three self-report questionnaires were used to assess general psychopathology, dissociative symptoms and personality pathology in a more dimensional way. Data on demographics and received treatment were obtained using psychiatric records. We described the cohort after a two-year follow-up and used t-tests or chi-square to test possible differences between respondents and non-respondents and between women and men. We used regression analysis to identify possible course predictors. Results: A total of 85 (56.7%) of the original 150 patients participated in the follow-up measurement. Female respondents reported more sexual abuse than female non-respondents. Six patients (4.0%; all women) died because of suicide. Levels of psychopathology significantly declined during the follow-up period, but only among women. Gender was the only significant predictor of change. Conclusions: Comorbidity between TRDs, DDs and PDs was more the rule than the exception, pleading for a more dimensional and integrative view on pathology following childhood trauma and emotional neglect. Courses significantly differed between men and women, advocating more attention to gender in treatment and future research.
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Affiliation(s)
- Sanne Swart
- FACT, GGZ Friesland, Drachten, The Netherlands
| | | | - Nel Draijer
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Willemien Langeland
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Adriaan W Hoogendoorn
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Jan H Smit
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health, Amsterdam, The Netherlands
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44
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Barr KR, Jewell M, Townsend ML, Grenyer BFS. Living with personality disorder and seeking mental health treatment: patients and family members reflect on their experiences. Borderline Personal Disord Emot Dysregul 2020; 7:21. [PMID: 32944249 PMCID: PMC7487914 DOI: 10.1186/s40479-020-00136-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/11/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Despite effective treatments for personality disorders being developed, consumers and carers often report negative experiences of mental health services, including challenges accessing these treatments. METHODS This qualitative study used separate focus groups to compare the unique perspectives of consumer and carers, and to investigate how to improve services for individuals with personality disorders. Reflexive thematic analysis was used to analyze the data. RESULTS Both consumers and carers (N = 15) discussed the value of providing appropriate information to consumers when they are diagnosed with personality disorder. Consumers and carers described the importance of creating a safe environment for consumers when they present to the emergency department. Both groups discussed experiencing positive and negative treatment from mental health professionals, and suggested that professionals should be trained to understand personality disorder. Limited accessibility and quality of services, and offering peer support to consumers were also described by consumers and carers. Consumers and carers also had perspectives which were unique to their group. Consumers identified the importance of psychological treatment, having a strong therapeutic relationship with a mental health professional, and the benefit of long term psychotherapy with the same professional. Broadening the scope of psychotherapies including creative, animal-assisted, and physical therapies was recommended by consumers. Carers described the importance of assessing for personality disorder and intervening early. Involvement in the assessment, diagnosis, and intervention process was important to carers. The desire to be recognized and supported by mental health professionals was discussed by carers. CONCLUSIONS This research contributes to the concern that consumers with personality disorder and their carers experience stigma and low quality care within mental health services. In line with these findings, we recommend guidelines for health professionals who work with consumers with personality disorder.
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Affiliation(s)
- Karlen R Barr
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2522 Australia
| | - Mahlie Jewell
- Project Air Strategy Consumer and Carer Advisory Committee, Wollongong, NSW Australia
| | - Michelle L Townsend
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2522 Australia
| | - Brin F S Grenyer
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2522 Australia
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45
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Acford E, Davies J. Exploring therapeutic engagement with individuals with a diagnosis of personality disorder in acute psychiatric inpatient settings: A nursing team perspective. Int J Ment Health Nurs 2019; 28:1173-1182. [PMID: 31286646 DOI: 10.1111/inm.12629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 06/12/2019] [Accepted: 06/14/2019] [Indexed: 01/19/2023]
Abstract
Individuals with a diagnosis of personality disorder (PD) face negative attitudes and are often deemed harder to care for than individuals with other diagnoses. To improve care and engagement with services, it is essential to understand the ways general psychiatric nursing staff approach this client group. This research aims to examine the ways inpatient psychiatric nursing staff therapeutically engage with individuals with a diagnosis of PD. Focus groups were conducted with Registered Mental Health Nurses (n = 7) and Health Care Assistants (formally known as nursing assistants; n = 12) who care for individuals with a diagnosis of PD in a general psychiatric inpatient setting. A thematic analysis indicated six themes: the right frame of mind, knowing the service user, knowing when to engage, service user input, a unified approach, and structured admissions. The findings highlight what non-PD specialist inpatient nursing staff do in order to engage therapeutically with this group of service users and areas that require improvement. Supporting good practice could improve staff confidence when caring for this client group, lower stigma around the diagnosis, and promote a more positive experience of care for individuals with a diagnosis of PD who are using general inpatient mental health services.
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Affiliation(s)
- Emma Acford
- Department of Psychology, College of Human and Health Sciences, Vivian Tower, Swansea University, Swansea, UK
| | - Jason Davies
- Department of Psychology, College of Human and Health Sciences, Vivian Tower, Swansea University, Swansea, UK
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46
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Fleury MJ, Grenier G, Farand L. Satisfaction with Emergency Departments and Other Mental Health Services among Patients with Mental Disorders. ACTA ACUST UNITED AC 2019; 14:43-54. [PMID: 31017865 PMCID: PMC7008685 DOI: 10.12927/hcpol.2019.25793] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background Few studies have investigated satisfaction with emergency departments (EDs) among patients with mental health (MH) issues. This study evaluated the use of and satisfaction with EDs and other MH services among 328 patients with MH disorders, as well as specific characteristics of patient satisfaction and dissatisfaction. Methods A mixed-methods study was conducted in four EDs located in different administrative healthcare regions of Quebec (Canada). Results Patients were highly satisfied with staff attitudes in EDs and other MH services (i.e., hospital in-patient services, outpatient services, community organizations). Major sources of dissatisfaction were the information received in EDs concerning community services and the physical environment or climate in EDs and other MH services. Conclusion Dissatisfaction with services may be reduced by extending hours of operation in MH services; promoting collaboration between psychiatrists, family physicians and other primary care providers; further integrating EDs with other healthcare services; and improving the characteristically austere and restrictive atmosphere in EDs.
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Affiliation(s)
- Marie-Josée Fleury
- Professor, Department of Psychiatry, McGill UniversityResearcher, Douglas Mental Health University Institute Research CentreMontreal, QC
| | - Guy Grenier
- Research AssociateDouglas Mental Health University Institute Research CentreMontreal, QC
| | - Lambert Farand
- Associate ProfessorDepartment of Health Administration, Policy and EvaluationSchool of Public Health, University of MontrealMontreal, QC
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47
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Bowen M. Stigma: A linguistic analysis of personality disorder in the UK popular press, 2008-2017. J Psychiatr Ment Health Nurs 2019; 26:244-253. [PMID: 31237384 DOI: 10.1111/jpm.12541] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 06/19/2019] [Accepted: 06/21/2019] [Indexed: 02/06/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: People with a diagnosis of personality disorder often experience stigma both outside of, and within, mental health services. The media contribute to people's understanding of mental health issues, and negative portrayals appear to lead to increased negative attitudes in readers. Relatively little is known about how the press represent personality disorder, and the types of messages that people with this disorder may be receiving, which may impact on their understanding of themselves and emotional well-being. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The key findings indicate that in a 10-year period, the representation of personality disorder in the popular tabloid press in the UK was characterized by the frequent use of language of violence. The research approach enabled the study to identify significant patterns in the language used, rather than only using a checklist of words that the press are directed to avoid. This adds to our understanding about the images repeatedly presented that may affect how readers treat people with a diagnosis of personality disorder and affect the self-esteem of those with the diagnosis. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses are well placed to address issues of stigma both in terms of the general public's beliefs and the impact it has on those who use mental health services. A greater understanding of the messages in the press can help nurses to support service users who are vulnerable to believing that their lives will start to reflect the negative messages they have read. ABSTRACT: Introduction Many people with a diagnosis of personality disorder experience stigma, and the press' representations may contribute to those processes. To date, little is known about how the press write about people with personality disorder and analysis of language used is often limited to checklists of words to avoid. Aim The aim of the study was to explore the linguistic characteristics of press articles about personality disorder in popular tabloids in the UK and consider the implications for stigmatization. Method Corpus linguistics was used to examine a 50% sample of all articles published by the popular press in the UK, from 2008 to 2017, that referred to personality disorder (n = 260). Results The findings identified a range of words that constructed narratives of violence. Discussion The method enabled the findings to expand the current level of knowledge in the field, identifying patterns in the use of the language of violence, which may contribute to the processes of self-stigma. Implications for practice Greater understanding of the messages in the press can sensitize nurses to common misconceptions about the disorder, how these may have become internalised and the need for psycho-social interventions to address the impact of self-stigma on self-esteem.
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Affiliation(s)
- Matt Bowen
- Faculty of Health and Social Care, University of Chester, Chester, UK
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48
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Vandyk A, Bentz A, Bissonette S, Cater C. Why go to the emergency department? Perspectives from persons with borderline personality disorder. Int J Ment Health Nurs 2019; 28:757-765. [PMID: 30779279 DOI: 10.1111/inm.12580] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2019] [Indexed: 01/22/2023]
Abstract
Through this qualitative study, we explored frequent emergency department use by persons with borderline personality disorder from their perspective. Interpretive description guided the study design, and data were collected through interviews with six individuals diagnosed with borderline personality disorder who had at least 12 emergency department visits for reasons related to their mental illness within a 1-year timeframe. Using thematic data analysis, we articulate the participants' experiences through two broad themes: cyclic nature of emergency department use and coping skills and strategies. Unstable community management that leads to self- or crisis presentation to the emergency department often perpetuated emergency department use by our participants and the ensuing interventions aimed at acute stabilization. The participants identified a desire for human interaction and feelings of loneliness, failure of community resources (such as crisis lines or therapy), and safety concerns following suicidal ideation, self-harm, or substance use as the main drivers for their emergency department visits. Our participants identified several potential strategies to protect them against unnecessary emergency department use and improve their health care overall. More work is needed to explore the viability and effectiveness of these suggestions.
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Affiliation(s)
- Amanda Vandyk
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Andrea Bentz
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Sarah Bissonette
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Caitlyn Cater
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
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49
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Lamont E, Dickens GL. Mental health services, care provision, and professional support for people diagnosed with borderline personality disorder: systematic review of service-user, family, and carer perspectives. J Ment Health 2019; 30:619-633. [DOI: 10.1080/09638237.2019.1608923] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Emma Lamont
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Geoffrey L. Dickens
- Division of Mental Health Nursing and Counselling, Abertay University, Dundee, UK
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50
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Sanatinia R, Afzal S, MacLaren T, McNulty A, Adele C, Morah A, Crawford M. Improved mental health among LABILE study participants: A qualitative exploration. Personal Ment Health 2019; 13:75-83. [PMID: 30848543 DOI: 10.1002/pmh.1440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/21/2018] [Accepted: 02/03/2019] [Indexed: 01/24/2023]
Abstract
Results of the LABILE trial showed no difference between people with BPD who were prescribed lamotrigine and those on placebo. However, most study participants experienced sustained improvement in their mental health during the trial. We conducted a thematic analysis of qualitative data from interviews with 47 LABILE study participants to identify factors that may have contributed to this improvement. We identified three main themes: initial reasons and expectations regarding trial participation, patients' experiences of the trial and areas of change. Reasons for participating in the trial included a search for consistent and stable professional care as well as altruistic motives. Improvements in symptoms over the course of the trial were explained by several factors including consistency provided by the research team, salience of the social context and the availability of alternative support networks. While participants appreciated the autonomy provided by the voluntary nature of the trial, they felt that improvements stemmed from the 'structure' brought about by their actively engaging in the study. This study highlights the importance of clear and transparent communication when treating people with BPD. Mental health professionals should ensure that services for people with BPD are consistent and structured. © 2019 John Wiley & Sons, Ltd.
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Affiliation(s)
| | | | - Thomas MacLaren
- Central and North West London NHS Foundation Trust, London, UK
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