Perspectives on person-centred care for borderline personality disorder: a critical research agenda

Talking about borderline personality disorder, shaping care: The multiple doings of narratives

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.

Experimenting with arts-based methods and affective provocations to understand complex lived experience of a diagnosis of borderline personality disorder

This article draws on arts-based psycho-social research to explore embodied and visceral knowing and feeling in the context of people living with a diagnosis of borderline personality disorder (BPD). It presents a discussion of creative artworks solicited through a nation-wide online survey conducted in Australia in 2021 that generated intimate and affective understanding about living with a diagnosis of BPD. To investigate what lived experiences of distress associated with a BPD diagnosis communicate through sensation, emotion, image and affective capacity, the authors put to work Blackman's (2015) concept of "productive possibilities of negative states of being" and the broader theoretical framework of new materialism. This approach allows a more transformative feeling-with that exceeds the normative affective repertoires and scripts associated with a diagnosis of BPD. The authors recognise the often unspoken and invisible affects of complex mental distress and trauma, and purposefully open the space for affective and symbolic aspects of creative artworks to communicate what is less known or has less presence in dominant biomedical frameworks about living with a BPD diagnosis. The article foregrounds the lived and living experience of participants to generate experiential rather than clinical understandings of the diagnosis.

'Is it in your basic personality?' Negotiations about traits and context in diagnostic interviews for personality disorders

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.