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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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Isaacs A, Lambert C, Lawn S, Dyer A. Shortcomings of services for persons with severe and persistent mental health challenges: a qualitative study of service users and family carers. Front Psychiatry 2024; 15:1341248. [PMID: 38419901 PMCID: PMC10899316 DOI: 10.3389/fpsyt.2024.1341248] [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] [Received: 11/20/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction The opinions of service users and carers are crucial to identifying ways to innovate and implement system change. This study aims to explore the views and experiences of service users and carerson the services they have used for their mental health challenges and their suggestions for service reform. Methods Twenty participants (15 carers and 5 service users) were interviewed for the study. Results Eight categories emerged from the data. They were: Several gaps in the system, Barriers to accessing services, Services are not fit for purpose, Services operate in isolation, System is not person focused, Service users and carers are treated poorly, Services are overloaded and under resourced and Recommendations for service reform. Respondents reported that a persistent lack of funding and resources for mental health services was a main cause of these shortcomings. Respondents also noted that innovations were needed to re-orient services to enable continuity of care, and training of mental health professionals was needed for a better understanding of the needs of service users and their carers. Discussion Additional research is needed with larger and more diverse samples to further explore these findings.
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Affiliation(s)
- Anton Isaacs
- School of Rural Health, Monash University, Warragul, VIC, Australia
| | - Caroline Lambert
- Tandem Inc., Abbotsford, VIC, Australia
- RMIT University, Melbourne, VIC, Australia
| | - Sharon Lawn
- Lived Experience Australia, Brighton, SA, Australia
- Flinders University, Adelaide, SA, Australia
| | - Anna Dyer
- Latrobe Regional Hospital, Traralgon, VIC, Australia
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Leichsenring F, Fonagy P, Heim N, Kernberg OF, Leweke F, Luyten P, Salzer S, Spitzer C, Steinert C. Borderline personality disorder: a comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies. World Psychiatry 2024; 23:4-25. [PMID: 38214629 PMCID: PMC10786009 DOI: 10.1002/wps.21156] [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: 01/13/2024] Open
Abstract
Borderline personality disorder (BPD) was introduced in the DSM-III in 1980. From the DSM-III to the DSM-5, no major changes have occurred in its defining criteria. The disorder is characterized by instability of self-image, interpersonal relationships and affects. Further symptoms include impulsivity, intense anger, feelings of emptiness, strong abandonment fears, suicidal or self-mutilation behavior, and transient stress-related paranoid ideation or severe dissociative symptoms. There is evidence that BPD can be reliably diagnosed and differentiated from other mental disorders by semi-structured interviews. The disorder is associated with considerable functional impairment, intensive treatment utilization, and high societal costs. The risk of self-mutilation and suicide is high. In the general adult population, the lifetime prevalence of BPD has been reported to be from 0.7 to 2.7%, while its prevalence is about 12% in outpatient and 22% in inpatient psychiatric services. BPD is significantly associated with other mental disorders, including depressive disorders, substance use disorders, post-traumatic stress disorder, attention-deficit/hyperactivity disorder, bipolar disorder, bulimia nervosa, and other personality disorders. There is convincing evidence to suggest that the interaction between genetic factors and adverse childhood experiences plays a central role in the etiology of BPD. In spite of considerable research, the neurobiological underpinnings of the disorder remain to be clarified. Psychotherapy is the treatment of choice for BPD. Various approaches have been empirically supported in randomized controlled trials, including dialectical behavior therapy, mentalization-based therapy, transference-focused therapy, and schema therapy. No approach has proved to be superior to others. Compared to treatment as usual, psychotherapy has proved to be more efficacious, with effect sizes between 0.50 and 0.65 with regard to core BPD symptom severity. However, almost half of the patients do not respond sufficiently to psychotherapy, and further research in this area is warranted. It is not clear whether some patients may benefit more from one psychotherapeutic approach than from others. No evidence is available consistently showing that any psychoactive medication is efficacious for the core features of BPD. For discrete and severe comorbid anxiety or depressive symptoms or psychotic-like features, pharmacotherapy may be useful. Early diagnosis and treatment of BPD can reduce individual suffering and societal costs. However, more high-quality studies are required, in both adolescents and adults. This review provides a comprehensive update of the BPD diagnosis and clinical characterization, risk factors, neurobiology, cognition, and management. It also discusses the current controversies concerning the disorder, and highlights the areas in which further research is needed.
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Affiliation(s)
- Falk Leichsenring
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
- Department of Psychosomatics and Psychotherapy, University of Rostock, Rostock, Germany
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Nikolas Heim
- International Psychoanalytic University, Berlin, Germany
| | - Otto F Kernberg
- Personality Disorders Institute, Weill Cornell Medical College, New York, NY, USA
| | - Frank Leweke
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
| | - Patrick Luyten
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - Simone Salzer
- International Psychoanalytic University, Berlin, Germany
| | - Carsten Spitzer
- Department of Psychosomatics and Psychotherapy, University of Rostock, Rostock, Germany
| | - Christiane Steinert
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
- International Psychoanalytic University, Berlin, Germany
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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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Tyrer P, Sharp C. Establishing efficacy and effectiveness in the treatment of personality disorders. Personal Ment Health 2023; 17:295-299. [PMID: 37957135 DOI: 10.1002/pmh.1595] [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] [Received: 10/18/2023] [Accepted: 10/18/2023] [Indexed: 11/15/2023]
Affiliation(s)
- Peter Tyrer
- Division of Psychiatry, Imperial College, London, UK
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston, Texas, USA
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Schäfer M, Luck-Sikorski C, Hochrein R, Schomerus G, Gollek S. [Development of a self-report questionnaire for the measurement of stigmatizing attitudes of the psychiatric staff towards patients with borderline personality disorder]. PSYCHIATRISCHE PRAXIS 2023; 50:424-430. [PMID: 37429316 DOI: 10.1055/a-2088-3629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
OBJECTIVE The development of a self-report questionnaire for quantitative measurement of stigmatizing attitudes of the psychiatric staff towards patients with borderline personality disorder. METHOD Online survey with psychiatrists, psychologists and nursing staff (n=94) in the (semi-)stationary psychiatric sector with translated items of an attitude questionnaire, followed by a principal component analysis and correlations between principal components and social distance. RESULTS Analyses revealed a 4-principal component structure (BPD-treatment difficulties, BPD-assessment of suicide risk, BPD-assumption of manipulative tendencies, BPD-negative emotions) with 63,60% explained variance and small to large correlations between principal components and social distance. CONCLUSION Results initially indicate possible validity and reliability of the developed questionnaire. Further analyses with larger sample size and confirmatory factor analysis for continued development are advised.
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Affiliation(s)
- Marvin Schäfer
- Forschungsgruppe COPE, SRH Hochschule für Gesundheit, Gera
| | | | | | - Georg Schomerus
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig
| | - Sabine Gollek
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig
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Lindell-Innes R, Phillips-Hughes AL, Bartsch D, Galletly C, Ludbrook C. Attitudes of psychiatry trainees towards patients with borderline personality disorder: Does the stigma begin during training? Personal Ment Health 2023; 17:387-395. [PMID: 37211385 DOI: 10.1002/pmh.1587] [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: 03/25/2023] [Revised: 04/24/2023] [Accepted: 05/03/2023] [Indexed: 05/23/2023]
Abstract
Research suggests there is a widespread stigma among clinicians towards patients with borderline personality disorder (BPD) and that this contributes to poor treatment outcomes. Given the influence of learning environments in shaping perceptions, this study investigated the attitude of South Australian psychiatry trainees towards patients with BPD. A questionnaire was distributed to 89 South Australian doctors, from both The Adelaide Prevocational Psychiatry Program (TAPPP) and psychiatry trainees of The Royal Australian and New Zealand College of Psychiatrists (RANZCP). This questionnaire investigated the domains of treatment optimism, clinician attitude and empathy towards patients with BPD. Results indicated that psychiatry trainees near the end of training scored significantly lower across all domains, indicating a more negative perception of patients with BPD, when compared to early- and mid-stage trainees. This study identifies a need to understand why trainees closer to qualifying as psychiatrists have increased stigma towards patients with BPD. Improved education and training surrounding patients with BPD is warranted to reduce negative stigma and improve clinical outcomes.
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Affiliation(s)
- Rhea Lindell-Innes
- Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
- Adelaide University, Adelaide, South Australia, Australia
| | | | - Dianna Bartsch
- Adelaide University, Adelaide, South Australia, Australia
- Borderline Personality Disorder Collaborative, Unley, South Australia, Australia
| | - Cherrie Galletly
- Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
- Discipline of Psychiatry, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Cathy Ludbrook
- Borderline Personality Disorder Collaborative, Unley, South Australia, Australia
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