Qualitative Analysis of Resources and Barriers Related to Treatment of Borderline Personality Disorder in the United States

Abstract

Objective Resources and treatment for individuals with borderline personality disorder (BPD) are limited and often difficult to obtain. Experiences and preferences of individuals seeking care are seldom examined but important elements in determining challenges to obtaining appropriate care. This article aimed to identify key resources for and barriers to obtaining supportive and treatment services for BPD, from the perspective of individuals seeking care. Methods Data came from transcripts of resource requests made to the Borderline Personality Disorder Resource Center from January 2008 to December 2015 (N=6,253). Basic statistics regarding requested BPD service types, demographic information, and national distribution of requests were generated for all eligible transcripts. Qualitative analysis was used to identify themes, challenges, and common experiences reported among a random subset of those seeking services (N=500). Results Primary services or resources requested were outpatient services (51%), informational materials (13%), and daycare programs (9%). Care-seekers identified family services, crisis intervention, and mental health literacy as areas where available resources did not meet current demand and which could be improved and/or expanded. Factors identified as potential barriers to finding and obtaining appropriate treatment for BPD included stigmatization and marginalization within mental healthcare systems, financial concerns, and comorbidity with psychiatric or medical disorders. Conclusions Individuals seeking supportive services and treatment for BPD face numerous barriers to obtaining appropriate care. Expanded services and resources to connect individuals with treatment are needed to meet the current demands and preferences of those seeking care.

Why go to the emergency department? Perspectives from persons with borderline personality disorder

“…These treatments are useful for reducing acute symptoms, such as suicidality, yet system and patient-level barriers exist that prevent proper access and implementation in the community (Reeves-Dudley 2017; Storebo et al 2018). Persons with BPD requiring community care often describe services as ambiguous and poorly integrated (Lohman et al 2017). Furthermore, they report that stigmatization of the disorder and past negative experiences with healthcare providers contribute to their avoidance of certain facilities (Lohman et al 2017).…”

“…Persons with BPD requiring community care often describe services as ambiguous and poorly integrated (Lohman et al 2017). Furthermore, they report that stigmatization of the disorder and past negative experiences with healthcare providers contribute to their avoidance of certain facilities (Lohman et al 2017). Not surprisingly, persons with BPD present to the emergency department (ED) nearly five times more often than the general population for complaints related to their disorder (Brennan et al 2014).…”

Interpersonal barriers to recovery from borderline personality disorder: A qualitative analysis of patient perspectives

“…Thus, clinicians may proceed with the view that the patient is intentionally seeking this secondary gain—which might be partially valid—however, this view does not consider the possibility that the clinician is already prejudiced by the stigma of BPD. Reactions like these can be damaging and leave patients feeling blamed and criticized . The link between stigma associated with BPD and clinician burnout in providing treatment is a growing area of study, with DBT showing promise in the potential to reduce burnout among clinical staff as a result of using the treatment …”

“…In this case, the construct of ‘mental patient’ behaviour is likely understood in a context that included public perceptions of mental illness and its stigmatization. This method is supported by research that documents the connections of public perceptions of mental illness to stigmatization and how stigma directly influences the quality of life for individuals diagnosed with a mental illness …”

“…Reactions like these can be damaging and leave patients feeling blamed and criticized. 12,13 The link between stigma associated with BPD and clinician burnout in providing treatment is a growing area of study, 14,15 with DBT showing promise in the potential to reduce burnout among clinical staff as a result of using the treatment. 16,17 A biosocial theory of BPD underlies DBT and assumes that many problematic behavioural patterns are created and maintained over time within a transaction between biological vulnerability to emotion dysregulation and an invalidating environment.…”