Borderline Personality Disorder: Annotated Bibliography & Care

Introduction and Case Overview

The following annotated bibliography and summary are organized around a case study of a 28-year-old male with borderline personality disorder (BPD). He was admitted to a mental health unit following a self-harm event. He works as a middle-level manager in clothing sales and lives with his girlfriend. The six articles selected below are evaluated for their methods, findings, conclusions, and relevance to this client's care and recovery.

Annotated Bibliography

Bartsch, D. R., Roberts, R. M., Davies, M., & Proeve, M. (2016). Understanding the experience of parents with a diagnosis of borderline personality disorder. Australian Psychologist, 51(6), 472–480.

Methods: This was a qualitative study that used thematic analysis to identify common themes. The study participants were 12 parents — eleven mothers and one father — who had a past or present diagnosis of borderline personality disorder. The researchers made use of focus groups in which participants were asked questions regarding their experiences of parenting and service provision. Participants were aged between 29 and 59 years, and the majority (83%) identified as Caucasian.

Findings: Four key themes were identified from the thematic analysis: parenting rewards, parenting challenges, barriers to accessing support, and recommendations for improving the parenting experience. The study offered detailed insight into the impact of BPD symptoms on an individual's parenting role.

Conclusions: The researchers found that parents diagnosed with borderline personality disorder experience parenting as both rewarding and challenging. While some uncovered themes were similar to those reported by parents diagnosed with other forms of mental illness, there was evidence of themes specific to BPD symptoms. The researchers recommended interventions directly targeting parents, and participants expressed a need for counselling for both parents and children.

Relevance: Since the client is in a relationship, he may have children in the future and should be prepared for parenting with borderline personality disorder. Understanding the challenges, rewards, barriers, and recommendations will assist in developing programs that support parents diagnosed with BPD and provide them with the emotional and social support they need around their parenting roles.

Carrotte, E., Hartup, M., & Blanchard, M. (2019). "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, 54(6), 526–535.

Methods: This study used semi-structured qualitative interviews to determine the kinds of treatment and support services accessed by individuals living with borderline personality disorder, the perceived benefits and challenges of those services, and what changes participants would like implemented. There were 12 participants in total: nine had a lived experience with BPD, three were carers, and two identified as having both roles.

Findings: The researchers found mixed experiences across a range of treatment types, intensities, and locations. Identified themes included miscommunication, identity and discovery, finding what works, complexities of care, carer empowerment, and an uncertain future. Community-based psychotherapy was described as critical for reducing symptoms and improving quality of life.

Conclusions: This study focused on the Australian mental health system and found it is not designed to meet the needs of individuals living with borderline personality disorder. The condition remains highly stigmatized and misunderstood. All participants faced challenges when attempting to access BPD services.

Relevance: This study is relevant because it demonstrates the lack of adequate resources to treat individuals with borderline personality disorder in Australia. As a result, the client may be at risk of being discharged without receiving proper care. Hospital staff should be attentive to his needs, seek assistance from professionals experienced with BPD, and actively work to avoid stigmatizing responses.

Kay, M. L., Poggenpoel, M., Myburgh, C. P., & Downing, C. (2018). Experiences of family members who have a relative diagnosed with borderline personality disorder. Curationis, 41(1), 1–9.

Methods: This was a qualitative, descriptive, exploratory, and contextual study aimed at exploring and describing the experiences of family members who have a relative diagnosed with borderline personality disorder. Eight participants aged between 24 and 74 years took part. The researchers used in-depth phenomenological interviews and field notes. Data analysis was conducted using Tesch's method.

Findings: Four themes were identified. In the first theme, family members described their relative as experiencing behavioural, emotional, interpersonal, and self-dysregulation, which led to negative feelings toward the relative. The second theme reflected the individual's desire to move forward and improve their mental health. The third theme involved family members experiencing a challenging process of coping and adaptation. The fourth theme described family members experiencing a quest for integration and harmony.

Conclusions: A lack of knowledge about the diagnosis led family members to experience disempowerment. The researchers identified a need for greater information on the implications of the diagnosis, and recommended that care and treatment support be offered to mental health professionals and service providers.

Relevance: Since the client currently lives with his girlfriend, it is vital that she be educated and given knowledge about what to expect when living with someone diagnosed with BPD. This will strengthen their relationship and allow her to provide care without undue distress. Preparation and understanding will equip her to manage the challenges that may arise.

Ng, F. Y., Carter, P. E., Bourke, M. E., & Grenyer, B. F. (2019). What do individuals with borderline personality disorder want from treatment? A study of self-generated treatment and recovery goals. Journal of Psychiatric Practice, 25(2), 148–155.

Methods: This qualitative study aimed to determine the individual treatment goals of 102 individuals who sought treatment for borderline personality disorder. Participants were asked to provide their personal goals at their first assessment session, and responses were content-analysed to establish goal categories.

Findings: A total of 268 goals were identified. Content analysis revealed four major themes: symptom reduction, desire to improve well-being, better interpersonal relationships, and a greater sense of self. Reducing symptoms was the most commonly reported goal; however, 88.2% of participants reported wanting better psychosocial functioning.

Conclusions: The study identified the narrow treatment targets of current BPD interventions as a limitation, as reported by participants themselves. Broader treatment targets may generate greater motivation for treatment engagement and behavioural change. Both clinicians and individuals stand to benefit from awareness of individual goals at the outset of treatment.

Relevance: This study is relevant because it supports establishing individual goals as the starting point for treatment. For this client, it would be important to first explore what his treatment goals are and incorporate them into the care plan. This approach is likely to increase his motivation and adherence, as he will feel actively engaged in working toward his own recovery. Individual goals can also broaden the overall treatment target.

Ng, F. Y., Townsend, M. L., Miller, C. E., Jewell, M., & Grenyer, B. F. (2019). The lived experience of recovery in borderline personality disorder: A qualitative study. Borderline Personality Disorder and Emotion Dysregulation, 6(1), 10.

Methods: The study made use of semi-structured interviews conducted by telephone. A total of 14 participants were included, all women, with an average age of 33.6 years. Interviewees were asked to describe their first experience with BPD, their current life, their views on recovery, and their experience of supports and treatment.

Findings: The researchers found that recovery in borderline personality disorder occurred across three stages: being stuck, diagnosis, and improving experience. Four processes were involved in recovery: hope, active engagement in the recovery journey, engagement with treatment services, and engagement in meaningful activities and relationships. The improving experience stage showed differences between those who had and had not recovered.

Conclusions: Recovery from BPD is an ongoing process facilitated by the interactions between identified stages and processes. A holistic recovery approach should place greater emphasis on individual motivation, hope, engagement in relationships, treatment, and meaningful activities.

Relevance: This study is relevant because it demonstrates that recovery is possible and clarifies what is needed for the client to feel he has recovered. Following the three stages of recovery, it is clear that recovery is an ongoing journey, and the client should be made aware of this. Guidance through each stage and process can support him in moving forward. The lived experiences of those who self-report recovery are valuable because they provide hope and demonstrate that a person can regain their quality of life.

Vandyk, A., Bentz, A., Bissonette, S., & Cater, C. (2019). Why go to the emergency department? Perspectives from persons with borderline personality disorder. International Journal of Mental Health Nursing, 28(3), 757–765.

Methods: This qualitative study explored frequent emergency department use by individuals with borderline personality disorder from their own perspective. The study design was guided by interpretive description, and data were collected using interviews. The six participants had all been diagnosed with BPD and had attended the emergency department at least 12 times for mental health-related reasons in the past year.

Findings: The results indicated that participants desired human interaction and felt lonely, which led them to present to the emergency department. A lack of stable community management also drove self-presentation and crisis presentation. Safety concerns identified by the researchers — including suicidal ideation, substance use, and self-harm — were additional drivers of emergency department visits.

Conclusions: Persons with borderline personality disorder appear to receive inadequate care in the community, and there are no effective community-based strategies aimed at improving social connection and decreasing loneliness. The development of such strategies may help reduce unnecessary emergency department use for this population.

Relevance: Care offered to persons with BPD is complex, and their emergency department visits are often perceived as unnecessary by healthcare staff. The findings of this study can be used to tailor effective community care. Participants also indicated a desire to avoid the emergency department due to stigma experienced from healthcare workers, which compounded their negative sense of self. This highlights the importance of non-stigmatizing care for this client.