How Mental Health Teams Make Sense of People Who Have Been Given a Diagnosis of Borderline Personality Disorder

Background: Stigmatising ideas about people who receive a diagnosis of Borderline Personality Disorder (BPD) are consistently demonstrated within mental health services. Existing research has predominantly focused on individual staff cognitions and actions, rather than considering stigmatisation on the grounds of BPD diagnosis as a social process, shaped by service and socio-political context.
Aims: To explore the social-psychological processes involved when mental health teams make sense of people who receive a diagnosis of BPD. To consider how contextual factors affect these processes.
Method: 3 focus groups were conducted involving 16 participants from 3 mental health teams. Constructivist Grounded Theory was used to analyse the data.
Results: The model ‘Protecting the professional self’ was constructed. Contrasting ideas about ‘personality disorder’ and ‘mental illness’, implicit professional and client role expectations, a culture of individual responsibility and mismatch between client need and service design meant clinicians experienced two core threats to their professional selves when working with people who receive a diagnosis of BPD. Two patterns of responding to these threats were demonstrated. ‘Distancing’ responses involved decontextualizing, discrediting and differentiating, and drew on culturally-dominant stigmatising ideas about ‘BPD’ to legitimise emotional and physical ‘distancing’ from clients, with a consequent reduction in felt threat. Alternative ‘connecting’ responses were also demonstrated, and these required resisting dominant ideas and practices.
Conclusion: Interventions should aim to reduce the experienced threat to professional self and make connecting responses more possible. This would involve changes to commissioning and service priorities, and the reconceptualisation of staff training. Furthermore, a new framework for understanding the distress known as ‘BPD’ is needed, which rather than reinforcing the ‘distancing’ processes, acknowledges our shared humanity and validates the distress as an understandable response to historical and current experience.