Abstract
Background: There have been significant advances in research, treatment, policy and service provision for people diagnosed with a personality disorder in England. However, diagnoses such as borderline personality disorder (BPD), continue to be controversial due to the validity of the construct itself, the ability of clinicians to diagnose reliably, and the significant impact stigma can have on those diagnosed. Aims: This study aims to provide a current service-user perspective on the diagnostic process in BPD within specialist PD outpatient services. It specifically focuses on how service-users perceive this process to influence how they understand themselves, given that past research has indicated a BPD diagnosis can influence self-concept, and understanding of their mental health, given research has highlighted a lack of clarity from professionals about the diagnosis. Method: Data were collected from six in-depth interviews with people currently accessing complex needs services, within a London NHS trust, who had experienced the diagnostic process in BPD. Transcripts were analysed using interpretative phenomenological analysis (IPA). Results: Two superordinate themes emerged from the data: “Making sense of a BPD diagnosis” which encapsulated participants’ experiences of understanding the diagnosis, in terms of whether it “fitted” from their perspective, how it made sense of traumatic and challenging past experiences and the clarity they received from professionals; “Struggling to get what I need from services” which captures participants’ experiences of needing to reach crisis point and exhaust all other treatment options before accessing specialist assessment and treatment. Conclusions: Service-users continue to experience a lack of clarity during the diagnostic process in BPD, particularly within secondary care, and feel they struggle to access the specialist support they need. The diagnostic process is an opportunity to help service-users make sense of their current difficulties and past experiences, and to help them feel fully informed about treatment choices.