Interpersonal narratives of frequently hospitalized women with borderline personality disorder

Abstract

Even though official guidelines for the treatment of borderline personality disorder (BPD) attempt to reserve hospitalization as a last resort, people with BPD continue to constitute a large portion of high-utilizers of inpatient psychiatric services. Because interpersonal factors are considered important for the etiology, course and treatment of the disorder, this qualitative study attempts to understand the emotional needs of two frequently hospitalized women with BPD in the context of their interpersonal histories. The results highlight that the needs underlying the use of psychiatric inpatient services may vary considerably within this population. In the context of high social support, psychiatric admissions may provide needed distance from family, whereas in the context of low social support, hospital may represent a secure base. The role that psychiatric staff is also discussed, warning that psychiatric staff can easily reinforce the harmful interpersonal learning underlying the difficulties people with BPD have, whilst also suggesting that relatively small actions can challenge that learning. Crucially, this study highlights the need to thoroughly consider how the emotional needs of this population will be met, which, if not met in other contexts, people with BPD may seek to meet in the context of the general health services. This information is especially relevant to psychologists and other professionals who participate in multidisciplinary teams working with people with BPD.