A “fireball of emotion”: a qualitative case study exploring the experiences of crisis and crisis intervention for people diagnosed with "borderline personality disorder", their family and friends, and professionals who work with them

Aim: To explore the perspectives of people diagnosed with ‘BPD’ and relevant stakeholders regarding experiences of crisis and subsequent crisis intervention.
Background: Crisis and the use of crisis intervention is described as frequent for people diagnosed with ‘BPD’, though as yet the quality of evidence is described as poor, and often people are offered standard care with no clear model of intervention. ‘Borderline personality disorder’ is recognised as a stigmatised diagnosis and experiences of poor care during crisis are not uncommon. This study sought to capture a depth of experience, and to begin to chart a path towards improved care.
Design and Methodology: The study was of qualitative design, adopting a case study approach to explore crisis intervention from the perspective of service users, family and friends, and professionals. Data was collected through interviews with people diagnosed with ‘BPD’, their family and friends, and professionals who work with them. Semi-structured interviews utilised a topic guide to remain consistent with study objectives. A thematic analysis was constructed using constant comparison.
Main Findings: Six cases included six people diagnosed with ‘BPD’, four family and friends, and six professionals. Data analysis saw the construction of five themes; crisis as a multidimensional experience, entering a confused and anxious system, acts and omissions which lead to harm, the complex simplicity of helping people in crisis, and building a better service. The ‘BPD’ label contributed to stigma and discrimination and often negatively impacted on the care people received. A concept map was developed to capture the possible journey through crisis and crisis intervention and its complex influences.
Conclusions: This study offers a depth of understanding the crisis and crisis intervention experiences of people diagnosed with ‘BPD’, their families, and professionals who work with them. Crisis is a multidimensional experience with unique triggers, manifestation and coping mechanisms. Access to care is a challenge and people diagnosed with ‘BPD' often enter a confused and anxious system where there is no clear model of intervention and poor interagency working. Where there were good experiences, these centered around quality relationships where people diagnosed with ‘BPD’ are treated as people, and the professionals working with them are authentic. Recommendations are offered which may influence future service design.