Perspectives of crisis intervention for people diagnosed with “borderline personality disorder”: an integrative review

Accessible Summary
What is known on the subject?
• People diagnosed with “BPD” often experience crisis and use services
• “BPD” is a controversial diagnosis, and the experience of crisis and crisis intervention is not well understood

What this paper adds to existing knowledge?
• People diagnosed with “BPD” have different experiences of crisis, and using the diagnosis alone as a basis for deciding care and treatment is not appropriate
• There are many human factors which can influence how professionals deliver care to people diagnosed with “BPD”

What are the implications for practice?
• The education of staff, views on responsibility, team conflicts and access to clinical supervision can have an impact on how care is delivered, and should be addressed by organizations providing crisis care.
• Access to care often occurs when a person is self-harming or suicidal, but does not address underlying distress. Crisis care should go beyond managing behaviour and address any underlying needs.

Abstract
Introduction: “Borderline personality disorder” (“BPD”) is associated with frequent use of crisis intervention services. However, no robust evidence base supports specific interventions, and people's experiences are not well understood.
Aim: To explore the experiences of stakeholders involved in the crisis care of people diagnosed with “BPD.”
Method: Integrative review with nine databases searched January 2000 to November 2017. The search filtered 3,169 titles and abstracts with 46 full-text articles appraised and included.
Results: Four themes were constructed from thematic analysis: crisis as a recurrent multidimensional cycle, variations and dynamics impacting on crisis intervention, impact of interpersonal dynamics and communication on crisis, and balancing decision-making and responsibility in managing crisis.
Discussion: Crisis is a multidimensional subjective experience, which also contributes to distress for family carers and professionals. Crisis interventions had limited and subjective benefit. They are influenced by accessibility of services, different understandings of “BPD” and human dynamics in complex decision-making, and can be experienced as helpful or harmful.
Implications for practice: Subjectivity of crisis experiences shows limitations of the diagnostic model of “BPD,” emphasizing that interventions should remain person-centred. While thresholds for intervention are often met after self-harm or suicidality, professionals should review approaches to care and support people with underlying distress.