“But what can a Psychiatrist do about my Bowel?!” Borderline Personality Disorder in Primary Care: A Qualitative Analysis of Patient Experience.

Abstract

Background: Borderline Personality disorder (BPD) is one of the most common disorders presenting to General Adult Psychiatry. Characterized by mood instability, impulsive, self-harming behaviour and significant difficulties in interpersonal relationships this disorder presents a significant challenge to those involved in their care. General Practitioners (GPs) are an important part of health care. In addition to meeting physical health needs they support the management of psychiatric illness and are the gatekeepers to other services. In recent years research into personality disorders has proliferated, mainly within specialist mental health services. Less is known about patterns of health care in primary care and what the experience of these services is like for individuals with BPD. Aim: The aim of the study is to ask individuals with a diagnosis of BPD about their experience of going to see their GP. Methods: Eleven individuals with a diagnosis of BPD were asked about their contact with GPs by way of a semi-structured interview. Interviews were recorded and analysis was carried out using an Interpretive Phenomenological Analysis (IPA). Results: Five super ordinate themes were identified: Experience of Having a BPD Diagnosis, Perceptions of GPs, Invalidating Experiences, Sense of Self and What Works Well. Conclusions: The findings demonstrate that many individuals with a diagnosis of BPD struggle in their consultations with GPs. Unsatisfactory encounters are internalised and reinforce perceived stigma thus perpetuating an already damaged sense of self. GPs need to have more awareness about such issues in order to deliver services more effectively to this population due to possible implications for mental and physical well being.