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Borderline Personality Disorder: Treatment and Management

Borderline Personality Disorder: Treatment and Management

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK)

Version: 2009

BORDERLINE PERSONALITY DISORDER

The term ‘borderline personality’ was proposed in the United States by Adolph Stern in 1938 (most other personality disorders were first described in Europe). Stern described a group of patients who ‘fit frankly neither into the psychotic nor into the psychoneurotic group’ and introduced the term ‘borderline’ to describe what he observed because it ‘bordered’ on other conditions.

THE CONFIGURATION AND ORGANISATION OF SERVICES

Concerns have repeatedly been expressed about the quality of services for people with personality disorder. In 2003, the Department of Health in England highlighted the problems that many people with personality disorder face when trying to access appropriate care in primary or secondary services (Department of Health, 2003). Consequently, the department set standards for delivering services to people with personality disorder in England that aimed to ensure that people with the disorder (including borderline personality disorder) would be able to access general and specialist mental health services. Mental health trusts in England are now expected to take responsibly for meeting the needs of people with personality disorder with an emphasis placed on local expertise, suitable skills and multi-agency working (Department of Health, 2006).

SUMMARY OF RECOMMENDATIONS

People with borderline personality disorder should not be excluded from any health or social care service because of their diagnosis or because they have self-harmed.

EXPERIENCE OF CARE

This chapter provides an overview of the experience of people with borderline personality disorder and their families/carers. In the first section are first-hand personal accounts written by service users, former service users and a carer, which provide some experiences of having the diagnosis, accessing services and caring for someone with the disorder. It should be noted that these accounts are not representative of the experiences of people with borderline personality disorder, and therefore can only ever be illustrative. The accounts were obtained through contacts of the service users and carers on the GDG, and therefore illustrate a relatively narrow range of experience (the majority are from people whose primary mode of treatment was in a therapeutic community). It should also be borne in mind that writing about borderline personality disorder can be an extremely painful process for many people, which further restricts the number of available personal accounts.

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