Evaluation and development of new intervention services for people with borderline personality disorder

The studies described in this thesis present a three-pronged approach into how services for individuals with personality disorder might be developed. The first two studies begin to examine constructs that appear related to features of borderline personality disorder which may potentially be targets of therapy. Study 1 (chapter 2.) examines the relationship between emotional dysregulation, cognitive dysregulation and features of borderline personality disorder. The findings suggest that both forms of dysregulation predict borderline personality disorder features, particularly depressed mood and a preoccupation with danger. Study 2 (chapter 3) examines the relationship between emotional intelligence, alexithymia and features of borderline personality disorder. The findings suggest that only alexithymia predicts borderline features and that alexithymia and emotional intelligence correlate only moderately. The third, fourth and fifth studies highlight a need for training as recommended by NIMHE's (2003b) 'Personality Disorder Capabilities Framework' for all staff and agencies that come into contact with individuals with personality disorder. In particular study 3 (chapter 4) investigates the reasons why patients are referred to a specialist personality disorder service, the problems that patients may present with to teams, how staff feel about and cope with such problems, what could be done to improve coping, and what training support and guidance staff feel they need from a specialist service. The findings indicate that many staff feel frustrated and stuck with this patient group, reporting high levels of negative behaviour such as self-harm and substance abuse. Although many staff feel confident most report the need for formal training and support. Study 4 (chapter 5) assesses Gwent Healthcare NHS trust nurses' attitudes towards patients with personality disorder. Here a sample of nurses who volunteered to undergo personality disorder awareness training is compared to those who did not volunteer. Both samples are combined and compared to samples taken from prison and high security setting. The findings indicate that nurses who volunteer to undergo personality awareness training display significantly more positive attitudes towards personality disorder than those who do not volunteer for the training. However nurses who work in prison and high security settings display significantly more positive attitudes towards personality disorder compared to Gwent Healthcare NHS nurse samples combined. Study 5 (chapter 6) comprises of a Delphi survey that elicits patients' views on their experiences of services en-route to a specialist personality disorder service. The findings indicate that patients value respect professionalism, and services that provide personal support that meets their needs. In general police, general practitioners and community psychiatric nurses are viewed positively whilst psychiatric hospital staff could improve. General hospital staff such as accident and emergency staff, and particular surgical wards are viewed unfavourably. Specialist personality disorder services are viewed favourably. The last two studies highlight that assessments need to be conducted on patients at the point of referral and that ongoing assessments are required over the course of a patient's contact with a specialist personality disorder service. Study 6 (chapter 7) investigates the differences between those who continue therapy for borderline personality disorder with those who discontinue therapy. The findings indicate that those who discontinue with therapy have more complex personality disorder profiles and are more externally motivated for therapy and were less internally motivated. A negative problem solving orientation predicts discontinuation of therapy. Therapy discontinues spend on average 3 times longer in hospital compared to continuers. Study 7 (chapter 8) begins to devise a method of assessing and measuring an individual's response to and progress in Dialectical Behaviour Therapy using single case experimental methods. The findings indicate that although effective methods exist they require tailoring to an individual patients' clinical functioning and ongoing monitoring.