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Women, self-harm and borderline personality\ud disorder: a search for understanding

By Tammi Walker


Adopting a case study approach (Yin, 1984; Stake, 1995;) this study aims to explore the\ud experiences of 'self-harm' by women who have been given a diagnosis of 'borderline\ud personality disorder' (BPD) within one area of a Mental Health NHS Trust. By taking a\ud material-discursive-intrapsychic approach (Ussher, 1999; 2000) this research explores\ud the accounts that have been constructed around 'self-harm' and 'BPD' by mental health\ud professionals working with women and women themselves. This research looks at the\ud ways in which 'self-harm' and the diagnosis of 'BPD' are operationalised by\ud professionals and the implications arising from these constructions and discourses when\ud delivering services to women. The study also explores the narrative accounts of women\ud who access the mental health care arena in relation to their experiences of 'self-harm'\ud and 'BPD', and in particular how they have constructed and experienced such responses\ud in their everyday lives.\ud The process of data gathering for this project was organised in two phases. In the first\ud phase of data gathering eight mental health professionals participated in conversational\ud interviews (Nichols, 1991; Conrad and Schober, 1998). These professionals worked for\ud the Mental Health NHS Trust and each of them aimed to provide care, support and\ud treatment for individuals accessing mental health services. The second phase of the\ud research involved the participation of four women, living in the locality of the NHS Trust,\ud in lengthy narrative interviews (Reissman, 1993). Data analysis for phase one drew\ud upon the guidelines developed by Willig (1999; 2001) and for phase two Reissman's\ud (1993) thematic narrative analysis and Langellier's (1989) personal narrative guided the\ud analytical process.\ud 5\ud Unlike previous research that has explored 'self-harm' and 'BPD' the present study\ud draws upon social constructionism, critical realism and post-modern thinking. This\ud approach has made it possible for an alternate way of considering 'self-harm' and 'BPO'.\ud Individual women at material, discursive and intrapsychic levels experience this\ud phenomenon. It's meaning to women, and to the mental health care professionals, has\ud to be understood in relation to the specific historical and cultural contexts in which both\ud are positioned and the dominant cultural discourses that exist at these times. By\ud drawing upon a critical realist epistemological standpoint and adopting a materialdiscursive-\ud intrapsychic analysis the present study has been able to incorporate these\ud different layers of the women's subjective experience, and the different types of expert\ud knowledge about 'self-harm' and 'BPO', into one framework. The present study has\ud been able to explore 'self-harm' and 'BPO', both as discursive constructs and a set of\ud symptoms experienced by individual women

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