Borderline personality disorder : studies of suffering, quality of life and dialectical behavioural therapy

The aims of the present thesis were: * To investigate how women patients with borderline personality disorder (BPD) perceive their suffering, quality of life and encounter with psychiatric care (paper 11 and III). * To describe BPD patients' and psychiatric professionals' perceptions of receiving and giving dialectical behavioural therapy, DBT (paper I). * To investigate how starting treatment of BPD patients with DBT affected the psychiatric professionals' experience of occupational stress and professional burnout (paper IV) Due to the different types of research questions the thesis deal with, it uses a mix of qualitative and quantitative research methods. In two of the studies (11 and 111) the main methods were qualitative. Data from free format questionnaires, individual- as well as group interviews and biographical texts, were analysed with content analysis or a hermeneutic approach. In study Ill the methods were quantitative. A summated rating scale measuring healthrelated quality-of-life (HRQOL) was analysed with descriptive and inferential statistics. In study IV quantitative and qualitative methods were combined. Two burnout inventories were analysed with descriptive and inferential statistics, and data from free format questionnaires and group interviews were analysed with qualitative content analysis. The main findings were that BPD patients suffer to an extent that is often unendurable, leading to deliberate self-harm (DSH) and suicide attempts to relieve suffering or just try to get away from it all (paper 11). In study Ill the BPD patients showed significantly poorer quality-of-life (even physical) than normal population controls of comparable age. The suffering, suicide attempts, DSH and poor quality-of-life (paper 11 and 111) put the patients in a position of voluntarily or involuntarily getting involved with psychiatric care. Study II revealed a double role of the psychiatric care in relation to BPD patients. On one hand, psychiatric professionals can add to the suffering by not being understanding and being disrespectful, on the other hand they can be helpful and relieve suffering by being respectful, understanding and validating. There was a clear relationship between the patients' experience of validation and the experience of being helped. DBT seems (both from the patients' and psychiatric professionals' perspective) to be a treatment with a philosophy, content and structure being able to relieve BPD patients suffering and helping them to independence and a bearable life-situation (paper I). Study IV confirms previous findings that psychiatric professionals experience treatment of self-harming patients as profoundly stressful. DBT was seen as stressful in terms of learning demands, but decreased the experience of stress in the actual treatment of the patients due to its high degree of structure and specific techniques. The DBT team-work and supervision were felt to be supportive, as was one particular facet of DBT, namely mindfulness training which some professionals felt also improved their handling of other work stressors not related to DBT. This finding also corresponds to BPD patients' perceptions of the mindfulness component in DBT, which they reported as particularly helpful (paper 1). It should be noted that the patient samples in the thesis may be considered as a "worse off" subgroup among BPD patients, as they usually entered special treatment programs after a period of escalating symptoms, which standard psychiatric services had had difficulties handling. The rather small number of participants and the lack of equivalent andlor concurrent control groups in the quantitative studies limit the generalization of the results

A sisyphean task : experiences of perfectionism in patients with eating disorders

Background: Despite the theoretical links between eating disorders and perfectionism, the definition of perfectionismin practice is complicated. The present study explored descriptions and experiences of perfectionism described by atransdiagnostic sample of patients. Methods: In-depth, semi-structured interviews were carried out with 15 patients. The interviews were analyzed byThematic Analysis. A comparison between the patients’ scorings on the Eating Disorder Inventory-Perfectionism scalewas also performed. Results: Seven themes were found: The origins of perfectionism, Top performance, Order and self-control, A perfectbody, Looking good in the eyes of others, A double-edged coping strategy, and A Sisyphean task. The women inthis study did not emphasize weight and body as the main perfectionistic strivings. Core descriptions were instead order,self-control and top performances. All of the participants described the awareness of reaching perfectionismas impossible. Scorings of self-oriented perfectionism was significantly higher compared to socially prescribedperfectionism. No differences in the narratives related to perfectionism scores or eating disorder diagnoseswere found. Conclusions: The results showed that psychometric measures do not always capture the patients’ definitionsof perfectionism, but regarding that perfectionism serves as a means to regulate affects and may lead into anexacerbation of the eating disorder, and the development of obsessive-compulsive symptoms, it is importantto investigate the personal definitions of perfectionism

Perfectionism and sense of coherence among patients with eating disorders

Background: There is a substantial body of research on eating disorders and perfectionism. Also there are several studies on eating disorders and sense of coherence (SOC), but studies regarding all three subjects are sparse. Perfectionism and the degree of SOC are considered central and aggravating aspects of psychiatric conditions, not least in relation to eating disorders. Aims: The present study aimed to describe the relationship between perfectionism as operationalized by Garner in the Eating Disorder Inventory-2 and SOC as defined by Antonovsky in the SOC-29 scale. The hypothesis was that SOC should be negatively associated with perfectionism. Methods: Data from the two self-measuring instruments collected from 95 consecutively recruited eating disorder outpatients were analysed with descriptive and inferential statistics. Results: The patients in the present study scored consistently with other Swedish eating disorder samples on the Perfectionism subscale in the Eating Disorder Inventory-2 (EDI-P) and on the SOC-29, indicating a higher degree of perfectionism and weaker SOC than normal population groups. Perfectionism was significantly correlated to SOC. The correlation was negative, confirming the study hypothesis. The hypothesis was further confirmed in a subgroup analysis comparing patients with different degrees of SOC related to their EDI-P scores. Conclusions: Perfectionism is associated with SOC in patients with eating disorders. Clinical implications: The clinical implications derived from the study could be a recommendation to focus on the SOC in patients with an eating disorder with the hope of lowering the patients’ perfectionism as well

A life tiptoeing : being a significant other to persons with borderline personality disorder

Aim The aim of this study was to describe significant others' experiences of living close to a person with borderline personality disorder and their experience of encounter with psychiatric care. Methods Data were collected by free-text questionnaires and group interviews and were analyzed by qualitative content analysis. Results and Conclusion The results revealed four categories: a life tiptoeing; powerlessness, guilt, and lifelong grief; feeling left out and abandoned; and lost trust. The first two categories describe the experience of living close to a person with BPD, and the last two categories describe encounter with psychiatric care

Need of support for significant others to persons with borderline personality disorder : A Swedish focus groupstudy

Background: Being a significant other (SO) to a person with borderline personalitydisorder (BPD) affect their health. High incidence of substance use disorder, posttraumaticstress disorder, stress, fear, anxiety, depression, family burden and griefare common. Some specific therapies for BPD, have included support to SOs, howeverresources are scarce and to participate in the support it assumes that the personwith BPD is included in these therapies. Although the SO support has been shown tobe helpful, they all have a similar structure, and only a small exclusive group of SOshave access to the support. Aim: The aim was to describe experiences and need of support for significant othersto persons with borderline personality disorder from the perspective of themselvesand of health care workers. Methods: Data was collected via two focus groups. One with five SOs to personswith BPD, one with five health care workers. Two interview sessions in each groupwere conducted and data were analysed with qualitative content analysis. The studywas approved by the research ethics committee of Lund (2016–1026). Results: The results revealed four themes; not being seen by health care professionalscreates hopelessness, being seen by healthcare professionals creates trust, experienceof support - helpful or shameful and the step from loosely structured supportto a structured support group. Both groups expressed a need for further support as acomplement to already existing support. Conclusions: The need of support is extensive. The results suggest a professionalcoordinator intended for SOs and peer support groups not linked to a particular psychiatrictreatment yet offering support in a structured way. Further studies examiningthese complements to existing support, is therefore recommended

The concept of 'work ability' from the view point of employers

BACKGROUND: Since work ability is manifested in working life and "bought" by employers, employers perceptions of the concept are important to understand. Studies have shown that people with health problems want to take part in the labour market, but experience difficulties in gaining access. Additionally, studies have demonstrated the doubt felt by employers when they consider hiring a person with a disability. OBJECTIVE: The aim was to identify and characterise employers' conceptions of work ability. METHODS: The study design was qualitative with a phenomenographic approach. Six male and six female employers from various workplaces and geographical areas in Sweden were interviewed. RESULTS: Three domains were identified: employees' contributions to work ability, employers' contributions to work ability and circumstances with limited work ability. Work ability was regarded as a tool in production and its output, production, was the main issue. The employees' commitment and interest could bridge other shortcomings. CONCLUSIONS: The employers highlighted their own contributions in shaping work ability in order to fit with work circumstances. Health problems were not the only limiting issues; other circumstances, such as individual characteristics and contextual factors, could limit work ability too. Knowing the importance of commitment and interest is valuable in work rehabilitation