Look at the human being in front of you who’s hurting : clients with a borderline personality disorder diagnosis describe their experiences of discriminatory and helpful behaviour from health professionals

Abstract

This thesis investigates discriminatory experiences shared by people with a borderline personality disorder (BPD) diagnosis in New Zealand focussing on interactions with health professionals. It also enquires into what participants found helpful from health professionals. While research has established the existence of negative attitudes from health staff toward this diagnosis, there is no existing research specifically exploring discriminatory behaviour from this client group’s perspective. This research remedies this gap.

Semi-structured interviews were conducted with eight individuals who self-identified as having a diagnosis of BPD and having experienced discriminatory behaviour; these interviews were analysed using an interpretive phenomenological analysis framework. Experiences discussed were grouped into three thematic areas: 1. Discriminatory behaviour from health professionals; 2. Helpful behaviour from health professionals and 3. The role of the individual. This third grouping acknowledges the active role of the client in their journey and also the potential of individual practitioners to make a noted difference, positively and negatively, in clients’ lives; the positive impact of professionals is an encouraging finding.

Discriminatory incidents all included the element of perceived lack of compassion and/or respect but also included elements of diagnostic stigma, judgement/misunderstanding, lack of enquiry and lack of transparency in health care decisions.

Incidents took place in a wide range of health-care situations, although particularly in relation to self-harming behaviour. The discriminatory and unhelpful behaviours frequently increased participants’ negative ideas about themselves. Complaints from service-users did not appear to be handled well; complaints by people with this diagnosis may be seen as indicative of pathology, and therefore not taken seriously. This situation may inhibit clients with this diagnosis from complaining about inappropriate practice.

Helpful experiences that participants shared were linked by themes of “connecting” (through caring and through building a relationship with the individual) and “seeing more” (beyond the diagnosis and negative behaviours, and seeing the context of an individual’s history and current situation).

Although an exploratory study, the results suggest that both iatrogenic and excellent practice is happening with this client group. The study findings suggest areas where health professionals may wish to examine their practice with clients who have been given this diagnosis.