0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

Articles   |    
Advance Statements for Borderline Personality Disorder: A Qualitative Study of Future Crisis Treatment Preferences
Rohan Borschmann, D.Clin.Psy.; Kylee Trevillion, Ph.D.; R. Claire Henderson, M.R.C.Psych., Ph.D.; Diana Rose, Ph.D.; George Szmukler, M.D., F.R.C.Psych.; Paul Moran, M.R.C.Psych., M.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300303
View Author and Article Information

The authors are with the Health Services and Population Research Department at the Institute of Psychiatry, King’s College London, London, United Kingdom (e-mail: rohan.borschmann@kcl.ac.uk).

Copyright © 2014 by the American Psychiatric Association

Abstract

Objective  Little is known about the crisis treatment preferences of people with borderline personality disorder. Clinicians may also question service users’ ability to make considered decisions about their treatment when in crisis. Therefore, this qualitative study aimed to investigate crisis treatment preferences of a sample of community-dwelling adults with borderline personality disorder.

Methods  Participants were 41 adults with borderline personality disorder who had created joint crisis plans during a randomized controlled trial. Data from all 41 joint crisis plans were analyzed iteratively via a thematic analysis framework.

Results  Participants gave clear statements in their crisis plans relating to the desire to recover from the crisis and to improve their social functioning. Key themes included the desire to be treated with dignity and respect and to receive emotional and practical support from clinicians. Many participants spoke of the importance of connecting with others during periods of crisis, but several reported a clear desire to be left alone during a future crisis. Other themes concerned preferences for specific treatment refusals during crises, including particular types of psychotropic medication and involuntary treatment.

Conclusions  The variation of participants’ preferences underscores the importance of developing individually tailored crisis plans for people with borderline personality disorder. The need to be treated with dignity and respect and to be given autonomy in decision making—also identified in global surveys of people with severe mental illness—is important to people with borderline personality disorder. Key messages for clinicians, service users, and policy makers, in addition to staff training issues, are discussed.

Abstract Teaser
Figures in this Article

Your Session has timed out. Please sign back in to continue.
Sign In Your Session has timed out. Please sign back in to continue.
Sign In to Access Full Content
 
Username
Password
Sign in via Athens (What is this?)
Athens is a service for single sign-on which enables access to all of an institution's subscriptions on- or off-site.
Not a subscriber?

Subscribe Now/Learn More

PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing PsychiatryOnline@psych.org or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Anchor for Jump
Table 1Characteristics of 41 participants with BPD who created joint crisis plansa
Table Footer Note

a BPD, borderline personality disorder

Anchor for Jump
Table 2Situations and actions participants with borderline personality disorder perceived as helpful and unhelpful in times of crisis
Table Footer Note

a Anonymous telephone counseling service in the United Kingdom

Anchor for Jump
Table 3Specific actions that participants with borderline personality disorder desired from their mental health professionals in future crises
+

References

 Diagnostic and Statistical Manual of Mental Disorders , 4th ed, Text Revision (DSM-IV-TR).  Arlington, Va,  American Psychiatric Association, 2000
 
Coid  J;  Yang  M;  Bebbington  P  et al:  Borderline personality disorder: health service use and social functioning among a national household population.  Psychological Medicine 39:1721–1731, 2009
 
Comtois  KA;  Russo  J;  Snowden  M  et al:  Factors associated with high use of public mental health services by persons with borderline personality disorder.  Psychiatric Services 54:1149–1154, 2003
 
Salkovskis  PM;  Atha  C;  Storer  D:  Cognitive-behavioural problem solving in the treatment of patients who repeatedly attempt suicide: a controlled trial.  British Journal of Psychiatry 157:871–876, 1990
 
McGirr  A;  Paris  J;  Lesage  A  et al:  Risk factors for suicide completion in borderline personality disorder: a case-control study of cluster B comorbidity and impulsive aggression.  Journal of Clinical Psychiatry 68:721–729, 2007
 
Borderline Personality Disorder: Treatment and Management. NICE Clinical Guideline 78. London, National Institute for Health and Clinical Excellence, 2009
 
Szmukler  G:  “Personality disorder” and capacity to make treatment decisions.  Journal of Medical Ethics 35:647–650, 2009
 
Borschmann  R;  Henderson  C;  Hogg  J  et al:  Crisis interventions for people with borderline personality disorder.  Cochrane Database of Systematic Reviews 6:CD009353, 2012
 
Borschmann  R;  Moran  P:  Crisis management in borderline personality disorder.  International Journal of Social Psychiatry 57:18–20, 2011
 
Swanson  JW;  Tepper  MC;  Backlar  P  et al:  Psychiatric advance directives: an alternative to coercive treatment? Psychiatry 63:160–172, 2000
 
Henderson  C;  Swanson  JW;  Szmukler  G  et al:  A typology of advance statements in mental health care.  Psychiatric Services 59:63–71, 2008
 
Henderson  C;  Flood  C;  Szmukler  G:  Shared decision making[reply to letter].  Psychiatric Services 58:140, 2007
 
Rucklewska A, Mulder CL, Van der Waal R, et al: Crisis plans facilitated by patient advocates are better than those drawn up by clinicians: results from an RCT. Administration and Policy in Mental Health and Mental Health Services Research (Epub Dec 13, 2012)
 
Srebnik  DS;  La Fond  JQ:  Advance directives for mental health treatment.  Psychiatric Services 50:919–925, 1999
 
Psychiatric Advance Directives. Alexandria, Va, Mental Health America, 2013. Available at www.mentalhealthamerica.net/psychiatric-advance-directives-taking-charge-your-care
 
Psychiatric Advance Directives: An Overview. Arlington, Va, National Alliance on Mental Illness, 2013. Available at www.nami.org/Content/ContentGroups/Policy/Issues_Spotlights/Psychiatric_Advance_Directives_An_Overview.htm
 
Sutherby  K;  Szmukler  GI;  Halpern  A  et al:  A study of “crisis cards” in a community psychiatric service.  Acta Psychiatrica Scandinavica 100:56–61, 1999
 
Henderson  C;  Flood  C;  Leese  M  et al:  Effect of joint crisis plans on use of compulsory treatment in psychiatry: single blind randomized controlled trial.  British Medical Journal 329:136, 2004
 
Thornicroft  G;  Farrelly  S;  Szmukler  G  et al:  Clinical outcomes of joint crisis plans to reduce compulsory treatment for people with psychosis: a randomised controlled trial.  Lancet 381:1634–1641, 2013
 
Swanson  JW;  Swartz  MS;  Elbogen  EB  et al:  Facilitated psychiatric advance directives: a randomized trial of an intervention to foster advance treatment planning among persons with severe mental illness.  American Journal of Psychiatry 163:1943–1951, 2006
 
Henderson  C;  Flood  C;  Leese  M  et al:  Views of service users and providers on joint crisis plans: single blind randomized controlled trial.  Social Psychiatry and Psychiatric Epidemiology 44:369–376, 2009
 
Borschmann  R;  Barrett  B;  Hellier  JM  et al:  Joint crisis plans for people with borderline personality disorder: feasibility and outcomes in a randomised controlled trial.  British Journal of Psychiatry 202:357–364, 2013
 
Moran  P;  Borschmann  R;  Flach  C  et al:  The effectiveness of joint crisis plans for people with borderline personality disorder: protocol for an exploratory randomised controlled trial.  Trials 11:18, 2010
 
First  M;  Spitzer  R;  Gibbon  M  et al:  The Structured Clinical Interview for DSM-III-R personality disorders (SCID-II). Part II: multi-site test-retest reliability study.  Journal of Personality Disorders 9:92–104, 1995
 
First  MB;  Spitzer  RL;  Gibbon  M  et al:  The Structured Clinical Interview for DSM-III-R personality disorders (SCID-II). Part I: description.  Journal of Personality Disorders 9:83–91, 1995
 
Boyatzis  RE:  Transforming Qualitative Information: Thematic Analysis and Code Development .  Thousand Oaks, Calif,  Sage, 1998
 
Sweeney  A;  Greenwood  KE;  Williams  S  et al:  Hearing the voices of service user researchers in collaborative qualitative data analysis: the case for multiple coding.  Health Expectations 16:e89–e99, 2013
 
Schwandt  TA;  Lincoln  YS;  Guba  EG:  Judging interpretations: but is it rigorous? trustworthiness and authenticity in naturalistic evaluation.  New Directions for Evaluation 114:11–25, 2007
 
Gunderson  JG;  Chu  JA:  Treatment implications of past trauma in borderline personality disorder.  Harvard Review of Psychiatry 1:75–81, 1993
 
Miller  SA;  Davenport  NC:  Increasing staff knowledge of and improving attitudes toward patients with borderline personality disorder.  Psychiatric Services 47:533–535, 1996
 
Shanks  C;  Pfohl  B;  Blum  N  et al:  Can negative attitudes toward patients with borderline personality disorder be changed? The effect of attending a STEPPS workshop.  Journal of Personality Disorders 25:806–812, 2011
 
Commons Treloar  AJ;  Lewis  AJ:  Targeted clinical education for staff attitudes towards deliberate self-harm in borderline personality disorder: randomized controlled trial.  Australian and New Zealand Journal of Psychiatry 42:981–988, 2008
 
Srebnik  DS;  Rutherford  LT;  Peto  T  et al:  The content and clinical utility of psychiatric advance directives.  Psychiatric Services 56:592–598, 2005
 
Kim  MM;  Van Dorn  RA;  Scheyett  AM  et al:  Understanding the personal and clinical utility of psychiatric advance directives: a qualitative perspective.  Psychiatry 70:19–29, 2007
 
Moran  P;  Jenkins  R;  Tylee  A  et al:  The prevalence of personality disorder among UK primary care attenders.  Acta Psychiatrica Scandinavica 102:52–57, 2000
 
Shinefield  W;  Kalafat  J:  Effective management of borderline individuals in crisis.  Crisis Intervention and Time-limited Treatment 2:267–282, 1996
 
Rosenheck  RA:  Introduction to the special section: toward social inclusion.  Psychiatric Services 63:425–426, 2012
 
Slade  M:  Everyday solutions for everyday problems: how mental health systems can support recovery.  Psychiatric Services 63:702–704, 2012
 
Schuermann  B;  Kathmann  N;  Stiglmayr  C  et al:  Impaired decision making and feedback evaluation in borderline personality disorder.  Psychological Medicine 41:1917–1927, 2011
 
Jacob  R;  Clare  ICH;  Holland  A  et al:  Self-harm, capacity, and refusal of treatment: implications for emergency medical practice: a prospective observational study.  Emergency Medicine Journal 22:799–802, 2005
 
Winburn  E;  Mullen  R:  Personality disorder and competence to refuse treatment.  Journal of Medical Ethics 34:715–716, 2008
 
Henderson  C;  Corker  E;  Lewis-Holmes  E  et al:  England’s Time to Change antistigma campaign: one-year outcomes of service user–rated experiences of discrimination.  Psychiatric Services 63:451–457, 2012
 
Thornicroft  G;  Brohan  E;  Rose  D  et al:  Global pattern of experienced and anticipated discrimination against people with schizophrenia: a cross-sectional survey.  Lancet 373:408–415, 2009
 
Richards  T;  Montori  VM;  Godlee  F  et al:  Let the patient revolution begin.  British Medical Journal 346:f2614, 2013
 
References Container
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content
Articles
Books
The American Psychiatric Publishing Textbook of Psychiatry, 5th Edition > Chapter 20.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 53.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 53.  >
Topic Collections
Psychiatric News
APA Guidelines