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Dialectical Behaviour Therapy for People with Borderline Personality Disorder: A Rapid Qualitative Review

Last updated: November 26, 2020
Project Number: RC1320-000
Product Line: Rapid Response
Research Type: Non-Pharma Mental Health Intervention
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What are the perspectives and experiences of people with borderline personality disorder, their family and friends, and those involved in their lives and their care, with respect to:
    •  Accessing treatment for borderline personality disorder?
    •  Expectations of treatment for and recovery from borderline personality disorder?
    •  Engaging with dialectical behaviour therapy for borderline personality disorder?
    •  The role of mental health or addiction comorbidities and of systematic inequalities
    (e.g., socio-economic status, lack of housing) in experiences of accessing and undergoing treatment for borderline personality disorder?

Key Message

This rapid qualitative evidence synthesis included 12 primary qualitative studies on the perspectives and experiences of people living with BPD and people involved in their lives on accessing and undergoing therapy for BPD including DBT.

Accessing treatment started with accessing a diagnosis of BPD. People living with BPD found receiving a diagnosis offered them a sense relief and a way forward to treatment. When accessing care for their BPD through non-BPD specialist services, they described facing stigma.

Due to the volatile nature of BPD, people living with the condition identified the need to be able to access services when they were in crisis (i.e., at all hours of the day). People reported facing long wait lists and a lack of specialists when trying to access treatment for their BPD.

For many living with BPD, recovery was seen as a long, hard road with many ups and downs. Recovery was framed not as a return to self but as a shift to another way of being, of being able to cope with emotional distress and symptom reduction in ways that allowed them to engage positively in life, interpersonal relationships and activities such as work and school.

Engaging with DBT was largely described as a positive experience by participants with BPD. Negative views, particularly of group skills training, tended to relate to the content and the way it was delivered. Participants of DBT valued the ability to learn skills from each other through group skills training, and the sense of community that shared learning offered. Individual psychotherapy and telephone support provided additional support for people living with BPD to feel secure and to learn and practice applying their skills.

The recovery process required that people with BPD continually practice applying the skills they acquired through DBT. Once these skills became second nature, they felt that they were making headway towards recovery. People engaging in DBT for BPD appreciated the opportunity for their family and partners to receive information on and training in DBT.

People living with BPD and another mental health condition or substance use found it difficult to find and access appropriate treatment for their conditions. Some described the financial barriers as limiting their ability to access treatment. People living in rural areas who sought care for their BPD described having limited access.