Perspectives on positive risk taking from people diagnosed with a borderline personality disorder : an interpretative phenomenological analysis

Abstract

Background: People with a borderline personality disorder diagnosis can require support from mental health services for managing risk behaviour. Evidence suggests current inpatient and community treatment can be unhelpful for this group, who usually require specialist approaches. Positive risk taking has been developed to help community teams manage risk with people with a borderline personality disorder. Aim: To understand how positive risk taking is experience by people with a borderline personality disorder diagnosis. Method: A qualitative study using Interpretative Phenomenological Analysis (IPA) to analyse transcripts from semi-structured interviews. Nine adults with a diagnosis of borderline personality disorder and experiences of positive risk taking approaches were sampled from one NHS Trust. Participants were either currently or had previously been under the care of a community mental health recovery service. Results: Participants’ engagement in positive risk taking was coloured by earlier negative experiences of the healthcare system (including previous risk management), interpersonal complexity in professional relationships and experiences of isolation. When participants were engaged in positive risk taking or with approaches using positive risk taking principles, these were experienced as a helpful alternative to traditional risk management. This seemed contingent upon collaborative and trusting relationships with professionals who created an emotional ‘safety net’, which appeared to empower participants to connect with outside agencies and challenge recovery-relapse patterns of service use. Conclusions: Positive risk taking seems to have the potential to benefit others with a borderline personality disorder based upon participants’ experiences. Participants’ experiences compliment those of service users in other studies emphasising the importance of interpersonal factors, such as compassion and empathy, when working with personality disorder. Positive risk taking itself was relatively unfamiliar to participants though findings are clinically relevant. Participants’ experiences suggest more training and increased resources are required to implement positive risk taking successfully with borderline personality disorder.