The needs and experiences of family members and friends of someone with Borderline Personality Disorder

While the past twenty years has witnessed a surge in studies of caregiving, the experiences and needs of family members and friends caring for someone with Borderline Personality Disorder (BPD) has received limited attention. The aim of this thesis was to fill this gap. It provides an in-depth examination of family members' and friends’ caregiving experiences, coping styles, psychological consequences, and interactions with health care systems when caring for someone with BPD. Two studies were conducted. Study one was largely exploratory and focussed on the lived experience of the thirteen family members who participated. Using semi-structured interviews and a phenomenological approach in the qualitative analysis, four distinct coping groups were identified. The Loving-Active coping group and In-Flux participant used high levels of problem coping in combination with emotion-focused coping strategies and low levels of avoidant coping strategies. The Bound and Powerless, and the Distanced Managers groups used higher levels of avoidant coping, with the Bound and Powerless also using high levels of drugs and alcohol to cope. Challenging behaviours demonstrated by their BPD family members in this study were associated with the coping styles and explanations given for the trauma symptoms experienced by all caregivers. Despite these challenges, most participants talked about experiencing turning-points and positive outcomes in the longer term. Many more negative than positive experiences were recalled by family members in their experience of services and in their contacts with professionals that contributed to caregivers’ feelings of isolation. The aim of Study Two was to examine whether findings of Study One could be generalized to a larger and more varied sample of carers. The sample comprised 175 family members and friends, who completed a paper or internet survey on experience of caregiving, quality of life, coping strategies, distress levels, possible trauma, experiences of services for their BPD relative, and possible personal growth as a result of their experiences. Five distinct groups were identified based on their differing use of coping strategies. The Calmer Positive, Reactive Positive, and the Mixed Extreme groups used high levels of a combination of emotion and problem focused coping strategies, with the first two groups also low on avoidant coping. The Mixed Extremes, however, resorted to high levels of avoidant coping as did the Mixed Coping group. The Mixed Coping group however, showed lower levels of effective coping strategies overall. The Less Challenged group tended to use lower levels of all coping strategies. Differences in the coping groups translated into differences in a number of areas of impact for family members/friends. Across all groups carers reported experiencing six or more crisis times in a year wherein they experienced severe levels of depression, anxiety and stress and subsequent clinical levels of PTSD symptoms. Despite overall high levels of negative caregiving experiences and low levels of positive caregiving experiences, well-being levels for most groups were in the average range. But there was variation. The Mixed Copers had considerably lower well-being and posttraumatic growth than the Calmer Positive and Reactive Copers, most likely due to their lower use of effective problem-solving coping. The Mixed Extreme Coping group presented the most complex picture. This group, more likely to be in a spousal relationship with their person with BPD, reported their person as experiencing more periods of crises and fewer periods of calm, and displaying higher levels of difficult behaviours including uncontrolled anger, which had a higher impact on the family. The Mixed Extremes themselves, experienced unmatched levels of PTSD symptoms and although this group demonstrated comparable levels of posttraumatic growth, and levels of well-being in some areas as the better functioning groups, they felt that their environment was beyond their control more often, and felt more personally challenged and selfdoubting. Common across all groups was the high dissatisfaction of professionals and services, both in the care they provided for their family/friend with BPD and in the support they provided to carers. Dissatisfaction levels were not related to whether the mental health sector was private or public. General practitioners were reported to be involved in the care of the BPD person more often than other professional and marginally higher satisfaction levels with GPs were conveyed. Lowest satisfaction was reported for Crisis Assessment Teams (CAT Teams). In conclusion, this research offers some insight into what it is to be a carer of someone who displays BPD behaviours. Typically family members and friends bear immense responsibility in the care of their person with BPD, without being able to rely on the support of professionals and services. The caring role has costs on their own mental health. However, turning points and posttraumatic growth was also experienced.