Infraestructura de integración regional inadecuada

5.1a. I’m unwell - I cant help it

Stops them choosing to take responsibility for stuff and-

Interviewer: And you've seen that happen?

Interviewee: Yeah, an awful lot (Melissa)

When young people start talking about "Oh, it's not me, it's my personality disorder." That's quite worrying, that they have detached themselves from their lives and from their behaviours… "Well, now I'm definitely ill, you know, so my parent has to care for me because there's something wrong with me." (Zachary)

or you kind of externalise that into a diagnosis and say, "Actually, um -- do you know if I -- if I have that it's not really me, it's not my fault. I don't have control”. "I've got this diagnosis." (Thomas)

5.1b. Fantasy of a cure; you need to fix me

you know there’s an invitation to staff to do that because then they feel like they’ve done a really good job and that people are really pleased, and the family, you know. but again it’s the ‘better fantasy’ it something that doesn’t exist. So there’s always a pull to do that (Brian)

I think she- she kept having, kept seeing the medics, kept seeing , kept getting changes in medication, um, and um she kept thinking "oh this one is gonna be the one that makes me better rather than I need to do this work to get better" (Thomas)

And maybe their expectations. Theres not, theres no magical cure, children they can expect- they kind of want to go to this fantasy place (Ewan)

Sub-theme 5.2: Impact on identity 5.2a. I’m wrong, I’m

bad

And now were sort of saying ‘here it is’ thats, thats what is wrong with you (Alana)

personality disorder, sounds like somehow that some-- That someth-that-that-- Wrong with them and they might be I-I don't know more to blame for it or they don't have control somehow over their personality (Mira)

Or the-the sense that the parents make of it. You know, my child is now disordered (Melissa)

5.2b. Identify with other BPD people/traits

And this if you look online the kind of things the kind of groups that you can find you know the information that you find its yeh its not, its very extreme and invites people into very extreme behaviours and its associated with being kind of, positions in relation to other people (Brian)

But cutting particularly or burning or hair pulling just is much more. But, I guess t- that would be my concern is kind of the under 18 little less emotionally developed. With kind of, "I am this, therefore, I need to do that." So why-why they do that kind of stuff. (Melissa)

Erm, and i think maybe people with BPD are owning it a bit more, they have quite kind of, they they theres forums and they talk about the diagnosis so, any actually could be... they feel a bit more sort of empowered in some ways (Ewan)

Sub-theme 5.3: Diagnosis being helpful 5.3a. Easy to

understand and validate difficulties

I think it helps keep people safe as a result. Because some people are like ‘what on earth is wrong with me, the way I’m feeling’ you know, ‘I’m acting in this way that is totally- it’s impossible to understand’ when you can actually sort of say well no this is

something we

understand and this is what we call it and you might be able to read something useful. If you go down that avenue of actually having a diagnostic label to research(Alexander)

What I've noticed in my time is that families like a diagnosis, they like an explanation, they enjoy knowing that that's the reason my child is behaving that way. Definitely. In the community, um, Cans Team as well. A lot of families we've contact-- uh, will go through the mental health system in order to pick up a diagnosis so that they have something to hang their experiences on. So, I definitely feel that for parents, it's a bit of a weight of-off their shoulders so that they know what's driving the behaviour (Zachary)

Maybe that would give- give room to have a conversation about why a child is behaving the way they are, what the meaning for the behaviour is rather than just it's not okay. That's not allowed (Melissa)

5.3b. Helps to foster engagement in interventions

Um, so I-I think for s- some people, I think being able to kind of give a-a kind of a name to their difficulties, um, can be very very helpful, um, because it gives them greater understanding, it means that they can learn skills and things to kind of manage that emotional

dysregulation, to kind of identify, to kind of, you know, to almost kind of have it

validated that there's-- There's difficulty with them (Mira)

actually when people are given a diagnosis if they feel that that then gives them some understanding and some explanation it helps to contain things enough that they can then engage with that therapeutic support and they can be like ‘ok there’s a reason why this is happening and this is what I need to do about it’ Yeh And then they can, it can work really really well as well (Grace)

I think if a client is given the label and explained, you know, that they are now in control of choosing to change it and they want to change it, then- brilliant - so- then-then we-we're on our way now (Melissa)

5.3c. Diagnosis helps to access additional support

that's what people need for, I'm not saying this is the case but you know people need the benefits (Thomas)

is it- is it useful to have a diagnosis of

something when it comes to things like applying for a job, and- and whether there's then extra support or consideration to be given. And maybe- and maybe that is a good reason to have, um, a diagnosis (Georgina)

Sometimes it means that then they get something else if they've had the diagnosis. In terms of resources, in terms of help in school or whatever (Josephine)

Appendix K

Participant contributions to each theme/sub-theme

Theme Sub-Themes Participant n contribution

to the sub- theme:

Therapists Psychiatry Case Managers

Alana Brian Grace Thomas Alexander Ewan Hari Josephine Mira Georgina Melissa Susan Zachary

A change in our understanding of BPD A shift in our understanding of BPD 8 pressure for service development 12 I feel hopeful for these young

people 10 Shit Life Syndrome The context of their upbringing is essential 10 Language is very powerful 11 The person behind the diagnosis 12 Dynamics in the MDT

Feels like a bit of a battle 13 Coping with conflict 12 Resolving dilemmas about BPD diagnosis It’s a difficult decision to make 13 Collaborating 13

with the young person How diagnosis impacts upon the YP Loss of autonomy 11 Impact on identity 11 Diagnosis being helpful 13