Ubicación de la fuente de la Plaza de la Alianza

Despite the increase in provision across mental health trusts in England and the evidence demonstrating cost-effective specialist interventions, there continues to be inconsistency in service availability for people with a diagnosis of PD (Evans et al., 2017). This is the first project to have successfully captured a group of service-users’ diagnostic journeys across services, following the implementation of NIMH(E) (2003) guidance, and explored the impact this has on identity and understanding of mental health. Participants’ narratives highlighted

38# how the diagnostic process, particularly within CNS, helped them make sense of themselves and challenging past experiences, and to better understand their mental health. However, this process and the pathway to specialist treatment was viewed as unnecessarily long and unclear. Participants felt they had to “jump through hoops” and that their difficulties had to get much worse before they could access the support they needed. These findings contribute to the limited research exploring service-users’ experiences of psychiatric diagnosis. Despite the potential challenges of recruiting service-users who experience high levels of distress to discuss sensitive topics (McCosker, Barnard & Gerber, 2001), this study highlights the importance of gaining a comprehensive understanding of service-users’ unique experiences and perspectives on accessing services. The is in line with the aims of NIMH(E) guidelines which emphasise the importance of service-user contribution to the development and functioning of services.

39# 5.! References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed. Rev) (DSM-5). Washington, DC: American Psychiatric Association.

Atkinson, M., Clark, M., Clay, D., Johnson, M., Owen, D., & Szczepura, A. (2001). Systematic review of ethnicity and health service access for London. Interpretation, 51(3.3), 4.

Awenat, F., Berger, B., Coles, S., Dooley, C., Foster, S., Hanna, J., Hemmingfield, J., Johnstone, L., Nadirshaw, Z., Wainwright, T., & Whomsley, S. (2013). Classification of behaviour and experience in relation to functional psychiatric diagnoses: Time for a paradigm shift. Leicester: British Psychological Society.

Bateman, A., & Fonagy, P. (2008). 8-year follow-up of patients treated for borderline personality disorder: mentalization-based treatment versus treatment as usual. The American Journal of Psychiatry, 165(5), 631-638.

Bateman, A.., & Fonagy, P. (2009). Randomized controlled trial of outpatient mentalization- based treatment versus structured clinical management for borderline personality disorder. The American Journal of Psychiatry, 166(3), 1355-1364.

Bateman, A., & Fonagy, P. (2013). Impact of clinical severity on outcomes of mentalisation- based treatment for borderline personality disorder. The British Journal of Psychiatry, 203(12), pp. 221-7.

Bateman, A., & Fonagy, P. (2016). Mentalization-based treatment for personality disorders: A practical guide. Oxford University Press.

Beckwith, H., Moran, P. F., & Reilly, J. (2014). Personality disorder prevalence in psychiatric outpatients: a systematic literature review. Personality and Mental Health, 8(2), 91-101.

40# Bhui, K., Stansfeld, S., Hull, S., Priebe, S., Mole, F., & Feder, G. (2003). Ethnic variations in pathways to and use of specialist mental health services in the UK: systematic review. The British Journal of Psychiatry, 182(2), 105-116.

Bilderbeck, A. C., Saunders, K. E. A., Price, J., & Goodwin, G. M. (2014). Psychiatric assessment of mood instability: Qualitative study of patient experience. The British Journal of Psychiatry: The Journal of Mental Science, 204(3), 234-239.

Bowlby, J. (1969). Attachment and loss: Vol 1. Attachment. New York: Basic Books.

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101.

Breakwell, G. M. (1986). Coping with threatened identities. London: Methuen.

Breakwell, G. M. (1988). Strategies adopted when identity is threatened. Revue Internationale de Psychologie Sociale, 1 , 189 – 204 .

Breakwell, G. M. (1992). Processes of self-evaluation: efficacy and estrangement. In G. M. Breakwell (ed.), Social psychology of identity and the self concept (pp.33–55). London: Academic Press/Surrey University Press.

Breakwell, G. M. (1993). Social representations and social identity. Papers on Social Representations, 2 (3), 1 – 20.

Breakwell, G. M. (2001). Social representational constraints upon identity processes. In K. Deauxand G. Philogene (eds.), Representations of the social: bridging theoretical traditions (pp. 271 – 84). Oxford : Blackwell.

41# Chiesa, M., Fonagy, P., Holmes, J., Drahorad, C., & Harrison-Hall, A. (2002). Health service. use costs by personality disorder following specialist and non-specialist treatment: a comparative study. Journal of Personality Disorders, 16(2), 160-173.

Cuthbert, B. N., & Insel, T. R. (2013). Toward the future of psychiatric diagnosis: the seven pillars of RDoC. BMC Medicine, 11(1), 126.

Dale, O., Sethi, F., Stanton, C., Evans, S., Barnicot, K., Sedgwick, R., ... & Urquia, N. (2017). Personality disorder services in England: findings from a national survey. BJPsych Bull, 41(5), 247-253.

Evans, S., Sethi, F., Dale, O., Stanton, C., Sedgwick, R., Doran, M., ... & Haigh, R. (2017). Personality disorder service provision: a review of the recent literature. Mental Health Review Journal, 22(2), 65-82.

Finlay, L., & Gough, B. (2008). Reflexivity: A practical guide for researchers in health and social sciences (Eds.). Oxford: Blackwell Science Ltd.

Fromene, R., & Guerin, B. (2014). Talking with Australian indigenous clients with a borderline personality disorder diagnosis: Finding the context behind the label. Psychological Record, 64(3), 569-579.

Giorgi, A. (2010). Phenomenology and the practice of science. Existential Analysis: Journal of the Society for Existential Analysis, 21(1).

Goddard, M., Smith, P. (1998). Equity of access to health care. Centre for Health Economics Occasional Paper. UK: University of York.

Green, M. F. (2006). Cognitive impairment and functional outcome in schizophrenia and bipolar disorder. Journal of Clinical Psychiatry, 67(10).

42# Gross, A. B., & Keller, H. R. (1992). Long, term consequences of childhood physical and psychological maltreatment. Aggressive behavior, 18(3), 171-185.

Haigh, R. (2002) Services for people with personality disorder: the thoughts of service users. Retrieved from:

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuida

nce/DH_4009546

Hefferon, K., & Gil-Rodriguez, E. (2011). Reflecting on the rise in popularity of interpretive phenomenological analysis. The Psychologist, 24, 756-759.

Horn, N., Johnstone, L., & Brooke, S. (2007). Some service user perspectives on the diagnosis of borderline personality disorder. Journal of Mental Health, 16(2), 255-269. Ingram, N. (2018). How does the diagnostic process in personality disorder influence how service-users understand their identity and mental health? "Manuscript in preparation"

Jaspal, R., & Breakwell, G. M. (Eds.). (2014). Identity process theory: Identity, social action and social change. Cambridge University Press.

Johnstone, L. (2014). A straight talking introduction to psychiatric diagnosis. PCCS Books. Johnstone, L., Boyle, M., Cromby, J., Dillon, J., Harper, D., Kinderman, P., ... & Read, J. (2018). The power threat meaning framework: towards the identification of patterns in emotional distress, unusual experiences and troubled or troubling behaviour, as an alternative to functional psychiatric diagnosis. Leicester: British Psychological Society.

Lamb, N., Sibbald, S., and Stirzaker, A. (2018) Shining lights in dark corners of people's lives: Reaching consensus for people with complex mental health difficulties who are given a diagnosis of personality disorder. Crim Behav Ment Health, 28, 1–4.

43#

Larkin, M., & Griffiths, M. D. (2002). Experiences of addiction and recovery: The case for subjective accounts. Addiction Research & Theory, 10(3), 281-311.

Lawn, S., & McMahon, J. (2015). Experiences of care by Australians with a diagnosis of borderline personality disorder. Journal of Psychiatric and Mental Health Nursing, 22(7), 510- 521.

Liebman, R. E., & Burnette, M. (2013). It's not you, it's me: an examination of clinician, and client, level influences on countertransference toward borderline personality disorder. American Journal of Orthopsychiatry, 83(1), 115-125.

Linehan, M. M., Comtois, K. A., Murray, A. M., Brown, M. Z., Gallop, R. J., Heard, H. L., ... & Lindenboim, N. (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry, 63(7), 757-766.

Lovell, L. J., & Hardy, G. (2014). Having a diagnosis of borderline personality disorder in a forensic setting: A qualitative exploration. Journal of Forensic Practice, 16(3), 228-240. Maniglio, R. (2009). The impact of child sexual abuse on health: A systematic review of reviews. Clinical Psychology Review, 29(7), 647-657.

McCosker, H., Barnard, A., & Gerber, R. (2001). Undertaking sensitive research: Issues and strategies for meeting the safety needs of all participants. Qualitative Social Research, 2(1). McCrone, P. R., Dhanasiri, S., Patel, A., Knapp, M., & Lawton-Smith, S. (2008). Paying the price: the cost of mental health care in England to 2026. King's Fund.

McManus, S. B., Bebbington, P., Jenkins, R., & Brugha, T. (2016). Mental health and wellbeing in England: Adult Psychiatric Morbidity Survey 2014. Retrieved from

44#

https://digital.nhs.uk/data-and-information/publications/statistical/adult-psychiatric- morbidity-survey/adult-psychiatric-morbidity-survey-survey-of-mental-health-and- wellbeing-england-2014

Meuldijk, D., McCarthy, A., Bourke, M. E., & Grenyer, B. F. (2017). The value of psychological treatment for borderline personality disorder: Systematic review and cost offset analysis of economic evaluations. PloS One, 12(3), e0171592.

Morris, C., Smith, I., & Alwin, N. (2014). Is contact with adult mental health services helpful for individuals with a diagnosable BPD? A study of service users views in the UK. Journal of Mental Health, 23(5), 251-255.

National Institute for Health and Care Excellence. (2009). Borderline personality disorder: Recognition and management (NICE Clinical Guidance CG78). Retrieved from

https://www.nice.org.uk/guidance/cg78

Nehls, N. (1999). Borderline personality disorder: The voice of patients. Research in Nursing & Health, 22(4), 285-293.

Paris, J. (2007a). The nature of borderline personality disorder: multiple dimensions, multiple symptoms, but one category. Journal of Personality Disorders, 21(5), 457-473.

Paris, J. (2007b). Why psychiatrists are reluctant to diagnose: borderline personality disorder. Psychiatry (Edgmont), 4(1), 35.

Ramon, S., Castillo, H., & Morant, N. (2001). Experiencing a personality disorder: A participative research. International Journal of Social Psychiatry, 47(4), 1-15.

Richardson, E., & Tracy, D. K. (2015). The borderline of bipolar: Opinions of patients and lessons for clinicians on the diagnostic conflict. Bjpsych Bulletin, 39(3), 108-113.

45# Rock, P. L., Roiser, J. P., Riedel, W. J., & Blackwell, A. D. (2014). Cognitive impairment in depression: a systematic review and meta-analysis. Psychological Medicine, 44(10).

Sansone, R. A., & Sansone, L. A. (2011). Gender patterns in borderline personality disorder. Innovations in Clinical Neuroscience, 8(5).

Sarkar, J., & Duggan, C. (2010). Diagnosis and classification of personality disorder: difficulties, their resolution and implications for practice. Advances in Psychiatric Treatment, 16(5), 388-396.

Smith, J. A. (2008). Qualitative Psychology: A Practical Guide to Research Methods. London: Sage.

Smith, J. A., Flowers, P., & Larkin, M. (2009). Interpretative Phenomenological Analysis: Theory Method and Research. London: Sage.

Smith, J. A., Michie, S., Stephenson, M. and Quarrell, O. (2002). Risk perception and decision making in candidates for genetic testing in Huntingdon's disease: An interpretative phenomenological analysis. Journal of Health Psychology, 7, 131 - 144.

Smith, J. A. & Osborn, M. (2003). Interpretative phenomenological analysis. In J. A. Smith (Ed.) Qualitative Psychology: A practical guide to research methods. London: Sage.

Stalker, K., Ferguson, I., & Barclay, A. (2005). 'It is a horrible term for someone': Service user and provider perspectives on 'personality disorder'. Disability & Society, 20(4), 359-373. Sulzer, S. H., Muenchow, E., Potvin, A., Harris, J., & Gigot, G. (2016). Improving patient- centered communication of the borderline personality disorder diagnosis. Journal of Mental Health, 25(1), 5.

46# Tuffour, I. (2017). A critical overview of interpretative phenomenological analysis: a contemporary qualitative research approach. Journal of Healthcare Communications, 2(4). Turner, A., Barlow, J. and Ilbery, B. (2002). Play hurt, live hurt: Living with and managing osteoarthritis from the perspective of ex-professional footballers. Journal of Health Psychology, 7, 285 - 301.

Veysey, S. (2014). People with a borderline personality disorder diagnosis describe discriminatory experiences. Kotuitui: New Zealand Journal of Social Sciences Online, 9(1), 20-35.

Vignoles, V. L., Chryssochoou, X., and Breakwell, G. M. (2002). Evaluating models of identity motivation: self-esteem is not the whole story. Self and Identity, 1 (3), 201 –218.

Warwick, R., Joseph, S., Cordle, C., & Ashworth, P. (2004). Social support for women with chronic pelvic pain: what is helpful from whom?. Psychology & Health, 19(1), 117-134. Widiger, T. A. (2011). A shaky future for personality disorders. Personality Disorders: Theory, Research, and Treatment, 2(1), 54.

Willig, C. (2013). Introducing qualitative research in psychology (3rd Ed.). McGraw-Hill Education: England.

Yardley, L. (2000). Dilemmas in qualitative health research. Psychology and Health, 15(2), 215-228.

Zanarini, M. C., Frankenburg, F. R., Reich, D. B., & Fitzmaurice, G. (2012). Attainment and stability of sustained symptomatic remission and recovery among patients with borderline personality disorder and axis II comparison subjects: a 16-year prospective follow up study. American Journal of Psychiatry, 169(5), 476-483.

47# Zanarini, M. C., Williams, A. A., Lewis, R. E., & Reich, R. B. (1997). Reported pathological childhood experiences associated with the development of borderline personality disorder. The American Journal of Psychiatry, 154(8), 1101.

Zimmerman, M. (2011). A critique of the proposed prototype rating system for personality disorders in DSM-5. Journal of Personality Disorders, 25(2), 206-221.

48# List of Appendices

Page number

Appendix A - Favourable ethical approval 49

A.1 - HRA approval 49

A.2 - Research and Ethics Committee 52

A.3 - University Sponsorship 56

Appendix B - Participant information sheet 58

Appendix C - Participant consent form 62

Appendix D - Semi-structured interview schedule 64

Appendix E - Analytic process for IPA as outlined by Smith, Flowers & Larkin (2009)

65