Patients' and informal carers' insights into influences on prescribing in borderline personality disorder: a qualitative interview study in the UK

Abstract

OBJECTIVES: To explore the patient and informal-carer reported factors that influence prescribing decisions in the management of borderline personality disorder (BPD). DESIGN: The study employed a qualitative methodology of semi-structured interviews with patients and informal carers to examine perspectives on prescribing decisions and the factors shaping them. SETTING: Interviews were conducted across both primary and secondary care settings in England. PARTICIPANTS: A total of 10 participants were recruited for the study, comprising eight females and two males, all aged 18 years or older. Participants either had a formal diagnosis of BPD or were informal carers of individuals diagnosed with BPD. All participants had experience with the prescribing of medication for the management of BPD. RESULTS: Thematic analysis, employing both inductive and deductive strategies and informed by agency theory, yielded three interrelated themes: prescribing for symptom relief, the impact of risk on prescribing and difficulties in accessing services. Participants described medication as a necessary means of managing distress, especially when access to psychological therapies was constrained. Despite awareness of potential adverse effects, many expressed a strong desire to make their own decision around medication. CONCLUSIONS: Improving clarity around the likelihood of both symptomatic relief and potential adverse effects through co-designed informational resources may support more informed decision-making in the treatment of BPD. Furthermore, to change prescribing patterns, systemic gaps in the provision of long-term psychological therapies must be addressed.