The experience of personal recovery in personality disorder - - - PowerPoint PPT Presentation

The experience of personal recovery in personality disorder - systematic review and meta- synthesis

Andrew Shepherd - NIHR DRF and Higher trainee in Forensic Psychiatry, North West Deanery

Background

Personal recovery “…a way of living a satisfying, hopeful, and contributing life even with limitations caused by illness.” [Anthony 1993, p527]

• Accepting of ‘illness’ [?biomedical]
• Rehabilitative framework

Background - personal recovery

“The goal of the recovery process is not to become

• normal. The goal is to embrace our human vocation of

becoming more deeply, more fully human.” [Deegan, 1996, p92]

• No reference to ‘illness’
• Human process

Personal recovery - tension?

• Role of ‘illness’?
• Who defines?
• How to offer support?

Personality disorder

• Problematic - unclear nature with challenge to

current classification systems?

• How to make sense of idea of personal recovery in

light of personality disorder?

Proposal

• All accounts agree on idiographic nature of

recovery experience

• Therefore by focussing on experience of individuals

we can better explore and contextualise the personal

Systematic review and meta- synthesis

Aims Background sensitisation to literature: “To adequately map existing qualitative research literature relating to the experience of personal recovery in personality disorder”

Literature search

Systematic literature search:

• 1. To identify qualitative methods

literature

• 2. Personal experience of

recovery

• 3. Excluding clinical recovery

definitions

• 4. Requiring transparent

involvement of primary material

Meta-synthesis

Aim - To thematically map existing literature and develop higher order descriptive concepts Analogous to approach of Noblit and Hare (1988)

• 1. 1st order themes [participant quotations]
• 2. 2nd order themes [original author interpretation]
• 3. 3rd order themes [synthesised through coding and

group discussion]

Results & Discussion

Three studies meeting inclusion criteria Developed three overarching third order themes

• 1. Safety and containment as prerequisite to

recovery

• 2. Social networks and personal autonomy in the

recovery process

• 3. Identity construction as a process of change

Safety and Containment

“…I can come in and cry. The important thing is that coming here makes you safe enough to change.” [Castillo, 2013]

Safety and containment

Previous experiences of danger and invalidation (both personal and in professional settings) led participants to need a place of safety to allow change to begin.

Social networks and personal autonomy

“It’s all about human contact. I think a lot of people here realise what it’s like to be lonely, we all know what it’s like…” [Castillo, 2013]

Social networks and personal autonomy

‘Turning points’ were described - where active choices to change were made. However these processes were recognised as occurring within a social setting - family and friend networks and the risk

• f tension with mental health services.

Identity construction

“…’Your disorder is the reason why you try to kill and harm yourself.’ I stayed alive and for this I was grateful, but nobody saw me or spoke to me as a person.” [Holm, 2011]

Goran Bogicevic / shutterstock.com

Identity construction

Descriptions of effort to understand previous acts and

• behaviours. Varying interpretations of ‘illness’ were

described - from accounts for behaviour through to rejection of stigmatising labels

Conclusions

• Understandings of recovery can challenge clinical

approaches to mental distress - including personality disorder

• There is evidence that routinely used outcome frameworks

do not match well with personal recovery aspirations [Andresen, 2009]

• This review is limited by the small number of included

studies and methodological limitations of these studies

• Further work is required to better explore the personal

experience of recovery in relation to personality disorder

References

• 1. Anthony, W. A. (1993). Recovery from mental illness: The guiding vision of the mental health service

system in the 1990s. Psychosocial Rehabilitation Journal, 16, 521–538.

• 2. Deegan, P. (1996). Recovery as a journey of the heart. Psychiatric Rehabilitation Journal, 19(3), 91–97.
• 3. Noblit, G. W., & Hare, R. D. (1988). Meta-Ethnography: Synthesizing Qualitative Studies. SAGE

Publications.

• 4. Holm, A. L., & Severinsson, E. (2011). Struggling to recover by changing suicidal behaviour: narratives

from women with borderline personality disorder. International Journal of Mental Health Nursing, 20(3), 165–173. doi:10.1111/j.1447-0349.2010.00713.x

• 5. Katsakou, C., Marougka, S., Barnicot, K., Savill, M., White, H., Lockwood, K., & Priebe, S. (2012).

Recovery in Borderline Personality Disorder (BPD): a qualitative study of service users' perspectives. PLoS ONE, 7(5), 1–e36517. doi:10.1371/journal.pone.0036517.t002

• 6. Castillo, H., Ramon, S., & Morant, N. (2013). A recovery journey for people with personality disorder.

International Journal of Social Psychiatry, 59(3), 264–273. doi:10.1177/0020764013481891

• 7. Andresen, R., Caputi, P., & Oades, L. G. (2010). Do clinical outcome measures assess consumer-defined

recovery? Psychiatry Research, 177(3), 309–317. doi:10.1016/j.psychres.2010.02.013

Acknowledgements

I am funded by a NIHR fellowship grant. Opinions expressed represent those of myself and co-authors, not necessarily those of the NIHR, NHS or DoH.

Thanks to my supervisory team: Caroline Sanders Michael Doyle Jenny Shaw