What Factors Influence The Shared Prescribing Decisions Made By Healthcare Professionals, Patients, And Informal Carers In The Management Of Borderline Personality Disorder?

: (Alternative Format Thesis)

Abstract

Borderline Personality Disorder (BPD) is a psychiatric condition characterised by pervasive patterns of thinking and feeling, which can lead to social dysfunction and poor mental health. BPD has a significant impact not just on individuals with the diagnosis but also on those around them. Currently, no medication is licensed for BPD. In addition, existing systematic reviews have concluded that the use of psychotropics do not improve outcomes of those with BPD. Despite this, it is common for people with BPD to be prescribed multiple psychotropics.

A systematic review and two qualitative interview studies were conducted to explore factors that influence prescribing in adult BPD patients. The systematic review encompassed an extensive review of the limited existing literature and identified two drivers of prescribing, the patient-HCP relationship and the care pathway, as crucial to the prescribing process from both perspectives.

The qualitative studies involved thirty semi-structured interviews with healthcare professionals involved in prescribing for individuals with BPD, patients with BPD and informal caregivers of those with BPD. Data was analysed using thematic analysis, utilising both inductive and deductive approaches. Five themes were generated in the first study and three in the second study.

The findings of this project indicate that the therapeutic relationship appears to be central to prescribing decisions in BPD, with persistent tension between the beliefs of patients and HCPs, and clinical guidelines. Furthermore, to change prescribing patterns, systemic gaps in the provision of long-term psychological therapies must be addressed. This research provides an initial exploration of the factors shaping prescribing in BPD, alongside suggested policy and structural changes to facilitate alternative treatments.

Date of Award	22 Jul 2026
Original language	English
Awarding Institution	University of Bath
Supervisor	Matthew Jones (Supervisor)