Women’s accounts of treatment for borderline personality disorder in adolescence

Research has established that borderline personality disorder (BPD) can be diagnosed before the age of 18. However, many clinicians are apprehensive about using the diagnosis and treating BPD in adolescence. Specialized treatments have been developed and evaluated for BPD in adolescence. Mentalization-based therapy (MBT) is one of these. However, long-term follow-up studies are lacking, and the potential effects of getting the BPD diagnosis and treatment in adolescence are not yet well understood. We set out to explore the experiences of MBT group treatment for BPD five years later. The aim was to understand how they experienced the treatment and how it may have influenced them since. Twelve women aged 19–23 were included in the study. The women had participated in a randomized controlled trial investigating group MBT five years earlier. Qualitative data was collected through semi-structured interviews. The data were analyzed using a narrative, phenomenological framework by an interdisciplinary research group. The results showed a common narrative consisting of four themes: (1) patients without influence, (2) the process of getting diagnosed in adolescence, (3) group therapy: dynamics & alliance, and (4) frustration & alternative coping strategies. The four themes were intertwined by two cross-cutting themes: (1) the system, (2) the life outside. The results showed that the BPD diagnosis had impacts on the participants’ identity and self-understanding. Feeling like a patient without influence made the participants unwilling to seek help from mental health services later in life. The MBT group treatment was generally experienced as unhelpful due to a range of treatment specific-, common- and systemic factors. The participants developed maladaptive coping strategies to deal with serious mental health problems to stay out of touch with the mental health services.