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Personality disorder overlooked

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SERVICE shortages and disagreements among staff about the best treatment often prevent people with borderline personality disorder (BPD) from receiving appropriate care, results from a survey carried out in Ireland suggest.

SERVICE shortages and disagreements among staff about the best treatment often prevent people with borderline personality disorder (BPD) from receiving appropriate care, results from a survey carried out in Ireland suggest.

Nurse specialists say the survey's findings have implications for the UK, where up to 13% of the population are estimated to have the condition.

Researchers in Dublin surveyed 157 psychiatric nurses and discovered that 81% of respondents believed people with BPD did not receive adequate levels of care.

Around 98% of respondents in the survey blamed a lack of services and 83% said that differences of opinion between staff about how best to care for people with BPD was a major factor.

Fiona McGruer, nurse specialist at the Birmingham Personality Disorder Service, one of only three specialist services for BPD in the UK, said: 'Because it is not a formal mental health primary diagnosis [patients] cannot get adequate treatment.

'There are services available, but a lot of mental health trusts don't think they are worth it.'

She added: ' There is a battle around diagnosis because BPD is very complex. Those with the condition can range from inpatients at Broadmoor, with serious sychiatric illness, to those who self-harm or have suicidal tendencies.'

More than a quarter of the nurses who took part in the Irish survey said they came into daily contact with patients with BPD, yet only 3% had received postgraduate training in the condition.

In addition, 80% said patients with BPD were more difficult to look after than patients with other mental health conditions.

Ian Hulatt, RCN mental health adviser, said: 'Often they have had traumatic life experiences and lead very chaotic lives. BPD is a poorly understood condition and is known as a "dustbin diagnosis" for difficult patients.

'This survey highlights the fact that a lot of nurses really don't know much about the condition, and a lot more education and training is needed if services are to be delivered in a consistent and appropriate manner.'

Journal of Psychiatric and Mental Health Nursing (2007) 14: 670-678

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