Autism, borderline personality disorder and the inpatient experience

Woods, Kat (2025) Autism, borderline personality disorder and the inpatient experience. PhD thesis, Lancaster University.

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Abstract

This thesis is comprised of a literature review, an empirical paper, a critical appraisal of the research process and ethics documentation. The literature review synthesised the findings of 12 qualitative papers and used a meta-ethnographic approach to understand the experiences of therapy for women with a diagnosis of borderline personality disorder (BPD). Three themes were developed: (i) respect and understanding are important for a positive therapeutic experience, (ii) responsibility and blame and (iii) pathological identity and the transformative influence of therapy. These results suggest that a focus on the woman’s identity within therapy would be helpful and that group elements of therapy should be prioritised. The empirical paper utilised qualitative research methods to understand the experiences of inpatient services for individuals with a diagnosis of both autism and BPD. Semi-structured interviews were conducted with seven participants recruited from inpatient and community NHS services across the North West. Six themes were developed using reflexive thematic analysis: “Never fully understood”, “Intense need for care and connection”, “Prisoner or patient? When care and punishment are intertwined”, “Necessary evil”, “The system always wins” and “Responsibility for own care”. These results suggest that the development of a specific pathway in inpatient services for patients with BPD and ASC would be helpful. Staff would also benefit from reflective practice to support them to provide the best individualised care to patients. The critical appraisal extends the discussion section from the empirical paper. This includes considering the impact of the researcher’s identity on the thesis and practical issues including recruitment. Finally, it considers ethical issues and decisions made in relation to language used.