The role of self-stigma in borderline personality disorder

Abstract

Research into self-stigma has received increased attention over the past decade, resulting in the development of several outcome measures. The first chapter of this thesis is a systematic review that appraises the quality of studies that evaluate self-stigma measures, particularly in relation to Serious Mental Illness (SMI) and Borderline/Emotionally Unstable Personality Disorder (BPD/EUPD). It also assessed the quality and sufficiency of resultant measurement properties and the clinical utility of the identified measures. This review was completed in line with COSMIN guidelines for systematic reviews of patient-reported outcome measures. The findings are discussed, and several outcome measures are recommended for use within this population.

BPD is a psychiatric diagnosis with high levels of associated public and structural stigma within healthcare systems. Although this is well-known within literature, few studies have considered self-stigma within the context of BPD. The second chapter of this thesis is a qualitative study which aimed to deliver an understanding of self-stigma development in BPD, and evaluate to what extent healthcare interactions contribute to this. It also aimed to provide evidence to inform guidance on personality disorder diagnosis in Northern Ireland. Eight participants with a diagnosis of BPD completed semi-structured interviews. A six-stage reflexive thematic analysis methodology was used, which generated four themes: (a) awareness of others' beliefs, (b) how professionals impact self stigma, (c) outcomes of stigma awareness and experiences, and (d) distancing from the diagnosis. This study provides support for the mediating effect of healthcare interactions in the development and maintenance of self-stigma in BPD. This study also adds to the limited literature base regarding self-stigma in BPD, supporting the need for systems-level change to reduce the likelihood of self-stigma development and support individual self-stigma intervention.

Thesis is embargoed until 31st December 2026.

Date of Award	Dec 2024
Original language	English
Awarding Institution	Queen's University Belfast
Supervisor	Rachael McGlinchey (Supervisor), Pauline Adair (Supervisor) & Nicola Gillespie (Supervisor)