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Cited by 43Personality Disorders and PsychopathologyMental Health and Patient InvolvementEating Disorders and Behaviors

Moving toward connectedness – a qualitative study of recovery processes for people with borderline personality disorder

Open access
Kverme, Britt, Natvik, Eli, Veseth, Marius, Moltu, Christian·2019·Frontiers in Psychology
DOI 10.3389/fpsyg.2019.00430PMC PMC6403141
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Abstract

Borderline personality disorder (BPD) is a mental health disorder estimated to affect 1-2% of the general population. As a group, people with BPD endure a high degree of suffering, often leading to suicide attempts, self-harm, and suicide. Comparatively few studies explore the first person perspective of the person suffering from any mental health disorder. This might be especially problematic for people diagnosed with BPD, as this particular diagnosis is followed by stigma potentially making help seeking harder and helping relationships more vulnerable. We interviewed 12 female participants recently diagnosed with BPD in-depth about their experiences with recovery and treatment, and used a stepwise reflective approach to rigorously analyze the data. Results show an overarching theme of working toward connectedness, with four constituent sub-themes. We discuss the findings with regard to empirical work, recovery and autonomy, and the risk of epistemic injustice that people with BPD risk facing.

AI snapshot

Written from the paper’s full text.

TL;DR

This qualitative study interviewed 12 women recently diagnosed with borderline personality disorder (BPD) about recovery and treatment, finding that recovery was experienced as “moving toward connectedness.” The overarching theme comprised four sub-themes: learning to hold one’s own, needing honesty and genuine mutuality, daring to belong, and making a room for recovery.

Key findings

  • The study’s central finding was an overarching theme of “Moving toward connectedness,” described as feeling “I am like others and others are like me” and feeling human among other humans.
  • Four constituent sub-themes described variations in recovery: “Learning to hold one’s own,” “Needing honesty and genuine mutuality,” “Daring to belong,” and “Making a room for recovery.”
  • Participants who experienced agency believed change could come through acting, felt seen by therapists as someone “who could,” and described using therapy-acquired knowledge to regulate emotions without self-harm; others struggled with powerlessness and did not experience the same degree of agency.
  • Treatment relationships and group contexts could help or hinder recovery: honest, validating, mutually open relationships and group belonging supported connectedness, while experiences of being perceived through the diagnosis, lack of transparency, or group anxiety could hinder it.

Methods

  • Qualitative interview study with 12 women aged 21–36 from different parts of Norway, recruited via clinicians at four hospitals; eligible participants had received a BPD diagnosis 6–18 months before inclusion and were currently in contact with a treatment provider. Exclusion criterion was active psychosis.
  • Individual in-depth interviews lasting 45–150 minutes were audio recorded and transcribed verbatim.
  • Data were analyzed using a systematic, team-based, stepwise reflective thematic analysis, with preliminary themes developed by three authors, refinement by the first author, and review by a fourth author acting as critical auditor.

Limitations

  • Stated: all participants were women, reflecting that about 75% of those diagnosed with BPD are women, but men’s lived experiences are needed; the Norwegian context means all mental health care was within the same public health system at approximately the same period; the sample was relatively small and homogenous.
  • Stated: all interviews were conducted within ongoing therapy, which necessarily shaped the interviews and analysis; the authors call for studies focusing more explicitly on recovery processes outside treatment and involving other stakeholders such as family and friends.
  • Stated: future studies might use methods more sophisticated for capturing power issues, such as discourse analysis. Evident from the text: the study did not carry out diagnostic assessments as part of procedures and relied on diagnoses established in clinical settings.

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Integrity signals

Registry

Crossref · 10.3389/fpsyg.2019.00430

Cites

73 of 73 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 50 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    To be agents in the processes of change was pivotal.

    “To be agents in the processes of change was pivotal.”
    Quote in the paperSubstantial claim
  • Findingown data

    Agency implied being able to believe that change could come about by acting, by changing old patterns and habits.

    “Agency implied being able to believe that change could come about by acting, by changing old patterns and habits.”
    Quote in the paperSubstantial claim
  • Findingown data

    The process of change seemed to be about learning to hold one's own.

    “The process of change seemed to be about learning to hold one’s own”
    Quote in the paperSubstantial claim
  • Findingown data

    Experiencing herself as one "who could" and seeing the changes she was making in her own life gave rise to feelings of pride, achievement and mastery.

    “Experiencing herself as one “who could” and seeing the changes she was making in her own life gave rise to feelings of pride, achievement and mastery.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Being encouraged to learn how to help themselves interconnected with taking ownership of their own recovery.

    “The participants highlighted that being encouraged to learn how to help themselves interconnected with taking ownership of their own recovery.”
    Quote in the paperSubstantial claim
  • May combine two claims. 40
  • Classified as probably not a substantial claim. 47
  • The quote only partly states this claim. 1

  • May combine two claims.

    Findingown data

    Some participants had started feeling that "they could," and were actively engaged in helping themselves to make moment-to-moment decisions that could help them deal with their emotions without needing to self-harm, moving them forward in their personal recovery.

    “Some participants had started feeling that “they could,” and were actively engaged in helping themselves to make moment-to-moment decisions that could help them deal with their emotions without needing to self-harm, moving them forward in their personal recovery.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Results show an overarching theme of working toward connectedness, with four constituent sub-themes.

    “Results show an overarching theme of working toward connectedness, with four constituent sub-themes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    By having and using their knowledge and capacity to act, participants experienced that they could turn away from destructiveness, altering the thoughts and emotions accompanying this darkened state.

    “By having and using their knowledge and capacity to act, by taking a walk or cuddle up by the TV with a comedy, the participants experienced that they could turn away from destructiveness, altering the thoughts and emotions accompanying this darkened state.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Other participants struggled and did not currently experience the same degree of agency, or that others did not encourage agency to grow.

    “Importantly, other participants struggled and did not currently experience the same degree of agency, or that others did not encourage agency to grow.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The participants who believed they could experienced that they had learned something through therapy; they had gathered knowledge about their emotions, thoughts, behavior, and how thoughts influenced emotions and behavior and vice versa.

    “The participants who believed they could, experienced that they had learned something through therapy; they had gathered knowledge about their emotions, their thoughts, their behavior, and how thoughts influenced emotions and behavior and vice versa.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Across participants, connectedness implied feeling "I am like others and others are like me," feeling human amongst other humans.

    “Across participants, connectedness implied feeling “I am like others and others are like me,” feeling human amongst other humans.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Findingnone given

    Connectedness expresses a sense of belonging to one's own being in the world, and means holding oneself, holding on to oneself, taking a place in the world, and feeling part of it.

    “Connectedness expresses a sense of belonging to one’s own being in the world, and means holding oneself, holding on to oneself, taking a place in the world, and feeling part of it.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Participants who believed that they could experienced having therapists who conveyed possibilities for how to make changes, and the therapists were carriers of hope.

    “The participants who believed that they could, experienced having therapists who conveyed possibilities for how to make changes, and, as such, the therapists were carriers of hope.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Findingown data

    The four sub-themes address important ways participants experienced that therapy could help or hinder their personal recovery processes.

    “The four sub-themes, “learning to hold one’s own,” “needing honesty and genuine mutuality,” “daring to belong,” and “making a room for recovery,” address important ways that participants experienced that therapy could help or hinder their personal recovery processes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In the face of setbacks this timeline could re-establish hope, showing the progress that had been made and could be made again.

    “In the face of setbacks this timeline could re-establish hope, showing the progress that had been made and could be made again.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    When the architecture and elements of togetherness were absent, being in a group could be a lonesome experience for some, causing anxiety and feelings of shame.

    “However, when the architecture and elements of togetherness were absent, being in a group could be a lonesome experience for some, causing anxiety and feelings of shame.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Making a room for recovery was about having patience with one's own recovery process, considering one's own timeline gently, and with care and compassion.

    “Making a room for recovery was about having patience with one’s own recovery process, considering one’s own timeline gently, and with care and compassion.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    She described a feeling of being deserted, when being told that she had to end her treatment before feeling ready to do so, not knowing where to go or who to turn to, feeling guilty over not getting better in the time she was expected to.

    “She described a feeling of being deserted, when being told that she had to end her treatment before feeling ready to do so, not knowing where to go or who to turn to, feeling guilty over not getting better in the time she was expected to.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Some participants had experienced honest mutuality in their treatment relationships, and others described being left longing for it.

    “For example, some participants had experienced honest mutuality in their treatment relationships, and others described they were left longing for it.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Participants created togetherness intentionally, supported by a structure within the treatment, bestowing continuity on a process of change.

    “Participants created it intentionally, supported by a structure within the treatment, bestowing continuity on a process of change.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    One participant disclosed that she felt change was time-restricted and for a lucky few to experience.

    “One participant disclosed that she felt change was time-restricted and for a lucky few to experience.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Opening up to others and taking a genuine part in relationships in the treatment context were seen as important for recovery and difficult to approach.

    “Opening up to others and taking a genuine part in relationships in the treatment context were seen as important for recovery and difficult to approach.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Togetherness was about learning and acting together, to help, and to encourage each other.

    “Togetherness was about learning and acting together, to help, and to encourage each other.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Participants who experienced moving forward in the process of recovery expressed that they believed in possibilities of change, and were actively pursuing each step toward it.

    “Participants who experienced moving forward in the process of recovery expressed that they believed in possibilities of change, and were actively pursuing each step toward it.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    All interviews were audio recorded and transcribed verbatim for analysis.

    “All interviews were audio recorded and transcribed verbatim for analysis.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Flanagan et al. (2007) underscore how persons' lived experiences can contrast how symptoms and suffering are understood in the diagnostic literature.

    “Flanagan et al. (2007) underscore how persons’ lived experiences can contrast how symptoms and suffering are understood in the diagnostic literature.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Flanagan et al., 2007 source

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    Study design and conductnone given

    None of the researchers had had any treatment relationship with any of the participants in the study.

    “None of the researchers had had any treatment relationship with any of the participants in the study.”
    Quote in the paperNot a substantial claim

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    Premisecitation

    Miller (1994) summarized that rather than having an unstable sense of self the participants in her study seemed to have a stable sense of being an impaired person.

    “Miller (1994) summarized that rather than having an unstable sense of self the participants in her study seemed to have a stable sense of being an impaired person”
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    Study design and conductnone given

    Care was taken to create a safe and welcoming atmosphere and avoiding disturbances in the interviews.

    “Care was taken to create a safe and welcoming atmosphere and avoiding disturbances in the interviews.”
    Quote in the paperNot a substantial claim

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    Study design and conductreasoning

    Choosing to invite people in current treatment contexts was one measure to ensure that participants had some level of support around them.

    “Choosing to invite people in current treatment contexts was one measure to ensure that participants had some level of support around them.”
    Quote in the paperNot a substantial claim

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    Study design and conductown data

    The study used a stepwise reflective approach to rigorously analyze the data.

    “We used a systematic, team-based and step-wise reflective approach to rigorously analyze the participants’ experiences”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisereasoning

    A need for knowledge from persons who suffer from BPDs' first-person perspective and of how they experience their recovery in the context of treatment is evident.

    “Consequently, a need for knowledge from persons who suffer from BPDs’ first-person perspective and of how they experience their recovery in the context of treatment is evident.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    In the context of treatment, agency seemed sparked by the experience of being seen as one "who could" by one's therapist, and by daring to embrace the faith that the therapist had in them.

    “In the context of treatment, this seemed sparked by the experience of being seen as one “who could” by one’s therapist, and by daring to embrace the faith that the therapist had in them.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The Regional Ethics Committee for Medical Health Research approved of the study (REK Vest 2015/882), and the data security agent at Helse Førde approved of the data security protocol.

    “The Regional Ethics Committee for Medical Health Research approved of the study (REK Vest 2015/882), and the data security agent at Helse Førde approved of the data security protocol.”
    Quote in the paperNot a substantial claim

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    Premisereasoning

    Research has shown that the symptoms of BPD are treatable, primarily by psychological, social, and relational approaches rather than medication.

    “research has shown that the symptoms of BPD are treatable, primarily by psychological, social, and relational approaches rather than medication.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Experiencing ownership seemed to help the participants in the context of treatment, as well as empowering them to hold their own even after finishing their treatment programs.

    “Experiencing ownership seemed to help the participants in the context of treatment, as well as empowering them to hold their own even after finishing their treatment programs.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    This lack of first-person perspective research might be especially problematic for people diagnosed with BPD because the diagnosis is followed by stigma, potentially making help seeking harder and helping relationships more vulnerable.

    “This might be especially problematic for people diagnosed with BPD, as this particular diagnosis is followed by stigma potentially making help seeking harder and helping relationships more vulnerable.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    A treatment intervention is but one out of many situations and practices where the individual person works toward his or her recovery, with the potential of being of high and low importance to any specific individual.

    “a treatment intervention is but one out of many situations and practices where the individual person works toward his or her recovery, with the potential of being of high and low importance to any specific individual.”
    Quote in the paperSubstantial claim

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    Premisecitation

    In the recovery tradition, the process of getting better is seen as a personal and continuous journey that revolves around learning to live with the challenges set by mental illness and restoring meaning in one's social and personal life.

    “In the recovery tradition, the process of getting better is seen as a personal and continuous journey that revolves around learning to live with the challenges set by mental illness and restoring meaning in one’s social and personal life”
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    • cites Anthony, 1993 source

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    Premisenone given

    Less effort has been put into researching how persons who are suffering and treated by some treatment modality experience these interventions and potential change processes.

    “However, less effort has been put into researching how the persons who are suffering and treated by some treatment modality experience these interventions and potential change processes.”
    Quote in the paperNot a substantial claim

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    Premisecitation

    Black et al. (2014) describe tensions between working to stay present to experiences and disappearing for oneself through dissociation and suicidal fantasies.

    “They describe tensions between working to stay present to experiences and disappearing for oneself through dissociation and suicidal fantasies.”
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    • cites Black et al., 2014 source

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    Study design and conductcitation

    The structure of the analytic process was Thematic Analysis aiming to establish emergent themes across the individual accounts.

    “The structure of the analytic process was Thematic Analysis aiming to establish emergent themes across the individual accounts”
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    • cites Braun and Clarke, 2006 source

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    Study design and conductnone given

    Participation was explicitly voluntary, with anonymity guaranteed, and participants who volunteered gave written consent and were informed that they could withdraw this consent without consequences at any time up until the publication of an article.

    “Participation was explicitly voluntary, with anonymity guaranteed, and participants who volunteered gave written consent and were informed that they could withdraw this consent without consequences at any time up until the publication of an article.”
    Quote in the paperNot a substantial claim

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    Premisecitation

    For general mental health suffering, multiple qualitative studies and meta-syntheses have reported that important aspects beyond symptom reduction are salient to recovery, including engaging in meaningful interpersonal processes, gaining understanding about one's own patterns of suffering, finding hope and motivation to drive autonomous change, and taking responsibility for one's own life.

    “For general mental health suffering, multiple qualitative studies, and meta-syntheses have reported that important aspects beyond symptom reduction are salient to recovery.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Young and Ensing, 1999

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    • cites Veseth et al., 2012 source

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    • cites Bjornestad et al., 2017 source

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    Premisereasoning

    Centring the research perspective on the suffering person's experiences with moving through different situations in the process of working toward recovery holds the potential of a sound contextual understanding of treatment processes and their place within a person's lifeworld.

    “Centring the research perspective on the suffering person’s experiences with moving through different situations in the process of working toward recovery holds the potential of a sound contextual understanding of treatment processes and their place within a person’s lifeworld.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims. The quote only partly states this claim.

    Study design and conductown data

    The analysis involved multiple researchers and a critical auditor to ensure that meanings corresponded to the interviews.

    “MV, who had not been part of the initial phases of analysis, reviewed the resulting themes in light of the data material, performing the function of a critical auditor”
    Quote in the paperNot a substantial claim

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    Premisecitation

    Knowledge and understanding of recovery for people with BPD can support health professionals in their effort to support the patient in finding his or her own personal way of recovering from their illness, while at the same time as assisting the person by helping alleviating clinical symptoms.

    “Knowledge and understanding of recovery for people with BPD can support health professionals in their effort to support the patient in finding his or her own personal way of recovering from their illness, while at the same time as assisting the person by helping alleviating clinical symptoms”
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    • cites Davidson et al., 2005 source

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    Premisecitation

    Qualitative explorations from first-person and therapist perspectives describe the importance of belonging and social connectedness for people with severe mental illnesses.

    “Qualitative explorations from a first-person- and therapist perspective describe the importance of belonging and social connectedness for people with severe mental illnesses (Bradshaw et al., 2007; Veseth et al., 2017; Ware et al., 2007).”
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    • cites Bradshaw et al., 2007 source

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    • cites Veseth et al., 2017 source

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    Premisecitation

    DBT integrates self-regulation, mindfulness, and acceptance in parallel individual and group settings.

    “A third-wave cognitive therapy form, DBT integrates self-regulation, mindfulness, and acceptance in parallel individual and group settings (Linehan et al., 2001).”
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    • cites Linehan et al., 2001

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    Premisecitation

    Shepherd et al. report that the higher order themes of safety, social relationships and autonomy are understood as a prerequisite for an individual to recover.

    “They report that the higher order themes of safety, social relationships and autonomy are understood as a prerequisite for an individual to recover.”
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    • cites Shepherd et al. (2016) source

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    Premisecitation

    Both MBT and DBT have proved effective in helping people with BPD.

    “Both MBT and DBT have proved effective in helping this group of people (Bateman and Fonagy, 2009; Kliem et al., 2010).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Bateman and Fonagy, 2009

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    Premisereasoning

    Clinical recovery in DBT is directed at helping people with BPD with self- and interpersonal safety and regulation for participation in social contexts.

    “Clinical recovery in DBT is directed at helping people with BPD with self- and interpersonal safety and regulation for participation in social contexts.”
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    Premisecitation

    Bottom-up analyses of the literature and syntheses of existing qualitative studies emphasize belonging as decisive factors to processes of recovery, through connecting to close relations, professionals, and the community and society at large.

    “Bottom-up analyses of the literature (Drake and Whitley, 2014) and syntheses of existing qualitative studies (Leamy et al., 2011) emphasize belonging as decisive factors to processes of recovery, both through connecting to ones close relations such as family and friends, to professionals, and to the community and society at large.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Drake and Whitley, 2014 source

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    • cites Leamy et al., 2011 source

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    Premisecitation

    A therapeutic focus in MBT is to explore and approach relational situations while working to support emotion regulation and mentalization in processes of intrapersonal and relational healing toward greater epistemic trust.

    “A therapeutic focus in MBT therapies is to explore and approach relational situations while working to support emotion regulation and mentalization in processes of intrapersonal and relational healing toward greater epistemic trust (Fonagy and Allison, 2014).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Fonagy and Allison, 2014

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    Premisecitation

    MBT is an attachment-based therapy form in which BPD is theorized and empirically shown to be associated with a lessened ability to "hold other minds in mind" based on (object)-relational trauma.

    “MBT is an attachment based therapy form, in which BPD is both theorized (Allen and Fonagy, 2006) and empirically shown (Gullestad and Wilberg, 2011) to be associated with a lessened ability to “hold other minds in mind” based on (object)-relational trauma (Allen and Fonagy, 2006).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Allen and Fonagy, 2006

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    • cites Gullestad and Wilberg, 2011

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    Premisecitation

    Moltu et al. (2017) reported that "doing differently" rather than "feeling differently" held importance to participants.

    “Moltu et al. (2017) studied what good outcomes from a patient perspective, and reported that “doing differently” rather than “feeling differently” held importance to participants.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Moltu et al. (2017) source

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    Premisecitation

    Johansen et al. (2017) described in a case study how recovery moved via three phases, from attachment and dependence on a therapist, through working level headed together, to moving autonomously on "into the world."

    “Last, in an in-depth case study of one individual’s recovery journey over 5 years, Johansen et al. (2017) describe how recovery moved via three phases, from attachment and dependence on a therapist, through working level headed together, to moving autonomously on “into the world.””
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Johansen et al. (2017) source

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    Premisecitation

    Empirical work studying different illness experiences underscores agency and autonomy as healing phenomena.

    “Empirical work studying different illness experiences underscore agency and autonomy as healing phenomena (Moltu et al., 2012, 2017; Bjornestad et al., 2017; Hansen et al., 2017).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Moltu et al., 2012, 2017

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    • cites Bjornestad et al., 2017 source

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    • cites Hansen et al., 2017 source

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    Premisecitation

    Little et al. (2017) conclude that their synthesis highlights how key factors in DBT impact day-to-day life and patients' identity, and that outcome measures may not capture the complexity and magnitude of this impact.

    “For instance, synthesizing seven studies in an otherwise interesting and well-written meta-synthesis of how individuals diagnosed with BPD perceive DBT, Little et al. (2017) conclude that the synthesis highlights how key factors in DBT impact day-to-day life and patients’ identity, and that outcome measures may not capture the complexity and magnitude of this impact.”
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    Premisecitation

    Historically, limited access to care has been reported in studies of persons with BPD experiences, and without a diagnosis, access to potentially helpful programs might continue to be limited.

    “Historically, limited access to care has been reported in studies of persons’ with BPD experiences (Nehls, 1999), and without a diagnosis, access to potentially helpful programs might continue to be limited.”
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    • cites Nehls, 1999 source

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    Premisecitation

    Important work in the field of mental health has established agency as pivotal in working toward better service.

    “Important work in the field of mental health has established such an understanding of agency as pivotal in working toward better service (Davidson and Shahar, 2007).”
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    • cites Davidson and Shahar, 2007

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    Premisecitation

    Lovell and Hardy (2014) reported an IPA study of interviews with eight women with a diagnosis of BPD in a forensic setting, with themes of identity, power, protection and confusion suggesting that the prison context allows for different expressions of vulnerability than voluntary treatment contexts.

    “Lovell and Hardy (2014) reported an IPA study of interviews with eight women with a diagnosis of BPD in a forensic setting. Their resulting themes of identity, power, protection and confusion seem to suggest that the prison context allows for different expressions of such vulnerability than do voluntary treatment contexts.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Lovell and Hardy (2014)

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    75% of people given the diagnosis of BPD are women.

    “Although this reflects an important statistical point, 75% given the diagnosis of BPD are women (Skodol and Bender, 2003), there is clearly also a need for more knowledge on the lived experiences of men with a diagnosis of BPD.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Skodol and Bender, 2003

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Lind et al. (2018) reported that people with BPD developed self-agency beyond the control group through a 12-month therapy program.

    “Most psychotherapy models have agency and autonomy building as central to their theories of change, and recently Lind et al. (2018) reported that people with BPD developed self-agency beyond the control group through a 12-month therapy program.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Lind et al. (2018) source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Diagnoses in the field of mental health are claimed to be uncertain and fundamentally problematic, underscoring that they do not identify patients with common symptoms and etiologies who respond to specific treatments.

    “Diagnoses in the field of mental health are by different accounts claimed to be uncertain and fundamentally problematic (Bentall, 2006; Horn et al., 2007; Pilgrim, 2013), underscoring that they do not identify patients with common symptoms and etiologies who respond to specific treatments.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Bentall, 2006 source

      Not checked in the free run.

    • cites Horn et al., 2007 source

      Not checked in the free run.

    • cites Pilgrim, 2013 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    For the specific population of people diagnosed with BPD, the first-person research literature on the suffering individuals' perspectives is scarce, but not non-existent.

    “For the specific population of people diagnosed with BPD, the first person research literature on the suffering individuals’ perspectives is scarce, but not non-existent.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The present study was conducted within a Norwegian context.

    “Furthermore, the present study was conducted within a Norwegian context, which means that despite that participants had experience with different treatment modalities such as mentalization-based therapy or dialectical behavioral treatment, the mental health care were all provided within the same public health system at approximately the same period.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In Lam et al.'s study, the group provided with the BPD label saw significantly fewer reasons to be optimistic about the woman's prognosis and rated her problems more negatively.

    “The group provided with the label saw significantly fewer reasons to be optimistic about the woman’s prognosis and rated her problems more negatively.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Lam et al. (2016) source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Holm and Severinsson (2011) reported that feeling safe, validated, and trusted within treatment helped women diagnosed with BPD in their recovery.

    “One study exploring recovery processes in a group of women diagnosed with BPD reports that feeling safe, validated, and trusted within treatment helped the women in their recovery (Holm and Severinsson, 2011).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Holm and Severinsson, 2011

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Bjornestad et al. (2017) underscore how environmental support and gentle pressure supports self-agency development for people with psychosis.

    “Similarly, reporting on self-agency development for people with psychosis, Bjornestad et al. (2017) underscore how environmental support and gentle pressure supports such processes.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Bjornestad et al. (2017) source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    Most psychotherapy models have agency and autonomy building as central to their theories of change.

    “Most psychotherapy models have agency and autonomy building as central to their theories of change, and recently Lind et al. (2018) reported that people with BPD developed self-agency beyond the control group through a 12-month therapy program.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Spodenkiewicz et al. (2013) interviewed 50 youths diagnosed with BPD in a lifeworld study and reported that fear-based negative feelings and experiences of social isolation or hostility were descriptive of their experiences, and that a sense of continuity and time is hard to hold onto.

    “Spodenkiewicz et al. (2013) interviewed 50 youths diagnosed with BPD in a lifeworld study, and reported that fear-based negative feelings and experiences of social isolation or hostility were descriptive of their experiences. They also find that a sense of continuity and time is hard to hold onto.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Spodenkiewicz et al. (2013)

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    If safety and autonomy are core aspects of recovery from personality disorder problems in general and for people diagnosed with BPD, a forensic setting seems challenging.

    “Indeed, if safety and autonomy are core aspects of recovery from personality disorder problems in general (Shepherd et al., 2016), and for people diagnosed with BPD, as suggested in our findings, a forensic setting seems challenging.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Shepherd et al., 2016 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    Findings in this study suggest that professionals in treatment and care can be more attentive to how power issues can be present in the way we use language, describe and diagnose people, and that this perspective could benefit clinical education.

    “Moreover, findings in this study suggest that professionals in treatment and care can be more attentive to how power issues can be present in the way we use language, describe and diagnose people, and that this perspective could benefit clinical education.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    Participants had experience with different treatment modalities such as MBT or DBT, but the mental health care were all provided within the same public health system at approximately the same period.

    “Furthermore, the present study was conducted within a Norwegian context, which means that despite that participants had experience with different treatment modalities such as mentalization-based therapy or dialectical behavioral treatment, the mental health care were all provided within the same public health system at approximately the same period.”
    Quote in the paperNot a substantial claim
70 of 70

  • The paper relies on this without support.

    Participants' retrospective accounts accurately reflect their experiences of recovery and treatment.

    “We interviewed 12 female participants recently diagnosed with BPD in-depth about their experiences with recovery and treatment”

  • The paper relies on this without support.

    The treatment contexts (DBT, MBT, TAU) are sufficiently similar to allow identification of shared recovery processes across them.

    “participants across different treatment contexts and at different stages in their processes shared the experience of moving toward connectedness.”

  • The authors state this as an assumption.

    The recovery process starts from a state of disconnectedness.

    “Such a formulation holds as a premise that this process starts from a state of disconnectedness.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • People with mental health problems which affect social interaction, such as people with a diagnosis of personality or bipolar disorder, were thought to face a greater challenge to achieve social recovery.

    “People with mental health problems which affect social interaction, such as people with a diagnosis of personality or bipolar disorder, were thought to face a greater challenge to achieve social recovery.”

    From Recovery from Severe Mental Health Problems: A Systematic Review of Service User and Informal Caregiver Perspectives (2021) · cites this paper as [53]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Participant age range conflicts with Table 1

    Minor

    The text says participants were aged 21 to 36, but Table 1 lists an age range extending to 37.

  • Odds ratio described as a percentage risk

    Minor

    The reported 13.55 is identified as an adjusted odds ratio, but the sentence also presents it as a 13.55% risk. An odds ratio and a percentage risk are different measures.

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 5

  1. 2000, Diagnostic and Statistical Manual of Mental Disorders-IV-TR.
  2. Anthony, 1993, Recovery from mental illness: the guiding vision of the mental health service system in the 1990s., Psychosoc. Rehabil. J., 16, 11, 10.1037/h0095240 · DOI · Paper page
  3. Husserl, The Crisis of European Sciences and Trancendental Phenomenology. An Introduction to Phenomenological Philosophy.
  4. Lambert, 2004, The efficacy and effectiveness of psychotherapy, Handbook of Psychotherapy and Behavior Change
  5. Watts, 2017, Testimonial Injustice and Borderline Personality Disorder.

Cited by

Sorted by citations

Related

Authors
Kverme, B., Natvik, E., Veseth, M., & Moltu, C.
Affiliations
  • Helse Førde (NO)
  • Western Norway University of Applied Sciences (NO)
  • University of Bergen (NO)
Corresponding author
Moltu, Christian
ORCID
Venue
Frontiers in Psychology
Publisher
Frontiers Media SA
Published
2019-02-28
Volume
10
Pages
430-430
ISSN
1664-1078 (ISSN-L)
DOI
10.3389/fpsyg.2019.00430
PMC
PMC6403141
OpenAlex
W2918637245
Semantic Scholar
f6e85f50ca499b16c068504514604898251cc94f
Cited by
43
References
73
Citations by year
2026: 5 · 2025: 2 · 2024: 4 · 2023: 8 · 2022: 7 · 2021: 8 · 2020: 7 · 2019: 2
FWCI
7.01
Type
journal article
Language
en
Open access
Licence
Locations
  • Frontiers in Psychology (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
  • Health Sciences › Health Professions › General Health Professions › Mental Health and Patient Involvement
  • Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
Keywords
borderline personality disorder, recovery, connectedness, lived experience, first-person perspective, stigma, help-seeking, treatment experience, autonomy, epistemic injustice, women with mental illness, suicide risk

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

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