DSM-5 diagnostic criteria for borderline personality disorder (APA, 2013)
A pervasive pattern of instability of interpersonal relationships, self-image and affects, and marked
impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or
more) of the following:
1 – Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating
behaviour covered in Criterion 5
2 – A pattern of unstable and intense interpersonal relationships characterized by alternating between
extremes of idealization and devaluation
3 – Identity disturbance: marked and persistently unstable self-image or sense of self
4 – Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse,
reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behaviour covered in
Criterion 5
5 – Recurrent suicidal behaviour, gestures or threats or self-mutilating behaviour
6 – Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability or
anxiety usually lasting a few hours and only rarely more than a few days)
7 – Chronic feelings of emptiness
8 – Inappropriate intense anger or difficulty controlling anger, (e.g., frequent displays of temper, constant
anger, recurrent physical fights)
9 – Transient, stress related paranoid ideation or severe dissociative symptoms.
Note: DSM-5 diagnoses as ‘borderline personality disorder‘ ICD-10 diagnoses as ‘emotionally unstable
personality disorder‘. MBT developed using DSM criteria.
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4 Wards within a Unit
28 Beds per Ward
Mixed Sex
Patients aged 18 – 65
Also 14 – 18 year olds in one ward
Staff on Shift Patterns
An accident and emergency for mental health
A melting pot of diagnoses and disorders
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Evidence-based and developed Specifically
for BPD
Mentalizing is how we implicitly and explicitly
interpret the actions of oneself and others
Empathy as a foundation
The Not Knowing Stance
Provide Alternative Perspectives
Restrained Imagination - Aims to encourage
patients and staff to see themselves from the
outside, others from the inside
Common sense view of the mind
Cost-effective
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BPD accounts for estimated 20% of psychiatric
inpatients
Associations with frequent and lengthy
admissions
BPD carries a diagnostic baggage and a
negative staff perception
No studies on staff perceptions of MBT
MBT studies limited to specialised settings
MBT Skills Training is a new and compact two
day workshop
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Ethical and R&D approval
Purposive sampling of staff nurses, across 4
acute mental health wards, who had
completed MBT Skills Training
50% participation – 9 from 18
2 x Focus Groups with a neutral facilitator
Semi-structured topic guide
Thematic analysis – 3 cycles of coding
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Staff Perceptions on BPD Inpatient Care
Impact on Staff
Impact of MBT Skills Training
Clinical Supervision
Changed Perceptions of BPD
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Inpatient Environment
BPD Behaviour on a Ward
BPD Effect on the Ward
Admission Pattern
Ability to Work Effectively with BPD
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Personal Distress
Uncomfortable Emotions
Negative Perceptions
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Empathy
Use of MBT
Changes in Staff
Benefits of MBT
MBT Limits
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Attendance
Benefits of Group CS
One to One Clinical Supervision
Informal Clinical supervision
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Yes!
An understanding of reasons behind
behaviour
Awareness of the impact of feelings of
abandonment
More empathy towards people with BPD
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BPD is extremely challenging for staff nurses
in acute mental health
Staff experience significant personal distress
MBT gives staff a ‘secret weapon’
Clinical Supervision provides support,
reassurance and ‘ammunition’
Staff had a better understanding of BPD and
more empathy as a result
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All staff nurses attend MBT Skills Training
MBT is offered as part of the pre-registration
nursing programme
Group Clinical Supervision is offered weekly
and within protected time
Further research into MBT skills training and
inpatient care of BPD
Any Questions?
daniel.warrender@nhs.net