Comprehensive DBT programmes for complex personality disorder

For over 25 years, St Andrew's has provided specialist care for women with a range of personality disorders, including those with a primary diagnosis of emotionally unstable personality disorder (EUPD) or borderline personality disorder (BPD).

Our treatment approach is led by specialist Dialectical Behaviour (DBT) therapists and includes all five functions of a comprehensive dialectical behaviour therapy (DBT) programme.

The recent creation of our DBT hub in Isham House, comprising Naseby and Silverstone personality disorder services for women, means that with a full multi-disciplinary team 'under one roof' we are able to provide increased personalisation of care and a collaborative approach.

BIGSPD conference Tuesday 14 - Thursday 16 June

We really enjoyed speaking to the British and Irish Group for the study of Personality Disorder (BIGSPD) community asking just One Question;

What’s important to you when thinking about the future development of mental health services for adults with Personality Disorder? 

Here was some of the feedback as part of the #PDconversation at the event and on twitter.com/StAndrewsCare

"

  • ‘Hope’ [not being told ‘Hope’ [not being told that there is no cure / hope for people with PD].
  • Local placements linked to community services.
  • Close networks with community teams to look at discharge planning early on, including experts by experience
  • Availability.
  • Better pathways to community services.
  • Quality of care.
  • Better use of Peer Support Workers.
  • Provide services to adults in the community as much as possible.
  • Do not give up on people and stop treatment.
  • Recognising that for some this is a life long effort living with this condition and support needs to be tailored accordingly.
  • Certainly move away from thinking about people with personality disorder and more about people who have survived adversity. When we cut off people's histories and locate the difficulties in them it means 'care' becomes quite brutal. "

What is Borderline Personality Disorder?

Borderline Personality Disorder is a disorder which is marked by emotional instability, difficulties, challenges in relationships, challenges around your sense of self, thoughts and cognitions, and challenges around being able to tolerate distress, so acting in impulsive ways. Self-harming behaviours, challenges around disordered eating, substance misuse are common. 

Personality Disorders are persistent, pervasive and problematic.

Persistent in that they have persisted through often adolescence and into adulthood. Pervasive in that they run through all walks of an individual's life. It's not just a home problem or a work problem. And problematic in that they cause problems not just to the individual but they cause problems to other people as well.

What we know about borderline personality disorder and it's causes is that there is a biological vulnerability and environmental challenges that interact so that a person living with a personality disorder learns to stop trusting the emotion and starts seeking external views about how it is that they should feel. For a person living with complex a personality disorder, environmental factors which have influenced their emotions and how they interact with the world commonly include sexual abuse, and violence within the house. It is known that 70% of all people with a diagnosed personality disorder have had some form of significant childhood trauma. 

A life worth living

"I would like people to understand that mental illness affects anyone, It doesn’t just affect a certain type of person. Just because you’ve got a mental illness it doesn’t define you as a person, it’s just a part who you are. I’m not Kayleigh because I have a disorder, I’m Kayleigh because I am person and I like horse riding and football.” Kayleigh, 25 years

Kayleigh lives with Borderline Personality Disorder, impacted by childhood trauma. She talks about her time at St Andrew's and how, through working with our expert staff, she has been able to understand and develop the skills to live well with Personality Disorder.

Kayleigh has ambitions to become a Chef and go to College and at St Andrew's she has been able to access Workbridge, our vocational opportunities service, which works alongside a patient's treatment programme developing work and life skills for the future once someone leaves hospital.

Kayleigh also talks about the dialectical behaviour therapy (DBT) programme. She describes it as helping to slow her thoughts and give her the tools to help her think rationally about her thoughts, feelings and emotions, especially during stressful or challenging situations.

I think if I hadn't come here, I would probably be dead

Sedona was diagnosed with anorexia nervosa and Borderline Personality Disorder. She had severe self-harming tendencies, with frequent trips to NHS A&E departments and operating theatres to help save her life.

"I didn't see anyway out and I was very suicidal."

Sedona talks about a genuine kindness that she has experienced from the care team and the positive relationships she has built through her recovery. 

A full and varied activity programme has also been key to her recovery. Occupational Therapy is a critical part of our dialectical behaviour therapy (DBT) programmes, where access to activities, such as art, cooking, music, gym, swimming and sports helps keep a patient busy and aids their health and wellbeing.

I've only got support and that is something I'm beyond happy about

Saffron also struggles with borderline personality disorder and anorexia nervosa.

She was being managed in services who did not understand her complexity and support her needs, which saw her being placed on extensive periods of enhanced nursing support and constant observations.

Saffron talks about the feelings she had experienced at other hospitals and what she has experienced at St Andrew's. In nine month's at St Andrew's, Saffron has developed from 3:1 enhanced support to unescorted leave with the support of the clinical staff and by working through a structured dialectical behaviour therapy (DBT) programme.

Collaborative decision-making across the multi-disciplinary team (MDT) is also highlighted by Saffron as a positive. She says that decision making is never done in isolation and always taken based on her needs.

The DBT programmes offer women with Borderline Personality Disorder structure allowing women to explore feelings in a safe environment. Saffron praises the programme and the opportunities which have been given to her during her recovery at St Andrew's.