Shepherd Andrew, Sanders Caroline, Shaw Jenny
University of Manchester, Manchester, UK.
BMC Psychiatry. 2017 Aug 1;17(1):282. doi: 10.1186/s12888-017-1442-8.
Understandings of personal recovery have emerged as an alternative framework to traditional ideas of clinical progression, or symptom remission, in clinical practice. Most research in this field has focussed on the experience of individuals suffering with psychotic disorders and little research has been conducted to explore the experience of individuals with a personality disorder diagnosis, despite the high prevalence of such difficulties. The nature of the personality disorder diagnosis, together with high prevalence rates in forensic settings, renders the understanding of recovery in these contexts particularly problematic. The current study seeks to map out pertinent themes relating to the recovery process in personality disorder as described by individuals accessing care in either community or forensic settings.
Individual qualitative interviews were utilised to explore the lived experience of those receiving a personality disorder diagnosis and accessing mental health care in either community or forensic settings. A thematic analysis was conducted to identify shared concepts and understanding between participants.
Fourty-one individual participant interviews were conducted across forensic and community settings. Recovery was presented by participants as a developing negotiated understanding of the self, together with looked for change and hope in the future. Four specific themes emerged in relation to this process: 1. Understanding early lived experience as informing sense of self 2. Developing emotional control 3. Diagnosis as linking understanding and hope for change 4. The role of mental health services.
Through considering personal recovery in personality disorder as a negotiated understanding between the individual, their social networks and professionals this study illustrates the complexity of working through such a process. Clarity of understanding in this area is essential to avoid developing resistance in the recovery process. Understanding of recovery in a variety of diagnostic categories and social settings is essential if a truly recovery orientated mental health service is to be developed.
在临床实践中，对个人康复的理解已成为传统临床进展或症状缓解观念的替代框架。该领域的大多数研究都集中在患有精神障碍的个体的经历上，尽管人格障碍诊断的困难情况普遍存在，但很少有研究探讨人格障碍诊断个体的经历。人格障碍诊断的性质，以及在法医环境中的高患病率，使得在这些背景下对康复的理解特别成问题。本研究旨在梳理出社区或法医环境中接受护理的个体所描述的与人格障碍康复过程相关的相关主题。
采用个体定性访谈来探索那些接受人格障碍诊断并在社区或法医环境中获得心理健康护理的人的生活经历。进行了主题分析，以确定参与者之间的共同概念和理解。
在法医和社区环境中对41名个体参与者进行了访谈。参与者将康复描述为对自我的一种不断发展的协商理解，以及对未来变化和希望的寻找。与此过程相关出现了四个具体主题：1. 将早期生活经历理解为自我意识的形成 2. 发展情绪控制 3. 诊断作为联系理解和改变希望的纽带 4. 心理健康服务的作用。
通过将人格障碍中的个人康复视为个体、其社会网络和专业人员之间的协商理解，本研究说明了经历这样一个过程的复杂性。在这一领域的清晰理解对于避免在康复过程中产生抵触情绪至关重要。如果要发展真正以康复为导向的心理健康服务，对各种诊断类别和社会环境中的康复理解至关重要。
