Barriers and facilitators to employment in borderline personality disorder: A qualitative study among patients, mental health practitioners and insurance physicians

• Published in: PloS one Vol. 14; no. 7; p. e0220233
• Main Authors: Juurlink, Trees T, Vukadin, Miljana, Stringer, Barbara, Westerman, Marjan J, Lamers, Femke, Anema, Johannes R, Beekman, Aartjan T F, van Marle, Hein J F
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 23.07.2019; Public Library of Science (PLoS)
• Subjects: Adult; Biology and Life Sciences; Borderline personality disorder; Borderline Personality Disorder - epidemiology; Borderline Personality Disorder - psychology; Borderline Personality Disorder - rehabilitation; Care and treatment; Content analysis; Disability; Employment; Employment - psychology; Employment - statistics & numerical data; Engineering and Technology; Female; Health Personnel - psychology; Humans; Impulsivity; Influence; Insurance; Male; Medical law; Medical personnel; Medical personnel training; Medicine and Health Sciences; Mental disorders; Mental health; Mental health care; Mental health services; Mentally ill persons; Middle Aged; Patients - psychology; People and Places; Personal relationships; Personality; Personality disorders; Physicians; Psychiatry; Qualitative research; Rehabilitation; Self image; Social aspects; Social Sciences; Social services; Social Work, Psychiatric - statistics & numerical data; Stigma; Stigma (Social psychology); Unemployment; Vocational rehabilitation; Netherlands
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0220233

Borderline personality disorder (BPD) is associated with unemployment and impaired functioning. However, a comprehensive understanding of barriers and facilitators to employment from a multidisciplinary perspective is currently lacking. Therefore, the aim of this qualitative study was to explore barriers and facilitators in gaining and maintaining employment in BPD from the perspectives of patients, mental health practitioners (MHPs) and insurance physicians (IPs). Fifteen semi-structured interviews were conducted in patients with BPD and two focus groups were carried out among MHPs (n = 7) and IPs (n = 6) following a thematic content analysis approach. All participants described barriers and facilitators relating to three overall themes: characteristics of BPD, stigma, and support to employment. Barriers to employment mainly related to characteristics of BPD, such as low self-image, difficulty posing personal boundaries, difficulty regulating emotions, and lack of structure. MHPs and IPs additionally mentioned externalization and overestimation of competencies on the part of patients. Enhancing emotion regulation and self-reflection by successful treatment was suggested as a facilitator to enhance employment. Increasing collaboration between mental health and vocational rehabilitation services, and increasing knowledge about BPD, were suggested to increase sustainable employment and decrease stigma. The present findings revealed that both facilitators and barriers are important in gaining and maintaining employment in BPD in which diminishing symptoms, examining stigma and increasing support to employment are key. As a next step, supported employment strategies that follow patient preferences and integrate employment and mental health services, should be studied in the context of BPD.