Women, self-harm and borderline personality disorder: a search for understanding

Adopting a case study approach (Yin, 1984; Stake, 1995;) this study aims to explore the
experiences of 'self-harm' by women who have been given a diagnosis of 'borderline
personality disorder' (BPD) within one area of a Mental Health NHS Trust. By taking a
material-discursive-intrapsychic approach (Ussher, 1999; 2000) this research explores
the accounts that have been constructed around 'self-harm' and 'BPD' by mental health
professionals working with women and women themselves. This research looks at the
ways in which 'self-harm' and the diagnosis of 'BPD' are operationalised by
professionals and the implications arising from these constructions and discourses when
delivering services to women. The study also explores the narrative accounts of women
who access the mental health care arena in relation to their experiences of 'self-harm'
and 'BPD', and in particular how they have constructed and experienced such responses
in their everyday lives.
The process of data gathering for this project was organised in two phases. In the first
phase of data gathering eight mental health professionals participated in conversational
interviews (Nichols, 1991; Conrad and Schober, 1998). These professionals worked for
the Mental Health NHS Trust and each of them aimed to provide care, support and
treatment for individuals accessing mental health services. The second phase of the
research involved the participation of four women, living in the locality of the NHS Trust,
in lengthy narrative interviews (Reissman, 1993). Data analysis for phase one drew
upon the guidelines developed by Willig (1999; 2001) and for phase two Reissman's
(1993) thematic narrative analysis and Langellier's (1989) personal narrative guided the
analytical process.
5
Unlike previous research that has explored 'self-harm' and 'BPD' the present study
draws upon social constructionism, critical realism and post-modern thinking. This
approach has made it possible for an alternate way of considering 'self-harm' and 'BPO'.
Individual women at material, discursive and intrapsychic levels experience this
phenomenon. It's meaning to women, and to the mental health care professionals, has
to be understood in relation to the specific historical and cultural contexts in which both
are positioned and the dominant cultural discourses that exist at these times. By
drawing upon a critical realist epistemological standpoint and adopting a materialdiscursive-
intrapsychic analysis the present study has been able to incorporate these
different layers of the women's subjective experience, and the different types of expert
knowledge about 'self-harm' and 'BPO', into one framework. The present study has
been able to explore 'self-harm' and 'BPO', both as discursive constructs and a set of
symptoms experienced by individual women.