Doctor of Philosophy
School of Psychology
Bailey, Rachel, Caring for a person with personality disorder: A study of carer burden, support needs and interventions, Doctor of Philosophy thesis, School of Psychology, University of Wollongong, 2014. http://ro.uow.edu.au/theses/4188
Personality disorders involve pervasive disturbances in self and interpersonal functioning as core criteria (American Psychiatric Association, 2013). As a consequence, the families and carers of people with a personality disorder can be challenged by the relationship. This work presents a sequential set of four studies aiming to advance our understanding of caregiving for a person with personality disorder. Study one was a systematic review of 6 studies meeting inclusion criteria with data on 465 carers of persons with borderline personality disorder. Study two evaluated new data on the experience of burden involving 287 carers. Taken together, the two studies showed that carers report significant levels of burden and grief compared to carers of persons with other mental disorders, and experience difficulties in wellbeing including symptoms consistent with depression, anxiety and posttraumatic stress. Study three explored the interpersonal environment reported by 280 carers. Findings revealed family environments characterised by elevated 'expressed emotion', representing a challenged interpersonal dynamic involving both conflict and emotional closeness. Study four evaluated a five session pilot intervention focused on modifying and enhancing the interpersonal environment with 32 carers of persons with personality disorder. Carers reported significant improvements in wellbeing, burden, quality of life and expressed emotion post-intervention. The four studies, taken together, demonstrate the interpersonal nature of personality disorder; both in terms of the interpersonal impact but also the opportunity to modify interpersonal patterns within the caregiving relationship to reduce burden and enhance carer wellbeing.