Recovery in Borderline Personality Disorder (BPD): A Qualitative Study of Service Users’ Perspectives Christina Katsakou 1 *, Stamatina Marougka 2 , Kirsten Barnicot 1 , Mark Savill 1 , Hayley White 3 , Kate Lockwood 3 , Stefan Priebe 1 1 Unit for Social and Community Psychiatry, Queen Mary University of London, London, United Kingdom, 2 Together (Mental Health Charity), London, United Kingdom, 3 Therapeutic Community and Outreach, East London Foundation NHS Trust, London, United Kingdom Abstract Background: Symptom improvement in Borderline Personality Disorder (BPD) is more common than previously hypothesised. However, it remains unclear whether it reflects service users’ personal goals of recovery. The present study aimed to explore what service users with BPD view as recovery. Methods: 48 service users were recruited from secondary mental health services and their views on their personal goals and the meaning of recovery were explored in in-depth semi-structured interviews. The study drew on grounded theory and thematic analysis. Results: Service users believed that recovery involved developing self-acceptance and self-confidence, gaining control over emotions, improving relationships, employment, and making progress in symptoms like suicidality and self-harming. They felt that psychotherapies for BPD often had an extreme focus on specific areas, like self-harming or relationships, and that some of their goals were neglected. Although full recovery was seen as a distant goal, interviewees felt that they could learn how to deal with their problems in more effective ways and make meaningful progress in their lives. Conclusions: Specialist therapies for BPD explicitly address some of the recovery goals that are important to service users, whereas other goals are only indirectly or poorly addressed. Professionals might need to work with service users towards devising comprehensive individualised case formulations, including all treatment targets that are important to service users, their priorities, and long-term plans on how their targets might be met and which services might be involved. Citation: Katsakou C, Marougka S, Barnicot K, Savill M, White H, et al. (2012) Recovery in Borderline Personality Disorder (BPD): A Qualitative Study of Service Users’ Perspectives. PLoS ONE 7(5): e36517. doi:10.1371/journal.pone.0036517 Editor: Antonio Verdejo Garcı ´a, University of Granada, Spain Received December 7, 2011; Accepted April 2, 2012; Published May 17, 2012 Copyright: ß 2012 Katsakou et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: This study was supported by the East London National Health Service (NHS) Foundation Trust. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. * E-mail: c.katsakou@qmul.ac.uk Introduction Borderline personality disorder (BPD) has long been a burden for those suffering from the condition and a challenge for clinicians. The prevalence of the disorder is between 1% and 5.9% in the general population [1–5]. Individuals with BPD experience great difficulties in regulating their emotions, unstable relationship patterns, mood swings, feelings of emptiness and chaotic lifestyles. Suicide attempts and/or self-harming are common in 69–80% and completed suicide occurs in up to 10% of those diagnosed [6–8]. Service users with BPD consume significant therapeutic resources [9] and professionals treating them often feel overwhelmed and distressed [10–11]. Self-harming behaviour is one of the main reasons for psychiatric hospitalisation and other costly interventions [10]. BPD was considered by many to be chronic and unresponsive to treatment [12]. However, recent evidence indicates that the severity of BPD symptoms among those receiving treatment in mental health services decreases dramatically over time. Studies from the USA and UK indicate that under half of patients initially meeting criteria for BPD still do so 6 years later [13] whilst after 10 years this drops to 26% [14]. Evidence from randomised controlled trials shows that several specialist psychotherapies for BPD are effective in reducing symptoms [13,15–26]. These have included Dialectical Behavioural Therapy (DBT) and Mentaliza- tion-based Therapy (MBT), which can lead to reduction in suicide attempts and self-harming, and less use of crisis services [15–20]. Although such clinical improvements are an important achievement and an obvious target for services, it remains unclear whether they reflect service users’ perceptions of personal recovery and desired outcomes. It has been observed that clinical improvement or risk reduction, traditionally assessed in mental health research, do not always coincide with patients’ personal evaluations of recovery and meaningful progress in their lives [27– 28]. Personal recovery is often seen as a way of ‘living a satisfying, hopeful, and contributing life even with the limitations caused by the illness’ [29]. Furthermore, recovery might be interpreted differently by different groups of service users. Although qualitative studies have explored the meaning of recovery for users of general psychiatric services with a diagnosis of Axis 1 disorders (depression, PLoS ONE | www.plosone.org 1 May 2012 | Volume 7 | Issue 5 | e36517