Investigating pathways to care in young people (14-25) with Borderline Personality Disorder features

Collins, Kirsty Margaret (2026) Investigating pathways to care in young people (14-25) with Borderline Personality Disorder features. PhD thesis, University of Glasgow.

Abstract

An extensive literature review was conducted prior to embarking on empirical paper write-up. To carry out this literature review the following was implemented: First, the area of review was established with University supervisors, then relevant articles were searched by the first author using these databases: Web of Science; Google Scholar; Pub Med; CAS and University of Glasgow library database and the integrity of each paper was assessed and critically analysed, with findings laid out in the form of a literature review. The search terms and key words included: Borderline Personality Disorder or BPD AND history*, phenomenology*, aetiology*, adolescence/adolescents*, myths*, co-morbidity* trauma*, theories*, pathways*, prevalence*. The literature searched spanned 1938 - 2026. The decision to not undertake a systematic review was made owing to the broad nature of borderline personality disorder features (BPD; here on referred to as BPD or BPD features) research available with nascent research on pathways to care for young people with BPD features; this allowed for a deeper investigation into the wide literature available and for the gaps in research and service provisions for young people with complex needs characteristic of BPD, particularly the importance of lived experience in research and pathways to care in BPD, to be identified.

The literature review introduces the concept of BPD, the key theories, and characteristic of BPD, which are explored throughout the papers in this PhD thesis.

The thesis presents four papers, with the first describing the importance of lived experience of BPD in research (chapter 3) for developing a shared understanding of BPD, from both a researcher’s perspective and from the point of view of those who are experts by experience. Throughout the thesis, there is emphasis on the importance of input from BPD experts by experience and emphasis of experiential analysis. Experts by experience play a pivotal role in both this thesis and in research overall (Fischer et al., 2024). The powerful nature of the impact of lived experienced voices allows for a first-hand insight into journeys through varied systems such as criminal justice and health care systems, in turn, allowing for unique perspectives to drive change, influence co-design of research and tackle systemic challenges i.e. structural stigma in BPD (Collins et al., 2025). Mental health funding institutes such as NIHR and the Wellcome Trust (Banfield & Palmer, 2025) claim lived experience input to be imperative rather than desirable in research. More often services are relying on peers for support work from experts by experience. This thesis meets in a middle ground whereby the author is both a researcher and expert by experience. Arguably, this could drive bias through the thesis, but this is mitigated by the empirical studies using varied methodologies and the researcher’s reflexivity throughout.

Chapter 4 uses data from ‘The Pathways Study’ (Gajwani et al., 2022) clinical case studies, exploring developmental pathways to care in conjunction with signs and symptoms from childhood through to age of participation in young adulthood (14-25). All participants had been through services but BPD, either threshold or subthreshold, was not identified. In this study, particular attention was paid to assessing developmental risk factors, particularly the role of neurodivergence in the emergence of BPD features. All four participants included in the case study analysis met criteria for neurodivergence traits but did not have a diagnosis at the time of the study. In addition, the lack of recognition of signs and symptoms of BPD features, by services during the course of the young person’s involvement, highlighted the missed opportunities for care and a better understanding of the developmental evolution of BPD features in a young person’s life. The findings in turn emphasised the potential for missing early markers of risk and resilience, such as neurodivergence. It is then argued that a comprehensive and collaborative approach to assessing pathways to care would support the understanding of development of BPD features as well as an understanding of when, across the trajectory, BPD emerges in the context of neurodivergence. In addition, the case study helps understand the complex interplay between early adversity and neurodivergence in the context of BPD features.

Chapter 5, an Interpretative Phenomenological Analysis (IPA), attempts to lay the foundations for understanding participant experience of pathways to care in the context of The BRIDGE Project (Gajwani et al., 2024); their journeys through mental health care prior to and during their participation, and the barriers and facilitators they have experienced. Participants (n = 7) described barriers such as stigma, poor individualised care, and lack of continuity of care. The BRIDGE Project is a feasibility randomised controlled trial (fRCT) of brief, intensive assessment, and integrated formulation for young people (age 14-24) with features of borderline personality disorder (BPD). Participants were recruited from multiple community sectors including the National Health Service (NHS), community colleges and Universities and through social media advertising in Glasgow, Scotland. Twenty-five participants were randomised to either BRIDGE intervention or services-as-usual (SAU) and followed up at 12 (T1) and 24 weeks (T2). Those in the BRIDGE intervention arm were offered comprehensive assessments, up to 16 sessions on cognitive analytic therapy (CAT) and contextual intervention with services unique to the young person.

Although there were limitations to analysis of pathways to care, such as a small sample size, the value of lived experience explored empirically, in the form of IPA, echoes the benefits of incorporating experts by experience into research and examining their experiences qualitatively (Fischer et al., 2024). The study highlighted the benefits of thorough, individualised assessment and care and directs future research to look at barriers to implementation of early BPD intervention. Importantly, the influence of historical missed identification for complex unmet needs and its impact on different aspects of the participants young lives is evident in the findings.

Further, in chapter 6, a clinical reflection is offered which explores the contentious issue of stigma associated with BPD and recommendations for informative collaboration between those with lived experience, including parents and carers, and health care professionals.

• Item Type: Thesis (PhD)
• Qualification Level: Doctoral
• Additional Information: Supported by funding from MQ Mental Health Research.
• Subjects: B Philosophy. Psychology. Religion > BF Psychology
• Colleges/Schools: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Mental Health and Wellbeing
• Funder's Name: MQ Mental Health Research
• Supervisor's Name: Minnis, Professor Helen and Gajwani, Dr. Ruchika
• Date of Award: 2026
• Depositing User: Theses Team
• Unique ID: glathesis:2026-86266
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 23 Oct 2026 10:06
• Last Modified: 23 Oct 2026 14:01
• Thesis DOI: 10.5525/gla.thesis.86266
• URI: https://theses.gla.ac.uk/id/eprint/86266

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