Working around a contested diagnosis : borderline personality disorder in adolescence

Koehne, Kristy, Hamilton, Bridget, Sands, Natisha and Humphreys, Cathy 2013, Working around a contested diagnosis : borderline personality disorder in adolescence, Health: an interdisciplinary journal for the social study of health, illness and medicine, vol. 17, no. 1, pp. 37-56, doi: 10.1177/1363459312447253.

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Title Working around a contested diagnosis : borderline personality disorder in adolescence
Author(s) Koehne, Kristy
Hamilton, Bridget
Sands, Natisha
Humphreys, Cathy
Journal name Health: an interdisciplinary journal for the social study of health, illness and medicine
Volume number 17
Issue number 1
Start page 37
End page 56
Total pages 20
Publisher Sage
Place of publication London, Eng.
Publication date 2013-01
ISSN 1461-7196
Keyword(s) adolescent
discourse analysis
borderline personality disorder
Summary This discourse analytic study sits at the intersection of everyday communications with young people in mental health settings and the enduring sociological critique of diagnoses in psychiatry. The diagnosis of borderline personality disorder (BPD) is both contested and stigmatized, in mental health and general health settings. Its legitimacy is further contested within the specialist adolescent mental health setting. In this setting, clinicians face a quandary regarding the application of adult diagnostic criteria to an adolescent population, aged less than 18 years. This article presents an analysis of interviews undertaken with Child and Adolescent Mental Health Services (CAMHS) clinicians in two publicly funded Australian services, about their use of the BPD diagnosis. In contrast with notions of primacy of diagnosis or of transparency in communications, doctors, nurses and allied health clinicians resisted and subverted a diagnosis of BPD in their work with adolescents. We delineate specific social and discursive strategies that clinicians displayed and reflected on, including: team rules which discouraged diagnostic disclosure; the lexical strategy of hedging when using the diagnosis; the prohibition and utility of informal ‘borderline talk’ among clinicians; and reframing the diagnosis with young people. For clinicians, these strategies legitimated their scepticism and enabled them to work with diagnostic uncertainty, in a population identified as vulnerable. For adolescent identities, these strategies served to forestall a BPD trajectory, allowing room for troubled adolescents to move and grow. These findings illuminate how the contest surrounding this diagnosis in principle is expressed in everyday clinical practice.
Language eng
DOI 10.1177/1363459312447253
Field of Research 111005 Mental Health Nursing
Socio Economic Objective 920210 Nursing
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2013, Sage
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Document type: Journal Article
Collection: School of Nursing and Midwifery
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