Forensic care needs of women diagnosed with a personality disorder

Forensic services have been described as largely based around the needs of men who form the vast majority of in patients. However women’s offending behaviour is quite distinct from men's: they are more likely to have a personality disorder, most commonly borderline personality disorder (BPD) and to have been victims of abuse both as children and adults. Abuse and borderline personality disorder are characterised by problematic relational styles which cause the person great distress. In the forensic services admission is not based upon treatment readiness and it may be difficult for women to form healthy relationships with care staff or their peers. The recovery model has been recently applied to the forensic service and emphasises that improving relationships is a fundamental target. Women in forensic services have said that their peers can help them to feel connected and less stigmatised but also they can find each other's behaviour very disruptive and disturbing. This research set out to develop a theoretical model of the peer relationships of women with BPD in forensic care using grounded theory methodology. 12 women with a diagnosis of BPD were interviewed about their experiences in forensic care. A model was developed that characterises how women's experiences of relating with each other will depend upon ward characteristics and personal readiness for forming relationships. This will determine whether the person is interacting in a survival mode where relationships are superficial or able to attempt to engage at a deeper relational level with their peers. Such engagement may perpetuate relational difficulties, or have the potential to develop recovery through fostering hope, providing encouragement, developing insight and learning new ways to connect with others and manage problems.