A thematic analysis of the views of neurodivergent women with a personality disorder diagnosis on clinical pathways within mental health services.

PURPOSE: Adults with a personality disorder diagnosis have a high prevalence of co-occurring autism and attention deficit hyperactivity disorder (ADHD). However, there is often no defined pathway within mental health services to meet the needs of this population, and a lack of evidence or consensus on the optimal approaches to identification, treatment and support for neurodivergent people with a personality disorder diagnosis. There has been little exploration of the views of this population on the care they receive in community mental health services. Therefore, the aim of this project was to understand the experiences and perspectives of neurodivergent people with a personality disorder diagnosis, to inform a clinical pathway which is effective, safe, sustainable and equitable. METHODS: Ten qualitative interviews were conducted with women with a diagnosis of, or had been referred for a diagnosis of, autism or ADHD, and a diagnosis of personality disorder. Interviews were analysed using reflexive thematic analysis. RESULTS: Five key themes emerged; staff factors (understanding and skills, attitudes and communication), pathways and processes (access to services and barriers to support), involving and enabling (through adaptations and empowerment), support and clinical interventions (experience of individual therapies and groups, and opportunities to evaluate support), and diagnosis and identification (the impact and accuracy of diagnosis). CONCLUSIONS: This study highlights gaps in current practice as well as personal preferences about identity and experiences of misdiagnosis. It identifies the components of an integrated clinical pathway, that include a person-centered, formulation-driven approach to assessment and reasonable adjustments; peer-led psychosocial support; adapted transdiagnostic psychological therapies; and embedded co-production. Clinical and research priorities are discussed.