Understanding individual and structural factors behind extensive care needs in personality disorders: an...

Extensive care needs, including frequent hospitalizations and compulsory care, are common among individuals with personality disorders (PD), yet the outcomes of such interventions remain uncertain. This study aimed to explore patient perspectives on the individual and structural factors contributing to the high demand for psychiatric interventions. Eleven high-care-consuming patients diagnosed with PD were interviewed, and data were analyzed using interpretative phenomenological analysis. The findings indicate that emergency department visits often stem from emotional turmoil and social isolation, reflecting acts of desperation. Participants described inpatient treatments as impersonal, lacking direction, and primarily focused on repeated pharmacological interventions that exacerbated feelings of hopelessness. Both inpatient and outpatient care were perceived as "a state of waiting for something that never happens," reflecting an ongoing sense of invalidation and unmet needs. These results highlight the urgent need for healthcare systems to prioritize individualized care plans, improved communication, and explore alternative approaches for managing crises or reforming emergency department practices for this group of patients. Addressing these factors could enhance patient well-being, reduce self-destructive tendencies, and alleviate reliance on the mental health system.