A profile of occupational therapy practice in Australia for people diagnosed with borderline personality disorder

Borderline personality disorder (BPD) is a complex and prevalent diagnosis with impact on occupational performance. Occupational therapists are well-placed to provide rehabilitation services for those diagnosed with BPD. Thus, this study aimed to explore the models, approaches, assessment tools, and interventions used by Australian occupational therapists, including perspectives on current practice.

An online questionnaire was constructed, piloted, and distributed to occupational therapists in Australia who had experience working with adults diagnosed with BPD within the last 5 years. Demographic details and drop-down responses were analysed using descriptive statistics, while open-text qualitative responses were analysed using summative content analysis.

There was no consumer or community involvement.

Sixty-three occupational therapists across Australia responded, with more than half employed in private practice. Occupation-based, trauma-informed, recovery and sensory approaches were most frequently reported. Over three-quarters of respondents used the Sensory Profile, with all except one respondent using open discussion with clients for assessment. Stress management techniques were the most frequently used intervention. The top three limitations and gaps for BPD practice were time constraints, underdevelopment of practitioner knowledge and skills and workload/capacity. Limited funding and fragmented service/system design (n = 32) were the top contributing factors to practice gaps.

Australian occupational therapists work with people diagnosed with BPD across diverse practice areas, predominantly in private practice settings. Trauma-informed care was valued by occupational therapists in practice, but its application needs to be more explicit in assessment and intervention choices. Occupation-based practice needs a distinct and stronger evidence base to determine effectiveness in promoting occupational performance.