Time to diagnosis and treatment for borderline personality disorder - opportunities and pitfalls during the consumer mental health journey.

Borderline personality disorder (BPD) typically begins in adolescence, however diagnosis and treatment are often delayed, contributing to suffering, frequent service contact for consumers, and distress for families. The aim of this cross-sectional study was to: (1) examine key events in the mental health journeys of consumers with BPD, (2) identify factors contributing to delays in diagnosis and treatment, and (3) explore lived experiences of diagnosis and care. One hundred and seventy participants (average age 34.6 years), most identifying as female (89.9%), completed an anonymous online survey that included questions about symptom onset, diagnosis, treatment, and lived experiences of diagnosis. Univariate and multivariate analyses as well as inductive thematic analysis were utilised. The median time to receiving a BPD diagnosis following initial onset of symptoms was 13.5 years (IQR = 8-20). This was longer for males (p < 0.001) and shorter for non-binary participants (p = 0.047) than for females, both of which were explained by participant age. The delay between symptom onset and diagnosis increased with participant age at time of survey completion (p < 0.001). Once age was taken into account, neither prior mental health diagnoses nor number of prescription medications delayed diagnosis. Post diagnosis, the median time to receive treatment was more than a year (IQR=0-3). Treatment delays and negative perceptions regarding recovery were more likely for participants who reported negative healthcare experiences at the time of diagnosis. These findings suggest improvements have occurred in the identification and diagnosis of BPD nationally, while highlighting the need for ongoing education for mental health professionals to enable them to communicate the diagnosis effectively and facilitate access to evidence-based treatment.