“Heart-Sink Patients”: Attitudes of Mental Health Professionals Toward Individuals With a Diagnosis of Borderline Personality Disorder—A Qualitative Evidence Synthesis

Borderline personality disorder is characterized by difficulties with mood and relational instability, poor self-image, self-injury, and suicidal ideation. Mental health professionals report a range of negative attitudes toward this population, viewing them as complex and challenging. This article systematically reviews current qualitative evidence of mental health professionals’ attitudes toward individuals diagnosed with borderline personality disorder. Seven electronic databases were searched. Studies were quality assessed and a thematic synthesis was conducted. A total of 471 participants were represented from 19 studies. Four themes were generated: “Trying to make sense of the chaos,” “Heart-sink patients,” “You treat people with borderline? Are you nuts?” and “Positive aspects and progress.” These themes demonstrated widespread negative and pejorative attitudes. Complex presentations, challenging interactions, and therapeutic futility were identified as contributors to negative attitudes. This review highlights the need to further understand how mental health professionals are prepared for working with this client group.