“It All Exists Within Me”: A Qualitative Study Exploring Mental Health Service Experiences in Adults With Comorbid Eating Disorders and Emotionally Unstable Personality Disorder

OBJECTIVE: Comorbidity between Eating Disorders (ED) and Emotionally Unstable Personality Disorder (EUPD) is high. This comorbidity is also linked with worse outcomes for traditional evidence-based treatments. We aimed to improve mental health service experience for adults with comorbid EUPD and ED by: (1) understanding the service-user experience of receiving and accessing care; (2) identifying areas of unmet need; and (3) creating recommendations for improving care for this population. METHODS: The project comprised semi-structured interviews with nine service-users within the UK National Health Service. Reflexive Thematic Analysis was used to generate themes, which informed clinical recommendations and a framework for improving care to meet local needs, with implications beyond. RESULTS: Service-users described long waits and disjointed care, often feeling pressured to prioritise one difficulty over another in ways that did not align with their own goals. Many reported that their needs were only recognised at crisis point, highlighting a gap between clinician understanding and personal experiences. Six themes were derived from patient interviews. Psychoeducation about the links between EUPD and ED was seen as helpful, as well as the need for more consistent individualised care that better reflects service-users' goals and needs. CONCLUSIONS: The project increased understanding of the experiences of mental health service use in adults with comorbid ED and EUPD, and produced a set of recommendations, aimed at improving care for these individuals. These included a thorough assessment of comorbidity, consideration of service-user choice, alongside appropriate service adaptations to best meet service-users' goals and needs.