Is Borderline Personality Disorder Madness? a Qualitative Study of the Perceptions of Medical Students in Somaliland

AIMS: As the next generation of doctors, medical students' perception of patients with personality disorder (PD) is critical. Yet a systematic review of the literature shows this has not been studied. The study aims to identify 1) the understanding and perception of medical students about PD and 2) factors that may relate to this knowledge and perception. METHODS: A focus group discussion (FGD) was conducted with eight medical students in their sixth year at Amoud University, Somaliland. We presented a case vignette of a patient with typical Borderline PD symptoms (which would meet DSM5 criteria for Borderline PD) and used Barts Explanatory Model Inventory (BEMI) to explore the issue. The FGD was recorded, transcribed, translated and thematically analysed. RESULTS: The Medical students showed accurate knowledge regarding Borderline PD, recognising features of unstable mood, impulsiveness, and emptiness. Medical students showed binary perception, whether this patient was ‘crazy’ (waali) or not crazy. They perceived their community as a strong African Muslim population. Half the participants believed religious intervention would be helpful “I believe in Islam. So, to some degree it could be managed in certain religious centrs”. Importantly, medical students, when asked to divest of their professional identity, and to describe their personal views as members of the local population, then associated PD with craziness or madness. CONCLUSION: The views of PD as craziness or ‘madness’ and the role of religious intervention have important implications for training and service development. The importance of a culturally sensitive training to medical students regarding PD in order to match cultural and religious views, and consideration of development of health services which are sensitive to religious practice is highlighted. We recommend including social and cultural implications in the training of medical students to better prepare them for the complexity of managing PD.