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Treatment Availability for Borderline Personality Disorder
All responses are anonymous and there is no information specific to you that would identify you as the respondent.
Thank you so much for your support in this effort.
1
. I have borderline personality disorder
I have borderline personality disorder
no
yes
2
. I am answering this survey as a family member.
If no, skip to Question #4
I am answering this survey as a family member. If no, skip to Question #4
no
yes
3
. My relative is my:
My relative is my:
mother
father
sibling
child
wife
husband
partner
friend
4
. If you are answering this survey about yourself, please answer the following 10 questions.
If you are answering this survey about someone else, your relative/other person, please SKIP the next 10 questions and answer questions 15-25.
I have been in treatment for BPD for:
If you are answering this survey about yourself, please answer the following 10 questions. If you are answering this survey about someone else, your relative/other person, please SKIP the next 10 questions and answer questions 15-25. I have been in treatment for BPD for:
Less than 1 year
Between 1-3 years
Between 3-5 years
Between 5-7 years
Between 7-9 years
More than 9 years
Other (please specify)
5
. I live in-----please name city/town and state
I live in-----please name city/town and state
6
. There is treatment for BPD within
There is treatment for BPD within
10 miles of my home
50 miles of my home
75 miles of my home
150 miles of my home
More than 300 miles of my home
Don't know
7
. I have had inpatient psychiatric admissions
I have had inpatient psychiatric admissions
no
One
More than 1
More than 3
More than 6
8
. I have been refused admission to a psychiatric hospital. If no, skip to Question #10
I have been refused admission to a psychiatric hospital. If no, skip to Question #10
no
yes
9
. The reason for not admitting me to a psychiatric hospital.
The reason for not admitting me to a psychiatric hospital.
10
. I have been in the following treatments
I have been in the following treatments
Dialectical Behavior Therapy (DBT)
Transference Focused Therapy (TFP)
STEPPS
Mentalization
Supportive Therapy
Schema-Focused Therapy
Other
11
. I am currently in
I am currently in
DBT
TFP
STEPPS
Mentalization
Supportive
Schema-Focused Therapy
No treatment
12
. In general, I have been pleased with the treatment I have received
In general, I have been pleased with the treatment I have received
Not at all true
Somewhat true
Mostly true
Always true
13
. I feel that when I seek treatment for BPD, I am easily able to get into treatment
I feel that when I seek treatment for BPD, I am easily able to get into treatment
Not at all
Sometimes
Often
Always
14
. I feel that I have been discriminated against receiving treatment because of my symptoms
I feel that I have been discriminated against receiving treatment because of my symptoms
Never
Sometimes
Often
Always
15
. My relative/friend was or has been in treatment for BPD for:
My relative/friend was or has been in treatment for BPD for:
Less than 1 year
Between 1-3 years
Between 3-5 years
Between 5-7 years
Between 7-9 years
More than 9 years
16
. My relative/friend lives in
Please name city/town and state
My relative/friend lives in Please name city/town and state
17
. There is treatment for BPD within
There is treatment for BPD within
10 miles of his/her home
50 miles of his/her home
75 miles of his/her ho,e
150 miles of his/her home
300 miles of his/her home
Don't know
18
. My relative/friend has had inpatient psychiatric admissions
My relative/friend has had inpatient psychiatric admissions
no
One
More than 1
More than 3
More than 6
19
. My relative/friend has been refused admission to a psychiatric hospital. If no, skip the next question
My relative/friend has been refused admission to a psychiatric hospital. If no, skip the next question
No
Yes
20
. The reason given for not admitting my relative/friend
The reason given for not admitting my relative/friend
21
. My relative/friend has been in the following treatments
My relative/friend has been in the following treatments
Dialectical Behavior Therapy (DBT)
Transference Focused Therapy (TFP)
STEPPS
Mentalization
Schema-focused Therapy
Supportive Therapy
No treatment
Other
22
. My relative/friend is currently in
My relative/friend is currently in
DBT
TFP
STEPPS
Mentalization
Schema-Focused Therapy
No treatment
Other
23
. In general, I am satisfied with the services that have been available for my relative/friend
In general, I am satisfied with the services that have been available for my relative/friend
Not at all
Sometimes
Often
Always
24
. As a family member/friend, I feel that I have needed support and/or services for myself
As a family member/friend, I feel that I have needed support and/or services for myself
Not at all
Sometimes
Often
Always
25
. There are supports/services available to me as a family member/friend of a BPD sufferer
There are supports/services available to me as a family member/friend of a BPD sufferer
Not at all
Some services
Many services
26
. My age is
My age is
27
. If it is your relative that has the disorder, the age of your relative is -------
If it is your relative that has the disorder, the age of your relative is -------
28
. If it is your relative that has the disorder, how does your relative spend the day. e.g. job, stay-at-home mother, day treatment program, without any structured activity.
If it is your relative that has the disorder, how does your relative spend the day. e.g. job, stay-at-home mother, day treatment program, without any structured activity.
29
. If it is your relative that has the disorder, please estimate about how many years your relative has had the disorder. ------- years
If it is your relative that has the disorder, please estimate about how many years your relative has had the disorder. ------- years
30
. Please feel free to add any information you feel is relevant in explaining your experience in finding available treatment for BPD either for yourself or your family member or friend.
Please feel free to add any information you feel is relevant in explaining your experience in finding available treatment for BPD either for yourself or your family member or friend.
31
. If you have attended any conferences, workshops or family programs specific to borderline personality disorder, please list them here..
If you have attended any conferences, workshops or family programs specific to borderline personality disorder, please list them here..
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