From Isolation to Empowerment: Processes and Early Lessons From a Peer-Designed Recovery-Oriented Borderline Personality Disorder Online Support Group

Background: Peer support for people with borderline personality disorder (BPD) holds promise to support recovery and reduce distress, but few BPD peer support programs have been developed or evaluated. We describe the design and implementation of a novel stakeholder-driven initiative to build a peer-led online support group for people with BPD. Methods: This manuscript does not present a traditional research study or follow an implementation science framework. Instead, it documents a radical, community-led model of care development—one that expands the possibilities for stakeholder-led innovation in mental health services. People with BPD and their families recognized an unmet need and co-created an intervention; researchers later joined to help assess program outcomes and capture impact. We describe support group design, peer facilitator training, and adaptation to online format during the COVID-19 pandemic using narrative format. We quantify changes in attendance over time (one-way ANOVAs) and participant demographics and satisfaction (n=598 survey respondents). Results: A two-year peer-driven process identified core principles and designed a peer-led support group. In the first 26 months, 138 peer-support sessions met (1383 total attendees) with significant increases in registered participants, program attendance, and waitlists. Participants were geographically diverse, likely to attend one session (72%), and reported high satisfaction. Many had never received BPD treatment (44%) or met someone else with BPD (48%).Conclusions: This program demonstrates an example of stakeholder-led design of a sustainable program for people with BPD. The sustained demand we observed underscores the need for accessible empowering support for people with BPD.