{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T20:03:37Z","timestamp":1785528217201,"version":"3.56.0"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Chiropr Man Therap"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Borderline personality disorder (BPD) is a complex and often stigmatised mental health condition frequently comorbid with chronic pain and musculoskeletal disorders. Despite regularly encountering individuals with BPD, manual therapists (e.g., physiotherapists, chiropractors, osteopaths, and massage therapists) receive limited training on how emotional dysregulation, trauma, and relational sensitivity may influence physical-care encounters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This clinically informed commentary explores how BPD\u2019s psychological and neurobiological features intersect with bodily pain, therapeutic touch, and clinical communication. It highlights the potential for both therapeutic benefit and unintended harm within manual therapy interactions, and identifies a need for trauma-informed, psychologically attuned care. Drawing primarily on the National Institute for Health and Care Excellence (NICE) guideline for BPD (CG78, 2024 update), this paper cautiously adapts selected principles\u2014such as collaboration, continuity, clear boundaries, and support for clinicians\u2014to manual therapy contexts. The National Health and Medical Research Council (NHMRC) guideline (2012) is used selectively to provide additional operational detail where not explicitly addressed in NICE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>While these considerations offer a pragmatic framework for enhancing safety and therapeutic engagement, their application requires careful adaptation to context, scope of practice, and resource availability. Further research, particularly co-designed with people with lived experience of BPD, is needed to evaluate feasibility and refine these approaches within manual therapy settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12998-026-00666-8","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T13:40:50Z","timestamp":1785159650000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Manual therapists and people living with borderline personality disorder (BPD): a commentary on building safety, trust, and therapeutic effectiveness in physical care"],"prefix":"10.1186","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7783-8328","authenticated-orcid":false,"given":"Stanley","family":"Innes","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8220-7627","authenticated-orcid":false,"given":"Karthika","family":"Kasiviswanathan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3549-9652","authenticated-orcid":false,"given":"Lee","family":"Daffin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8710-1714","authenticated-orcid":false,"given":"Helen","family":"Mildred","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,27]]},"reference":[{"issue":"2","key":"666_CR1","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1192\/bjp.2019.166","volume":"216","author":"C Winsper","year":"2020","unstructured":"Winsper C, Bilgin A, Thompson A, Marwaha S, Chanen AM, Singh SP, et al. The prevalence of personality disorders in the community: a global systematic review and meta-analysis. Br J Psychiatry. 2020;216(2):69\u201378.","journal-title":"Br J Psychiatry"},{"issue":"4","key":"666_CR2","doi-asserted-by":"publisher","first-page":"561","DOI":"10.1016\/j.psc.2018.07.008","volume":"41","author":"WD Ellison","year":"2018","unstructured":"Ellison WD, Rosenstein LK, Morgan TA, Zimmerman M. Community and clinical epidemiology of borderline personality disorder. Psychiatr Clin North Am. 2018;41(4):561\u201373.","journal-title":"Psychiatr Clin North Am"},{"key":"666_CR3","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association, Diagnostic and statistical manual of mental disorders: Dsm-5, Washington, DC, American Psychiatric Publishing, 2013.","DOI":"10.1176\/appi.books.9780890425596"},{"issue":"1","key":"666_CR4","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1002\/wps.21156","volume":"23","author":"F Leichsenring","year":"2024","unstructured":"Leichsenring F, Fonagy P, Heim N, Kernberg OF, Leweke F, Luyten P, et al. Borderline personality disorder: a comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies. World psychiatry. 2024;23(1):4\u201325.","journal-title":"World psychiatry"},{"key":"666_CR5","unstructured":"Linehan M. Cognitive-behavioral treatment of borderline personality disorder. Guilford Press; 1993."},{"issue":"1\u20134","key":"666_CR6","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1159\/000527041","volume":"9","author":"KJ Johnston","year":"2023","unstructured":"Johnston KJ, Huckins LM. Chronic pain and psychiatric conditions. Complex Psychiatry. 2023;9(1\u20134):24\u201343.","journal-title":"Complex Psychiatry"},{"issue":"1","key":"666_CR7","first-page":"10","volume":"9","author":"RA Sansone","year":"2012","unstructured":"Sansone RA, Sansone LA. Chronic pain syndromes and borderline personality. Innovations Clin Neurosci. 2012;9(1):10.","journal-title":"Innovations Clin Neurosci"},{"issue":"8","key":"666_CR8","doi-asserted-by":"publisher","first-page":"e0309332","DOI":"10.1371\/journal.pone.0309332","volume":"19","author":"M Karimov-Zwienenberg","year":"2024","unstructured":"Karimov-Zwienenberg M, Symphor W, Peraud W, D\u00e9camps G. Childhood trauma, PTSD\/CPTSD and chronic pain: a systematic review. PLoS ONE. 2024;19(8):e0309332.","journal-title":"PLoS ONE"},{"issue":"14","key":"666_CR9","doi-asserted-by":"publisher","first-page":"4973","DOI":"10.3390\/jcm14144973","volume":"14","author":"E Giannoulis","year":"2025","unstructured":"Giannoulis E, Nousis C, Krokou M, Zikou I, Malogiannis I. Wired for intensity: the neuropsychological dynamics of borderline personality disorders\u2014an integrative review. J Clin Med. 2025;14(14):4973.","journal-title":"J Clin Med"},{"issue":"5","key":"666_CR10","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1007\/s11920-024-01498-0","volume":"26","author":"M Nance","year":"2024","unstructured":"Nance M, Stetsiv K, McNamara IA, Carpenter RW, Hepp J. Acute, chronic, and everyday physical pain in borderline personality disorder. Curr Psychiatry Rep. 2024;26(5):240\u20138.","journal-title":"Curr Psychiatry Rep"},{"key":"666_CR11","doi-asserted-by":"publisher","first-page":"110024","DOI":"10.1016\/j.pnpbp.2020.110024","volume":"104","author":"J Hudak","year":"2021","unstructured":"Hudak J, Prince KC, Marchand WR, Nakamura Y, Hanley AW, Bryan CJ, et al. The temporal dynamics of emotion dysregulation in prescription opioid misuse. Prog Neuropsychopharmacol Biol Psychiatry. 2021;104:110024.","journal-title":"Prog Neuropsychopharmacol Biol Psychiatry"},{"issue":"4","key":"666_CR12","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1037\/cps0000036","volume":"28","author":"JL Fales","year":"2021","unstructured":"Fales JL, Schmaling KB, Culbertson MA. Acute pain sensitivity in individuals with borderline personality disorder: a systematic review and meta-analysis. Clin Psychol Sci Pract. 2021;28(4):341.","journal-title":"Clin Psychol Sci Pract"},{"key":"666_CR13","doi-asserted-by":"crossref","unstructured":"Heywood SE, Connaughton J, Kinsella R, Black S, Bicchi N. Setchell. Physical therapy and mental health: a scoping review. Phys Ther. 2022;102(11).","DOI":"10.1093\/ptj\/pzac102"},{"key":"666_CR14","first-page":"2127","volume":"29","author":"M Hooblaul","year":"2023","unstructured":"Hooblaul M, Nadasan T, Oladapo OM. Mental health education for physiotherapists: a scoping review. South Afr J Psychiatry. 2023;29:2127.","journal-title":"South Afr J Psychiatry"},{"issue":"1","key":"666_CR15","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1186\/s12998-020-00332-7","volume":"28","author":"JA Gliedt","year":"2020","unstructured":"Gliedt JA, Battaglia PJ, Holmes BD. The prevalence of psychosocial related terminology in chiropractic program courses, chiropractic accreditation standards, and chiropractic examining board testing content in the United States. Chiropr Man Ther. 2020;28(1):43.","journal-title":"Chiropr Man Ther"},{"issue":"5","key":"666_CR16","doi-asserted-by":"publisher","first-page":"e0321498","DOI":"10.1371\/journal.pone.0321498","volume":"20","author":"VA Bensel","year":"2025","unstructured":"Bensel VA, Cupler Z, Poppen O, Joyce J, Allgeier M, Wiles M, et al. An exploration of trauma-informed care curricula in chiropractic programs: a scoping document analysis protocol. PLoS ONE. 2025;20(5):e0321498.","journal-title":"PLoS ONE"},{"issue":"4","key":"666_CR17","doi-asserted-by":"publisher","first-page":"572","DOI":"10.1111\/jpm.13009","volume":"31","author":"J Miller","year":"2024","unstructured":"Miller J, Nguyen E, Lam AYH, Brann P, Innes S, Buntine P, et al. Experiences of consumers, carers and clinicians during borderline personality disorder presentations to the emergency department\u2014An integrative review. J Psychiatr Ment Health Nurs. 2024;31(4):572\u201382.","journal-title":"J Psychiatr Ment Health Nurs"},{"issue":"3","key":"666_CR18","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1521\/pedi_2019_33_458","volume":"35","author":"J Attwood","year":"2021","unstructured":"Attwood J, Wilkinson-Tough M, Lambe S, Draper E. Improving attitudes towards personality disorder: is training for health and social care professionals effective? J Personal Disord. 2021;35(3):409\u2013S4.","journal-title":"J Personal Disord"},{"issue":"5","key":"666_CR19","doi-asserted-by":"publisher","first-page":"972","DOI":"10.1111\/inm.12737","volume":"29","author":"K Campbell","year":"2020","unstructured":"Campbell K, Clarke KA, Massey D, Lakeman R. Borderline personality disorder: to diagnose or not to diagnose? That is the question. Int J Ment Health Nurs. 2020;29(5):972\u201381.","journal-title":"Int J Ment Health Nurs"},{"issue":"1","key":"666_CR20","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1186\/s13643-022-01960-1","volume":"11","author":"P Klein","year":"2022","unstructured":"Klein P, Fairweather AK, Lawn S. The impact of educational interventions on modifying health practitioners\u2019 attitudes and practice in treating people with borderline personality disorder: an integrative review. Syst Reviews. 2022;11(1):108.","journal-title":"Syst Reviews"},{"key":"666_CR21","unstructured":"International Organization of Physical Therapists Working in Mental Health. Physiotherapy in Mental Health Newbury, United Kingdom: World Physiotherapy Specialty Group. 2024. Available from: https:\/\/world.physio\/subgroups\/mental-health"},{"issue":"3","key":"666_CR22","doi-asserted-by":"publisher","first-page":"773","DOI":"10.1007\/s10862-022-09965-9","volume":"44","author":"G Abramov","year":"2022","unstructured":"Abramov G, Kautz J, Miellet S, Deane FP. The influence of attachment style, self-protective beliefs, and feelings of rejection on the decline and growth of trust as a function of borderline personality disorder trait count. J Psychopathol Behav Assess. 2022;44(3):773\u201386.","journal-title":"J Psychopathol Behav Assess"},{"issue":"3","key":"666_CR23","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1002\/pmh.1609","volume":"18","author":"CC van Schie","year":"2024","unstructured":"van Schie CC, Lewis K, Barr KR, Jewell M, Malcolmson N, Townsend ML, et al. Borderline personality disorder and stigma: lived experience perspectives on helpful and hurtful language. Personal Ment Health. 2024;18(3):216\u201326.","journal-title":"Personal Ment Health"},{"issue":"2","key":"666_CR24","doi-asserted-by":"publisher","first-page":"e70178","DOI":"10.1002\/ijop.70178","volume":"61","author":"X Chi","year":"2026","unstructured":"Chi X, Hu K, Ma Y, Liu Q, Chai H. Impaired processing of bodily signals is associated with borderline personality traits: insights from the predictive coding model. Int J Psychol. 2026;61(2):e70178.","journal-title":"Int J Psychol"},{"key":"666_CR25","doi-asserted-by":"publisher","first-page":"1011146","DOI":"10.3389\/fresc.2022.1011146","volume":"3","author":"E Thornquist","year":"2022","unstructured":"Thornquist E. Movement, touch and talk in Norwegian psychomotor physiotherapy. Front Rehabil Sci. 2022;3:1011146.","journal-title":"Front Rehabilitation Sci"},{"key":"666_CR26","first-page":"45","volume":"5","author":"B Bunkan","year":"1990","unstructured":"Bunkan B, Thornquist E. Psychomotor therapy: an approach to the evaluation and treatment of psychosomatic disorders. Int Perspect Phys therapy. 1990;5:45\u201374.","journal-title":"Int Perspect Phys therapy"},{"key":"666_CR27","unstructured":"Ekerholt Kirsten. Aspects of psychiatric and psychosomatic physiotherapy. Oslo: University College; 2010."},{"key":"666_CR28","unstructured":"N.I.C.E. Clinical Guideline 78- Borderline personality disorder: recognition and management. 2009 (2024)."},{"key":"666_CR29","volume-title":"Clinical Practice Guideline For The Mangement Of Borderline Personality Disorder","author":"NHMR Council","year":"2012","unstructured":"Council NHMR. Clinical practice guideline for the mangement of borderline personality disorder. Canberra: NHMRC; 2012."},{"issue":"1","key":"666_CR30","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1002\/cpp.2783","volume":"30","author":"I Culina","year":"2023","unstructured":"Culina I, Fiscalini E, Martin-Soelch C, Kramer U. The first session matters: therapist responsiveness and the therapeutic alliance in the treatment of borderline personality disorder. Clin Psychol Psychother. 2023;30(1):131\u201340.","journal-title":"Clin Psychol Psychother"},{"issue":"1","key":"666_CR31","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1016\/j.auec.2018.12.001","volume":"22","author":"K Acres","year":"2019","unstructured":"Acres K, Loughhead M, Procter N. Carer perspectives of people diagnosed with borderline personality disorder: a scoping review of emergency care responses. Australasian Emerg care. 2019;22(1):34\u201341.","journal-title":"Australasian Emerg care"},{"key":"666_CR32","unstructured":"World Health Organization rehabilitation competency framework. Geneva: World Health Organisation; 2020."},{"issue":"1","key":"666_CR33","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1037\/a0038768","volume":"25","author":"SF McMain","year":"2015","unstructured":"McMain SF, Boritz TZ, Leybman MJ. Common strategies for cultivating a positive therapy relationship in the treatment of borderline personality disorder. J Psychother Integr. 2015;25(1):20\u20139.","journal-title":"J Psychother Integr"},{"issue":"6","key":"666_CR34","doi-asserted-by":"publisher","first-page":"526","DOI":"10.1080\/00050067.2025.2550383","volume":"60","author":"JH Broadbear","year":"2025","unstructured":"Broadbear JH, Heidari P, Huppert D, Qorbani M, Rao S. Are public mental health clinicians ready, willing, and able to support people with personality disorders? Outcomes of the Victorian clinician survey. Australian Psychol. 2025;60(6):526\u201337.","journal-title":"Australian Psychol"},{"issue":"4","key":"666_CR35","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1111\/jpm.12812","volume":"29","author":"C Marshman","year":"2022","unstructured":"Marshman C, Hansen A, Munro I. Compassion fatigue in mental health nurses: a systematic review. J Psychiatr Ment Health Nurs. 2022;29(4):529\u201343.","journal-title":"J Psychiatr Ment Health Nurs"},{"key":"666_CR36","unstructured":"Miller WR, Rollnick S. Motivational interviewing: helping people change. Guilford Press; 2012."},{"key":"666_CR37","volume-title":"Interpersonal process in therapy: An integrative model","author":"E Teyber","year":"2011","unstructured":"Teyber E. Interpersonal process in therapy: an integrative model. 5 ed. Belmont, California: Thomson Brooks \/ Cole; 2011.","edition":"5"}],"container-title":["Chiropractic &amp; Manual Therapies"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12998-026-00666-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12998-026-00666-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12998-026-00666-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T18:19:49Z","timestamp":1785521989000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12998-026-00666-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,27]]},"references-count":37,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["666"],"URL":"https:\/\/doi.org\/10.1186\/s12998-026-00666-8","relation":{},"ISSN":["2045-709X"],"issn-type":[{"value":"2045-709X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,27]]},"assertion":[{"value":"10 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 July 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Not applicable.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"27"}}