BPD – are we doing enough, are we doing it right ? 🤖✏️📚

Its 1 am , I had just finished clerking a rather complex patient to the wards. Time for a quick brew may be, I tell my self as on call night rolls on. Its been a busy day so far, assessments, assignments and attendances to medical concerns of various service users. My to – do list still showed quite a few boxes awaiting to be ticked off. ‘There are just not enough hours in the day’, this thought occurs quite a lot often these days.
Just about then I receive a call from the crisis team, there’s a lady who needs assessment. I head to the assessment room, the brew could definitely wait, this lady becomes my priority- a knee jerk reflex to every on-call bleep . I make a quick entry to my ever-growing task tab.
I meet this lovely but clearly distressed lady, it was lengthy conversion, she reported she felt extremely lonely and helpless to the point she might harm herself, she had no one to go to, no one to listen. She had material possessions, adequate funds, food supplies but that’s not what she was after rather desperately so, in the middle of the night. At this point of time she needed emotional support, psychological nurturing, reassurance, may be some form of human contact, some sort of magic solution that could bring her out of this misery there and then. She yearned for a place of safety where she could feel at ease, safe from her thoughts ,safe from her mind, safe from her own mind .

At 2 am in the morning all she wanted was a hospital admission.

Borderline personality disorder (BPD) is also known as emotionally unstable personality disorder (EUPD).

Borderline-type
– Difficulties with relationships, self-harming and feelings of emptiness.
Impulsive-type
– Impulsive behaviour and angry feelings.

There are different factors that can lead to someone getting Emotionally Unstable Personality disorder (EUPD). Difficult childhood, neglect, physical, emotional or sexual abuse while growing up are the commonest causes. The experiences can have long standing effects on one’s emotional state and have proven to dictate feelings about self and others later in life .

Emotionally Unstable Personality Disorder is a rather common occurrence, may be less recognised in world outside medical circles and hence rather neglected in terms of appreciation and attendance.
Around 1 in 100 people have BPD. BPD is an illness that makes one feel distressed and anxious. It affects relationships, can cause extreme reactions to minimal stimuli, the person feels abandoned, has unstable relationships with others , Confused, impulsive in ways that could be damaging. Tendency towards excessive spending, sex, substance abuse, reckless driving, and binge eating, regular suicidal behaviour, threats, or self-harm, Long lasting feelings of emptiness, difficulty controlling anger, getting into fights, Intense, highly changeable moods, Paranoid thoughts when stressed. The list by no means is exhaustive.

Inpatient admission

As a on call psych doctor this is a challenging situation. EUPD in itself is a dilemma when it comes to crisis management. Local and National guidelines state hospital admission must be the last resort. The effectiveness of
which itself remains greatly debateable. Moreover, there is little evidence of pharmacotherapy being beneficial, especially in emergent circumstances.

Multiple hospital admissions remains a common occurrence in these cases
, over burdened NHS reaching its threshold, struggling with utmost
bed crisis of all times.

There are ways we could help individuals with EUPD before the boiler bursts and minimise crisis induced compulsive hospital admissions that do little benefit if at all. Options that we encourage our service users to consider, these include

Mindfulness

– The NHS offers mindfulness courses
– Helps manage emotions

Cognitive Analytical Therapy (CAT)

– Helps understand problems in relationships.
– ‘switch’ between liking and disliking people

Psychodynamic psychotherapy

– This therapy focuses on your unconscious. Your unconscious is the part of your mind that controls beliefs, emotions or behaviours without you thinking about them.
– Therapists think that past experiences, especially those in your childhood, can affect your unconscious. The therapist will try to link your current problems to past events. This may help to explain why you feel the way you do.

Dialectical Behaviour Therapy (DBT)
– helps you to build skills to deal with distress.
– Therapists call this ‘emotional regulation’.
– DBT can help you learn how to control harmful ways of coping with distress, such as self-harming11 or using drugs or alcohol

Medication
– There is no medication to treat borderline personality disorder
– Can offer you medication in a crisis, but this isn’t helpful as a long-term treatment

The question is, are we employing them effectively enough to yield benefits or is it just a formality we entertain to dot our Is and cross our Ts.

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