BORDERLINE PERSONALITY DISORDER

A presentation by Christine Rushworth

Cognitive Behaviour Therapist

AIMS

• To briefly examine the impact Personality Disorders on Primary Care

• To facilitate understanding of EUPD/BPD and what it is like to work with people with this diagnosis

• To think about when to refer to secondary services

• Things to think about when interacting with people with BPD/EUPD

• Resources

PREVALENCE

Personality disorder:

• Affect up to 13% of the population (NICE estimate that between 0.7 and 2% of the general population are diagnosed with EUPD)

• Account for 25% of GP consultations

• Affect 50% of homeless

• 60% of prison population (NICE estimate that 23% of males on remand and 14% of males who are sentenced have EUPD and 20% of female prisoners have it).

• 33.66% of inpatient stays (NICE estimate that 20% of hospital admissions are people with EUPD and 10 – 30% of outpatients)

The majority of people with personality disorders are managed in primary care

EFFECTS ON PRIMARY CARE

• Frequent visits to GPs

• Greater number of prescriptions

• More phone calls

• More referrals to specialist services

• Drain on resources

WHAT IS BPD?

People with the diagnosis may have the following symptoms;

• Fear of abandonment

• Unstable relationships

• Unstable or unclear self-image

• Impulsive and self-destructive behaviours

• Self-harm and suicidal behaviour

• Extreme emotional swings

• Chronic feelings of emptiness

• Explosive anger and very short temper

• Feeling suspicious or out of touch with reality

passionate individual

spontaneous

curious

intense

insightful empathetic and compassionate

creative

Sense of humour

I am useless, nobody likes

me, nobody wants me

nobody cares about me.

People negatively judge

me. I am odd, different,

weird. I don’t fit in with

other people. Everyone is

talking about me and

laughing at me

Rejected, sad, angry,

lonely, hopeless, helpless,

unwanted, different,

anxious

Kick off, verbal aggression,

physical aggression, suspicious,

withdrawn, isolate self, hyper

vigilant , self harm, suicide

attempts, cry, cling to people, push

people away, people please.

BEHAVIOUR

I am not likeable, nobody

likes me, people judge me, I

don’t fit in, I am weird and

odd

THOUGHTS

Standoffish, unfriendly,

aggressive, withdrawn,

avoid eye contact,

feel uncomfortable

and ill at ease,

hypervigilant,

suspicious, angry,

avoidant.

BEHAVIOUR

What is happening

here? This person

seems uncomfortable

and I don’t know why.

Have I don’t

something to upset

them? They don’t like

me

Standoffish, unfriendly/less

friendly, avoidant, cold,

uncomfortable, keep

interactions to a minimum,

aggressive, suspicious,

anxious

BEHAVIOUR

THOUGHTS

PROJECTION/MIND

READING

REINFORCING

WHAT IS IT LIKE WORKING WITH PEOPLE WITH BPD?

Can appear to be difficult

Can appear to be demanding

Can appear to be manipulative

Can be disruptive

Can be aggressive verbally and physically

Can be frustrating

Heart sink

CAN BE VERY CHALLENGING

Can also be very rewarding

Trigger

External

/Internal

Feeling

Distress/anxiety

Thoughts

I cant cope, I need to get

rid of this feeling

Behaviour

Seek help

Short term effect

Reduced anxiety/relief/ less distress

Learning

I cant deal with distress on my own I need help

MAINTENANCE

REFERRAL TO SECONDARY SERVICES

• When is a crisis a crisis?

• When the person is in the preparation phase of the cycle of change

• If in doubt ask for advice

THE CYCLE OF CHANGE

PROCHASKA & DICLEMENTE 1982

APPROACH • Calm and non threatening, recognise feelings but set boundaries.

• Validation - try and understand the problem from the patients point of view, if the patient is angry or verbally aggressive empathise with the distress

• Be reliable and consistent do what you say you will do, if you cant do it tell the patient why and when it will be done

• Be aware of body language/tone of voice

• Focus on current problems and current distress

• Explore what has been helpful in the past

• Give positive feedback if it is appropriate

• Be aware of transference and countertransference (could be positive or negative)

• Be aware of the potential for splitting

• Have a chaperone for physical examinations

• Set tasks such as keep a mood diary, a sleep diary and make an appointment in a weeks time to monitor/check on what they have done and how they are.

• Assess risk

• Use crisis plan/wrap plan if they have one

THINGS TO RECOMMEND: • The women’s Centre – offers counselling, groups and has a crèche

• Mind –offers counselling, groups and activities

• The Wellness Centre – offers groups and activities

• Getselfhelp.com – has self-help materials

• Self-help groups on Facebook – offers support and resources

• Mindfulness (apps such as headspace or you tube)

• There are DBT apps for phones and computers

• Elefriends – supportive online community from MIND

• The Samaritans – offers support when people are in crisis (116 123 or email jo@samaritans.org)

• SANEline – offers emotional support and information from 6pm to 11 pm daily (phone number 0300 304 7000)

• The Rethink Helpline – offers support when people are in crisis

• Many more organisations offer support for people in crisis (google who to ring/text in crisis in uk)

THANK YOU FOR LISTENING