Post on 14-Jul-2020
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withdrawn, isolate self, hyper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aggressive, withdrawn,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