To ask if you think eupd is stigmatised

[Happiestyearofmylife]

Dd feels it is her worker said it might just be how she feels. I don’t know much about it so just wondering what other people though?

Imnewhere1991 no it’s understandable all patients will warm to some staff more than others and that’s fine

We all do in our interactions we feel more comfortable with some people than others

I work in forensic too (ex offenders with mh diagnosis) so hierarchy plays out too

I have worked with really positive progression with some patients it’s not overnight and it’s not linear but too often people have been labelled as difficult and that won’t change

Does patients favouring one or two staff members cause issues between the staff? I never really saw it that way as a patient. Selfish I know..

Rarely because staff are very very used to this behaviour. It’s not selfish and it happens almost daily.

Also staff on MH wards often disagree on things like diagnosis, treatment plan, risk level etc, so MDT meetings tend to get heated simply because you have so many different professions coming at the case from different angles (eg psychiatrist, junior doctors, psychologist, nurses, ward manager, therapy staff, pharmacist, liaison staff etc). Even if patients talk to everyone honestly and openly the team may still be split on the case.

If you have a patient who won’t talk to many people some of the staff may feel rejected (it’s human nature) and experienced staff may warn juniors about getting over attached as it makes it harder for the patient to transfer back into the community. (Patient gets attached to nurse then suffers another perceived abandonment when they’re discharged and nurse isn’t allowed to stay in contact).

But it often happens that a patient only feels safe speaking to a couple of people and as long as these staff listen, are professional and good at feeding back to the MDT it’s fine.

It’s safer (IMO) if the patient has a few staff members they trust rather than none, even if this means they take up more of their time. Particularly when EUPD is combined with traits of other illnesses or the diagnosis is uncertain. More than once I’ve had a patient with EUPD get very attached to me and because of this rapport and extra time with them I’ve discovered they’re masking psychosis or they confess something critically important like they’re detoxing from a medication that’s causing their symptoms but couldn’t tell anyone else, (eg their unwitnessed seizure that the MDT thought was a panic attack was actually real as they’d just come off a high dose of illegal benzodiazepines and they need a medically managed detox to prevent further seizures). Or they’ve self harmed and it’s badly infected but they haven’t told the nurses for fear of being in trouble, and it’s turning into cellulitis that can lead to life threatening sepsis. In these cases it needs to be thrashed out amongst professionals in MDT or the team can get the wrong idea and miss something crucial to the patient’s safety and recovery. A patient who can’t advocate for themselves needs someone to get through to them and get their views and needs across in MDT.

Or they need to go somewhere eg for an MRI scan and will go with certain staff members, as they feel able to tell these staff members if they need to run away (before they do it, giving staff a chance to calm them down and talk them out of it).

It only causes real problems between staff if patients make false allegations or if staff get paranoid and turn against each other (which they shouldn’t).

then suddenly when it's realised I've become too attached they suddenly take her away and she leaves the job. I worry I caused that as we were more like friends, but I know she was a mental health nurse...but she would stay later than she should, said she had hope for me 'not as a professional', commented on my home and style and seemed really invested. Then she was gone..that really hurt

I’m sorry this has happened to you. I’m afraid it happens quite often on inpatient wards. Many staff really do have an intense desire to help patients and by taking a nurturing approach she may have over-stepped. It’s often junior doctors, trainee psychologists and the less experienced nurses or therapy staff who do this, then they’re moved on (either due to being on rotation or placement, or the ward manager worries patient is getting too attached and moves the nurse to a different ward). Nobody wants the patient to feel abandoned and rejected on discharge or seek re-admission to a particular ward because they bonded with a certain member(s) of staff.

But just to reassure you, some staff are fully capable of handling an over-attached patient with compassion and kindness. If staff see potential in a patient or find something that helps the patient’s recovery they may go above and beyond to help.

@StrangeToSee thank you for replying. It is really helpful to read your perspective. It's hard to see it when you're in the thick of it yourself.

Patient gets attached to nurse then suffers another perceived abandonment when they’re discharged and nurse isn’t allowed to stay in contact.

^^ I had this massively. I wonder if it was that which made me get diagnosed with eupd as they said I had 'attachment issues as seen in our team'. I was so attached to that particular nurse, her leaving made me feel worse than when I lost my own mother and I know it's not normal, but it felt like she was the first person to listen and care about me since..always I guess. I would also tell her things that I wouldn't tell others but was important so I guess in that way it was somewhat ok that I felt I could speak to her. And I know she tried to push for extra help etc but the psychiatrist wouldn't have it. I requested my notes and read a lot. That's why when she suddenly was gone, it hurt SO much and it lead to me feeling intensely abandoned and wanting to harm myself because I felt rejected and that she wasn't being true to herself and did she ever really care. But then I also felt bad because I know I pushed the boundaries and sometimes I think she loosened them too. It was just how we got on and now she's gone. I never got to thank her properly and I think I should have been allowed to do that. My new care co now keeps me at arm's length, so it feels the total opposite atm.
Do you think the original woman would have got in trouble, it seems they moved her to a completely different area and team after being off sick?

Thank you for your perspective.

You’d have to see a psychiatrist to be diagnosed, and yes you would know

I hope this is true. I’ve never heard of a GP diagnosing EUPD but they may mention EUPD traits if referring on to a psychiatrist.

Sometimes medical notes can get a bit tangled. In my early 20s I had an anxiety disorder and at some point a GP must have written something about agoraphobia because a decade later, when awaiting surgery for a physical problem, an anaesthetist said to me ‘this must be very hard for you, with agoraphobia’. I had to tell him I hadn’t suffered from agoraphobia or anxiety for many years! I was a bit shocked it had come up on my notes, especially as I’d never been agoraphobic (that I know of!)

I requested my notes and read a lot. That's why when she suddenly was gone, it hurt SO much and it lead to me feeling intensely abandoned and wanting to harm myself because I felt rejected and that she wasn't being true to herself and did she ever really care

Medical notes can often sound very clinical and cold, she would have had to have kept her notes professional even if she loosened the boundaries too much. Reflecting your own emotions in notes is a no no.

Many staff can’t help feeling motherly and protective towards certain patients. She probably cared about you and your recovery very much but you couldn’t write that in the notes. However she may have pushed and advocated hard for you in MDT meetings and this won’t always be documented eg if she was trying to get you a certain placement or therapy aftercare service, and the MDT was against it (or there were no places). She may have advocated passionately for you.

Sadly MH services are very underfunded and short staffed and many staff end up with ‘compassion fatigue’ which can make them appear cold and uncaring.

I doubt she got into trouble for getting over-involved in your case, as over-attachment happens so often. She may have been given extra training or supervision. Even staff who take every step possible to prevent over-attachment can end up with a few patients over-attached to them.

Some staff get a reputation for being more empathetic and caring, and if this information spreads between women with EUPD (who often make friends in hospital and communicate daily after discharge) the staff member can end up with a lot of patients requesting their time or showing a strong preference. Sometimes that can lead to stress or pressure. But stress related sickness in MH professionals is very common and usually due to the long hours, assaults and even bullying within teams. Staff often get re-deployed to wards that are short staffed, or if she had a period of sickness that was physical they may have moved her to a role that was less physically strenuous on her return. Eg after my surgery I couldn’t work on the ward for months so they gave me a temporary desk job.

It wasn’t your fault so please don’t worry. The team should have stepped in earlier and managed the situation before it became detrimental to you. If anybody got told off it was probably her manager.