Anyway, just a few things on your comments about EUPD. It is true EUPD is very misunderstood among many staff who have not had much training in that area. Admission can indeed 'cure' EUPD (in terms of not meeting criteria) when the gold standard of DBT is undertaken or sometimes schema/trauma therapy. As I already said it isn't so much that admission in and of itself makes it worse but the situation and environment
Yes DBT is the gold standard treatment for EUPD, along with schema and trauma therapy, but it’s rarely undertaken as an inpatient treatment.
The cost of keeping someone in an inpatient bed for a DBT course would be astronomical. DBT, trauma therapy, schema therapy etc can be delivered as part of group therapy in the community, by outpatient psychologists on a 1:1 basis etc.
Occasionally if someone with EUPD is considered very risky, staff will try to secure a Tier 4 placement where trauma therapy and DBT is carried out as an inpatient on a locked unit. But even these placements are not failsafe; if someone is determined to take their own life they will. They cannot be watched 1:1 24/7 and often show signs of false improvement. One of the things with EUPD is how unpredictable emotions can be. Someone might be happy and laughing one minute, suicidal the next.
Admission over 3 days for people with EUPD has been found to be detrimental for a variety of reasons (hence the 3 day pathway).
I agree an acute psychiatric ward is not an ideal therapeutic environment! There’s often lots of noise, shouting, screaming, restraints happening, patients head-banging or self harming or fighting. Staff are doing their best to keep everyone safe but these wards are notoriously understaffed and hard to recruit to and retain staff. Often there will be one qualified nurse on duty and the rest are agency or HCPs. You have people suffering with paranoid delusions, people hallucinating, people detoxing from drugs and alcohol, people having functional seizures and people who are manic and disinhibited to the point they don’t know where they are or why. Running a DBT group on this type of ward is very difficult to do effectively! Believe me I’ve tried!
EUPD is a personality disorder, so although it can be serious and even fatal, a long term admission is rarely the answer. People with EUPD need to learn life skills and techniques to cope with past trauma. Of course not everyone had the same symptoms but even in training, the EUPD traits are made clear and the diagnosis isn’t given lightly.
I’ve cared for groups of young women with EUPD, and while not everyone is the same, it’s worrying how on an acute ward some link up and share tips to SH, ligature, plan escapes, take against certain staff members etc; this type of networking goes beyond the ward and they often contact friends outside so their friends try to get admitted to the same unit. I’ve had women say they feel safe on the ward and they keep trying to come back, openly admitting this; one of the key symptoms of EUPD is seeking care and becoming reliant on a certain place/team to provide that. It’s very sad that people sometimes seek admission to a psychiatric unit as I wonder how awful or empty their lives outside of that unit are. Once admitted they are often model patients, attending all therapy groups and accepting medication, yet I’ve never known anyone to be ‘cured’ by admission. Long term community therapy and age can sometimes cure EUPD.
More complex medication/mix of medication is often needed for EUPD as with many SMIs. But yes anti-depressants and anti-psychotics are often used with good effect
Medics often regard antidepressants as useless for EUPD unless the patient is depressed as well as having a PD. Mood stabilisers are often used to good effect as EUPD is characterised by extreme mood swings. Anti psychotics have little effect on EUPD unless the patient has genuine psychosis as well. In which case EUPD wouldn’t be given as the primary diagnosis. I’ve seen entries in notes like ‘Psychotic episode with EUPD traits’ but the psychosis is the main concern in these cases.