Rosemari Mohamad Ali
Background and aim Emotionally unstable, borderline personality disorder (EUPD) is an extremely challenging condition. In inpatient services its prevalence is around 20%. The US and European guidelines support adjunctive, symptom-targeted pharmacotherapy; however, UK guidelines are against the symptom-targeted pharmacotherapy and recommend psychotherapy. Nevertheless, the use off-licence medications and polypharmacy are widespread. We aim to identify socio-demographics, clinical and service-delivery characteristics of people with EUPD admitted to Lincolnshire inpatient services between 1st January 2017 and 31st December 2018. Methods Individuals aged 18 to 65 years old diagnosed with EUPD, ICD 10 diagnosis of F60.30/31 were included. Of 1646 inpatients (731 women, 915 men), 267 (16.2%) were identified with EUPD; 66 people were excluded; 35 (13%) with schizophrenia and 31 (11.6%) with affective spectrum disorders. 201 individuals; 133 women, (66%) and 68 men (34%), average age 32 years were included. Statistical analysis of results was conducted by the Mann-Whitney-Wilcoxon test with Yates’s continuity correction. Results Four (2%); three men and one woman died of suicide. All EUPD patients were of White background. Most patients were single (67%), unemployed (75%) had basic education (73%). 53% of EUPD cohort had at least one physical co-morbidity; 72% at least one, and 16% two psychiatric co-morbidities. Significantly more men (53%) than women (28%) abused substances, however, relatively more women (28.5%) than men (19%) suffered from “neurotic” and stress-related conditions, and more women (8%) than men (1.4%) from eating disorders. 42% of patients received psychotherapy, however 97% pharmacotherapy, of whom 90% were on polypharmacy; 81% were prescribed one antidepressant; 77.5% one antipsychotic’ 55% one anxiolytic and 26% mood stabilizers. Conclusion Borderline personality disorder is a complex and multifactorial condition with widespread comorbidity. The term “Borderline Personality Disorder” causes stigma to patients and their families. The definition of borderline personality disorder as “a mild form of schizophrenia, on Borderline Personality Disorder” causes stigma to patients and their families. The definition of borderline personality disorder as “a mild form of schizophrenia, on borderline between neurosis and psychosis” as expressed by A. Stern is out of date, incorrect and too simplistic to reflect the true nature, gravity and psychopathology of this compounded syndrome. Instead, enduring personality changes, ICD 10 F62, or tardive and complex PTSD, ICD 10 F43.1 should be considered.
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