Unstable Personality Research Articles

Relationship Between Personality and Handwriting Using Eysenck Test

This study attempts to examine ways of writing (handwriting) include: pen pressure, the character size, the distance between the rows, words and letters, the base line, stand line, punctuation of punctual letters, with introvert and extrovert personality, emotional stability- instability (neuroticism) and psychotic features associated with them and study the relationship between these variables using the Eysenck personality questionnaire (adult). The sample used in this study consists of 68 people among the members of community (Miyaneh city in Iran, regardless of their job and position) randomly including 36 women and 32 men. In this study Eysenck Tests questionnaire is used in the form of 90 questions. Chi-squared test results show that there is a significant relation with 99% confidence level between all studied variables in handwriting and the kind of personality characteristics. According to the results, personality of people couldn’t be realized based on just one variable and different variables of personality must taking into account in the handwriting judge. In general, it may be judged that (a) In society, number of people with unstable extrovert personality is more; (b) the amount of instable people is more than stable and (c) the number of extroverts is more than introverts.

Differentiating Recurrent Unipolar Depressive Disorder from Bipolar Affective Disorder as a diagnostic code within the Coventry IPU 3-8 (Affective Disorders).

Differentiating Recurrent Unipolar Depressive Disorder from Bipolar Affective Disorder as a diagnostic code within the Coventry IPU 3-8 (Affective Disorders).

A Case Study Demonstrating the Effectiveness of an Adapted-DBT Program Upon Increasing Adaptive Emotion Management Skills, With an Individual Diagnosed With Mild Learning Disability and Emotionally Unstable Personality Disorder

ABSTRACTThe effectiveness of an adapted-DBT (dialectical behavioral therapy) program upon adaptive emotion management is reviewed. This case study focuses upon a male forensic inpatient diagnosed with mild learning disabilities and emotionally unstable personality disorder who presented with behavioral difficulties including self-harm and aggression. Following development of a psychological formulation, informed by an initial psychological assessment process, the client was referred for the “I Can Feel Good” program (Ingamells & Morrissey, 2014), which is designed to reduce difficulties managing emotions and resulting problematic behaviors. This was in addition to supplementary individual sessions designed to support and reinforce skills developed within the group. The effectiveness of this intervention was assessed using a combination of approaches including a range of self- and staff-report psychometrics and observational data. Findings demonstrated an effect upon some secondary treatment targets (namely an increase in use of mindfulness techniques and adaptive coping strategies) but no overall reduction of the primary treatment target of emotional management or associated emotional and psychological problems. Reflection upon the initial formulation in light of findings is discussed. Methodological difficulties and issues of evaluation are reviewed. Future adaptation of the “I Can Feel Good” program is considered.

Basal Exposure Therapy: A New Approach for Treatment-Resistant Patients with Severe and Composite Mental Disorders.

New treatment approaches are needed for patients with severe and composite mental disorders who are resistant to conventional treatments. Such treatment-resistant patients often have diagnoses of psychotic or bipolar disorders or severe personality disorders and comorbid conditions. In this study, we evaluate basal exposure therapy (BET), a novel ward-integrated psychotherapeutic approach for these patients. Central to BET is the conceptualization of undifferentiated existential fear as basic to the patients’ problem, exposure to this fear, and the therapeutic platform complementary external regulation, which integrates and governs the totality of interventions throughout the treatment process. BET is administered at a locked-door ward with 6 patient beds and 13.5 full-time employees, including a psychiatrist and 2 psychologists. Thirty-eight patients who had completed BET were included, all but two being female, mean age 29.9 years. Fourteen patients had a diagnosis of schizophrenia or schizoaffective disorder (F20/25), eight had bipolar disorder or recurrent depressive disorder (F31/33), eight had diagnoses in the F40–48 domain (neurotic, stress-related, and somatoform disorders), five were diagnosed with emotionally unstable personality disorder (F60.3), and three patients had other diagnoses. Twenty of the patients (53%) had more than one ICD-10 diagnosis. Average treatment time in BET was 13 months, ranging from 2 to 72 months. Time-series data show significant improvements in symptoms and functioning from enrollment to discharge, with effect sizes at 0.76 for the Dissociation Experience Scale, 0.93 for the Brief Symptom Inventory, 1.47 for the Avoidance and Action Questionnaire, and 1.42 and 1.56, respectively, for the functioning and symptom subscales of the Global Assessment of Functioning Scale. In addition, the patients used significantly less antiepileptic, antipsychotic, anxiolytic, and antidepressant medications at discharge than at treatment enrollment. Patient improvement across treatment was associated with the following duration of time in BET, the successful completions of the exposure component of BET, positive changes in experiential avoidance as measured with the Acceptance and Action Questionnaire, and high symptom levels and low levels of functioning at treatment start. The findings indicate that BET may be a promising inpatient psychotherapeutic approach for previously treatment-resistant patients with severe and comorbid conditions.

Profile of Young Suicide Attempt Survivors in a Tertiary Care Hospital in Puducherry.

Context:Puducherry has the highest suicide prevalence rate in India by 2014, predominantly among the 14–30 years age group.Aims:The aim of the present study is to study the characteristics of adolescent and youth suicide attempters in Puducherry and measure the suicide intent.Settings and Design:An observational study of 6 months duration was conducted in the Department of Psychiatry, at Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India.Materials and Methods:Modified version of World Health Organizations SUicide PREvention Multisite Intervention Study on Suicidal questionnaire was used to collect sociodemographic data and Beck's suicide intent scale was used to measure the suicide intent scores. International Classification of Diseases-10 was used for diagnosis.Statistical Analysis:Statistical Package for the Social Sciences version 13 was used for descriptive analysis and correlation statistics. P value was set as <0.05.Results:Of 56 eligible participants, 40 formed the sample, their mean age was 18. 13 (±2.50), more females (1.1:1), rural, literate, lower socioeconomic status (67.5%), mostly single (90%), living in nuclear (95%), and Hindu (87.5%). One hundred percent had psychosocial stressors before suicide attempt. Acute stress disorder/adjustment disorder was the most common diagnosis. Emotionally unstable and anankastic personality traits were seen in 12%. Pesticide ingestion (45%) was the most common suicide method. Sixty percent attempted suicide within <30 min of suicidal contemplation. Statistical associations were found between the alleged purpose, seriousness, attitude toward living/dying, conception about medical rescuability, and the overall suicide intent.Conclusions:Adolescent and youth suicide attempts occur due to psychosocial stressors rather than due to the past or on-going mental health disorders with above personality traits suggest poor coping skills and resilience taken to deal with stressful situations by younger people.

The frozen borderline

I frequently leap over the fence between “professional” and “patient” (a note on terminology here: I don't ever refer to myself as a “service user”) and sometimes plank on said fence and refuse to move for long periods of time. Time for full disclosure. I've never told anyone this outside a consulting room, but when I was 18 and left home to go to university, I had recently been diagnosed with severe obsessive-compulsive disorder (OCD) and recurrent depression, having been self-harming for several years by this point. I'd been started on an SSRI antidepressant, and the psychiatrist had gently explained that if this didn't work, there were other, similar medications and cognitive behavioural therapy which were the gold standard treatment for OCD. I was surprised, then, when having asked the university GP to make a referral to the community mental health team as I had been advised to do, that I was seen by a consultant for half an hour and advised to seek “long term counselling”. When my copy of the clinic letter arrived, it read “I suspect this young lady has an underlying borderline (emotionally unstable) personality disorder as evidenced by her self-harming.”

Pain management in context of emotionally unstable personality disorder

IntroductionEmotionally unstable personality disorder (EUPD) is characterised by Pain Paradox. The response for acute, self-induced pain seems to be attenuated while chronic, endogenous pain is usually intolerable. Pain management of this group of patients poses many difficulties, including discrepancies between subjective and objective pain assessment, patients’ demands for strong analgesics and impact on relationship with other professionals.Objectives and aimsThe purpose of the study was to review pain management options for persons diagnosed with EUPD and complaining of chronic pain.MethodsMEDLINE and PsycINFO databases were searched for all English-language articles containing the keywords “chronic pain”, “pain management”, “borderline personality disorder”, and “emotionally unstable personality disorder”.ResultsSeventeen relevant papers were identified. Suggested first step in pain management was ongoing clarification with EUPD patients that analgesics are unlikely to fully treat their pain and support of non-pharmacological approaches to pain, including cognitive-behavioural strategies. Regarding pharmacology, liberal use of non-addicting analgesics was recommended with highly conservative use of opioid analgesics. Importance of evaluation and treatment of any underlying mood and/or anxiety syndromes was stressed as well as liaison with other professionals (e.g. psychologists, neurologists, orthopaedics, and physiotherapists).ConclusionsPatients with EUPD often report chronic pain, which can only be managed by close collaboration of professionals from different disciplines.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Emotional instability and borderline personality disorder

Affective instability is widely regarded as being the core problem in patients with borderline personality disorder (BPD) and the driving force behind the severe clinical manifestations of BPD symptoms. In ICD-10, BPD is even labelled as emotionally unstable personality disorder. In the last years, the advent of electronic diaries, in combination with sophisticated statistical analyses, enabled studying affective instability in everyday life. Surprisingly, most recent studies using state-of-the-art methodology to assess and model affective instability in BPD failed to show any specificity, supporting the idea of a transdiagnostic construct. In addition, dysfunctional emotion regulation strategies revealed results contradictory to current clinical beliefs. Using multiple data sets and multilevel modelling, we will demonstrate that to understand affective instability it is important:– to statically model basic subcomponents of affective dynamics simultaneously;– in combination with dysfunctional regulation strategies;– cognitive processes in everyday life.Altogether, current research suggests that the dynamics of affective states and their intentional regulation are even more important to psychological health and maladjustment, than the affective states itself. Current initiatives to fundamentally improve psychopathological research are looking at basic physiological processes spanning across disorders. However, these approaches do fall short in understanding human behaviours as dynamical processes that unfold in the broadest setting imaginable – everyday life. Only the combination of basic physiological processes and methods assessing dynamical affective mechanisms in everyday life will enhance our understanding how dysregulations and dysfunctions of fundamental aspects of behaviour cut across traditional disorders.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Description of the activity of a psychiatric day hospital from its opening up to the present day

IntroductionDescription of the most relevant data found in a Psychiatric Day Hospital opened ten months ago in the hospital complex of Ávila.ObjectivesThe goal is to evaluate clinical and management data in patients of the Psychiatric Day Hospital.MethodsRetrospective cross-sectional descriptive study. A data collection form where each patient is classified into: sex, age, average stay, first admission or readmission, origin, reason for discharge, destination on discharge and diagnoses (classification ICD-10) was used.ResultsFrom the opening of the Psychiatric Day Hospital ten months ago, 58 patients have been admitted: 70.7% women and 29.3% men. Readmissions: 1.7%. Their origin was: psychiatric hospitalization (53.5%), outpatient department (31%), emergency room (13.8%) and Centre for Psychosocial Rehabilitation (1.7%). 41 out of 58 patients have been discharged. Reasons for discharge: improvement (78%), referral to other units (7.4%), voluntary discharge (4.8%) and others (9.8%). The destination on discharge was: outpatient department (90.4%), Centre for Psychosocial Rehabilitation (4.8%), and Inpatient Rehabilitation Unit (4.8%). The most frequent diagnoses on discharge were: bipolar affective disorder, adaptation, emotionally unstable personality disorder, dysthymia, persistent delusional disorders, specific personality disorders and severe depressive episode with psychotic symptoms.ConclusionsThe Psychiatric Day Hospital is an intensive treatment unit with a partial hospitalization system, which is distinguished by the variety of patients it is able to admit, as well as the clinical and management benefits the dynamic of these units can provide.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Long-acting injectable antipsychotics: Diagnostics and patient profile

IntroductionLong-acting injectable antipsychotics (LAIs) were developed in the sixties with the purpose of improving schizophrenia maintenance treatment. The main advantages are: the ability to ensure compliance, maintaining stable plasma concentrations and allowing better clinical management of drug therapy. Long-acting atypical injectable antipsychotics start to develop in the late nineties. Currently, they are the most widely used depot treatment for severe mental illness.ObjectiveChecking patient profile and diagnosis where we use LAIs.MethodsReview of 217 patients treated with LAIs in CSM El Coto–Gijón.ResultsIn our sample, the average age of the patients was 48.94 years old. Most of them were men (135 vs. 82). More than half of treated patients were diagnosed with schizophrenia (112), the paranoid subtype was the most repeated (93). Other severe mental illnesses were also treated with LAIs: emotionally unstable personality disorder (31), delusional disorder (19), bipolar disorder (15), schizoaffective disorder (12) and other less frequently. For all groups, paliperidone palmitate was the most used injectable antipsychotic. The new aripiprazole long-acting injectable starts being used in psychotic patients with a significant affective component.ConclusionsThe schizophrenic patient remains being the prime candidate for this therapy although other severe mental disorders may also benefit of LAIs treatment. Most classical long-acting injectable antipsychotics have been replaced by new atypical injectable antipsychotics with a more tolerable side effects profile.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Emotion regulation, depression and self-harming behaviours in people with borderline personality disorder: the moderating role of action vs. state orientation

&lt;b&gt;Background&lt;/b&gt;&lt;br /&gt; The aim of this research is to determine the level of emotion regulation, studied through the method of variable action orientation vs. state and its relationship with depressiveness and dimension of the reasons for living and self-harming behaviour of patients with borderline personality disorder.&lt;br /&gt; &lt;br /&gt; &lt;b&gt;Participants and procedure&lt;/b&gt;&lt;br /&gt; The research studied 61 patients diagnosed with an emotionally unstable personality of borderline type. The research used the Polish adaptation of tests to measure the action vs. state orientation (SSI-K), the self-harming behaviour (SHI), depression (BDI) and the reasons for living vs. suicidal tendency (RFL-I).&lt;br /&gt; &lt;br /&gt; &lt;b&gt;Results&lt;/b&gt;&lt;br /&gt; In people with borderline personality disorder, the level of emotion regulation (action vs. state orientation), reasons for living and depression are predictors of self-harming behaviour. The experience of a depressive episode or lack thereof does not have a relationship with the increase of self-harming. Analysis of the interaction between variables showed that the reasons for living and the action orientation after failure are related to the reduction of self-harming behaviour in all subjects. In depressed people, state orientation is associated with an increase in the action orientation with decreased self-destructive behaviours.&lt;br /&gt; &lt;br /&gt; &lt;b&gt;Conclusions&lt;/b&gt;&lt;br /&gt; High levels of reasons for living in interaction with the action orientation have a negative relationship with the self-harming behaviour of patients diagnosed with borderline personality disorder. Among those subjects, depressive patients, a statistically lower level of self-harm is related to the action orientation. These results suggest that therapeutic treatment is important to activate both reasons for living as well as action orientation as effective dimensions in preventing self-harming.

SOCIODEMOGRAPHIC AND PSYCHIATRIC CHARACTERISTICS AMONG HOMICIDE OFFENDERS IN SERBIA - THE PROVINCE OF VOJVODINA (1996-2005).

Recent studies have shown a growing correlation between violence and mental illness, but there is a higher risk of violent crimes only in certain cases of mental disorders. This study presents sociodemographic and psychiatric characteristics of homicide offenders in Serbia, in the Province of Vojvodina in a 10-year period (1996-2005). Material and Methods~ The obtained data are based on performed forensic and psychiatric expert investigatfons of 154 homicide offenders in preceding period, considering sociodemographic data, personal history and current psychiatric status. Data were analyzed using the statistical John's Macintosh programe. The male offenders were in the great majority (92%) as well as a low level of education (87%). A positive history of criminal acts was found in 24% of the subjects. Minority of subjects (21%) consumed alcohol on a daily basis. At the time of committing the crimes, 57% of homicide offenders were under the influence of alcohol, and just 2% of other psychoactive substances. Among the offenders who had previously received psychiatric treatment (31.2%), the most frequent diagnosis was alcohol addiction (25%) and anxiety disorders (22.9%). During the psychiatric examination 70.8% of the subjects were diagnosed with mental disorder: personality disorders (41%), alcohol addiction (84%), neurotic disorders (65%), schizophrenic psychosis (5.2%), affective disorders (3.2%), paranoid psychosis (2.6%), organic disorders (19%), psychoactive drug addiction (13%) and mental retardation (0.6%). Emotionally unstable personality disorder was dominant among personality disorders (55.6%). Diminished mental competency was established in 77.9% of subjects at the time of the homicide, being rather sever in most of them. All those diagnosed to have a psychotic disorder were mentally incompetent. Emotionally unstable disorders were the most common among the offenders who underwent forensic evaluation. A relatively low presence of psychotic disorders imposes the need for de-stigmatization particularly of the patients suffering from major mental illnesses.

Prevalence and risk factors of suicide in a rural area of Shandong province in mainland China: a case control study

Objective: Suicide is a major public health problem in China, particularly in rural areas. This study aimed to examine the rate and the risk factors for suicide in a rural area of China. Methods: The mortality data of two counties in Shandong Province from January 1st, 2004 to December 31st 2005 were used. Death information was collected via face-to-face interview with informant(s). Psychological autopsy was conducted on 137 completed suicides and 137 matched controls died from other illnesses. Chi-square/Fisher exact and multiple logistic regression were used for bivariate analyses and predictor analyses, respectively. Results: The suicide rate was 20.90 per 100,000 persons per year with almost equal rates of males and females. Among those with the age over 40 years old, the suicide rate in males was significantly higher than that in females. The peak of suicide fell in the age group of 70-79 years for males and the age group of ≥ 80 years for females. The most commonly used method for suicide was pesticide ingestion (76.7%). Poor interpersonal relationship ( OR =12.79), childhood adversities ( OR =7.26), a history of mental illness ( OR =5.95), adverse life event(s) within 1 year prior to death ( OR =3.19), and unstable extravert personality traits ( OR =6.12) were independent risk factors for suicide. Male gender positively interacted with majority of these risk factors, especially with a history of mental illness ( OR =17.89). Advanced age positively interacted with all independent risk factors, with a history of mental illness having the largest OR of 1.51 as every 10 year of age advancement. In bivariate analyses, a history of previous suicide attempt ( OR =13.06), a family history of suicide ( OR =7.08), and unstable introvert personality trait ( OR =1.83) were also associated with increased risk for suicide; and stable extravert personality trait ( OR =0.21) was associated with decreased risk for suicide. Conclusions: In this rural population of mainland China, the risk for suicide was almost equal in both males and females with the elderly having the highest risk. The positive interactions of advanced age and male gender with independent risk factors suggest that suicide prevention strategies targeting specific groups with different risk factors are essential.

The main tendencies of development of morality and religiosity in modern society

The tendencies of morality and religion interconnection and their further development in the period of globalization and informatization of modern society based on the philosophical and religious analysis of morality and religion is considered in the article. The author argues that morality serves as a social culture of coexistence organization and as an internal regulator and personal judge of individual deeds, internal law of action in terms of good and evil. But it is also an attempt to achieve freedom, because very often is powerless before the nonfree world. In light of this problem, freedom is possibility of choices, but a choice is a quality of that person who has freedom. In fact, author is considering that a person thinks about proposed behavioral patterns. Morality is associated with such a quality of person, as spirituality, which is now divided into secular and religious. The article draws attention to their features. Attention is drawn to the fact that it is not appropriate to oppose the morality of believers and unbelievers. Psychologists, sociologists, experts on ethics researches show that is not directly proportional relation between person’s attitude to religion and his behavior in society. Formal religion will not keep unstable personality from immoral acts. No religion and no church is unable to resist temptation, injustice, aggression that are a product of real contradictions of social life. The era of globalization has brought radical changes: a huge number of new developments, borrowed cultural values and value systems, philosophical and pseudo-philosophical concepts appeared in the community. This leads to the fact that more and more people are trying to live their minds, changing our country’s traditional Christian values to something else.

Quality of physical health care among patients with personality disorder.

To investigate the assessment and treatment of physical health in patients with personality disorder and compare this to the care received in schizophrenia. We collected data from a random sample of 246 patients with personality disorder on monitoring and intervention for seven key aspects of physical health. We compared the results with those from a random sample with schizophrenia. In our sample, 160 (65%) people had the diagnosis of emotionally unstable personality disorder. In total, 104 (42.3%) people with personality disorder were being prescribed antipsychotic medication; 23 (9.3%) participants had all seven aspects of physical health recorded. Alcohol was most frequently recorded (76%); BMI (38.6%), blood glucose (25.2%) and blood cholesterol (20.7%) were less likely to be recorded. Interventions were not given to all those requiring them. Compared to people with schizophrenia, a lower proportion had evidence of assessment of smoking, illicit drug use, blood glucose and blood lipid levels. Smoking cessation advice was more likely to be offered to people with schizophrenia (difference = 29.4%, 95% CI = 12.5 to 44.7). Physical health is under-assessed and under-treated in patients with personality disorder. Medical staff must do more to help tackle increased morbidity among this group.

Modeling the effect of regulation of negative emotions on mood

In this paper a computational model is presented that describes the role of emotion regulation to reduce the influences of negative events on mood. Emotion regulation is a process based on a set of regulatory strategies used by persons to down-regulate their negative emotions or to up-regulate their positive emotions. For a given situation, the selection of specific regulation strategies is dependent on that particular situation. The current paper presents work focusing on a cognitive reappraisal (re-interpretation) strategy, that involves changing the way one interprets a stimulus or situation, or alter the semantic representation of an emotional stimulus in order to reduce the influence of such stimuli. The model incorporates an earlier model of mood dynamics and a model for the dynamics of emotion generation and regulation. Example model simulations are described that illustrate how adequately emotion regulation skills can avoid or delay development of a depression. The presented computational analysis shows how regulation of stressful emotions helps unstable persons to avoid a depression, and to postpone it in very unstable persons. Furthermore, the analysis shows that if a stressful event persists for a longer time period, then emotion regulation can also help an unstable person to prevent the mood level from becoming too low, for a certain time.

Is the seclusion policy of mental health care users a necessary evil?

Background . Seclusion in the psychiatric context is the involuntary confinement of an agitated, unstable person alone in a contained, controlled environment. Differing views on seclusion presents clinicians with an ethical dilemma. Significant morbidity and mortality have been associated with seclusion. No data exist in South Africa on rates of seclusion for psychiatric purposes. Consequently neither the need for seclusion nor alternatives to seclusion have been explored. Objective . To determine the number of patients secluded over six months, provide a profile of patients that were secluded, and to ascertain the reasons for seclusion. Methods . A retrospective record review of patients secluded at Sterkfontein Hospital, over a six-month period. Results . A total of 112 patients were secluded over the six-month period. Users were secluded for a total of 59 415.5 hours and on 4 814 separate occasions. A total of 84.8% of the users secluded were male. The mean age of users secluded was 29 years. Just under half the users (49.1%) were secluded for their own safety and 40% of users were secluded for aggression (either physical or verbal). The most common diagnosis was schizophrenia (31.4%) followed by cognitive impairment (20.6%) and bipolar mood disorder (13.7%). The most commonly used medication was sodium valproate (17%), followed by haloperidol (11%) and risperidone (11%). Conclusion. Younger male patients with psychosis were most likely to be secluded. More research should be conducted locally to compare seclusion rates and patient profiles so that we may improve seclusion practices.

Management and effectiveness of psychopharmacology in emotionally unstable and borderline personality disorder.

The article by Paton and colleagues on the use of psychotropic medication in patients with emotionally unstable personality disorder (EUPD) in the current issue of JCP is an important article. Making the assumption that EUPD as defined by ICD-10 (F60.3) is reasonably equivalent to borderline personality disorder (BPD) as defined in the United States by DSM, we are provided some insight into how practitioners think about prescribing medications to people with EUPD/BPD. The article not only offers information as to the class of medication these practitioners are using but also provides reasons why, ie, for what clinical signs and symptoms, the medications are being prescribed.

The use of psychotropic medication in patients with emotionally unstable personality disorder under the care of UK mental health services.

Guideline recommendations for the pharmacologic treatment of personality disorder lack consensus, particularly for emotionally unstable personality disorder (EUPD), and there is limited information on current prescribing practice in the United Kingdom. To characterize the nature and quality of current prescribing practice for personality disorder across the United Kingdom, as part of a quality improvement program. A cross-sectional survey of self-selected psychiatric services providing care for adults with personality disorder (ICD-10 criteria) was conducted. Data were collected during May 2012. Of 2,600 patients with a diagnosis of personality disorder, more than two-thirds (68%) had a diagnosis of EUPD. Almost all (92%) patients in the EUPD subgroup were prescribed psychotropic medication, most commonly an antidepressant or antipsychotic, principally for symptoms and behaviors that characterize EUPD, particularly affective dysregulation. Prescribing patterns were similar between those who had a diagnosed comorbid mental illness and those who had EUPD alone, but the latter group was less likely to have had their medication reviewed over the previous year, particularly with respect to tolerability (53% vs 43%). The use of psychotropic medication in EUPD in the United Kingdom is largely outside the licensed indications. Whether the treatment target is identified as intrinsic symptoms of EUPD or comorbid mental illness may depend on the diagnostic threshold of individual clinicians. Compared with prescribing for EUPD where there is judged to be a comorbid mental illness, the use of off-label medication for EUPD alone is less systematically reviewed and monitored, so opportunities for learning may be lost. Treatment may be continued long term by default.

Why patients with severe personality disorders are overmedicated.

Emotionally unstable personality disorder (EUPD), more widely known as borderline personality disorder (BPD), has long been considered a clinical challenge. Patients meeting criteria for these diagnoses are emotionally dysregulated, impulsive, and involved in troubled relationships; in clinical settings, they may threaten suicide or attempt it and are frequently seen in emergency departments. Patients with BPD can be treatment resistant, even when clinically depressed, to both pharmacotherapy and standard types of psychotherapy.