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Emotionally unstable personality disorder | Insight

Introduction

Emotionally unstable personality disorder (EUPD) is a psychiatric condition which can cause fluctuations in mood, and which affects how an individual interacts with and relates to others.

Formerly known as borderline personality disorder (BPD), EUPD is part of a group of psychiatric conditions known as personality disorders – where someone’s personality can interfere with their function, perceptions, behaviour and relationships with others. EUPD commonly presents in adolescence/early childhood and is often experienced along with other mental health conditions.

Key takeaways

EUPD affects just under 1% of the population*
It is common for EUPD to co-exist with other psychological health conditions, e.g. depression, anxiety or eating disorders — which may also require treatment
The cause usually includes both genetic and environmental factors, with a history of childhood trauma being common in individuals with EUPD
Symptoms vary, but typically include intense and fluctuating emotions and moods, instability in relationships, recurrent thoughts regarding self-harm and/or suicide and using self-harm as a way of managing emotional distress
Treatment is primarily psychological therapy, aimed at optimising an individual’s function — dialectical behaviour therapy (DBT) is commonly used
Individuals with EUPD can experience recurrent fluctuations in symptoms and may require varying levels of support and adjustment at work, over time
Workplace adjustments and management support are likely to help an employee with EUPD in maintaining good psychological wellbeing, and to help them optimise their function within the workplace
Equality legislation may apply to an employee with EUPD

Symptoms of EUPD

Symptoms, difficulties and experiences can vary between individuals diagnosed with EUPD. The diagnosis is usually made by a psychiatrist, but individuals struggling with these symptoms may be managed by their GP in the first instance.

Symptoms can include:

Intense and fluctuating emotions, with mood changes from hour-to-hour or day-to-day
Difficulty in maintaining stable relationships
Impulsivity in behaviour and behaviours which may cause risk of harm, such as using alcohol or drugs
Recurrent suicidal thoughts and/or using self-harm as a way of managing emotional distress
Disturbances in thought processes or perception
Persistent feelings of emptiness
Fear and avoidance of abandonment
Not having a strong sense of identity

Treatment and recovery

Psychological therapy is the main treatment for EUPD, aiming to improve an individual’s function, interactions and relationships. Patients are likely to require prolonged treatment, which may be on a group or individual basis.

Dialectical behaviour therapy (DBT) is commonly used. While medication may be used to address co-existing conditions, it is not generally advised for the treatment of EUPD*.

Depending on the severity of symptoms, some individuals may require support from a psychiatrist or mental health team, while others may be managed by their GP.

Lifestyle factors to promote good mental wellbeing are also recommended. These include keeping a good routine, healthy eating, regular exercise and limiting alcohol consumption within recommended limits (14 units per week). Self-help techniques such as mindfulness, meditation or breathing exercises may also be helpful in managing symptoms of EUPD.

Prognosis can vary between individuals. While symptoms and function can often improve with treatment and as people move into older adulthood, some continue to experience significant and persistent symptoms.

EUPD at work

> Crisis plan

Recurrent self-harm and/or suicidal thoughts can be common in individuals with EUPD. For employees who experience this, it can be helpful to discuss and agree a crisis plan with a healthcare professional.

This may include steps to take and points of contact to keep themselves safe, in the event of a mental health crisis. If an individual has such a plan in place, it may be helpful for them to share this with their manager to enable support to be offered, if required at work.

> Wellness action plan

A wellness action plan might also be created, to share with the employee’s manager. This could detail early warning signs of deteriorating mental health, work-related triggers for reduced psychological wellbeing, actions and steps to be taken should deterioration occur and who to contact in the event of an emergency**.

> Regular contact

It could be beneficial to arrange for regular contact between the employee and a manager or senior colleague, so any deterioration in mental health can be spotted and support arranged. Any work-related issues could be addressed via a stress risk assessment.

> Signposting

Employees with EUPD could be directed towards sources of support in the workplace, such as an employee assistance programme (EAP) or mental health first aiders.

Work-focussed mental health support, such as the government-funded Access to Work Mental Health Support Service, may be of benefit as well. Employees with EUPD may also find peer support helpful***.

> Manager training

The emotional reactivity and mood fluctuations experienced by those with EUPD may present challenges within the work environment and for managers.

Training and awareness as to the difficulties and symptoms that an individual with EUPD might face is likely to be helpful in managing and supporting them at work.

Strategies such as using sensitive and clear communication and setting clear objectives and expectations may be helpful.

Individuals might also be allowed time off work to attend psychological therapy or medical reviews, if required.

> Occupational Health

Equality legislation may be relevant to an individual with EUPD, and an occupational health referral could be considered if bespoke advice on adjustments and support at work is required.

* Nice guidance 2009 Borderline personality disorder: recognition and management

** Mind Wellness Action Plan for Managers

*** Mind’s Side by Side supportive online community