Mental Health Matters Seminar Personality Disorder Dr Martin Humphrey. Kingston College Thursday 29 October

Transcription

1 Mental Health Matters Seminar Personality Disorder Dr Martin Humphrey Kingston College Thursday 29 October

2 About us We provide NHS mental health services to over 1.1 million people of all ages in the London boroughs of Merton, Richmond, Kingston, Sutton and Wandsworth. Our 2,200 staff provide community and outpatient services in each borough and inpatient services at Queen Mary s, Springfield and Tolworth hospitals.

3 Chronic Psychological Distress Or Personality Disorder by another name

4 Dr Martin Humphrey Consultant Psychiatrist Richmond Personality Disorder Intensive Treatment Team Associate Trainer and Supervisor in MBT, Anna Freud Centre Specialist in the treatment of patients suffering from chronic psychological distress (PD) working in specialist PD settings during my 11 years training as a psychiatrist (Henderson Hospital, HMP Grendon) Set up and led MBT treatment services since 2006 Supervisor to teams in Switzerland, Italy and Spain

5 Thanks Debt to the patients, and in many cases their friends and families, I have met over the years who have had the courage to share their lives and struggles with myself and my colleagues Guidance and wisdom of Professors Peter Fonagy and Anthony Bateman

6 Personality Disorders Wide range, but reduced in recent guidelines Emotionally unstable or borderline core most problematic

7 Mental health matters Life expectancy for people with serious mental disorder is reduced by years US: no health without mental health UK: parity of esteem for mental health Investment in mental health

8 Clinical features of borderline (emotionally unstable) PD 5 of 9 criteria: 1. Frantic efforts to avoid real or imagined abandonment. 2. A pattern of unstable and intense relationships. 3. Markedly and persistently unstable self image or sense of self. 4. Self damaging impulsivity. 5. Recurrent suicidal behaviour or self harm. 6. Mood swings of great intensity over hours to days. 7. Often feeling empty. 8. Intense anger out of proportion to events. 9. Short lived paranoia or dissociation.

9 New way of looking at it: first how personality functions Difficulty with either Identity: excessive self criticism, empty Or Self direction: unstable goals, aspirations, values or career plans AND Struggle recognize feelings of others and highly sensitive Or Unstable relationships marked by mistrust, neediness and anxiety

10 And second personality features or traits Problematic mood a. Unstable b. Anxious c. Insecure d. Depressive

11 And second personality features or traits Disinhibition Impulsive Risk taking Conflict Angry hostility

12 And second personality features or traits Stable over time Not age or environment related (mentalising skills decrease from puberty to 25) Not caused by drugs or head injury

13 So how does this come about: the origin of PD Development: living in large social groups Social learning capacity: trusting others to guide us Normal variable function: bonds of affection and safety Risk factors: trauma, temperament

14 Treatment NICE guidelines General principles: not short term, understood by patients and clinicians Medication: no evidence for treating BPD

15 Specific therapies Dialectical Behaviour Therapy (DBT): Marsha Linehan Schema Focussed Therapy (SFT): Jeffrey Young Transference Focussed Psychotherapy (TFP); Otto Kernberg Mentalisation Based Treatment (MBT): Anthony Bateman and Peter Fonagy

16 Mentalisation Based Treatment Based on mentalising as a crucial human social skill See ourselves as others see us Turn hindsight into foresight Be careful about judging a book by its cover To be mindful To cooperate: get otherrs to help us and know how to help them

17 Examples of mentalising Comforting a friend in distress Calming down a child who s having a tantrum Persuading your boss to give you a pay rise Proposing marriage Clearing up a misunderstanding with a friend Working out how not to over eat Describing symptoms and problems to your psychiatrist

18 Patient journey in MBT Assessment & engagement: 3-6+ months Introductory psycho-educational group: 3 months 18+ month group plus individual treatment: intensive phase Possible Therapy pause: 3-9 months 15-month treatment review: exact timing of ending intensive phase Stepdown: monthly evening Transition Group once end date set (externally focused) Stepdown: tapering of individual contact 3-6+ months Maintenance (3-monthly plus crisis): 1-2+ years Overall contact with pt from referral to discharge to primary care (exceptionally secondary care) 3-5+ years

19 Further reading Why love matters Sue Gerhardt, Routledge Overcoming borderline personality disorder: a family guide for healing and change Valerie Porr, OUP

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