Mental Health Week 8&9

What is a personality disorder?

An enduring pattern of inner experience and behaviour that significantly deviates from cultural expectations, is pervasive and inflexible, stable over time, and causes distress or impairment.

What are 3 common features of personality disorders?

Affect dysregulation, identity disturbance, and relationship difficulties.

What is affect dysregulation?

Intense emotions, emotional sensitivity, and difficulty managing or expressing feelings.

What is identity disturbance?

An unstable self-image and difficulty developing a stable sense of self or life direction.

What are relationship difficulties in personality disorders?

Challenges with empathy, intimacy, trust, and understanding others.

How common are personality disorders in Australia?

Approximately 6.5% of Australians.

How long must personality disorder traits generally be present?

At least 1 year and occur frequently enough to significantly affect functioning.

What are the 3 personality disorder clusters?

Cluster A = odd/eccentric; Cluster B = dramatic/emotional/erratic; Cluster C = anxious/fearful.

What disorders are in Cluster A?

Paranoid, schizoid, and schizotypal personality disorders.

What disorders are in Cluster B?

Borderline, narcissistic, histrionic, and antisocial personality disorders.

What disorders are in Cluster C?

Avoidant, dependent, and obsessive-compulsive personality disorders.

Which cluster is BPD in?

Cluster B: dramatic, emotional, and erratic.

What is Borderline Personality Disorder (BPD)?

A pervasive pattern of instability in interpersonal relationships, self-image, and emotions, with marked impulsivity.

How common is BPD in Australia?

Approximately 2–5% of Australians.

When do BPD symptoms commonly begin?

Adolescence or early adulthood.

What tends to happen to BPD symptoms over adulthood?

Symptoms often improve over adulthood.

What is BPD strongly associated with?

Adverse childhood experiences, trauma, and related neurobiological changes.

How does BPD affect a person's life?

It can affect self-beliefs, emotional regulation, impulse control, relationships, work, family, social functioning, and risk of self-harm.

What conditions commonly occur with BPD?

Substance use, eating disorders, anxiety, depression, and physical health problems.

What are the 4 main symptom domains of BPD?

Emotional dysregulation, interpersonal instability, identity disturbance, and impulsivity/risky behaviours.

What is emotional dysregulation in BPD?

Intense, rapidly changing emotions and difficulty regulating emotional responses.

What is interpersonal instability in BPD?

Unstable or intense relationships and difficulty maintaining safe, consistent relationships.

What is identity disturbance in BPD?

An unstable or changing sense of self, values, goals, or identity.

What is impulsivity in BPD?

Acting quickly without considering consequences, sometimes involving risky or harmful behaviours.

What is essential when caring for someone with BPD?

A strong therapeutic relationship.

What type of care should be used with BPD?

Trauma-informed and recovery-oriented care.

Is inpatient admission standard treatment for BPD?

No. It is generally reserved for serious crises such as significant self-harm/suicide risk or comorbid illness.

What should BPD inpatient admissions generally focus on?

Brief containment, risk reduction, and development of coping skills.

Is medication first-line treatment for BPD?

No. Structured psychological therapy is the primary treatment.

What is the gold-standard psychological treatment for BPD?

Dialectical Behaviour Therapy (DBT).

What are the 4 main DBT skill areas?

Mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation/modulation.

What does DBT aim to improve?

Agency, emotional regulation, behavioural control, and the ability to link feelings, events, and actions.

Why is trauma-informed care important for BPD?

People with BPD often have trauma histories and may experience stigma or punitive care.

Why can people with BPD be at risk of stigmatising care?

Their behaviours may be wrongly labelled as difficult, manipulative, or antisocial rather than understood as responses to distress or trauma.

What emotional reactions might nurses experience when caring for someone with BPD?

Fear, frustration, anger, or disgust.

How should nurses manage strong emotional reactions to BPD patients?

Use self-awareness, reflective practice, clinical supervision, and maintain professional boundaries.

How should nurses understand challenging behaviours in BPD?

As possible survival responses to distress or trauma, rather than character flaws.

What are key nursing principles for BPD?

Compassion, empathy, calmness, respect, non-judgement, consistency, clear communication, validation, hope, autonomy, and recovery focus.

Why is consistency important when caring for someone with BPD?

It helps build trust, safety, and a predictable therapeutic relationship.

What does validating a person's emotions mean?

Acknowledging that their emotional experience is real and understandable without necessarily agreeing with their interpretation or behaviour.

What should nurses promote in BPD care?

Agency, autonomy, hope, recovery, and safe expression of emotions.

Can people recover from BPD?

Yes. Many people can and do recover.

What supports recovery from BPD?

Early diagnosis, appropriate psychological therapy, strong therapeutic relationships, and ongoing support.

What are eating disorders?

Mental illnesses involving disturbed eating patterns, negative body image, weight/shape concerns, and/or compensatory behaviours that affect physical and mental health.

Can eating disorders affect anyone?

Yes. They can occur regardless of age, gender, ethnicity, or education.

What percentage of Australians may experience an eating disorder?

Up to 9%.

What is a major concern with eating disorders?

They can cause serious physical and mental health complications and have a high risk of mortality.

What is the mortality risk of eating disorders like anorexia nervosa?

Anorexia nervosa has one of the highest mortality rates of any mental illness.

What proportion of deaths in anorexia nervosa are due to suicide?

Approximately 1 in 5.

Can people recover from eating disorders?

Yes, recovery is possible, although it can be long-term.

What are the main eating disorder diagnoses?

Anorexia nervosa, bulimia nervosa, binge eating disorder, ARFID, and OSFED.

What does AN stand for?

Anorexia nervosa.

What are the key features of anorexia nervosa?

Restriction leading to significantly low body weight, intense fear of gaining weight, and disturbed body image or lack of recognition of the seriousness of low weight.

What does BN stand for?

Bulimia nervosa.

What are the 3 key features of bulimia nervosa?

Recurrent binge eating, compensatory behaviours, and self-evaluation strongly influenced by weight or shape.

What is binge eating?

Eating an unusually large amount of food in a short period while feeling unable to control the eating.

What are examples of compensatory behaviours in bulimia nervosa?

Vomiting, laxatives, diuretics, fasting, and excessive exercise.

What is a key difference between anorexia nervosa and bulimia nervosa?

Anorexia involves significantly low body weight due to restriction, while bulimia involves recurrent binge eating with compensatory behaviours.

What is ARFID?

Avoidant/Restrictive Food Intake Disorder, involving food avoidance or restriction that is not primarily driven by weight or body-shape concerns.

What does OSFED stand for?

Other Specified Feeding or Eating Disorder.

What supports recovery from eating disorders?

Early treatment, psychological therapy, dietetic support, medical monitoring, and supportive non-judgmental care.

Why is early engagement in eating disorder treatment important?

It can improve outcomes and may shorten recovery time.

What is externalising the eating disorder?

A communication strategy that separates the person from the illness by referring to the eating disorder as something influencing them.

Why is externalising useful?

It can reduce shame and blame, increase compassion, and strengthen the therapeutic relationship.

What is an example of externalising an eating disorder?

“I feel the eating disorder is making things hard for you this evening.”

What question can a nurse ask using externalising?

“What does the eating disorder tell you about yourself?”

How can externalising help the patient?

It helps them feel understood and allows them to see the illness as separate from their identity.