National Institute for Health and Clinical Excellence (NICE)
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New NICE guidelines set to improve treatment and management of people with borderline personality disorder

NICE guidance published yesterday (28 January) outlines how healthcare professionals can identify, treat and manage people with borderline personality disorder.

 
Borderline personality disorder is a condition that affects a person’s thoughts, emotions and behaviour. Symptoms include having emotions that are up and down, with feelings of emptiness and often anger, difficulty in making and maintaining relationships, having an unstable sense of identity and harming yourself or thinking about harming yourself (for example, cutting yourself or overdosing). People with borderline personality disorder come from many different backgrounds, but most will have suffered some kind of trauma or neglect as children.


Key recommendations from the guideline include:
• People with borderline personality disorder should not be excluded from any health or social care service because of their diagnosis or because they have self-harmed.

• When working with people with borderline personality disorder:
− explore treatment options in an atmosphere of hope and optimism, explaining that recovery is possible and attainable

• Community mental health services should be responsible for the routine assessment, treatment and management of people with borderline personality disorder.

• Drug treatment should not be used specifically for borderline personality disorder or for the individual symptoms or behaviour associated with the disorder (for example, repeated self-harm, marked emotional instability, risk-taking behaviour and transient psychotic symptoms).

• Mental health trusts should develop multidisciplinary specialist teams and/or services for people with personality disorders. These teams should have specific expertise in the diagnosis and management of borderline personality disorder.

Dr Tim Kendall, Joint Director, National Collaborating Centre for Mental Health and Adult Consultant Psychiatrist said: “Approximately 2 million people in the UK have personality disorders, with antisocial and borderline disorders being the most common. We have largely ignored this problem or have been too dependent on drug treatments that don’t work and in some cases (for example the use of antipsychotics) can be harmful. With this guideline we want to make sure that all professionals working in mental health services take responsibility for people with borderline personality disorders with the support of specialists teams. We want attitudes to change inside the health profession and amongst the public – borderline personality disorder is a real condition that can be treated effectively to the benefit of the person with BPD, their families and the wider community.”

Professor Peter Tyrer, Professor of Community Psychiatry, Imperial College
London and GDG Chair said:
“The diagnosis of personality disorder often carries with it the notion of untreatability and persistence. Neither of these is true, especially with respect to borderline personality disorder. Patients are often pleasurably surprised that problems that have formerly appeared to be misunderstood, ignored or dismissed, are appreciated as a source of real suffering and treated with much greater respect when they are seen in a personality context. The notion of a ‘quick fix’ is not appropriate for this group of conditions and far too many are given treatments such as drugs for their symptoms that only give brief relief and when they return more drugs are added. Many people with this disorder suffer all the adverse effects of multiple drug prescription (polypharmacy) and this is not only unhelpful but
carries the risk of serious adverse effects. When people with these disorders are treated consistently with primarily psychological approaches the outcome is good and relapse unlikely, so these longer term treatments are much more cost-effective.”

Victoria Green, guideline development group member representing service
user and carer interests said:
“For people who have Borderline Personality Disorder overcoming the difficulties associated with this diagnosis can be a huge struggle. However, this struggle is made much more difficult by the frequent lack of understanding and the stigma people with this disorder receive both from inside and outside mental health services; they can be denied services, told they are untreatable, or seen as being to blamed for their difficulties. It is frequently overlooked that people with this diagnosis often have had difficult early experiences and difficult lives. For me, this guideline is an important step forward in addressing these issues. If people with this diagnosis are able to have better access to treatment that addresses their needs and are in an environment that encourages understanding, optimism and hope then I believe more people will be able to move on from this disorder to live fulfiling lives: recovery is possible.”

Ms Jenifer Clarke-Moore, Consultant Nurse, Gwent Healthcare NHS Trust and GDG member said: "The implementation of these guidelines will ensure that individuals who are often extremely vulnerable and have complex health and social care needs are no longer excluded from mental health services but are able to access responsive, equitable, quality care. Through the development of specialist personality disorder services within trusts, mental health nurses will be able to access, not only education/training, but also ongoing support and supervision to better equip them with the knowledge and skills to provide effective, evidence-based nursing interventions for people with this diagnosis. This will inevitably result in improved patient care and most importantly a better service for people with the diagnosis of borderline personality disorder".

Notes to Editors

1. The guidance is available at www.nice.org.uk/CG78

 
About NICE


2. The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.

3. NICE produces guidance in three areas of health:
public health – guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
health technologies – guidance on the use of new and existing medicines, treatments and procedures within the NHS
clinical practice – guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

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