Calls for change as new report finds Victorian paramedics under stress levels akin to a mental disorder


Paramedic Dean Adams was coming home from a 12-hour night shift during which a patient had threatened to murder him when he realised something had to give.

He’d barely had time to use the toilet, let alone eat anything that night, as his crew was sent from job to job — culminating in treating a man who’d assaulted a police officer, and then turned on him.

In his three years since starting as a paramedic, Mr Adams has seen the workload increase dramatically.

“The relentlessness was just unsustainable going forward, and for me that was evidenced by sleeping difficulties … it was impacting my eating patterns,” he said.

He was dreading going to work, especially to back-to-back 12-hour night shifts.

He stopped seeing friends and felt drained.

“I think we all strive to provide the best care to our patients … but there’s times where you’ve been working for 10-12 hours and you haven’t had time to stop and recover … and that’s when it becomes dangerous,” he said.

A new study, led by researchers at Swinburne and RMIT universities and obtained exclusively by the ABC, has found that like Mr Adams, many Ambulance Victoria employees are at breaking point.

More than a third feel burnt out by their work, and 10 per cent are looking to leave the profession in the next year.

Almost one in 10 are exhibiting stress levels comparable to having a severe psychological disorder, while a quarter report being under moderate levels of psychological distress.

In comparison, previous studies have found less than 13 per cent of the general population exhibits similar distress levels.

Report author Peter Holland said the research pointed to a dangerous level of emotional exhaustion in the workforce, far beyond anything he’d seen in his previous studies on nurses in hospitals.

“They’re under very significant levels of stress, to the extent that some of these people need some help themselves in that sense,” Professor Holland said.

The survey of 663 staff — about 17 per cent of on-road Ambulance Victoria employees — was completed in September last year during Melbourne’s second COVID-19 lockdown. 

But Professor Holland and co-author Lara Thynne believe the situation would not have changed since that time because workloads had increased dramatically since the lockdown ended.

“If anything, things have gotten worse,” Dr Thynne said.

She said while being a paramedic was always a high-intensity job, the research found recent trends of missing meal breaks, working overtime, and gruelling night shifts with no rest time were taking their toll.

“The damage is the emotional effects on paramedics outside work. We know paramedics [already] have higher rates of suicide, and higher rates of marriage breakdown,” she said.

Since the COVID-19 lockdown ended, Victoria’s health system has been under strain, with demand for ambulances skyrocketing.

Victoria’s hospital emergency departments are full, which leads to ramping — a situation where paramedics care for a patient in the ambulance outside a hospital until a bed becomes available inside.

This in turn prevents the crew from attending emergencies in the community.

Pair that with an increase in call-outs in recent months, and ambulance wait times are now at their worst levels in six years, according to new quarterly data.

The deadly consequences of this were evident two weeks ago, when 32-year-old Christina Lackmann died after waiting six hours for an ambulance.

It prompted the Victorian government on Friday to announce more than $750 million in the upcoming budget for more paramedics, better systems to deal with non-urgent emergency calls, and better access to beds in emergency departments.

The exact reasons for increased call-outs are not known, but Danny Hill from the Victorian Ambulance Union said his members were seeing more patients with chronic illnesses who had let their treatment go during the pandemic.

He also believes his members are increasingly taking patients who don’t need further care to hospital, because the paramedics fear they won’t be supported by Ambulance Victoria if the patient later suffers an adverse event.

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One in four people with an eating disorder has autism and current treatments might be failing them


One in four people with an eating disorder may have autism according to some experts, which can mean they aren’t receiving the right type of treatment.

This was the case for 20-year-old Kayla*, who developed an eating disorder at the age of 11 and was diagnosed with anorexia nervosa at the age of 14. 

After years of treatment that did little to help her recover, her family searched for an alternative support option and found a therapist that specialised in both eating disorders and Autism Spectrum Disorder (ASD).

Kayla became aware that she had ASD traits that were contributing to her eating disorder, and inability to recover.

“Everything suddenly made sense as to why I am the way I am, and why I’m thinking like this. And it’s OK, it’s nothing to be ashamed of,” she said.

Ever since Kayla can remember she has been extremely sensitive to sound, but she didn’t realise this was an ASD trait.

“Mealtimes are really difficult because not only have I got all the sensory stuff from the ASD, but then I’ve got the actual eating disorder as well at the same time. So it’s almost like my brain just shuts down,” she said.

Kayla’s mother Beth* said it was scary when Kayla was first diagnosed with an eating disorder.

“All of a sudden our daughter had stopped eating. It was impossible to get her to engage in wanting to put anything into her mouth,” she said.

When Kayla was finally recognised as having ASD traits, Beth took a different approach to her treatment.

“We immediately became involved as a family, it was a big learning curve,” she said.

“We really had to step back and explore the roots of what was happening inside her mind. And just be really accepting of where she was at, and what she was going through.

“I think for the first time she felt heard and she felt like someone understood what she was going through on a daily basis.”

This person-centred approach is when Beth felt her family finally became “calm”.

Professor Tony Attwood is a clinical psychologist at Griffith University and he said research shows about one in four of those reaching out for eating disorder services have characteristics of autism, and sometimes are diagnosed with autism for the first time when they’re involved with eating disorder services.

He feels more needs to be done to provide a program specifically designed for people with autism.

“Group work is a challenge for those with autism,” he said.

“Because they may have a condition called alexithymia, which means difficulty disclosing inner thoughts and feelings, they appear to be obtuse and not really engaging with therapy, but they just often can’t convert thought and emotion to speech.”

Professor Atwood said the health sector needs to look at the trend of “professional isolation” as it can create problems for people with more than one issue to deal with.

“Those who specialise in autism often have minimal knowledge of eating disorders, and those in the area of eating disorders may have minimum knowledge of autism. And this is where we need to get together to share our expertise,” he said.

Katherine Annie, the operations manager of the Autistic Self Advocacy Network Australia and New Zealand, said this lack of a combined approach is not uncommon.

“There needs to be a degree of up skilling of clinicians around the different presentation, so that people can understand the needs of autistic people in treatment,” she said.

Ms Annie said autistic people need to be centred when receiving health care, in a co-production model to support all their needs.

“There needs to be research and training, so that health care specialists have the ability to understand the particular presentation of autism and eating disorders,” she said.

“That might be done through a general practitioner network, it might be inserted into the clinical space where autism is treated, as well as where eating disorders are treated so that people who are working with autistic people can recognise the signs of eating disorders and people working with eating disorders can recognise the signs of autism.”

This person-centred treatment is something Kayla is now also advocating for. While it’s been a long road to recovery, she is now finding purpose by sharing her experiences to help others.

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NIMH » NIMH Livestream Event on Borderline Personality Disorder


Date/Time:

Location: Virtual

In recognition of National Borderline Personality Disorder Awareness Month in May, NIMH is hosting a livestream event on Friday, May 21, 2021, from 1:30 – 2:00 p.m. ET.

Borderline personality disorder is an illness marked by an ongoing pattern of varying moods, self-image, and behavior. These symptoms often result in impulsive actions and problems in relationships. People with borderline personality disorder may experience intense episodes of anger, depression, and anxiety that can last from a few hours to days. Borderline personality disorder is also associated with a significantly higher rate of self-harm and suicidal behavior than those without the disorder.

Stephen O’Connor, Ph.D., chief of the Suicide Prevention Research Program in the NIMH Division of Services and Intervention Research, will moderate the discussion with NIMH grantees Stephanie D. Stepp, Ph.D., Associate Professor of Psychiatry and Psychology at the University of Pittsburgh, and Shireen L. Rizvi, Ph.D., ABPP, Associate Professor of Clinical Psychology at Rutgers University. Experts will discuss the signs, symptoms, diagnosis, treatments, and the latest research on borderline personality disorder. Also, experts will discuss some of the challenges that the coronavirus (COVID-19) outbreak has presented for individuals living with borderline personality disorder and other mental illnesses.

Participating is easy.

  • Watch the livestream event on NIMH’s Facebook or Twitter feeds. You must have either a Facebook or Twitter account to watch.
  • Follow NIMH on Facebook or Twitter for updates on the livestream event and other information about mental health research.
  • Refresh NIMH’s Facebook or Twitter feeds at 1:30 p.m. ET on May 21 to watch the livestream discussion.

The livestream will be archived on NIMH’s website and Facebook page so you can access it after the event is over.

Note: The experts cannot provide specific medical advice or referrals. Please consult with a qualified health care provider for diagnosis, treatment, and answers to your personal questions. If you need help finding a provider, visit www.nimh.nih.gov/findhelp. If you or someone you know is in crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255); En Español 1-888-628-9454.



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NIMH » NIMH Expert Dr. Mary Rooney Discusses Bipolar Disorder in Adolescents and Young Adults


Transcript

MARY ROONEY: Thank you for joining me today. I’m Dr. Mary Rooney, a clinical psychologist and chief of the Child and Adolescent Psychosocial Interventions Research Program at the National Institute of Mental Health or NIMH, which is part of NIH, the National Institute of Health. For world bipolar day, we’re focusing on adolescents and young adults for the discussion. And while bipolar disorder is far less common than depression in adolescents, it can be extremely impairing and is associated with a high risk for suicide if it’s left untreated. Bipolar disorder can be particularly difficult to diagnose in adolescents if they’re already experiencing mood swings related to activity and hormonal changes, and the signs and symptoms of bipolar disorder may overlap the symptoms of other disorders that are common in young people like ADHD, conduct problems, major depression, and anxiety disorders. So diagnosing bipolar disorder can be complicated and it requires a careful and thorough evaluation by a trained and experienced mental health professional. During the next half hour, I’ll provide an overview of the signs and symptoms, proper diagnosis, and treatments for bipolar disorder in adolescents and adults. I’ll also discuss some of the challenges that the COVID-19 outbreak has presented for individuals living with bipolar disorder. And if there’s still time at the end, I’ll also take some of your questions, so please, ask them in the comments section under this video feed on Facebook or tweet NIMH on Twitter.

It’s important to note that I can’t provide specific medical advice or referrals, so please consult with a qualified healthcare provider for diagnosis, treatment, and answers to your personal questions. And if you need help finding a provider, please visit www.nimh.nih.gov/findhelp. And if you or someone you know is in crisis, please call the National Suicide Prevention Lifeline at 1-800-237-TALK. You can also ask for help in the comments section of this feed, and someone from NIMH will assist. All of the websites and phone numbers that I just mentioned will also be posted in the comments section of this feed so that you can easily access them. So let’s start by talking a little bit about what is bipolar disorder and what are some of the signs and symptoms. So bipolar disorder is a mental disorder that causes people to experience noticeable, sometimes extreme, changes in mood and behavior. And sometimes children with bipolar disorder feel very happy or up and are much more energetic and active than usual, and this called a manic episode, and sometimes children or teens and young adults with bipolar disorder feel very sad or down and are much less active than usual. So this called a depressive episode. Bipolar disorder, which used to be called manic depressive illness or manic depression is not the same as the normal ups and downs that every other young adult or teen experiences.

The mood changes in bipolar disorder are much more extreme, they are often unprovoked and accompanied by changes in sleep, energy level, and the inability to think clearly. Bipolar symptoms can make it hard for young people to perform well in school or get along with their friends and their family members. Mood episodes in bipolar disorder include intense emotions along with significant changes in sleep habits, activity levels, thoughts, or behaviors, and a person with bipolar disorder may have manic episodes, depressive episodes, or mixed episodes, which includes both manic and depressive symptoms. These mood episodes cause symptoms that often last for several weeks or days, and during an episode, the symptoms last every day for most of the day. And as I mentioned before, these mood and activity changes are very different from a person’s usual behavior and from the behavior of healthy people the same age. So children and teens having a manic episode, they might show intense happiness or silliness for long periods of time. They have a very short temper or seem extremely irritable. You’ll find that they talk fast about a lot of different things and think from topic to topic quickly. They’ll have trouble sleeping, but they won’t feel tired the next day. And they’ll have trouble staying focused and experience racing thoughts, where the thoughts are going through their head faster than they can even keep up with.

They’ll seem overly interested or involved in pleasurable but risky activities, and they’ll very likely do riskier reckless things that show what most people would consider to be poor judgment. Children, teens, and young adults who are having a depressive episode might feel frequent and unprovoked sadness, show increased irritability, anger, or hostility. They complain a lot about pain like stomach aches, headaches. In contrast to a manic episode, you’ll notice that someone in a depressive episode will have a noticeable increase in the amount of sleep. So they’ll be sleeping a lot more than usual. They’ll also have difficulty concentrating. They may feel hopeless or worthless, will have difficulty communicating or maintaining friendships. They’ll eat more. Either too much or they’ll eat too little. And they’ll have little energy and they’ll have almost no interest in activities that they usually enjoy. And they also think about death and have thoughts of suicide or wanting to hurt themselves. So who can develop bipolar disorder? Well, technically, anyone can develop bipolar disorder. And most people with bipolar disorder develop it in their late teens or early adult years, and occasionally, bipolar disorder symptoms can appear in children. We don’t know what cause bipolar disorder, but we do know that it can run in families. And this doesn’t mean that just because someone in your family has bipolar disorder it just means that you or someone else in your family will develop it, it just means that your chances of developing it are a bit higher because someone in your family has it already.

Another factor that may lead to bipolar disorder is the brain structure or brain function of the person with the disorder. And scientists are finding out more about this disorder by studying it. And if you consider joining an NIMH research study on bipolar disorder to help scientists learn more about it and if you want to learn more about studies that are funded through NIMH, you can go to www.nimh.nih.gov/joinastudy. And if you think you or your child may have bipolar disorder, a professional healthcare provider will carefully examine you or your child and ask about your family’s medical history. There’s no blood tests or brains scans that can diagnose bipolar disorder, but a provider may use tests to see if something other than bipolar disorder is causing your child’s symptoms. Now, let’s talk a little bit about how it’s diagnosed and what that process looks like. As I mentioned earlier, most people are diagnosed with bipolar disorder in late adolescence or adulthood, but the symptoms can appear earlier. Bipolar disorder is often episodic, right? So there’s discreet periods of mania or depression, but the disorder itself is chronic and it typically lasts a lifetime. The healthcare provider will ask questions about your child’s mood, speaking patterns, energy levels, and behavior. And while there’s no blood tests as I mentioned or brain scans that can be used, the provider may use tests to make sure there isn’t something else like a medical condition that might be causing your child’s symptoms and use tests like this in those phases.

Sometimes healthcare providers and you need to know about medical conditions in the family like depression or substance use or other mental health conditions. Other disorders also have symptoms that are like those of bipolar disorder, and this can include ADHD, disruptive mood dysregulation disorder, oppositional defiant disorder, conduct disorder, and anxiety disorders. So one of the clinician’s main jobs is to distinguish bipolar disorder from the depression that occurs without mania and is often referred to as major depression. The healthcare provider who specializes in working with children, teens, or young adults can make a careful and complete evaluation of your child’s symptoms and provide the right diagnosis. Now, when we’re thinking about treatments, children, teens, and young adults can work with their healthcare provider to develop a treatment plan that will help them manage the symptoms and improve their quality of life.

[silence]

Okay. I think I’m back. All right. Let’s start again [inaudible]. Okay. I think I had seemed to be back for [inaudible]. All right. So let’s start by talking about medication as a treatment option. So there’s several types of medication that can help treat symptoms of bipolar disorder. Children, teens, and young adults respond to medications in different ways, so the right type of medication depends on the individual. So this often means that someone may need to try different types of medication to see which one works best for them before they finally get on one that they are able to take long-term. Some children, teens, and young adults may need to take more than one type of medication because their symptoms are complex. Individuals should take the fewest number of medications in the smallest doses possible to help their symptoms because that way you minimize side effects. So a good way to remember this is as start low and go slow. Always tell your child’s healthcare provider about any problems with side effect and have conversations upfront about what the side effects might be so you know what to look out for.

But if you do notice side effects, don’t stop giving your child the medication without speaking to the healthcare provider first. Stopping medication suddenly can be dangerous, and it can exacerbate bipolar disorder symptoms. Now, medication isn’t the only option, although it’s a very important component of treatment for most people with bipolar disorder. Psychosocial therapy or talk therapy [inaudible] also very powerful for bipolar disorder. So different kinds of psychosocial therapy can help children, teens, young adults, and their families manage the symptoms. Therapies that are based on scientific research or what we would call evidence-based treatments include cognitive-behavioral approaches and family-focused therapy. And these treatments provide support, education, and guidance to teens, young adults, and their families. And in each of these treatments, family involvement is a very important component. These therapies teach skills that can help people manage bipolar disorder, including skills for maintaining routines, enhancing emotional regulations, and improving social interactions. Improving family communication and family functioning can also be an important part of these treatments. With treatment, children and teens and young adults with bipolar disorder can get better over time. Treatment is most effective when healthcare providers, parents, and young people all work together as part of a team.

Sometimes a person with bipolar disorder may see their symptoms change or disappear and then come back, and when this happens, your child’s healthcare provider may recommend changes to the treatment plan. And treatment can take time, it does require patience, but sticking with the treatment plan can help young people manage their symptoms and reduce the likelihood of future episodes. Your child’s healthcare provider may recommend keeping a daily life chart or mood chart, either kept by the adolescent or an adult or kept by parents and the teen or young adult themselves, and this will track your child’s moods, behaviors, and sleep patterns. This might make it easier to track the illness and see whether the treatment’s working. And if you’re not sure where to get help, your doctor, pediatrician, or other family healthcare provider is a great place to start. A healthcare provider probably won’t provide the diagnosis and primary care, but they can refer you to a qualified mental health professional like a psychiatrist or a psychologist who has experience treating bipolar disorder and can evaluate your child’s symptoms. And you can also start, as I mentioned before, by visiting www.nimh.nih.gov/findhelp. Now, let’s talk a little bit about what parents can do to help your teen or young adult.

Help begins with the right diagnosis and treatment. So talk to your family healthcare provider about symptoms you notice as soon as possible. Ad if you find that your child does have bipolar disorder, here are some basic things you can do. You can start by being patient. Mental illness always takes a while to treat, it’s not a– nothing’s a quick fix, but when you’re patient, it can be effective over time. Keep the lines of communication open with your child, encourage them to talk to you, and listen to your child carefully. Pay attention to their moods and be alert and sensitive to any major changes. If you notice a change, then very quickly reach out to your child’s healthcare provider. Learn to understand triggers. Often changes in mood, whether it’s a depressive episode or a manic episode, can have triggers that proceed it. And when you are aware of those triggers, you can manage them in advance and even help your child or teen learn strategies for managing intense emotions and irritability, and also focus on managing your own emotions and your irritability. For some teens and young adults with bipolar disorder, family stress and strain can be a trigger, so managing your own intense emotions and irritability can also be an important part of treatment. Helping your child have fun is also very important. It can be easy to lose sight of that when you’re in the midst of trying to treat someone with a mental illness, but staving off depressive symptoms and even manic episodes can really be helped by making sure your child is engaging in things that they enjoy doing, and that includes things they enjoy doing with their family.

And remember that treatment takes time, so sticking with a treatment plan can help your child get better and stay better, and help your child understand that treatment may make life better and that if they stick with their treatment plan, they can manage their symptoms. Now, let’s just take a minute to talk about the pandemic and its impact on individuals with bipolar disorder and a few things that you can do to manage bipolar disorder within the context of the pandemic. So feelings of anxiety and uncertainty are completely normal during a global pandemic. I think it’s something that just about everyone has experienced in the last year, but it can be a lot more challenging facing this uncertainty when you’re having a mental illness like bipolar disorder. So it’s very important that your child, if they’ve been diagnosed with bipolar disorder, continue their treatment regimen and to not deviate from that regimen. And if you haven’t already, consider developing a plan for telehealth sessions with your doctor so treatment isn’t interrupted. And reach out as a parent to friends and family for support and encourage your child to stay connected with other teens or young adults and their friends and their families throughout the remainder of the pandemic and connect virtually if necessary. What we do know is that social isolation increases stress and loneliness and that both of these can be triggers for a bipolar episode.

Now, some people may be more prone to manic episodes where they feel excited or irritable or energized, and while others experience more depressive episodes where they feel more down. So they may have more mild episodes called hypomanic episodes or, as I mentioned before, mixed episodes that involve both manic and depressive symptoms. Each of these kinds of episodes can have their own specific triggers, so it’s best as I mentioned before, to map out what these might be in the context of typical life but also being aware of what they might be in the context of the pandemic. It’s also important for teens and adolescents– sorry, teens and young adults to void drugs and alcohol because it can interfere with medications that are used to treat bipolar disorder. And high levels of caffeine can also trigger an episode. Regular exercise like jogging, racewalking, or cycling helps with depression and anxiety, and promotes better sleep and can help stave off manic or depressive episodes. And also some evidence that anaerobic exercise like weight-lifting, yoga, and palates can be helpful, but always check with your child’s healthcare provider before they start a new exercise regimen. And even with proper treatment, mood changes can occur. And as I mentioned before, it’s most effective when the patient and healthcare provider work together and talk openly about concerns and choices.

So throughout the pandemic, make sure that you continue to maintain an open line of communication with your child’s provider and reach out as soon as possible if you notice change in symptoms. Patients can easily also share data now collected via smartphone app. So things like self-reports, ratings, and activity data. And that can be a great way for healthcare providers and therapists to monitor teens and changes in these – in sleep or activity – that might act as a trigger for a bipolar episode or the onset of a bipolar episode. And lastly, it’s very important to maintain good sleep hygiene. So loss of sleep is a big trigger and is one of the signs of mania. It’s very important to contact your child’s doctor if you find that they’re not sleeping, and it’s a good idea to have a plan in place already to help manage your adolescent or young adult’s sleep. And the risk of developing a manic episode, even one night of missed sleep is high. And the consequences of a manic episode might be even greater during these stressful times, so intervening early is key. To hear more information about COVID-19 and strategies for coping, you can visit www.nimh.nih.gov/covid-19. So I want to make sure that we have enough time for some questions from the audience, so I’ll stop there, and I’ll take a look at some of the questions that are coming.

So one question that I see here is whether ADHD can be misdiagnosed in youth, and it’s a case that it’s not ADHD, it’s actually bipolar disorder. So in youth, especially children and younger teens, it can be very difficult even for a highly trained clinician to distinguish between things like ADHD or a disruptive dysregulation mood disorder and what is earlier symptoms of bipolar disorder. So it does happen that someone who is diagnosed with bipolar disorder later in life, either in late adolescence or in young adulthood, has a history of an ADHD diagnosis. So when a clinician is assessing bipolar symptoms in an adolescent or young adult, they will also be asking about symptoms from childhood. And when a clinician hears that there was a prior diagnosis of ADHD, it’s not assumed that what we’re seeing now in adolescence or young adulthood is ADHD. We assume that it might still be ADHD or it might be that earlier symptoms that were thought to be ADHD were actually earlier onset bipolar symptoms and now we’re seeing what we would consider the full clinical disorder or clinical presentation in adolescence or young adulthood. So yes, that does happen. It’s hard to know if it was a clear misdiagnosis in some cases because of the overlap, but yes, a history in ADHD isn’t uncommon when someone receives diagnosis of bipolar disorder later.

I see another question here about if there’s an age in which children may begin experiencing bipolar disorder symptoms. So there’s a lot of variability, but when you see the onset of really discreet manic or depressive episodes, usually, it’s in mid to late adolescence is the earlier time when you see it. Now, there are some cases where we do see it earlier, but the younger you go, the rarer it is. So what we think of as classic bipolar disorder episodes, usually, we don’t see until mid to late adolescence at the earliest. However, there may have been some symptoms that were emerging earlier and that’s where some of the diagnostic confusion comes in, when you get into younger age ranges. A question here about what type of assessments doctors use to diagnose. So most clinicians will use a combination of what we call semi-structured clinical interviews. So these are interviews where there’s question prompts about various symptoms, not just of bipolar disorder, but also other disorders like ADHD or depression or anxiety disorders or even PTSD. And all of those disorders are assessed because we want to rule out anything other than bipolar disorder, right, if we’re trying to focus on whether it’s bipolar disorder or not.

And in those questions, we’re trying to assess how often do these symptoms happen and how intense ae they. Right? Do they rise to the level of being something that’s clinical? Or are they something where it’s kind of typical for an adolescent who might be going through some hormonal changes and having some mood swings? Does it fall within that range of typical or is it really something that we’re seeing that rises to the level of a clinical problem within that symptom? So in addition to those semi-structured interviews, which often happened with parents as well as with the adolescent themselves– and so we assessed both because parents provide a different perspective than the adolescent of course, and have a good handle usually on the adolescent’s history. But the adolescent can provide a wider insight into their current mood state, level of anxiety, etc. And in addition to those interviews, often we’ll also use rating scales, and these rating scales are normed. So they’re scales that have been administered to thousands of children at the same age and gender, and what we’re looking for in these rating scales that are completed by parents and the adolescent and sometimes also by teachers are, do the responses fall in what we see in kind of a typical response range for all of the thousands of people who have taken this measure already or been in this sort of measure already, or are they falling in an elevated range?

So it’s the combination of those rating scale responses and those semi-structured interviews that really give us the information we need to make a diagnosis. And occasionally, also some medical tests will be run to rule out a medical cause of the condition. We have a few other great questions here as well. So someone’s asking what should a parent look for when finding a mental health professional for your child? So that’s a great question. The main thing that you– there’s a bunch of different things that you want to look for, but some things that can really be a proof that you’re onto someone who’s really going to be providing some evidence-based treatments is looking for someone who– looking for what we know are evidence-based treatments for bipolar disorder like cognitive-behavioral therapy or family-focused therapy, and do they have training in that. Is that one of the main modalities of treatment that they provide? Are they someone who provides treatment to adolescents and young adults regularly? And what is their history of treating bipolar disorder? Also, because bipolar disorder also often includes pharmacotherapy or medication as well, it’s ideal if they have close relationships with psychiatrists, either because they’re part of the same practice or they’re someone they work with regularly.

And in the most ideal of situations, you would want to find a provider who’s affiliated with an academic medical center or a group practice that is specialized in adolescents or bipolar disorder. Accessing treatment can be tricky if you don’t live in a major metropolitan area where a lot of clinicians are found, especially those who are more specialized. Currently, fortunately with telehealth being used more frequently you can look further away from home if you’re comfortable with telehealth sessions, but I always recommend that people stay within their home state because things could get tricky with licensure. So you want to find a clinician whose licensed in the state where you live. Let’s see. What about trauma and its impact on affect regulation? So that’s also a great question. Trauma symptoms can mimic or mirror a lot of other disorders as well. It’s not common for kids, adolescents, and young adults to be misdiagnosed with something like ADHD, an anxiety disorder that’s not trauma-specific, or even a behavioral disorder like conduct disorder or oppositional defiant disorder, or really any other disorder that does involve affect and mood regulation challenges. So when you have a diagnostic assessment completed, the clinician should also assess for trauma history and take that into consideration, and that’s really all part of the diagnostic picture and parsing out whether or not the symptoms that are being seen currently are related to the trauma or if they are not completely unrelated, maybe influenced by the trauma but are really a discreet mental illness.

So that’s a number of additional reasons why a very comprehensive diagnostic assessment is so important. And we’re getting close to our wrap-up time here, so I’m going to stop answering questions, but thank you to everyone for listening, and thank you for the great questions that were submitted. And, again, my main take-home message today, I think, would be that if you’re seeing symptoms in your adolescent or young adult and you have any concerns, please reach out as quickly as possible to your child’s primary care provider to get some referrals to a qualified clinician who can conduct an assessment. Thank you, everyone, take care.

[silence]

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Bipolar Disorder in Adolescents and Young Adults


Date/Time:

Location: Virtual

In recognition of World Bipolar Day, NIMH is hosting a livestream event on bipolar disorder in adolescents and young adults on Tuesday, March 30, 2021, from 1:00 – 1:30 p.m. ET.

Bipolar disorder is not the same as the typical ups and downs every kid goes through. The mood swings are more extreme and accompanied by changes in sleep, energy level, and the ability to think clearly. While bipolar disorder is far less common than depression in adolescents, it can be extremely impairing and is associated with a high risk for suicide if untreated. Bipolar disorder can be particularly difficult to diagnose in adolescents as they are already experiencing mood swings related to puberty and hormonal changes. The symptoms of bipolar disorder often mirror those of other mental disorders like attention-deficit hyperactivity disorder (ADHD).

During the event, clinical psychologist and chief of the Child and Adolescent Psychosocial Interventions Research Program at NIMH, Mary Rooney, Ph.D., will discuss the signs and symptoms, proper diagnosis, and treatments for bipolar disorder in adolescents and young adults. Also, Dr. Rooney will discuss some of the challenges that the coronavirus (COVID-19) outbreak has presented for individuals living with bipolar disorder and other mental illnesses.

Participating is easy.

  • Watch the livestream event on NIMH’s Facebook or Twitter feeds. You must have either a Facebook or Twitter account to watch.
  • Follow NIMH on Facebook or Twitter for updates on the livestream event and other information about mental health research.
  • Refresh NIMH’s Facebook or Twitter feeds at 1:00 p.m. ET on March 30 to watch the livestream discussion.

The livestream will be archived on NIMH’s website and Facebook page so you can access it after the event is over.

Note: The experts cannot provide specific medical advice or referrals. Please consult with a qualified health care provider for diagnosis, treatment, and answers to your personal questions. If you need help finding a provider, visit www.nimh.nih.gov/findhelp. If you or someone you know is in crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255); En Español 1-888-628-9454.



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Matildas star Katrina Gorry opens up about her eating disorder and using pregnancy to heal


Katrina Gorry doesn’t quite know how or when it started.

There wasn’t a single moment — a passing comment from someone she trusted, a photo of herself she didn’t like — that flipped a switch in her head, making her care more about numbers on the bathroom scale or the nutrition panels on food containers than how she felt within herself.

Instead, like many people who develop eating disorders, it crept up on her slowly.

So quiet and cumulative were the various pressures she had to navigate as a woman and an athlete that the Matildas midfielder didn’t realise she had an eating disorder until she was caught right in the middle of one.

“I’ve never really had issues with the way I look or my body or nutrition or anything like that, but as I got older, it became more prominent,” Gorry says.

“We now get density scans, we get body fat testing all the time, and it really does play in your mind when you know that you have to weigh in and weigh out.

“You start reading into the numbers on the scale instead of your performance on the field.

“As I got older, I started to realise that maybe I did have issues around all of that. And when you try and change so many things, your body starts to change in different ways. I found that a lot. It really hit me for about two years.

“Being an athlete, you feel like you can get through it by yourself, that you’re strong enough. I felt like that for the first nine months or so, I was like, ‘No, I’m okay, I’m going to get through it, it’s fine’.

“And then the months tick on and you’re still in a pretty bad place — or you’re even worse than what you were a couple months before.

Eating disorders are one of the most common yet misunderstood issues affecting high-performance athletes in Australia.

Research has found that there is a higher rate of disordered eating and clinically-diagnosed eating disorders among athletes compared with non-athletes, particularly athletes who compete in what’s called “aesthetic, gravitational or weight-class sports” such as gymnastics, swimming, endurance running and boxing.

Last year, the Australian Institute of Sport (AIS) partnered with the National Eating Disorders Collaboration network to develop a position statement and free toolkit that sports across the country can use to prevent, identify, and help treat athletes who are at risk of developing or have developed unhealthy or disordered eating habits.

“Sport attracts people who have some personality traits around perfectionism and obsessive behaviours,” AIS’s chief medical officer David Hughes told the ABC last year.

“Almost certainly in high-performance sport, there are some environments which increase a risk for those who are already vulnerable.

“The aim is that we have a healthier, more robust high-performance system, and that’s good for athletes, it’s good for their health, it’s good for their mental well-being, and in the long run, it’ll be good for performance as well.”

Even though football is not a weight-based sport, Gorry believes eating disorders — and the unhealthy culture around food and physical appearance — affect more of its athletes than studies have so far accounted for.

Other Australian footballers who have spoken publicly about developing eating disorders within the environment of high-performance sport include Sally Shipard and Dianne Alagich.

“It’s getting more commonplace,” Gorry, who also plays for W-League team Brisbane Roar, says.

“When we weigh in and weigh out, even on national team camps or at our clubs, you hear people talking about their weight: ‘I probably shouldn’t eat this this morning’ or ‘Why was I heavier on the scales?’

“Football is not even a weight sport, so you can only imagine what athletes who depend on their weight and the impact it’d have on their life and mental state in and around food.”

Gorry credits speaking to a psychologist alongside a dietician with helping her recognise the disordered habits she had formed, not just in her eating but also in the way she thought about food generally.

“When I look back now, I really don’t know where I’d be if I hadn’t started speaking about it,” she says.

“I started talking to a psychologist who was really helpful at the time; that was through the Matildas.

“Then I started speaking to my family about it, which I think was really important. Knowing that you have that support and knowing that other people have gone through it, I think it makes you feel more comfortable, knowing that you can get through it and you have that support around you.

“Working closely with a dietician, not counting your calories or having a food plan, and being really flexible around it helped.

“I stopped labelling foods as ‘good’ and ‘bad’. When you stop doing that and start realising the energy that foods give you, you know more about nutrition and what it’s actually doing to your body.

“Humans are going to fluctuate. Women are going to fluctuate if they have their period or not. I don’t think we know enough about why we fluctuate but now we’re getting the support and knowledge.

“Knowing that so many athletes do go through things like this — we have so much pressure on us to live a certain way and for our bodies to be a certain way, to be in peak condition all the time.

“If you’re in and around that kind of sport for 10-plus years, it does eventually take its toll.”

The players’ union, Professional Footballers Australia (PFA), and Football Australia have resources and protocols in place if a player is suspected of having or reveals they have an eating disorder.

The PFA, which is currently researching eating disorders among W-League and A-League players, offers a nationwide confidential mental health referral network through The Mindroom as well as nutrition resource partner Compeat Nutrition, which provides one-on-one counselling and education sessions.

Football Australia, meanwhile, told the ABC it is well-resourced in its women’s national teams to deal with eating disorders and disordered eating.

It also says it has identified and prioritised the wellbeing of players and worked to provide services to support, assist and improve their physical, mental and emotional wellbeing.

“FA follows best practice with a multidisciplinary approach that involves the team doctor, dietician, performance psychologist and wellbeing manager,” a spokesperson says.

“We are proactive with screening protocols and, once identified, the multidisciplinary team are the case managers that collaborate to provide the best avenue of support for the player.”

In addition to professional services, another — slightly less expected — process that Gorry believes will help her reshape her relationship with food and her body is pregnancy.

In February, the 28-year old announced on social media that she is expecting her first child, having successfully conceived through IVF.

While she’s just starting on her pregnancy journey, Gorry is already feeling the psychological benefits of the process, particularly in helping rebuild trust and appreciation of her body after years of restriction, monitoring and guilt.

“I’ve been listening to a lot of podcasts around pregnancy and it’s all about being kind to your body,” Gorry says.

“At the end of the day, you’re growing a human, so you need to give it what it wants. And as an athlete, not exercising as much as you were is something that’s hard as well.

“In the first 12 weeks, you’re so tired so it’s really hard to keep the same exercise up. I got reminded a lot to just take my rest when I needed it and look after my body because growing a human does suck a lot out of you.

“I guess pregnancy is going to throw a curve ball at me again. It’s been hard with the cravings; as an athlete, you have a pretty strict diet the whole time and you know what you ‘should’ and ‘shouldn’t’ eat, but when you become pregnant, you crave the most random foods.

“I was vegan before I fell pregnant but all I craved was meat. I called my mum straight away and was like, ‘Mum, why? Why am I craving meat? What’s happening?’ and she said, ‘You’ve just got to eat it.’

“And then just really carby foods: hot chips, bread and Jatz [crackers] were pretty much all I lived off in that first trimester. Really strange to start eating those foods when they were the ‘bad’ foods when you’re in and around sport.”

For now, Gorry’s aim is to enjoy the transformational process of pregnancy, to get back in touch with the ebbs and flows of her body, to treat herself with patience and gentleness, and if she craves a certain food, to eat it without fear or regret.

“I’m so happy to have so many people supporting me because it’s going to be an exciting journey,” she says.

Thanks for dropping by and seeing this article on “News & What’s On in Brisbane” titled “Matildas star Katrina Gorry opens up about her eating disorder and using pregnancy to heal”. This news update was brought to you by My Local Pages Australia as part of our local events, news and stories aggregator services.

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Somatic Symptom Disorder Confuses Physical Symptoms With Danger


Somatic symptom disorder is a condition where a person somaticizes or “feels their emotional pain.” For example, you may feel joint pain or numbness and tingling in your body and then be confused as to the source. You automatically assume that there is danger afoot. The pain you’re feeling in your body is due to anxiety, but it feels so “real.” Living with somatic symptom disorder can be frustrating when you go to see a doctor. Medical professionals aren’t sure whether the patient is experiencing a mental health condition, a physical problem, or both. It’s challenging to evaluate them. Here’s how somatic symptoms disorder impacts a person’s life.

Treating physical versus mental health conditions

The challenge for somebody with somatic symptom disorder is decoding between mental health issues and physical health ones. For example, a person with somatic symptom disorder could experience a panic attack. Their chest hurts, and they feel tightness in their stomach, and they are convinced that they have a heart attack. In reality, they’re having an anxiety attack. But it can be nearly impossible for someone around them to convince the person that they’re not in physical danger. It’s challenging for the individual with the condition and the people who want to support them. The question is – what’s mental and what’s physical? A person with somatic symptoms disorder may be devalued or not believed by medical professionals, which can be frustrating and difficult to get the right help for their problems.

How medical professionals treat somebody with somatic symptom disorder

When you have “anxiety” or “anxiety disorder” written in your medical chart, doctors often dismiss your concerns. That’s particularly the case for a client with somatic symptom disorder. The individual could have severe numbness and tingling their body and explain that to their doctor only to be dismissed. It can be challenging for them to even go to the doctor’s office because they’re afraid that something is terribly wrong. Then they dare to go in and make an appointment, and when they visit with the doctor, the medical professional brushes off their concerns as “just anxiety.” It could be that they are experiencing nervousness or panic; however, there is a chance that their physical symptoms are something that is medically related. The trouble is that medical professionals write it off as anxiety because the person is often having panic.

Health worries

Those who have this condition ruminate on whether they’re sick. It could take a toll on a person’s mental and physical wellbeing. When you ruminate on your health, it can directly impact your body. You can get stress-related conditions such as acid reflux or stomach problems. It’s crucial to be mindful of your overall well being and talk to the medical professional if you need to do so.

Validating yourself

If you are a person living with somatic symptom disorder, it’s important to validate your physical and emotional feelings. Regardless of where the sensations are coming from, they are real to you. Do not let medical professionals or loved ones invalidate your experiences. Your pain and that is real. One of the things that people struggle with when they have this condition is others telling them that what they feel is not real. You have the power to validate your feelings, mental and physical ones. It’s important to search for a good doctor who will believe you and get to the root cause of the discomfort.

Therapists need to believe their patients

If you’re interested in learning more about somatic symptom disorder, you can visit Mind Diagnostics. Another tool you can use is going to counseling. Seeing a licensed therapist is a way to discuss your struggles. Online therapy is an excellent place for people with somatic symptom disorder to talk about their health. It’s convenient, affordable, and can be done from the comfort of a person’s home. If you’re living with any mental health condition, or want to talk about daily life challenges, don’t be afraid to reach out for help. Therapy can be a game-changer when it comes to living with any kind of mental health concern. Online therapists are compassionate, and they will believe you when you tell them that you’re hurting. It’s important to be validated when you have mental health issues or physical health ones. Search for an online professional who can help you with your mental health and someone who believes your feelings.

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NIMH » NIH-funded Study Sheds Light on Abnormal Neural Function in Rare Genetic Disorder


Findings show deficits in the electrical activity of cortical cells; possible targets for treatment for 22q11.2 deletion syndrome

A genetic study has identified neuronal abnormalities in the electrical activity of cortical cells derived from people with a rare genetic disorder called 22q11.2 deletion syndrome. The overexpression of a specific gene and exposure to several antipsychotic drugs helped restore normal cellular functioning. The study, funded by the National Institutes of Health (NIH) and published in Nature Medicine, sheds light on factors that may contribute to the development of mental illnesses in 22q11.2 deletion syndrome and may help identify possible targets for treatment development.

22q11.2 deletion syndrome is a genetic disorder caused by the deletion of a piece of genetic material at location q11.2 on chromosome 22. People with 22q11.2 deletion syndrome can experience heart abnormalities, poor immune functioning, abnormal palate development, skeletal differences, and developmental delays. In addition, this deletion confers a 20-30% risk for autism spectrum disorder (ASD) and an up to 30-fold increase in risk for psychosis. 22q11.2 deletion syndrome is the most common genetic copy number variant found in those with ASD, and up to a quarter of people with this genetic syndrome develop a schizophrenia spectrum disorder.

“This is the largest study of its type in terms of the number of patients who donated cells, and it is significant for its focus on a key genetic risk factor for mental illnesses,” said David Panchision, Ph.D., chief of the Developmental Neurobiology Program at the NIH’s National Institute of Mental Health. “Importantly, this study shows consistent, specific patient-control differences in neuronal function and a potential mechanistic target for developing new therapies for treating this disorder.”

While some effects of this genetic syndrome, such as cardiovascular and immune concerns, can be successfully managed, the associated psychiatric effects have been more challenging to address. This is partly because the underlying cellular deficits in the central nervous system that contribute to mental illnesses in this syndrome are not well understood. While recent studies of 22q11.2 deletion syndrome in rodent models have provided some important insights into possible brain circuit-level abnormalities associated with the syndrome, more needs to be understood about the neuronal pathways in humans.

To investigate the neural pathways associated with mental illnesses in those with 22q11.2 deletion syndrome, Sergiu Pasca, M.D., associate professor of psychiatry and behavioral sciences at Stanford University, Stanford, California, along with a team of researchers from several other universities and institutes, created induced pluripotent stems cells — cells derived from adult skin cells reprogramed into an immature stem-cell-like state — from 15 people with 22q11.2 deletion and 15 people without the syndrome. The researchers used these cells to create, in a dish, three-dimensional brain organoids that recapitulate key features of the developing human cerebral cortex.

“What is exciting is that these 3D cellular models of the brain self-organize and, if guided to resemble the cerebral cortex, for instance, contain functional glutamatergic neurons of deep and superficial layers and non-reactive astrocytes and can be maintained for years in culture. So, there is a lot of excitement about the potential of these patient-derived models to study neuropsychiatric disease,” said Dr. Pasca.

The researchers analyzed gene expression in the organoids across 100 days of development. They found changes in the expression of genes linked to neuronal excitability in the organoids that were created using cells from individuals with 22q11.2 deletion syndrome. These changes prompted the researchers to take a closer look at the properties associated with electrical signaling and communication in these neurons. One way neurons communicate is electrically, through controlled changes in the positive or negative charge of the cell membrane. This electrical charge is created when ions, such as calcium, move into or out of the cell through small channels in the cell’s membrane. The researchers imaged thousands of cells and recorded the electrical activity of hundreds of neurons derived from individuals with 22q11.2 deletion syndrome and found abnormalities in the way calcium was moved into and out of the cells that were related to a defect in the resting electrical potential of the cell membrane.

A gene called DGCR8 is part of the genetic material deleted in 22q11.2 deletion syndrome, and it has been previously associated with neuronal abnormalities in rodent models of this syndrome. The researchers found that heterozygous loss of this gene was sufficient to induce the changes in excitability they had observed in 22q11.2-derived neurons and that overexpression of DGCR8 led to partial restoration of normal cellular functioning. In addition, treating 22q11.2 deletion syndrome neurons with one of three antipsychotic drugs (raclopride, sulpiride, or olanzapine) restored the observed deficits in resting membrane potential of the neurons within minutes.  

“We were surprised to see that loss in control neurons and restoration in patient neurons of the DGCR8 gene can induce and, respectively, restore the excitability, membrane potential, and calcium defects,” said Pasca. “Moving forward, this gene or the downstream microRNA(s) or the ion channel/transporter they regulate may represent novel therapeutic avenues in 22q11.2 deletion syndrome.”

Reference

Khan, T. A., Revah, O., Gordon, A., Yoon, S., Krawisz, A. K., Goold, C., Sun, Y., Kim, C., Tian, Y., Li, M., Schaepe, J. M., Ikeda, K., Amin, N. D., Sakai, N., Yazawa, M., Kushan, L., Nishino, S., Porteus, M. H., Rapoport, J. L. … Paşca, S. (2020). Neuronal defects in a human cellular model of 22q11.2 deletion syndrome. Nature Medicine. doi: 10.1038/s41591-020-1043-9

Grants

MH107800; MH100900; MH085953; MH060233; MH094714

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About the National Institute of Mental Health (NIMH): The mission of the NIMH is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery and cure. For more information, visit the NIMH website.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit the NIH website.

NIH…Turning Discovery Into Health®



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Borderline Personality Disorder Doesn’t Make You Crazy or a Bad Person




Borderline Personality Disorder is characterized by rapid fluctuating moods, fear of abandonment, and unstable relationships. Those are a few of the nine symptoms that people with BPD experience. People who have borderline personality disorder are often stigmatized as being “too much” or “crazy.” That’s not the truth. If you’re living with BPD, don’t let anyone tell you that you’re too difficult to handle. Everyone has strengths, and we all have flaws. Living with a mental illness isn’t easy, but you can thrive with the right treatment. Here’s what to expect when you have borderline personality disorder and how you can handle it when people don’t understand your condition.

Educate yourself: what is borderline personality disorder?

The condition borderline personality disorder has nine hallmark symptoms. They are:

  • Extreme fear of abandonment
  • Angry outbursts
  • Unstable relationships
  • Shifting self-image (or lack of a sense of self)
  • Self-destructive or risky behaviors, such as drug use, reckless driving, or unprotected sex
  • Self-harm
  • Paranoia or losing touch with reality
  • Mood swings
  • Feeling empty much of the time

If you have five or more of these symptoms, you may have borderline personality disorder. It’s essential to speak to your doctor to get an official diagnosis. You may be worried about being judged, but it’s better to know so you can get the right treatment. If any of these symptoms resonate with your life experience, it’s crucial to talk to a mental health professional.

The stigma of borderline

Borderline personality disorder is a widely misunderstood condition. Some people are hesitant to look into their mental health diagnosis. They may be afraid to be diagnosed with borderline because of the stigma that society has attached to it. In the media, a person with BPD is often characterized as unstable, needy, and even dangerous. These stereotypes aren’t real. People with borderline personality disorder struggle just like anyone else. If their condition isn’t treated, it can lead to dangerous behaviors, but with the proper mental health care, a person with BPD can live a fulfilling life. What we can do to combat stigma is talk about the reality of living with borderline:

  • Educate yourself on the misconceptions of borderline personality disorder
  • Talk to those with BPD and learn their personal experiences
  • Speak openly about borderline to your loved ones to show them the reality of the condition
  • If you hear someone stigmatizing BPD – gently correct their assumptions with facts

Treatment options

It’s crucial to understand your treatment options when you live with borderline personality disorder. Knowing what can help is half the battle of getting a wellness plan. Borderline is often labeled “treatment-resistant.” That’s another stigma that we have to fight against as a society. There’s some truth to it, but it’s not a helpful statement. What mental health professionals mean by “treatment-resistant” is that the symptoms of borderline are challenging to address with many common types of therapy, such as psychodynamic therapy or cognitive behavioral therapy. In the 1980’s Marsha Linehan, a psychological researcher at The University of Washington developed Dialectal Behavior Therapy as a treatment for borderline personality disorder. She was inspired to look for different treatment options as a result of living with her own mental illness. DBT combines elements of CBT (cognitive behavior therapy) but adds on a mindfulness component, similar to that which you see in Buddhism. The four tenets of DBT are:

  • Mindfulness
  • Emotional regulation
  • Distress tolerance
  • Interpersonal effectiveness

An individual living with DBT learns to be mindful of their emotions, observe them, accept their feelings, and keep going. The idea is that those with borderline personality disorder have difficulty experiencing their feelings because they feel too painful. When you practice DBT and radical acceptance, it becomes easier to tolerate distress associated with strong feelings. There is help out there for people living with BPD, and DBT is an excellent treatment option.

Keep hope alive

If you or someone you love has borderline personality disorder, it’s essential to know that there’s help out there, like counseling and therapy from BetterHelp. Therapy is a great place to start. Online counseling is an excellent and affordable treatment option. Don’t be afraid to advocate for yourself and get the help that you need for your mental health. Try seeing a therapist and discussing these feelings so you can find ways to cope with your emotions and live a great life.

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Borderline personality disorder is still misunderstood and misdiagnosed, so patients turn to each other for support


Morgan Bayer has spent most of her life gripped by a volatile mental disorder so misunderstood that she did not know she was a sufferer, despite years of mental health support.

“I just thought I was a very angry child that was going crazy,” she said.

Morgan dropped out of high school in year eight after experiencing symptoms including emotional instability and outbursts, conflict, and self-harm.

“In a lot of my adolescence, I was like, ‘I know there’s depression and anxiety but there’s clearly something else here’,” she said.

“I was in and out of the mental health system for 10 years but only diagnosed a couple of years ago.”

Morgan’s diagnosis?

Borderline personality disorder (BPD) — a mental illness characterised by erratic emotions, dysfunctional relationships, deep insecurities, and self-harm.

Patients’ pain can mask a diagnosis

Mental health organisation SANE Australia estimate between one and four per cent of Australians are living with BPD.

Natalie Malcolmson started a borderline personality disorder support group to help people like her husband, Todd.(ABC News: Tahlia Roy)

Morgan said that once she learned her diagnosis it “made a lot of sense”, and led to her seeking specialised support through local peer group BPD Awareness ACT.

Natalie Malcolmson has grown BPD Awareness ACT over the past six years, supporting Morgan and other members as well as having a deeply personal reason for doing so: the condition came close to taking her husband Todd’s life.

Todd was middle-aged by the time he received his BPD diagnosis.

“It was pretty much sheer hell. I did everything from alcohol abuse to self-harm, but I didn’t know why,” Todd said.

“But after getting a diagnosis, it was like all of a sudden, ‘Woah, I know what’s wrong with me now.'”

According to SANE Australia, sufferers have long been misdiagnosed because key BPD symptoms align closely with common conditions such as anxiety, depression and addiction.

Sufferers have reported being misunderstood and labelled as manipulative or attention-seeking for expressing behaviours outside of their control as well as false assumptions that people with borderline personality disorder have multiple personalities.

Researchers have not yet uncovered the causes of BPD but it is believed to stem from both biological and environmental factors, with symptoms likely to surface in late adolescence or early adulthood.

Helping others come out of the shadows

When Natalie first launched the peer group, it attracted few members.

“It’s difficult for people with BPD to reach out, given the symptoms,” Natalie said.

Natalie said some of the most challenging aspects of Todd’s BPD have stemmed from the family’s dealings with Canberra Health Services, peaking with a life-threatening overdose at the Canberra Hospital while in the care of emergency department staff.

“The most stigmatisation against BPD is actually from the health professions and it’s certainly the case in the ACT,” Natalie said.

“Some health professionals still believe that there’s no treatment, that people will always live in hell … but that’s just not true.”

Morgan Bayer in a park.
Morgan Bayer says treatment has changed her life for the better.(ABC News: Tahlia Roy)

Morgan’s transformation has shown that BPD can be treated effectively with a combination of medication, counselling and peer support groups.

“I’m a lot more aware of why I’m doing certain things,” she said.

“I still obviously slip up sometimes, but [BPD Awareness ACT] has definitely helped bring that acknowledgement and understanding of my patterns rather than questioning and being negative towards myself for having unrealistic reactions to such simple things.”



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