“A doctor needs to know what’s important to each individual”

This was an interesting article I found on: M. Q. Mental Health

See credits below.


As individuals, we all have different needs and wants – and it’s important these values are taken into account during important decisions.

Bill Fulford is a Fellow of St Catherine’s College and a Member of the Philosophy Faculty at the University of Oxford. His work focuses on making sure that the values of people living with mental illness can be incorporated into decisions about the treatment they receive. We caught up with Bill, ahead of his appearance at this year’s Mental Health Science Meeting.

Thanks for taking the time to chat to us, Bill. Can you tell us a bit about how you chose this field of research?

Great to meet you! I’m a bit of a hybrid, I suppose – my background is in medical science, including immunology and the study of bacteria. But I’ve always had lots of other interests, one of which is philosophy, which I studied alongside my medical degree. I saw psychiatry as a field where philosophy overlaps with medicine – where the question of what constitutes a disease rises to the surface and becomes part of the practice.

For example, if we take someone with appendicitis, there isn’t a debate as to whether they have a disease or not – there’s only the practical question of how you treat it. But for a person with depression, the issue of whether it is a disease they have, or whether it is a different aspect of them as a person – that philosophical question has a direct impact on how we might treat that person.

Going into psychiatry allowed me to bring my interests in medicine and philosophy together.

Your work centres around something called ‘Values-Based Practice’ – firstly, what do we mean by ‘values’?

When we talk about ‘values’, we’re talking about anything that matters or is important to us as individuals.

In most cases, it’s obvious that having a disease is something important to a person, in a negative way. Pain, for example, would be something that almost everyone would want to get rid of.

But in mental health it’s more challenging. For with the things we’re dealing with in psychiatry – emotion, motivation, desire, sexuality, and so on – what is ‘good’ or ‘bad’ varies widely between people.

For example, take something like hearing voices. For many people, that may be a bad experience – but others may consider hearing voices to be a positive experience. This is because a person’s values, the things that matter to them, are specific to that individual.

How does considering a person’s values impact on treating mental illness?

Values-Based Practice is a process of working with values which are complex and conflicting, as they often are in mental health.

Going back to the example of hearing voices – a person experiencing that may feel it is a positive experience, but it may have negative consequences for family and friends around them, and their doctors may also see the voice-hearing negatively.

So how do we best go about treating that person? Values-Based Practice can help make a balanced judgement on their individual case. It’s about making the best use of the science of medicine, while also taking into account the individuality of people and their needs, wishes, and wants.

Can you give us an example of Values-Based Practice in action?

Certainly – I know a woman who was being treated for a mental illness, and she had been given some medication by her psychiatrist which was controlling her symptoms effectively. However, she said that the medication was making her “a bit fuzzy”. She had a teaching job coming up and was worried that she wasn’t going to be able do it while she was feeling this way.

After having spoken with her psychiatrist about the fuzziness, she told me, “I was able to change my medication, with permission”. She felt empowered that she could have a dialogue with her psychiatrist and explain that, although the medication was working, it was more important to her to get rid of the side-effect of fuzziness. She was prepared to accept that changing medication may make her feel a bit worse overall if it meant she could do the teaching, because that was what mattered most to her at that time.

Doctors ought to know what will work best for a majority of patients. What Values-Based Practice adds on top of this is that the doctor should also look at what’s important for their patient as an individual. This will mean that, presented with a range of treatments available, the doctor and the person can come to a shared decision on what will be best way forward.

Why do we need Values-Based Practice now?

When I was starting in medicine, there was a pervasive attitude that ‘the doctor knows best’. Previously, there may have been only one treatment option for a condition, so it may have seemed that there was no need to consult people on what was best – there was simply no choice.

But today, as a result of 50 years of medical advances, there is often a range of options available which didn’t exist before. Whilst the doctor may know the risks and benefits for any particular option, they also need to consider what matters to the individual. That’s what Values-Based Practice can help with, and why it’s becoming increasingly important – not only in mental health, but in other areas of medicine too.

So what are the challenges of implementing Values-Based Practice?

Let’s use treatments for psychosis as one example. Anti-psychotic drugs can have side-effects such as weight gain, which is generally undesirable, as it can be detrimental to physical health and self-esteem. Values-Based Practice would suggest that it is important to discuss these side-effects, but it is possible that, as a result, people may decide not to take them.

The problem arises if the psychosis is acute – perhaps the individual is very distressed, may be having dangerous hallucinations or delusions, or possibly poses a danger to other people. From the doctor’s perspective, it’s important that their condition is controlled as quickly as possible.

So you can see the dilemma: should a doctor discuss the possibility of side-effects with a person who urgently needs medication, even if they may refuse it as a result? There is no overall ‘right’ or ‘wrong’ answer to this – but Values-Based Practice can help us to come to a balanced decision in the particular circumstances presented by a given situation.

Finally, what are your hopes for the future, and how we treat people experiencing mental illness?

I hope that we move towards increased shared-decision making, based on the model of ‘co‑production’, where there is an equality of voices between the patient and the doctor.

And I hope we can expand this model of co-production to other areas too -so that mental health service users have a voice in decisions about what research we do and how we do it, how we translate the science into practice, how we teach and train medical professionals, and how our healthcare services operate.

For some people facing mental illness, a medical approach is what they find helpful, but for others they would prefer a psychological or social approach. We need that range of provision and the ability to provide a mental health service that is responsive to individual people and their values.

Bill will be speaking at this year’s Mental Health Science Meeting – an event bringing together researchers across different disciplines to explore cutting-edge new ways to understand, treat and prevent mental illness. To find out more, click here.

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Trauma in childhood can affect your health

This was an interesting article I found on: Talk Health Partnership

See credits below.


In the mid 90s a team of researchers from a private healthcare company in America made a startling discovery. They asked over 17,000 people about their experiences of abuse and trauma in childhood, and followed them over 15 years. They called what they were measuring Adverse Childhood Experiences (or ACEs) and included trauma directly affecting a child, like abuse or neglect, as well as trauma affecting the environment, like witnessing domestic violence.

The people they studied were not from disadvantaged communities; they had jobs, college degrees and good healthcare. What they found changed our understanding of the impact of trauma.

For one thing, ACEs were much more common than anyone had imagined. More than two thirds of people had at least one ACE and over 10% had four or more.

Having a history of ACEs was strongly linked to the 10 leading causes of death in the US. For example, a person with four or more ACEs had two and half times the risk of getting a respiratory disease like COPD, were four times more likely to get depression and seven times more likely to be an alcoholic compared to a person with no ACEs. A person with seven or more ACEs had triple the risk of lung cancer and three and half times the risk of ischemic heart disease.

A person with six ACEs was likely to die twenty years earlier than someone with no ACEs.

The more ACEs you experienced as a child, the more likely you are to take risks with your health: smoke, drink and take illegal substances. But even when you control for lifestyle choices, the risks are still much higher the more ACEs you’ve experienced.

Scientists believe that the relationship between ACEs and health problems later in life is linked to our automatic response to danger. When you’re exposed to a threat your body prepares itself to deal with danger; known as the fight, flight or freeze response, your heart rate increases, your pupils dilate and your body is flooded with adrenalin and cortisol. After the danger has passed, your body and all the stress hormones return to their normal state. Scientists believe that repeated triggering of this threat response in childhood causes tissue damage, inflammation and wear and tear on the body. It changes immune system functioning and even determines the way the brain develops so that parts associated with decision making and problem solving are underdeveloped whilst those parts responsible for emotional regulation are overactive.

You can score your own ACEs here: Take the ACE quiz.

If you have a high score it shouldn’t feel hopeless. We’re beginning to understand more about the things that make someone resilient and there are things you can do to help.

Learn to meditate. The brain has plasticity, which means the more you use certain parts, the more they develop. Regular meditation practice can help you respond to stress without automatically triggering the fight or flight mechanisms.

Seek support to help you cope with the trauma. Confiding in a trusted friend or family member can help. Visit the NAPAC and the NSPCC for more advice and support.

Inform yourself. Watch this excellent TED talk from Nadine Burke Harris and this informative short animation from Public Health Wales. I’ve written about the link between ACEs and psoriasis on my blog copingwithpsoriasis.com.

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Dr Catherine OLeary

Dr Catherine OLeary

Catherine is a Consultant Clinical Psychologist who trained at the Institute of Psychiatry in London. She specialises in working with people with long term health conditions. She has had psoriasis for over thirty years.

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Sepsis: Life-Threatening Yet Difficult to Spot

This was an interesting article I found on: Talk Health Partnership

See credits below.


Sepsis is responsible for 52,000 deaths in the UK each year. A distressing 250,000 people contract the condition, which can have life changing implications; such as amputations, internal organ failure and brain damage.

Why has sepsis been in the news?

Caught early, the outcome from sepsis is good. It is the delay in treatment that can lead to spiralling of the condition resulting in multi-organ failure and potential death. The Sepsis Trust claims that improved national awareness could save as many as 14,000 lives a year.

Sadly, the early symptoms are often easy to miss and often there is a delay in Emergency Services, GPs and hospital staff recognising the condition. This delay has major implications and often the window of opportunity when antibiotics can treat the sepsis, is missed.

What is sepsis?

Sepsis arises due to the body’s abnormal response to an infection. The immune system usually works to fight any germs (such as bacteria, viruses and fungi) and infection in the body. However, for reasons that are not fully understood, sepsis results in the immune system going into overdrive and attacking health organs and other tissues.

What damage does it cause?

This inflammation causes injury to the body’s tissues and organs. The initial, localised infection spreads into the blood stream and is circulated around the body spreading and increasing the damage. This life-threatening breakdown in circulation can lead to organs all over the body being affected, including the brain, lungs, heart, skin and kidneys.

What has septicaemia got to do with it?

Sepsis is sometimes referred to as septicaemia or blood poisoning. However, septicaemia is an old, now defunct term which implied there was something we could measure in the blood which indicated sepsis – this is not the case. Sepsis is the preferred and more accurate term for the condition.

What causes sepsis?

Sepsis can be triggered by an infection in any part of the body. The most common causes of sepsis are the following;

  1. Pneumonia (or a chest infection),
  2. Urinary infections,
  3. Intra-abdominal infections (such as a burst ulcer or hole in the bowel),
  4. Skin infections (an infected cut or bite),
  5. A wound from trauma or surgery,
  6. Soft tissue infections (a leg ulcer for example).

Most cases are caused by common bacteria which wouldn’t normally induce illness. Trauma is responsible for 2-3% of reported cases.

Is it linked with meningitis?

Meningitis causes less than 1% of adult cases of sepsis. However, it is the cause in around 10% of cases in children.

Whilst most cases of meningitis are viral and therefore not life-threatening (or sepsis-inducing), a minority are bacterial infections and can lead to sepsis. Both conditions are serious and so it is important to be able to recognise common early signs and symptoms.

What is sepsis in more detail?

Sepsis is a massive reaction that damages blood flow all over the body. The immune system releases chemicals causing tiny blood vessels (capillaries) to leak fluid into the surrounding tissues. This causes inflammation which can ultimately lead to reduced blood flow to vital organs and organ damage.

The chemicals damage the capillary walls, which leak even more, causing dangerously low blood pressure. Blood clots try to repair the damage, but many break loose, causing blockages and further impairing blood flow to tissues.

If the cellular metabolism is damaged in this way and blood pressure drops to dangerously low levels, the amount of blood and oxygen reaching the body’s organs is reduced and prevents them functioning properly. This is known as septic shock.

What needs to be improved nationally?

The Royal College of Nursing held a conference in May 2019 in which they stressed the need for an urgent dissemination of a national Paediatric Early Warning Score to improve identification of the signs of sepsis in children. Currently, between 1000 and 4000 children die each year from the condition. An adult symptoms checklist is already used by the NHS, but trusts use individual systems for children which results in an inconsistent and unreliable approach

A symptoms checklist for adults already exists but NHS trusts often use their own systems for children. The children’s checklist would help medics spot when a youngster is deteriorating through:

  1. Checking temperature,
  2. Heart rate,
  3. Respiration rate,
  4. Other signs, such as urination, skin colour and rash.

The Sepsis Trust claim that patients presenting early being around half as likely to die than those presenting late. This emphasises the importance of awareness.

The condition deteriorates in children far quicker, and therefore it is particularly important for those in childcaring positions to be fully informed of the signs and symptoms.

What would I feel like if I had sepsis?

  1. Flu-like symptoms are common,
  2. Chest infection or gastroenteritis type symptoms,
  3. Feverish and shivering – although sepsis can cause an abnormally high or low temperature.
  4. Rapid heartbeat,
  5. Quick breathing
  6. Feeling extremely unwell.

In more extreme cases, you may experience:

  • Dizziness,
  • Feel faint,
  • Disorientation and confusion,
  • Nausea and vomiting,
  • Diarrhoea,
  • Cold, clammy, pale or mottled skin.

In children:

  1. Fast breathing,
  2. Lethargic behaviour and fatigue,
  3. Mottled, bluish or pale skin,
  4. Fits or convulsions,
  5. Failure to pass urine,
  6. A rash that doesn’t fade when pressed – NEVER wait for a rash, it is often a very late sign and may not show at all.

Any baby or child under 5 years old who is not feeding, vomiting repeatedly or hasn’t had a wee or wet nappy for 12 hours, might have sepsis.

What do I need to remember?

If you think you have these symptoms, or feel that something isn’t right, seek urgent medical advice (e.g. call NHS 111 or go into hospital). It is vital that you trust your instincts and get help to fight the infection as fast as possible.

Written by Emma Hammett for First Aid for Life

Award-winning first aid training tailored to your needs – Please visit our site and learn more about our practical and online courses. It is vital to keep your skills current and refreshed.

It is strongly advised that you attend a fully regulated Practical or Online First Aid course to understand what to do in a medical emergency. Please visit https://firstaidforlife.org.uk or call 0208 675 4036 for more information about our courses.

First Aid for Life is a multi-award-winning, fully regulated first aid training provider. Our trainers are highly experienced medical, health and emergency services professionals who will tailor the training to your needs. Courses for groups or individuals at our venue or yours.

First Aid for life provides this information for guidance and it is not in any way a substitute for medical advice. First Aid for Life is not responsible or liable for any diagnosis made, or actions taken based on this information.

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Emma Hammett

Emma Hammett is a qualified nurse, author and first aid trainer with over 30 years’ healthcare and teaching experience. Emma is the Founder of three multi-award-winning businesses; First Aid for Life, Onlinefirstaid.com, First Aid for Pets and her social cause StaySafe.support. She has published multiple books and is an acknowledged first aid expert and authority on accident prevention, health and first aid. Emma writes for numerous online and print publications and regularly features in the press, on the radio and on TV. She is the first aid expert for the British Dental Journal, British Journal of School Nursing, the Mail online and Talk Radio with Eamonn Holmes. She is a member of the Guild of Health Writers and Guild of Nurses.

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Why bank holidays are so dangerous and 14 tips for safer DIY!

This was an interesting article I found on: Talk Health Partnership

See credits below.


The bank holidays in May are the traditional time to undertake longer home or garden improvement projects.

You have the extra day, the weather is better and there is work to be done to ensure your home – and in particular – your garden, can be enjoyed over the coming summer months.

The queues for DIY stores are often longer on these extra holidays – but sadly it seems, so are the queues for A&E as hospitals see a marked rise in DIY and gardening injuries on bank holidays.

According to the NHS, these figures are continuing to rise, year on year, perhaps as people are inspired by home improvement TV shows such as 60 Minute Makeover, DIY SOS and Grand Designs.

In fact, when it comes to hospital admissions for DIY and gardening injuries, 58% of these injuries took place between the months of April and September.

Furthermore, figures from the Royal College of Surgeons suggest that over the past three years, there have been a staggering 25,700 hospital admissions for DIY-related and gardening accidents.

The NHS prepares

The NHS national clinical advisor for A&E, Dr Cliff Mann, urged people to take care when doing DIY, but offered reassurance that should an accident happen, the NHS was increasingly its capacity to meet the increased bank holiday need.

Dr Mann said:

“While there are plenty of ways to come a cropper with your DIY, fortunately there are also plenty of places to get help from the NHS this bank holiday. Urgent treatment centres can provide convenient access to care for anyone who needs it, while tens of thousands more appointments will be available in GP practices over the long weekend than last Easter, while High Street pharmacists can also offer expert help as part of our Long Term Plan for the NHS.’’

Figures for A&E

The Royal Society for the Prevention of Accidents (RoSPA) statistics also make sobering reading for those hoping to do a bit of bank holiday DIY.

In England in 2016-17:

  • 3,391 people needed hospital treatment following accidents involving “non-powered” hand tools
  • 522 people were admitted to hospital after being hurt by lawnmowers
  • 4,648 hospital admissions for people injured in accidents involving other powered hand tools and household machinery

Children

Sadly, six per cent of those admitted to hospital were children under the age of 18. Children should be closely supervised to avoid accidents whether they are directly involved in the DIY projects or not.

Common accidents

Catching fingers on hedge trimmers and getting infections after being pricked by rose thorns are common injuries at this time of year.

The biggest culprit

The top gardening incident however involved the lawnmower – often while people were cleaning the blades. The age group most likely to be hurt by the lawnmower were the middle-aged and older people, with 58% of admissions being in the 40-74 year-old-age group.

Gender bias

Additionally, figures released by the Royal College of Surgeons show that of the accidents involving hand tools, lawnmowers and other household machines, 90% of them involved men.

Figures from the NHS support this view. In the 12 months to March 2019 there were 7,400 instances when men sought care from a consultant after being injured by a lawnmower or tool, compared with fewer than 1,200 women.

During the same period of time, consultants had to help 5,000 men who had fallen from a ladder compared to just 1,260 cases of women needing help as a consequence of ladder-related accidents.

General guidance and precautionary measures for DIY and gardening

In order to minimise the risk of accidents occurring, follow our general guidance to staying safe when doing DIY and gardening.

  • Children should be safely supervised at all times, especially with tools around
  • Pets should be kept well away from where you are working
  • Tools, paint and chemicals should be kept out of the reach of children and pets
  • Household chemicals should be kept in their original containers and never stored in unmarked containers where they could be mistaken for juice etc
  • Disconnect all electrical appliances and tools before repairing or cleaning them or even leaving them for a short while in case of inquisitive children who like to copy their parents
  • If machinery isn’t working, do disconnect it before trying to investigate the problem
  • Refrain from using machinery or electrical equipment if you are drowsy from a nap, drowsy from medication or have drunk alcohol
  • When using tools, materials – especially hazardous ones – or products do follow the instructions carefully.
  • If using power tools, such as electric saws or hedge trimmers, use an RCD (residual current device) if your home is not already wired with one
  • Do use protective gloves, helmets or goggles if appropriate
  • Plan out your projects leaving plenty of time so you are not rushing to finish them
  • Avoid falls from height by checking a ladder’s condition before use and setting it firmly on the ground before climbing it
  • Tidy up at the end of your task
  • If you are not confident, pay someone else to do it!

If an accident does happen here are your NHS options

Urgent treatment centres such as A&E can provide emergency access to care for anyone who needs it.

GP practices and high street pharmacists can also offer expert help as part of the NHS Long Term Plan.

If you are unsure where to turn advice is available online and over the phone from the NHS 111 service.

Our article on how to help someone who is seriously bleeding can be read here:

How to help someone who has been stabbed or is seriously bleeding

Our article on bumps, grazes and splinters can be read here: https://firstaidforlife.org.uk/bumps-bruises/

Our free eBook 7 Vital first aid skills every family should know can be downloaded here: https://firstaidforlife.org.uk/6-vital-first-aid-skills-every-family-know/

Written by Emma Hammett for First Aid for Life

Award-winning first aid training tailored to your needs

It is strongly advised that you attend a fully regulated Practical or Online First Aid course to understand what to do in a medical emergency. Please visit https://firstaidforlife.org.uk or call 0208 675 4036 for more information about our courses.

First Aid for Life is a multi-award-winning, fully regulated first aid training provider. Our trainers are highly experienced medical, health and emergency services professionals who will tailor the training to your needs. Courses for groups or individuals at our venue or yours.

First Aid for life provides this information for guidance and it is not in any way a substitute for medical advice. First Aid for Life is not responsible or liable for any diagnosis made, or actions taken based on this information.

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Emma Hammett

Emma Hammett is a qualified nurse, author and first aid trainer with over 30 years’ healthcare and teaching experience. Emma is the Founder of three multi-award-winning businesses; First Aid for Life, Onlinefirstaid.com, First Aid for Pets and her social cause StaySafe.support. She has published multiple books and is an acknowledged first aid expert and authority on accident prevention, health and first aid. Emma writes for numerous online and print publications and regularly features in the press, on the radio and on TV. She is the first aid expert for the British Dental Journal, British Journal of School Nursing, the Mail online and Talk Radio with Eamonn Holmes. She is a member of the Guild of Health Writers and Guild of Nurses.

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Why I Support the Government Stance on Textured Breast Implants

This was an interesting article I found on: Talk Health Partnership

See credits below.


In April this year, amid a growing global clamour, the UK Government’s Medicines and Healthcare products Regulatory Agency (MHRA) announced that it has no plans to ban ‘macrotextured’ breast implants, or breast implants with polyurethane-coated surfaces.

And in spite of increasing concerns, I agree with them.

It’s my view textured implants are not only being scapegoated, but by doing so we’re missing the bigger picture and creating an even more dangerous landscape.

As you may have read, textured implants have linked with a slight risk of developing a rare form of non-Hodgkin lymphoma, called Anaplastic Large cell Lymphoma, or ALCL.

This cancer has been given an official name by the World Health Organisation (WHO) – Breast Implant Associated Anaplastic Large Cell Lymphoma or ‘BIA-ALCL’.

As pressure mounted earlier this year, France’s National Agency for Medicines and Health Products (ANSM) banned the implants, as did Health Canada.

So if other countries are banning them, why isn’t the UK making similar moves to protect patients?

It’s my view that the MHRA are doing precisely the right thing by holding their nerve – as any knee-jerk reactions now could be extremely damaging for the future.

Because I believe it’s not the implants that are to blame, but instead it’s the surgical techniques, or poorly sterilised operating environments, that could be putting patients at risk.

And by ignoring this, and shifting the blame elsewhere, we do nothing to address the real problem.

Let’s take a look at the facts.

There is no evidence that BIA-ALCL is caused by textured implants.

The critics will argue that most cases of ALCL have occurred in textured implants – but in less than half the reported cases is the type of implant surface actually known.

So, they are basing their conclusions on less than half the reported cases.

Also, since textured implants are used by the majority of surgeons, if ALCL is evenly distributed, then it is expected that there would be more cases of ALCL with textured implants.

And, for me, the evidence so far suggests that it is the technique of the surgeon, or environment of implantation, which may be the causative effect on the risk of ALCL.

As I’ve mentioned in a previous blog, I suspect bacterial contamination could be the real guilty party.

If bacteria is able to contaminate the implant during insertion – due to poor practice – there could be the formation of ‘biofilm’, where microbial cells form on the surface.

It is these bacteria which could be stimulation the immune response, and potentially causing further complications.

The long and the short of it is that we don’t yet know the dangers of BIA-ALCL – other than the fact that in the UK, based on the reported confirmed cases, the risk of developing it is one per 24,000 implants sold.

And the subversive move to discredit textured implants needs to be re-thought.

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Christopher Inglefield

Christopher Inglefield

Christopher Inglefield is a highly experienced Consultant Plastic and Transgender Surgeon and Medical Director of London Transgender Clinic. He is a member of the World Professional Association for Transgender Health, the UK Association of Aesthetic Plastic Surgeons and the International Society of Aesthetic Plastic Surgeons.

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Healthy Fasting for Ramadan 2019

This is an interesting article I found on: www.psychcentral.com

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There are 2.8 million Muslims in Britain and many will be following Ramadan, a month-long fast. To ensure you remain healthy when fasting, it is sensible to plan ahead and understand how fasting can affect your health.

Read on for more advice on how to fast and stay healthy.

Ramadan

Ramadan started on the 5th May in 2019 and will last until 4 June. Fasting is one of the 5 pillars of Islam. During Ramadan, Muslims are encouraged to fast from sunrise to sunset. In the UK, that is approximately 17 hours a day, for almost a full month. The strict fasting does not allow even for water to be taken during the daylight hours. This can be a major challenge for some people, particularly if the weather is hot, they have underlying health issues, are trying to take exams or have other extenuating circumstances that can make fasting much harder.

Who should not fast:

The majority of people fast without any ill effects, but it is important to ensure that provision is made for people who are pregnant, breast feeding have pre-existing medical conditions or whose life styles, work, exercise or study makes it more difficult and possibly dangerous for them.

The following groups should be more cautious when fasting and the Qur’an permits them to be excused:

  • Those with mental health issues
  • Children pre-puberty
  • The elderly and chronically ill for whom fasting would be unreasonably strenuous
  • Pregnant women and nursing may postpone the fasting at a later time
  • The ill and the travellers can also defer their fasting

It is possible for those that are excused from fasting to either give additional support to charity (ideally sufficient to feed at least one poor person every day during the fasting period) or postpone their fast until they are clinically in a better position to undertake it.

Heat wave upcoming!

The weather hasn’t been especially warm yet, but a heat wave is predicted for the coming months. People should not underestimate how important it is to remain hydrated in hot weather, particularly if undertaking rigorous work or exercise. Speaking with the Imam can clarify the position, but ultimately it is up to the individual whether they choose to fast and how strictly they undertake the fast, they should not put their health at risk.

The period of fasting for Ramadan in the UK is about 17 hours per day and that amount of time in hot weather without drinking anything at all can lead to severe dehydration. Not everyone is obliged to fast and if they are ill or have an underlying medical condition they are exempt.

Please bear in mind that the Qur’an also states that no one should do anything to harm their body and fasting if someone is not healthy enough to do so, can make them very ill.

What to eat:

Everyone observing the Ramadan should aim to have at least two meals a day. These are the pre-dawn meal (called Suhoor) and a meal at dusk (called Iftar).

These meals should be well balanced and should mimic follow your usual diet. All the food groups should be represented, so think about including: fruit and vegetables, bread, cereals and potatoes, meat/fish (or alternatives), milk and dairy foods and some foods containing fat and sugar.

Try not to include too many sugary foods though and include foods that are healthier carbohydrates instead as these will help your body sustain you further over your fasting period.

These include: wholegrains, potatoes, vegetables, fruits, legumes, and lower fat dairy products. Foods that help you to feel fuller for longer tend to be those that are higher in fibre, such as fruit, vegetables, pulses and a variety of starchy foods (especially wholegrain varieties). Caffeinated drinks should be avoided, as they are diuretic, so may lead to dehydration.

Ramadan Mubarak!

All this advice given, it is of course normally safe for people to fast as long as they do so mindfully. First Aid for Life wishes you all Ramadan Mubarak! Enjoy the season.

Further information:

The following articles contain really helpful advice to help remain healthy whilst fasting

NHS advice for people fasting in the heat during Ramadan

Asthma and Fasting is a great article containing key advice from Asthma.org.uk for people with Asthma wishing to observe Ramadan

Diabetes and Fasting is a really helpful article from Diabetes UK concerning fasting for Diabetics.

For people with Sickle cell disease it is vitally important that they maintain a healthy diet and keep fully hydrated. Failure to do this can precipitate a painful sickle cell crisis.

For Epileptic patients controlled on medication, the medication needs to continue to be taken regularly otherwise it can be very difficult to bring the condition back under control.

Ramadan Fasting and the Medical Patient is a helpful paper discussing fasting advice in various medical conditions

First Aid for Life provides this information for guidance and it is not in any way a substitute for medical advice. First Aid for Life is not responsible or liable for any diagnosis made, or actions taken based on this information. It is strongly advised that you attend a First Aid course to understand what to do in a medical emergency.

Written by Emma Hammett from First Aid for Life – http://www.firstaidforlife.org.uk

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Emma Hammett

Emma Hammett is a qualified nurse, author and first aid trainer with over 30 years’ healthcare and teaching experience. Emma is the Founder of three multi-award-winning businesses; First Aid for Life, Onlinefirstaid.com, First Aid for Pets and her social cause StaySafe.support. She has published multiple books and is an acknowledged first aid expert and authority on accident prevention, health and first aid. Emma writes for numerous online and print publications and regularly features in the press, on the radio and on TV. She is the first aid expert for the British Dental Journal, British Journal of School Nursing, the Mail online and Talk Radio with Eamonn Holmes. She is a member of the Guild of Health Writers and Guild of Nurses.

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Dying for the Ultimate Selfie: We’re Really Bad at Accurately Assessing Risk

This is an interesting article I found on: www.psychcentral.com

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Selfies are the journaling of our time. We take them everywhere we go, not only to remind our future selves of things we’ve done, but to also broadcast to the world what a fun, exciting, and carefully-curated life we lead.

But in a story that’s becoming as commonplace as school shootings in America, more and more people are either dying or putting themselves in extreme physical danger to take the ultimate selfie. And for what? Fame in the form of more likes and followers on social media.

Why are we so bad at rationally assessing risk in situations such as this?

It’s hard to believe we’ve come to a point in humanity where a simple act of photography could be life-threatening. But combine narcissism, the desire for popularity that extends beyond high school, and the human psychology of risk assessment, and you get a dangerous combination.

Reasons People Put Their Life at Risk for a Selfie

Humans fundamentally underestimate risk. Our minds have developed evolutionary shortcuts in order to make decisions more quickly — especially decisions about risk. This quick shortcut reaction in our brains evolved because it provided us an advantage in our fight-or-flight response, allowing us to decide whether we needed to get away from a potential predator or fight it. It served humanity well for thousands of years.

But over time, the risks changed from natural predators and dangers in the wild to less obvious risks in a mechanical and technologically-driven world. Our brains aren’t naturally wired to take into account these new man-made risks, and so the brain engages in a faulty and biased risk assessment.

Rewards can obscure the risk. When a person becomes so focused on the reward of attaining a goal they’ve worked hard to get — such as taking that ultimate selfie — their brains put aside risk or downplay it in such a way as to make the risk seem significantly less than it actually is. The amount of new follows and likes a person believes they are likely to receive from an amazing selfie simply outweigh their own personal safety.

Sunk costs may come into play as well. If a person has spent the past two hours trying to get to a specific remote rock outcropping to take the ultimate selfie, most people can’t imagine spending all that time and effort — and then not take the selfie. At that point, the person already has so much sunk cost — a cost that has already been expended in time, money, and effort that cannot be recovered. Turning back doesn’t seem like a reasonable option to most people’s brains. The supposed benefits gained from the once-in-a-lifetime selfie simply outweigh the risk.

Risks that we have control over — such as standing on a dangerous ledge — are perceived as lesser and more acceptable than risks we don’t have control over. This is why flying in an airplane is so scary to some — they aren’t the ones driving it; they have no control over the minimal risk they’re taking. This is also why nobody thinks about injury or death when getting into their car. Even though the statistical chances are infinitely higher in getting into an automobile accident rather than an airplane accident, we have control over the car we drive. In our brain, such control provides more acceptable risk — even when the data show that our brain is biased and wrong.

Memory also gets us into trouble when it comes to accurate risk assessment. If we’ve taken dozens of selfies in potentially-dangerous situations in the past without issue, our mind remembers and emphasizes that datapoint. So if 100 percent of the previous times we’ve taken a risky selfie, we’ve had no problem, our brain says, “Why would this time be any different?”

Humans regularly overestimate the odds of unlikely or rare events occurring, while simultaneously underestimating how dangerous or risky commonplace events can be. For instance, we believe that catastrophes, like a school shooting, happen far more frequently than they do. Some people even have a fear of going to school because of them. It’s splashed all over the news when it happens. Statistically, however, school shootings are still relatively rare events.

Everyday risks, on the other hand, we take for granted. They never get any news coverage. Auto accidents, for instance, occur far more frequently and are just as traumatizing to those involved. But you rarely see one in the news, or hear about it from friends — unless it affects someone you personally know.

That’s why people driving an automobile feel safer and believe they’ll never get into an accident — that sort of thing happens to other people. This false belief completely obscures the truth — that most people will be involved in an auto accident in their lifetime. And some people will even lose their lives from one.

Add all these reasons up, and you have a perfect equation for why people take extreme risks to take a selfie. Their brains have miscalculated the risks involved and decided that the rewards, sunk costs, and sense of control outweigh any possible downside.

Sadly, some people are paying for it with their lives. No selfie is worth a person’s life. But saying that won’t magically make a person reassess their selfie choices, because fame and popularity are the virtual drug of choice these days. Sometimes common sense just won’t win out until the fad has faded.

Dying for the Ultimate Selfie: We’re Really Bad at Accurately Assessing Risk

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Universities need to do more to promote positive body image

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Monday, 13 May 2019

Universities need to do more to promote positive body image

Lorna shares her experience of body image at university and calls for universities to do more to promote body positivity. – Lorna
University can be a really scary time. You leave all you have ever known and trek halfway across the country to live with strangers and work harder than you ever have before.
It’s not surprising therefore it’s a particularly risky time for the development of mental health disorders. Whilst universities are becoming increasingly sensitive to the need to reduce stress and support those facing depression and anxiety, I feel they continue to fail in regards to promoting positive body image.
I went to a particularly sporty university in the South West. Millions was spent on campus gym facilities, and the university prided itself on pumping out a significant number of Olympic athletes. This was great, as it brought huge funding to campus, and there was always a sense of pride when one of our own did well in national and international competitions.
A side effect of this focus on sport however was what I considered an institutionally warped sense of body image. All promotional images for campus contained individuals who looked like they had walked off the cover of a fitness magazine. I rarely saw people across campus who weren’t in sporting gear – at times it felt like skin tight leggings and running tops were some form of uniform!
Every single food outlet on campus served some sort of protein fuelled food, including shakes, bakes and meals. All menus contained calorific content, and some café’s even added protein to hot drinks at your request!
It was standard for people to spend long periods of time in the gym, pushing themselves way beyond any norms, and no one batted an eyelid. I know loads of people who continued to work out when injured, desperate to push themselves and maintain their place on their sporting team of choice. The gym staff never questioned anyone on their extreme workout habits, and were not trained in spotting the signs of dysmorphic or eating disordered behaviour – to the contrary, I feel they often promoted it.
To me, it came as no surprise to hear eating disorder rates at this university are extremely high, according to a recent survey. I too developed anorexia whilst studying here, having been left feeling inadequate whilst walking across campus alongside in what felt like a sea of models. I had never wanted to join a gym, but during my time at university not only did I join one, I became obsessed; going often and pushing myself even when exhausted.
I feel universities could do so much more to promote body positivity or a less dysmorphic way of thinking about body image. From educating students of the dangers of excessive exercise to helping gym staff spot the signs of disordered behaviours. They should be always willing to put the wellbeing and safety of their students above their sporting accomplishments.

I'm Lorna, a psychology graduate from the University of Bath. I love spending time with my two dogs, Poppy and Pippa! I'm passionate about challenging mental health stigma, particularly relating to Eating Disorders and Personality Disorders. Posted by Student Minds Blogging Editorial Team at 11:14 Email ThisBlogThis!Share to TwitterShare to FacebookShare to Pinterest Labels: Active Mental Health, Eating Disorders

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Understanding Antisocial Personality: The Stigma Tied to ASPD

This is an interesting article I found on: www.goodtherapy.org

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Antisocial personality (ASPD) is one of the cluster B personality disorders, which typically involve emotional, impulsive, or dramatic thoughts and actions. This group of personality disorders is also significant because it includes borderline personality disorder (BPD) and narcissistic personality disorder, in addition to ASPD. These issues, and personality disorders in general, are among the most stigmatized mental health conditions.

Colloquially, many people use the terms psychopath and sociopath interchangeably with antisocial personality. A common assumption is that all people who have ASPD are incapable of emotion and feeling and will eventually commit violent crimes and harm others. It’s true many people living with ASPD typically don’t feel remorse or guilt. They may also lack empathy, struggle to understand the emotions of other people, or experience frequent legal issues, due to a tendency toward impulsive and often dangerous or illegal actions.

But sociopathy isn’t a mental health diagnosis, and not every person with ASPD will hurt other people or engage in violent acts. It’s possible for people who have ASPD to avoid actions that could harm others, especially when they have support from a compassionate therapist. In therapy, people can develop interpersonal skills along with coping techniques for impulsivity and aggression. These tools can benefit people who want to improve relationships and avoid illegal or dangerous activity and behaviors that harm others.

It’s possible for people who have ASPD to avoid actions that could harm others, especially when they have support from a compassionate therapist.

How Common Is ASPD?

The estimated prevalence of ASPD may vary depending on the study and criteria used. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), between around 0.2 and 3.3% of the population has ASPD in a given 12 month period. This condition is only diagnosed in people over the age of 18.

More than 90% of people diagnosed with ASPD also live with another mental health issue. Substance abuse is the most common co-occurring condition. Research suggests ASPD occurs much more frequently in men diagnosed with alcohol use disorder. Higher prevalence is also seen in prison settings, as well as population samples from impoverished areas. Other common co-occurring issues are anxiety and depression.

Though ASPD is far less common in women than it is in men, some research has suggested when ASPD develops in women, the condition may become more severe. Women living with ASPD are even more likely to abuse substances than men living with ASPD. However, research also indicates antisocial behavior may persist longer in men. Men who have ASPD also have an increased risk of early death.

Aggressive and violent behavior in childhood, such as that seen with conduct disorder, can be an indicator for ASPD. Not all children who have conduct disorder will go on to develop ASPD, but a history of conduct disorder is one of the diagnostic criteria for ASPD. These symptoms must appear before the age of 15. Parental neglect, abuse, or inconsistency and a lack of stability from primary caregivers can all increase the risk that a child with conduct disorder will develop ASPD.

Asocial vs Antisocial

It’s not uncommon to hear antisocial used to refer to people who prefer to be on their own and avoid spending a lot of time with others. But “asocial” is a more accurate way to define this lack of interest in social interaction. Asocial can describe a general disinterest in society and engagement with others, but it doesn’t indicate a person harbors any ill will or negative intent toward others.

Antisocial, on the other hand, goes beyond a general dislike or avoidance of society and community. People who meet criteria for a diagnosis of ASPD typically feel hostile toward other people. Even those who don’t have actively hostile feelings toward others may care very little for the safety, general well-being, and feelings of most other people. It’s also not uncommon for people who have antisocial traits to have significant disregard for their own safety.

It’s important to note that these feelings don’t necessarily translate to violent tendencies. Studies of people in prison do reveal high rates of ASPD, but this condition occurs on a spectrum, and not everyone living with the condition becomes violent or dangerous. Research has also observed that some people who display antisocial traits may have developed these behaviors in order to survive and protect themselves when growing up in difficult circumstances.

Many people use psychopathy as a synonym for ASPD, but this usage isn’t accurate. Psychopathy can best be considered a severe form of ASPD, rather than the most characteristic presentation of the condition. Most people who meet criteria for psychopathy according to the Psychopathy Checklist – Revised (PCL – R) do also meet criteria for ASPD. But only about 10% of people diagnosed with ASPD also meet criteria for psychopathy.

What Is Antisocial Personality Disorder?

At the core of ASPD lies a consistent lack of regard for the rights of others, which generally includes impulsive, irresponsible, and reckless behavior. People may take action without considering potential consequences and experience little or no remorse for harm caused by their behavior. Theft, manipulation, and other deceit are common, and people living with ASPD also tend to rationalize or minimize their actions.

Antisocial behavior can include violent or criminal acts, but people living with ASPD aren’t always aggressive or violent. Similarly, while many people with ASPD lack empathy, this isn’t always the case. People living with ASPD often struggle to develop or maintain meaningful relationships, and they may cause emotional harm to their partners; but it’s still possible for people with ASPD to feel love and empathy, often for a select few people such as children, partners, or close family members.

Abuse, neglect, or absent caregivers can increase risk for ASPD when other factors are present, particularly early onset conduct disorder. In people who develop ASPD, early childhood mistreatment can reinforce the belief that no one else will look out for them, so they should do whatever they can to look after themselves and get their needs met. This belief commonly occurs with ASPD.

In recent years, a few people with ASPD have written about their experience living with the condition. This may have had a small effect on the stigma surrounding the condition, but many people still struggle to accept that ASPD doesn’t always mean a person is violent or “evil.” The stigma associated with personality disorders, ASPD in particular, may make it even more difficult for people who want to improve to get the help they need. Negative attitudes from caregivers and educators may begin early on, often when children first display signs of conduct disorder.

The stigma associated with personality disorders, ASPD in particular, may make it even more difficult for people who want to improve to get the help they need.One study of 202 kindergarten teachers found teachers were most likely to have a harsh response toward aggressive children. But negative attitudes, or writing children off as troublemakers or delinquents, can reinforce ideas such as, “I’m bad,” “I’ll never amount to anything,” or “No one cares what happens to me,” from early childhood. Some experts believe this can increase the chances aggressive behavior and disregard for others will continue and worsen.

Treatment for Antisocial Personality Disorder

Not everyone considers ASPD a mental health issue. Research has shown that many people believe people with this condition are:

  • Violent
  • Evil
  • Dangerous
  • Impossible to treat

Having a mental health issue doesn’t absolve a person of responsibility for their actions, but it’s an important factor in understanding why some people behave the way they do. When stigma perpetuates the idea of a group of people as evil, positive change becomes even more difficult to achieve.

Specific characteristics associated with ASPD, such as self-sufficiency, a tendency to externalize problems, disdain for authority, and general hostility, also make it less likely people with ASPD will ever reach out for help, complicating treatment and decreasing the chance of improvement.

When people with ASPD do enter treatment, it’s more often to get help for a co-occurring condition or because a legal authority or family member has steered them toward therapy. Among those who do get help, many drop out of treatment early. Negative attitudes among therapists or ineffective treatment methods can contribute to this.

It’s important for people with ASPD to work with therapists who offer compassionate support and are willing to try a range of approaches to find the most effective treatment. In many cases, people with antisocial traits can learn skills to cope with their condition and avoid acting in ways that negatively affect others. When people with a dual diagnosis seek treatment, it’s essential for therapists to recognize the ways ASPD can contribute to and worsen other mental health symptoms.

A key factor in successful therapy for ASPD is recognizing individual fault. People living with ASPD who can’t admit or accept their actions are harmful or that they have a role in the harm they’ve caused may not be able to improve. One approach to treatment that’s shown some promise is mentalization-based therapy. This approach helps people explore their state of mind, including emotions, desires, and feelings toward others. Once they better understand their thoughts, they can use this understanding to address impulses and control them.

Some research suggests schema therapy, an approach that helps people work to identify and address maladaptive behavior patterns and develop more effective ways of relating, may also be helpful for people with ASPD. It’s effective for other personality disorders, including BPD and narcissistic personality, and some research suggests people are less likely to drop out of this type of therapy than other approaches.

Research has shown treatment can help improve many of the behaviors associated with ASPD when a person is willing to work toward change. It’s important for future research to continue exploring the most helpful types of treatment for ASPD to increase the chances of people with the condition improving with treatment. Successful treatment can not only improve well-being and quality of life for people with ASPD, it can also have a positive impact on the people in their lives.

If you or a loved one is struggling with the effects of ASPD, know that help is available. Begin your search for a trained, compassionate counselor at GoodTherapy.

References:

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition. Arlington, VA: American Psychiatric Association.
  2. Antisocial personality disorder. (2017, November 20). Cleveland Clinic. Retrieved from https://my.clevelandclinic.org/health/diseases/9657-antisocial-personality-disorder
  3. Antisocial personality disorder. (2018, May 25). NHS. Retrieved from https://www.nhs.uk/conditions/antisocial-personality-disorder
  4. Arbeau, K. A., & Coplan, R. J. (2007). Kindergarten teachers’ beliefs and responses to hypothetical prosocial, asocial, and antisocial children. Merrill-Palmer Quarterly, 53(2), 291-318. doi: 10.1353/mpq.2007.0007
  5. Brians, P. (2016, May 17). Asocial. Retrieved from https://brians.wsu.edu/2016/05/17/asocial
  6. Brill, A. (2017, June 16). Life with antisocial personality disorder (ASPD). Retrieved from https://www.mind.org.uk/information-support/your-stories/life-with-antisocial-personality-disorder-aspd/#.XMY0wJNKjOT
  7. British Psychological Society. (2010). Antisocial personality disorder: Treatment, management, and prevention. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK55333
  8. Hesse, M. (2010). What should be done with antisocial personality disorder in the new edition of the diagnostic and statistical manual of mental disorders (DSM-V)? BMC Medicine, 8, 66. doi: 10.1186/1741-7015-8-66
  9. Mayo Clinic Staff. (2017, August 4). Antisocial personality disorder. Retrieved from https://www.mayoclinic.org/diseases-conditions/antisocial-personality-disorder/diagnosis-treatment/drc-20353934
  10. Sheehan, L., Nieweglowski, K., & Corrigan, P. (2016, January 16). The stigma of personality disorders. Current Psychiatry Reports, 18, 11. doi: 10.1007/s11920-015-0654-1

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How to Tell the Difference Between Bipolar and Borderline Personality

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Impulsivity, mood swings, irritability, high and low periods, patterns of troubled relationships—these symptoms often indicate bipolar, but they can just as easily appear in people who have borderline personality (BPD).

Neither condition is uncommon. Approximately 2.6% of adults in the United States live with bipolar. Estimates for BPD vary, but it’s believed somewhere between 1.6% and 5.9% of adults in the U.S. live with this condition. Many people have a dual diagnosis, or both conditions.

The resemblance between the traits characterizing each issue and the possibility of co-occurrence has led some professionals to question whether BPD is a subtype or variation of bipolar. The general consensus among mental health experts, however, is that while these conditions often present with similar features, they are two separate mental health issues that can usually be distinguished in a few key ways.

It’s during periods of mania that bipolar may be most suggestive of BPD, as manic episodes often involve thrill-seeking, impulsive, or aggressive behavior.

Bipolar vs. Borderline Personality

A mood disorder, bipolar is primarily characterized by shifts between high-energy (manic) states and low-energy (depressive) states. Bipolar-related mood changes can range from mild to extreme, and they’re typically accompanied by changes in a person’s energy and activity.

Not every person who has bipolar will experience a classic manic episode. These episodes generally last several days and frequently involve increased activity and productivity in schoolwork, work-related tasks, or creative pursuits. Feeling very energized or charged, with little or no need to sleep, is common.

People living with bipolar II experience milder manic periods known as hypomania. Cyclothymia, a subtype of bipolar, involves hypomanic and depressive periods that don’t meet typical bipolar criteria. But mania is a symptom specifically linked to bipolar, so having even one manic episode indicates bipolar in most cases.

It’s during periods of mania that bipolar may be most suggestive of BPD, as manic episodes often involve thrill-seeking, impulsive, or aggressive behavior. Impulsive actions might include risky sex, excessive spending, or substance abuse, along with other behavior that isn’t typical. Rapid cycling bipolar may particularly resemble BPD, as mood fluctuations happen more frequently than with typical bipolar.

Frequent manic episodes could also contribute to relationship difficulties, since the way a person behaves during a manic episode could have a negative impact on the people close to them. For example, during a manic episode, a person in a monogamous relationship may cheat on their partner or decide to redo all of their home furnishings and max out multiple credit cards in order to purchase new interior decorations. A person who uses drugs during a manic episode could face legal consequences, especially if their actions while under the influence of drugs cause harm to others.

But with BPD, particularly untreated BPD, emotional shifts tend to be sudden and happen frequently. BPD is a personality disorder, so the associated traits don’t simply relate to mood changes, they’re persistent behavior patterns. Extreme, all-or-nothing thinking patterns also help characterize this condition. For example, a person with BPD who experiences mild criticism at work may become very upset and distressed. They may feel they’ve failed and fear they’ll lose their job.

Another characteristic of BPD is difficulty interpreting emotions. People often view neutral or other expressions as negative, and this misinterpretation could lead to conflict or strained personal relationships.

Similarly, a minor disagreement with a partner could lead someone to believe they’re unlovable and the relationship is over. They might end the relationship first, fearing rejection. Relationship conflict can also trigger devaluation of a partner who was previously idealized, depending on the circumstances. With devaluation, feelings of anger, disdain, and contempt may abruptly replace feelings of love and happiness in the relationship.

Lifetime suicide risk is high with either bipolar or BPD, while recurring non-suicidal self-harming behaviors as well as multiple suicide attempts are common with BPD. Cutting and other self-harm doesn’t necessarily indicate suicidal intent. Research indicates many people with BPD self-harm as a way of coping or as a way of feeling something during a period of dissociation.

How Do Treatment Approaches Differ?

These two conditions have separate underlying causes, though people with a family history of either bipolar or BPD have a higher risk for that condition.

The causes of BPD aren’t fully known, but it’s believed to develop from a combination of factors. A tendency to experience extreme emotionality, which can also run in families, is believed to contribute, especially in people who’ve experienced abuse, trauma, and neglect. Brain chemistry is a significant contributing factor to bipolar, though environmental factors can also increase risk.

Correct diagnosis is important, because treatment approaches vary depending on the condition. It’s important to understand that therapy alone typically can’t treat mania in people living with bipolar. It may also not be enough to treat severe depression in some people.

Therapy can help address some symptoms and challenges of living with bipolar, but in most cases people with typical bipolar will need medication to help stabilize mood shifts. Untreated mania and depression can have serious emotional and even physical health consequences, so it’s important to seek, and continue with, treatment.

Mood stabilizers such as lithium won’t help BPD symptoms. In some cases, bipolar treatment might even make certain symptoms worse. There’s no medication that specifically treats BPD. The typical treatment is dialectical behavior therapy, though other therapy approaches such as schema therapy can also have significant benefit.

Can Bipolar and Borderline Personality Co-occur?

A person experiencing symptoms of both bipolar and borderline personality may have both conditions.

A person experiencing symptoms of both bipolar and borderline personality may have both conditions. This isn’t uncommon, in fact. A 2013 review of multiple studies on the two conditions found that around 10% of people diagnosed with borderline personality also had bipolar I, while about 10% had bipolar II as well as BPD.

Living with untreated borderline personality and bipolar can cause significant distress, in part because the two conditions may play off each other.

  • Feelings of emptiness or failure may be even worse during a bipolar depressive period, causing emotional turmoil or disconnect, both of which may increase risk for self-harming behavior or suicide.
  • A person struggling with trust or abandonment issues in their relationship could have an even harder time maintaining a healthy relationship during a low mood state.
  • A period of mania may be more likely to trigger risky or impulsive behavior in a person who feels distressed or disconnected from their sense of self and wants to feel something.
  • Substance abuse isn’t uncommon with BPD or bipolar, and alcohol and drugs can often trigger mania.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) recommends mental health professionals avoid diagnosing personality disorders during untreated mood episodes. Taking a detailed mental health history that looks back at patterns and symptoms over a longer period of time can help differentiate the two conditions.

Between manic and depressive episodes, people with bipolar generally experience fairly normal moods. Months or even years could pass between high and low periods, especially when treatment is effective at managing symptoms. So once a mood episode has stabilized, diagnosis may be somewhat clearer. When a manic or depressive mood seems to respond to treatment but symptoms of emotional dysregulation persist, a dual diagnosis is likely.

Treatment for Co-occurring Bipolar and Borderline Personality

Living with co-occurring BPD and bipolar may be more challenging than having either condition alone, especially if it takes time to get an accurate diagnosis. Bipolar-related mood swings, when combined with more frequent and rapid changes in emotional state, can make daily life difficult and negatively affect work, school, and personal life. People living with bipolar and BPD may feel even more unstable or unable to control what’s happening around them than those living with only one of these conditions.

While treatment such as therapy can be very helpful for reducing symptoms and improving quality of life, the recommended treatments for each condition differ. This makes an accurate diagnosis essential for successful treatment.

For bipolar, therapy may involve learning to recognize mood triggers, developing ways to cope with bipolar symptoms, and working to reduce the effects symptoms have on daily life. The combination of mood stabilizing medication and dialectical behavior therapy may be recommended for people with both bipolar and BPD, since DBT is generally the ideal approach to therapy for BPD. This therapy involves developing the skills to manage and cope with difficult emotions and practicing positive ways of relating to others.

For people experiencing BPD-related distress during a manic or depressive episode, mood stabilization is an important first step. Research suggests BPD symptoms may improve slightly once mood has stabilized, which can increase the chance of successful treatment. It’s also essential to talk about suicidal thoughts or self-harm, since these may be more likely in people with both conditions than people who only have bipolar.

Psychotic symptoms such as hallucinations can also occur during a manic episode, and these can be dangerous. They’re not as common with BPD, but they do occur, so it’s important to discuss any hallucinations, delusions, or magical thinking when a person presents with symptoms of both conditions.

Finding a Therapist for Bipolar or Borderline Personality

For some mental health concerns, diagnosis may not significantly impact treatment since symptoms can still be addressed in therapy. But when bipolar and BPD, which sometimes present similarly, are misdiagnosed for each other, treatment may be less effective. Symptoms of both conditions can further complicate diagnosis. Some mental health professionals may fail to recognize the presence of both issues, particularly if they’re less experienced with the differences between the two or unaware bipolar and BPD often occur together.

When seeking a diagnosis or working to address symptoms of both bipolar and BPD, it’s recommended to seek support from a therapist who has experiencing helping people with both conditions. While other trained, empathic therapists can certainly provide compassionate care, a therapist who specializes in working with people living with these conditions may offer support that’s designed to address specific symptoms of these conditions. This may be especially important when beginning therapy for the first time.

References:

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition. Arlington, VA: American Psychiatric Association.
  2. Bipolar disorder. (2017). National Alliance on Mental Illness. Retrieved from https://www.nami.org/learn-more/mental-health-conditions/bipolar-disorder
  3. Bipolar disorder. (2018). National Institute of Mental Health. Retrieved from https://www.nimh.nih.gov/health/publications/bipolar-disorder/index.shtml
  4. Borderline personality disorder. (2017). National Alliance on Mental Illness. Retrieved from https://www.nami.org/Learn-More/Mental-Health-Conditions/Borderline-Personality-Disorder
  5. Borderline personality disorder. (2017). National Institute of Mental Health. Retrieved from https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml
  6. Fenske, S., Lis, S., Liebke, L., Niedtfeld, I., Kirsch, P., & Mier, D. (2015, June 26). Emotion recognition in borderline personality disorder: Effects of emotional information on negative bias. Borderline Personality Disorder and Emotion Dysregulation, 2, 10. doi: 10.1186/s40479-015-0031-z
  7. Ghaemi, S. N., Dalley, S., Catania, C., & Barroilhet, S. (2014). Bipolar or borderline: A clinical overview. Acta Psychiatrica Scandinavica, 130(2), 99-108. doi: 10.1111/acps.12257
  8. Kvarnstrom, E. (2017, October 5). Borderline personality disorder misdiagnosed as bipolar disorder: Differences and treatment. Retrieved from https://www.bridgestorecovery.com/blog/borderline-personality-disorder-misdiagnosed-as-bipolar-disorder-differences-and-treatment
  9. Linehan, M. M., Korslund, K. E., & Harned, M. S. (2015). Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: A randomized clinical trial and component analysis. JAMA Psychiatry, 72(5), 475-482. doi:10.1001/jamapsychiatry.2014.3039
  10. Paris, J. (2004). Borderline or bipolar? Distinguishing borderline personality disorder from bipolar spectrum disorders. Harvard Review of Psychiatry, 12(3), 140-145. doi: 10.1080/10673220490472373
  11. Zimmerman, M., & Morgan, T. A. (2013). The relationship between borderline personality disorder and bipolar disorder. Dialogues in Clinical Neuroscience, 15(2), 155-169. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3811087

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