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Mood instability about personality disorder

This is a chronic problem for people with personality disorder.
Relatively small things can have huge consequences. This causes further problems for the person who cannot explain their emotions in terms of an understandable response to circumstances. This leads to one of the most difficult presentations seen in personality disorder: ‘exaggerations and untruths’. People with personality
disorder often talk in parables. They will tell you a story that explains or accounts for the way they feel. The following scenario illustrates this.

Scenario

Alison was a woman who had suffered multiple sexual abuses throughout her life. She was so damaged by these that she viewed any sexual advances or behaviours as assaults and was totally unable to understand healthy sexual desire or activity. While travelling on a bus one day, she noticed a male passenger looking at her. Immediately, she interpreted this as a danger signal.
She felt that she was being assaulted and became extremely distressed.
She went to the community centre for support. However, she knew that she could not explain her extreme emotional distress in terms of the truth (i.e. a man on the bus looked at me). Therefore, in order to make sense of her distress and get the support she needed, Alison told the staff that a man sexually assaulted her on the bus.
Although not literally true, the emotions behind this event were true.

Since it is often impossible to determine the underlying truth in these situations,the health care professional is in a position where it becomes impossible to be sure about what actions are appropriate Therefore, in these situations it is important to focus on the needs of the person rather than respond to the literal presentation.
In Alison’s case, for example, if the staff respond to the emotional need they will be able to give Alison the support she needs and dissipate the situation; if however, they respond to the situation they may have involved the police or bus company leading to more stress and problems for Alison, who would be left having to elaborate on her story – and possibly even being caught out lying, leading to more
distress and self-loathing. This process often damages the therapeutic relationship and exacerbates the whole situation.
While dealing with these situations, especially in the early stages of treatment, it is better not to ‘add insight to injury’ and instead simply address the emotion behind the story and look to meet the ‘expressed need’. Later on in the treatment process,
the client can be supported to understand this process and moderate their behaviours accordingly. Until this level of understanding and social skill is achieved, it is best to offer support to your client without either challenging or acting on the story itself.

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