# MHApps BPD Manage Crisis Presentations Consistently BPD EUPD GP Health Professional

6 Crisis
GP

- 6. Manage crisis presentations consistently Patients will often present to GPs in a crisis, highly distressed about, for example, a situation, themselves, a child or other family member. They may have harmed themselves (e.g. cutting or poisoning) or report being seriously depressed or suicidal.
  It is important to acknowledge how distressed they are without rewarding the behaviour. There is often a chain of reactions in response to a prompting event. Commonly something happens which they respond to and think about in a specific way, and from that point they quickly move into a highly anxious or aroused state. They then tend to misinterpret that emotion, make a generalised statement about themselves, as a result have a bigger reaction, the aroused state increases further, and so on.
  If they are in this state at presentation to you, try this approach:
  - 1. Acknowledge that they are distressed.
  - 2. Get them to do slow, controlled (not necessarily deep) breathing exercises use counting in and out to focus attention. Be very directive until they physically appear to calm.
  - 3. When they are more settled refocus them to the situation which started the chain - try to understand how they got from this situation to feeling out of control. You might need to stop and reinitiate the breathing exercises intermittently if their distress levels increase as you talk. Then revisit or initiate the care plan and make appropriate follow-up with yourself or arrange to refer them to someone who can work on this with them.
- Crises are inevitable for people with BPD / EUPD and are essential learning opportunities for them to develop a more adaptive repertoire of responses. The aim of your intervention is to assist them to get back to their pre-crisis level of function and to live to fight another day. Wherever possible, avoid taking responsibility for them.
- There are a number of options for dealing with problems and the following list can be a useful thing to give to your patient.
  - Solve the problem
    - leave, get out of the situation for good
    - change the situation
  - Feel better about the problem
    - regulate your emotional response to the problem
  - Tolerate the problem
    - accept and tolerate both the problem and your response to the problem
  - Stay miserable

6 Crisis
GP