Treatment of Severe Emotionally Unstable Personality Disorder with Comorbid Ehlers-Danlos Syndrome and Functional Neurological Disorder in an Inpatient Setting: A Case for Specialist Units without Restrictive Interventions

Abstract

We present the case of a young woman with an Emotionally Unstable Personality Disorder (EUPD) diagnosis suffering from high-risk self-injurious behaviour. She was also diagnosed with Ehlers-Danlos Syndrome and Functional Neurological Disorder, manifesting as nonepileptic seizures and immobility. Our patient, “A,” endured traumatic childhood abuse and became highly dependent on services in her late teens. Recurrent suicide attempts resulted in twenty to thirty acute psychiatric admissions, Intensive Care Unit stays, and multiple failed trials of psychological therapy. Nonepileptic seizures and wheelchair dependency made her “too complex” for many specialist services. She was eventually admitted to Springbank ward in Fulbourn Hospital, Cambridge. The EUPD specialist unit prides itself on evidence-based treatments, shared values, and a least restrictive approach. At discharge, our patient was self-harm free and able to walk unaided and no longer met EUPD diagnostic criteria. We include “A’s” personal views on her illness and how Springbank ward facilitated her recovery, together with results from structured clinical outcome measures.

Psychological interventions for individuals with Ehlers-Danlos syndrome and hypermobility spectrum disorder: a scoping review

“…The studies were published between 2011 and 2021. There were four case reports [44][45][46][47], five cohort studies [32,[48][49][50][51], and one study that featured two case reports and a literature review [52]. Three were conducted in the United States [47,50,51], two in the United Kingdom [46,49], two in France [45,48], one in Australia [44], one in Norway [32], and one in Canada [52].…”

“…Nine of the ten studies included a higher proportion of female participants (90-100%) compared to males, with only one case study featuring a male patient. The ten studies included participants with EDS (hypermobile [32,44,48,51,52], classic [45], vascular [47], or unspecified [46,50,52] subtype) and/or JHS [32,44,49,51]. JHS would be presently referred to as HSD.…”

Ehlers-Danlos Syndrome in the Field of Psychiatry: A Review

“…Neurodevelopment disorders (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) Anorexia nervosa (12,(23)(24)(25)(26)(27)(28)(29)(30) Addiction (33,34) Anxiety disorders (35)(36)(37)(38)(39)(40)(41)(42)(43) Mood disorders (17,37,(45)(46)(47)(48)(49)(50) Personality disorder (42,49,64)…”

“…The patients with hEDS had obsessive-compulsive personality disorder (OCPD) with an observed prevalence rate of >10% (42). With regard to other personality disorders, borderline personality disorder along with depression, emotionally unstable personality disorder was observed in each patient with EDS (49,64). However, there is still not much information about personality disorders that are common in EDS.…”

“…A patient with borderline personality disorder reported a reduction in suicidal ideation after taking selective serotonin reuptake inhibitor and lithium as its enhancer ( 49 ). Another patient with emotionally unstable personality disorder treated with duloxetine, quetiapine, lamotrigine and with Dialectical Behavioral Therapy reported self-harm free and stable emotion ( 64 ). In our patient with clEDS, described above, who is suffering from general pain in the whole body, duloxetine, an antidepressant that targets pain, was dramatically effective for both pain relief and anxiety/depressiveness.…”