Crisis management
Personality disorder integrated care pathway
Introduction
For the purposes of this section a “crisis” can be usefully defined as a brief acute, non-illness impairment of functioning characterised by behavioural disorganisation and increased emotional dysregulation with escalating dysphoria. The specific clinical features of a crisis will vary according to the precipitating situation and the personality structure of the individual.
moved indicators of a crisis section here I've put these down below.... or maybe move to a separate page?
Crisis is identified by acute changes in a range of domains. Assess for the presence of co-occurring mental state disorders such as psychosis or affective disorder which may sometimes present with similar features.
Indicators of a crisis
Affective changes may include:
- Increased emotional lability
- Panic and anxiety
Escalating dysphoria:
- Low mood
- Anger
Behavioural changes may include:
- Parasuicidal behaviour (includes suicidal gestures and attempts, and non-suicidal selfinjury)
- Increased impulsivityCognitive / perceptual changes may include:
-
- Dissociation or transient psychotic features
- Reduced cognitive processing ability including reduced ability to cope and utilise
resources, to think logically and to problem solve. - Reduced ability to retain awareness of the internal processes of oneself and others
Presence of these features can lead to worsening of difficulties regarding self, others and
society. Interpersonal stress is frequently a precipitating or perpetuating factor for crisis
episodes.