IT'S been described as having an exposed emotional nerve ending. People with it often jump from one extreme emotion to the next.
Those living with Borderline Personality Disorder (BPD) can find it highly distressing as it affects their ability to manage their emotions, relate to people and maintain a stable self-image. And it doesn't go away as they age.
Mental health advocate Janne McMahon said while it's often diagnosed in the teenage and young adult years, BPD also affects older people.
"The school of thought is that as you get older, symptoms decrease but really you become better at managing your own behaviour," Janne told The Senior ahead of Borderline Personality Disorder Awareness Week, October 1-7.
"For people who are well treated and taught coping techniques, it doesn't mean they're cured, just better at managing the symptoms."
"Mental health of the elderly is one of those things missing in Australia," she said. "It's almost like you're old enough, you've lived life, let's focus on the younger people.
"Treatment is just as effective if you're 70 or 17, but access is entirely different."
Janne said this was especially true in residential aged care facilities.
For those with BPD, the fear of abandonment is higher than any other mental illness. Janne said that for those moving into an aged care facility, this can be perceived as abandonment by family and cause great distress.
She said currently, mental health teams visit residents while general practitioners also play a roll, but staff don't have much training.
"Mental health of the elderly is one of those things missing in Australia. It's almost like you're old enough, you've lived life, let's focus on the younger people.
In a submission to the Royal Commission into Aged Care Quality and Safety last year, Australian Borderline Personality Disorder Foundation president Rita Brown highlighted problems for those in aged care with the condition.
She wrote many older Australians with BPD had lived their entire adult lives without therapeutic intervention for their mental illness and enter into old age in distress.
She recommended better training for a skilled and supported workforce, and improved access to mental health services including ongoing psychology and other mental health and support services.
"The duty of care of those in the aged care systems is to all older persons," the submission read.
"This group who have lived with a chronic mental health condition all their lives do not require psycho-geriatric aged care accommodation, just services and support enabling them to live with dignity and support in the most appropriate and less restrictive setting for the individual."
One of the issues facing the sector is there is no national strategy to educate health professionals to follow the published evidence-based treatment guidelines.
Another challenge is that public sector psychiatrists are limited to treat those under 65. After 65 years, those with BPD come under the remit of the aged care services, which has limited expertise and time to deal with people with this condition in either a home care or residential care setting.
"Achieving a satisfying life for older people living with BPD can only occur if and when they can claim to have received throughout their lives respectful, supportive and compassionate mental, physical and geriatric health care, regardless of where they live," the submission said.
What is BPD?
Borderline Personality Disorder (BPD) is a complex mental disorder that is often misunderstood. People with this disorder are frequently discriminated against and stigmatised.
Janne said this was even the case in the medical field.
"People who are struggling to live day-by-day, to have them excluded from health care because of their diagnosis. It's just not right."
BPD symptoms may include emotional distress, self-harm, difficulty relating to others and the world around them. This can be very distressing for the person and for people close to them.
Currently between two and five per cent of Australians are affected by BPD at some stage in their lives.
The causes of BPD are not fully understood. They are likely to involve biological, social and environmental factors. For some people these factors may relate to childhood experiences of trauma or neglect.
Contrary to common belief, people with BPD can recover.
"The prognosis is excellent if people can access the right service at the right time," Janne said. "It's critical to having a better life."
Treatment often involves Dialectical Behaviour Therapy, which focuses on teaching skills to build distress tolerance, mindfulness and emotional regulation.
For more information www.bpdawareness.com.au