Inpatient Treatment for Mental Health Conditions

Borderline Personality Disorder

Borderline personality disorder (BPD) is a serious mood disorder. It’s often misdiagnosed as bipolar disorder, and to the untrained eye, symptoms may appear extremely similar. However, BPD is more closely related to PTSD and C-PTSD, as traumatic life events can cause symptoms to appear or worsen. These experiences may interfere with a person’s ability to develop a stable sense of self, regulate their emotions, and maintain healthy relationships. Patients exhibit at least 5 of the 9 official diagnostic criteria for BPD, as defined by the DSM-5. Quoted directly from an article on diagnosing borderline personality disorder ((Biskin, R. S., & Paris, J. (2012). Diagnosing borderline personality disorder. CMAJ : Canadian Medical Association Journal, 184(16), 1789–1794. https://doi.org/10.1503/cmaj.090618)) published by the National Center for Biotechnology Information, these criteria are as follows:

• Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behaviour covered in criterion 5.
• A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
• Identity disturbance: markedly and persistently unstable self-image or sense of self.
• Impulsivity in at least 2 areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behaviour covered in criterion 5.
• Recurrent suicidal behaviour, gestures or threats, or self-mutilating behaviour.
• Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability or anxiety usually lasting a few hours and only rarely more than a few days).
• Chronic feelings of emptiness.
• Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
• Transient, stress-related paranoid ideation or severe dissociative symptoms.

Although borderline personality disorder may have a neurochemical component, it is primarily a behavioral disorder. Because of this, it’s absolutely possible for these patients to improve and even go into remission from BPD. ((Biskin, R. S. (2015). The lifetime course of borderline personality disorder. Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie, 60(7), 303–308. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4500179/))

Treatment Options for Borderline Personality Disorder

BPD is usually treated with dialectical behavioral therapy (DBT). This type of therapy combines group sessions with 1-on-1 talk therapy. The group therapy component resembles a class, as patients go through lessons from a textbook and even complete homework assignments. Groups normally meet several times a week, while 1-on-1 sessions take place at least once a week. Unlike most other forms of therapy, patients may be invited to contact their providers by phone in between sessions.

While DBT can be effective in an outpatient setting, residential treatment allows patients to focus on healing with fewer distractions. Research suggests that inpatient DBT may be more effective at treating borderline personality disorder ((Bohus, M., Haaf, B., Simms, T., Limberger, M. F., Schmahl, C., Unckel, C., Lieb, K., & Linehan, M. M. (2004). Effectiveness of inpatient dialectical behavioral therapy for borderline personality disorder: A controlled trial. Behaviour Research and Therapy, 42(5), 487–499. https://doi.org/10.1016/S0005-7967(03)00174-8)) than other modalities. Talk therapy of any kind is often combined with prescription medications, such as mood stabilizers, antidepressants, or anti-anxiety medications.

Depression

Depression, or major depressive disorder, ((Major depression. (n.d.). National Institute of Mental Health (NIMH). Retrieved from https://www.nimh.nih.gov/health/statistics/major-depression)) is an extremely common diagnosis. As of 2019, an estimated 7.8% of all adults in the U.S. had major depression. This condition is characterized by a period of at least two weeks in which the patient “experienced a depressed mood or loss of interest or pleasure in daily activities, and had a majority of specified symptoms, such as problems with sleep, eating, energy, concentration, or self-worth.”

It is important to differentiate between depression and sadness or grief. ((What is depression? (n.d.). Retrieved March 25, 2022, from https://www.psychiatry.org/patients-families/depression/what-is-depression)) Depression is a mental health condition, and not a proportionate response to current life events. It is also known to damage a person’s self-esteem, and may cause feelings of worthlessness or hopelessness. Sadness and grief, on the other hand, are generally caused by specific circumstances. These emotions can be overwhelming, but they do not necessarily damage a person’s sense of self.

Depression may be caused by genetics, ((What is depression? (n.d.). Retrieved from https://www.psychiatry.org/patients-families/depression/what-is-depression)) biochemistry, or environmental factors. Those with low self-esteem may also be at risk for developing this condition. Fortunately, most cases of depression are highly treatable.

Treatment Options for Depression

Perhaps because of its high prevalence, there are many different treatments available for major depressive disorder. ((Depression. (n.d.). National Institute of Mental Health (NIMH). Retrieved March 25, 2022, from https://www.nimh.nih.gov/health/topics/depression)) Most patients benefit from some combination of medication, talk therapy, and brain stimulation therapies.

Antidepressants, including SSRIs (like Prozac) and SNRIs (like Cymbalta), are commonly used to treat major depression. Patients normally begin to see results 2-4 weeks after they begin taking a new prescription. Severe cases are usually treated with talk therapy at the same time, and mild cases may be treated with talk therapy alone. “The length and severity of the symptoms and episodes of depression ((Can counseling help with depression? (n.d.). Verywell Mind. Retrieved from https://www.verywellmind.com/depression-counseling-4769574)) often determine the type of therapy.”

If a patient has treatment-resistant depression, they may be advised to try alternative modalities, such as brain stimulation therapies. ((Ect, tms and other brain stimulation therapies | nami: National alliance on mental illness. (n.d.). Retrieved from https://www.nami.org/About-Mental-Illness/Treatments/ECT,-TMS-and-Other-Brain-Stimulation-Therapies)) Specifically, depression can be treated with electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), vagus nerve stimulation (VNS), and deep brain stimulation (DBS). These therapies are intended to have a direct effect on brain or nervous system function, alleviating the most extreme symptoms of depression.

Because it may lead to suicidal ideation, some patients may be hospitalized for depression on an urgent basis. If possible, it’s best to get help before your symptoms become so severe. There’s no need to wait for an emergency before attending a residential program.

Eating Disorders

Eating disorders affect at least 9% of the global population. ((Eating disorder statistics | general & diversity stats | anad. (n.d.). National Association of Anorexia Nervosa and Associated Disorders. Retrieved March 25, 2022, from https://anad.org/eating-disorders-statistics/)) These conditions can affect anyone, regardless of gender, body type, ability, occupation, age, race, ethnicity, or sexual orientation. However, certain demographics may be at a higher risk for developing certain diagnoses. Following are some of the most common types of eating disorders: ((Types of eating disorders | anxiety and depression association of america, adaa. (n.d.). Retrieved from https://adaa.org/eating-disorders/types-of-eating-disorders#Binge%20Eating%20Disorder))

• Anorexia nervosa is characterized by the severe restriction of caloric intake. Patients with this condition may exhibit dramatic weight loss, a preoccupation with food and dieting, or adherence to an overly strict or taxing exercise routine.
• Bulimia nervosa follows a binge-purge cycle. Patients with bulimia tend to binge eat, and then induce vomiting. Some also present with dental problems, weight loss, and excessive time spent in the bathroom after meals.
• Binge eating disorder involves episodes of binge eating. Unlike bulimia, these episodes are not followed by purging. People with this condition may feel or express guilt and shame, hide food in strange places, and create lifestyle schedules that make time for binging behaviors.
• Other specified feeding and eating disorders (OSFED) is a term that refers to eating disorders that do not fit neatly into any of the above categories. Patients with OSFED may exhibit weight loss or gain, and their self-esteem may be overly tied to body image.

Eating disorders are defined by a person’s behavior and emotional state, and not their body size. For example, it’s possible for someone to have anorexia and not appear clinically underweight. Eating disorders can be serious, and even life-threatening, no matter whether the patient’s weight is perceived to be healthy.

Treatment Options for Eating Disorders

Many people with eating disorders develop physical complications due to malnutrition. Because of this, hospitalization or inpatient treatment may be an important first step toward healing. This is not necessary for all patients, as it depends on the severity of their symptoms.

Some patients may benefit from residential treatment even if they don’t present with physical complications. This is an opportunity for them to begin intensive psychotherapy, work with a nutrition counselor, and be closely monitored for disordered behavior around food.

Medication alone is not usually used to treat eating disorders. ((How medication may help treat eating disorders. (n.d.). Verywell Mind. Retrieved March 25, 2022, from https://www.verywellmind.com/medications-used-to-treat-eating-disorders-4153046)) In some cases, antidepressants or antianxiety medications may be prescribed in addition to therapy and behavioral health strategies. These patients may benefit from a number of different types of psychotherapy, ((Types of Psychotherapy. (n.d.). National Eating Disorders Association. Retrieved from https://www.nationaleatingdisorders.org/treatment/types-psychotherapy)) including but not limited to acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), and interpersonal psychotherapy (IPT).

PTSD and C-PTSD

Post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (C-PTSD) are very similar mental health diagnoses, and are both caused by adverse life experiences. It’s important to differentiate between PTSD and C-PTSD ((Cloitre, M., Garvert, D. W., Weiss, B., Carlson, E. B., & Bryant, R. A. (2014). Distinguishing ptsd, complex ptsd, and borderline personality disorder: A latent class analysis. European Journal of Psychotraumatology, 5, 10.3402/ejpt.v5.25097. https://doi.org/10.3402/ejpt.v5.25097)) in order to design an appropriate treatment plan.

PTSD is normally caused by specific, time-bound traumatic occurrences. On the other hand, C-PTSD is caused by complex trauma, ((Giourou, E., Skokou, M., Andrew, S. P., Alexopoulou, K., Gourzis, P., & Jelastopulu, E. (2018). Complex posttraumatic stress disorder: The need to consolidate a distinct clinical syndrome or to reevaluate features of psychiatric disorders following interpersonal trauma? World Journal of Psychiatry, 8(1), 12–19. https://doi.org/10.5498/wjp.v8.i1.12)) which is the prolonged exposure to extreme circumstances such as “domestic violence, childhood sexual or physical abuse, torture, genocide campaigns, slavery etc. along with the victim’s inability to escape.” It’s important to note that C-PTSD is not yet considered an official diagnosis. ((Maercker, A. (2021). Development of the new CPTSD diagnosis for ICD-11. Borderline Personality Disorder and Emotion Dysregulation, 8(1), 7. https://doi.org/10.1186/s40479-021-00148-8)) Despite this, it is an area of interest for researchers, and some have proposed that it be included in the next edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The shared symptoms of PTSD and C-PTSD ((Cloitre, M., Garvert, D. W., Weiss, B., Carlson, E. B., & Bryant, R. A. (2014). Distinguishing ptsd, complex ptsd, and borderline personality disorder: A latent class analysis. European Journal of Psychotraumatology, 5, 10.3402/ejpt.v5.25097. https://doi.org/10.3402/ejpt.v5.25097)) include the following:

• flashbacks to and nightmares of the inciting traumatic event
• avoidance of thoughts, people, places, and activities that may bring up painful memories
• hypervigilance due to a constant or persistent sense of threat/danger
• an exaggerated startle response

C-PTSD may also involve personality and mood changes, difficulty with emotion regulation, a sense of worthlessness, the risk of self harm, paranoia, and/or dissociation.

“Most people with PTSD—about 80%—have one or more additional mental health diagnoses. They are also at risk for functional impairments, reduced quality of life, and relationship problems. PTSD and trauma ((Co-occurring conditions – ptsd: National center for ptsd. (n.d.). [General Information]. Retrieved March 25, 2022, from https://www.ptsd.va.gov/professional/treat/cooccurring/index.asp)) are linked to physical health problems as well.” People with a history of trauma may benefit from intensive therapy for these co-occurring disorders, which may include a period of residential treatment.

Treatment Options for PTSD and C-PTSD

It’s important for people with these diagnoses to seek out trauma-informed care. This approach to treatment takes their unique symptoms and experiences into account, and fosters a more productive environment for healing.

The primary treatment for PTSD ((Treatments for ptsd. (n.d.). Https://Www.Apa.Org. Retrieved from https://www.apa.org/ptsd-guideline/treatments)) and C-PTSD is psychotherapy. Clinicians strongly recommend cognitive behavioral therapy (CBT) and prolonged exposure therapy, although other styles of therapy may also be helpful. These two modalities invite patients to face the original traumatic events head-on, developing skills that will help them navigate flashbacks and triggers in the future.

Patients may be prescribed medication in additionto—but not instead of—therapeutic interventions. Most often, PTSD is treated with SSRIs. ((Medications. (n.d.). Https://Www.Apa.Org. Retrieved from https://www.apa.org/ptsd-guideline/treatments/medications))

Schizophrenia

Schizophrenia ((What is schizophrenia? (n.d.). Retrieved from https://www.psychiatry.org/patients-families/schizophrenia/what-is-schizophrenia)) is a chronic brain disorder, characterized by difficulty distinguishing between the real and the unreal. Symptoms generally fall into one of three categories:

• Positive symptoms: The abnormal presence of visual or aural hallucinations, paranoia, distorted perceptions of the world
• Negative symptoms: An abnormal loss of or decrease in the ability to make and carry out commitments, speak, express or feel emotion
• Disorganized symptoms: Confused speech and/or thinking, disconnected logic, and abnormal behavior or movements

Experts believe schizophrenia may be caused by a combination of genetic and environmental factors. However, the disease’s exact etiology is unknown. There may be a link between schizophrenia and substance misuse, ((What is schizophrenia? | nami: National alliance on mental illness. (n.d.). Retrieved March 25, 2022, from https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Schizophrenia/Overview)) especially among teens. Specifically, research suggests that “taking mind-altering drugs during teen years and young adulthood can increase the risk of schizophrenia. A growing body of evidence indicates that smoking marijuana increases the risk of psychotic incidents and the risk of ongoing psychotic experiences. The younger and more frequent the use, the greater the risk.” Continued substance use—and especially the use of psychedelics like LSD or psilocybin—can make it difficult to diagnose schizophrenia, because the effects of these drugs can mimic its symptoms.

Treatment Options for Schizophrenia

It’s extremely important to treat schizophrenia using both pharmaceutical and behavioral modalities. These patients are commonly prescribed antipsychotic medications, ((What is schizophrenia? | nami: National alliance on mental illness. (n.d.). Retrieved March 25, 2022, from https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Schizophrenia/Treatment)) such as Abilify or Seroquel.

Talk therapy not only helps people to manage the symptoms of schizophrenia; ((Patel, K. R., Cherian, J., Gohil, K., & Atkinson, D. (2014). Schizophrenia: Overview and treatment options. Pharmacy and Therapeutics, 39(9), 638–645. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4159061/)) it can also “ensure that patients remain adherent to their medications.” This makes every aspect of treatment more effective in the long term. In particular, beneficial talk therapies for schizophrenic patients ((Patel, K. R., Cherian, J., Gohil, K., & Atkinson, D. (2014). Schizophrenia: Overview and treatment options. Pharmacy and Therapeutics, 39(9), 638–645. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4159061/)) include cognitive behavioral therapy (CBT), supportive psychotherapy, and cognitive enhancement therapy (CET).

If a person’s symptoms are severe enough to require immediate medical attention, they are likely to require admission to a hospital or residential treatment program. According to the CDC, approximately half of all emergency room visits related to schizophrenia ((Products—Data briefs—Number 215—September 2015. (2019, June 7). https://www.cdc.gov/nchs/products/databriefs/db215.htm)) “led to either a hospital admission (32.7%) or a transfer to a psychiatric hospital (16.7%).” These patients, as well as patients who are not in crisis, may find relief through longer-term residential treatment.

Suicidal Ideation

If you or someone you know is experiencing suicidal ideation, get immediate help by calling the National Suicide Prevention Lifeline at 800-273-8255.

Suicidal tendencies may be symptomatic of another diagnosis, or may appear independently. Regardless of the circumstances, suicidal ideation is an extremely serious symptom, and should be urgently treated.

Patients with this symptom may experience thoughts or fantasies of suicide, or may be actively planning to engage in self-harm. The warning signs of suicide ((We can all prevent suicide. (n.d.). Retrieved from https://suicidepreventionlifeline.org/how-we-can-all-prevent-suicide/)) include, but are not limited to the following:

• talking about wanting to die or to kill themselves
• looking for a way to kill themselves, like searching online or buying a gun
• talking about feeling hopeless, trapped, or in unbearable pain
• talking about feeling trapped or in unbearable pain
• talking about being a burden to others
• increasing reckless behavior, such as substance misuse
• withdrawing or isolating themselves, losing interest in activities they once enjoyed
• a sudden and unexplained lift in mood, expression of a feeling of peace or tranquility
• sudden and extreme generosity, giving away money or treasured keepsakes

Not all instances of suicidal ideation are followed by suicide attempts. In some cases, this symptom is an expression of major depression, PTSD, or another co-occurring disorder. While emergency action may or may not be necessary, it’s important to get help as soon as this symptom appears. That may mean going to therapy, starting or changing a medication, or seeking inpatient care.

Treatment Options for Suicidal Ideation

Severe symptoms of suicidal ideation require immediate care. It may be appropriate to call an ambulance, or even call the police to request an in-person wellness check. Depending on your specific location, it may be possible to have the patient temporarily hospitalized with or without their consent. During this time, they may be closely supervised by healthcare providers to ensure they do not attempt self harm.

After the immediate threat of suicide has passed, it’s important to continue with an ongoing plan of care. Patients should begin by obtaining an official diagnosis, which will help their providers design a long-term plan. Because suicidal ideation is a symptom, and not officially a mental health condition, treatments vary widely.

Remember that you deserve care. Remember: a mental health diagnosis means nothing about your willpower or your character, and healing is absolutely possible. If you’d like to learn more about treatment for these or other conditions, you can browse our list of inpatient mental health treatment centers here.

Reviewed by Rajnandini Rathod