Its 1 am, I have just finished clerking a rather complex patient to the wards. Time for a quick brew maybe, I tell myself, as my night on-call rolls on. It has been a busy day so far, assessments, assignments, and attendances to medical concerns of various service users. My to–do list still remained incomplete with quite a few boxes waiting to be ticked off. There are simply not enough hours in the day – this thought occurs quite a lot often these days. Just about then I receive a call from the crisis team, there’s a lady who needs assessment. I head to the assessment room – the tea can wait – this patient becomes my priority; a knee jerk reflex to every on-call bleep. I make a quick entry to my ever-growing list of tasks. Finally, I meet this lovely, but clearly distressed, lady. It was lengthy conversation – she reported feeling extremely lonely and helpless, to the point of self-harm. She had no one to go to, no one to listen. She had material possessions, adequate funds, food supplies but that’s not what she was after rather desperately in the middle of the night. At this point in time, she needed emotional support, psychological nurturing, reassurance, maybe some form of human contact, some sort of magic solution that could bring her out of her misery there and then. She yearned for a place of safety where she could feel at ease, safe from her thoughts, safe from her mind, safe from herself. At 2 am all she wanted was a hospital admission. Stated above is a next to usual occurrence in a busy hospital in the north of the United Kingdom. My mind drifts off and I wonder how differently it would play out if this situation occurred in one of the healthcare set ups in Pakistan. Emotionally Unstable Personality Disorder (EUPD) is a highly under-diagnosed condition, if not out rightly neglected. It is, however, highly prevalent in Pakistan. The sufferers might be people like you and me, getting on with their lives, functioning rather satisfactorily. Yet what would not be evident is the struggle in their inner selves; it doesn’t kill them, but they may feel like they die from within, every day. Borderline personality disorder (BPD) is also known as an Emotionally Unstable Personality Disorder, and is divided into the following two broad terms: Borderline-type – Difficulties with relationships, self-harming and feelings of emptiness. Impulsive-type – Impulsive behaviour and angry feelings. There are different factors that can lead to someone getting EUPD. A difficult childhood, neglect, and physical, emotional or sexual abuse while growing up are the most common causes. The experiences can have long standing effects on one’s emotional state and have proven to dictate one’s feelings about self and others later in life. EUPD is a rather common occurrence, perhaps less recognised in the world outside medical circles and therefore rather neglected in terms of appreciation and attendance. Around 1 in 100 people have Borderline Personality Disorder (BPD), an illness that makes one feel distressed and anxious. It affects relationships, can bring about extreme reactions to minimal stimuli, causing the person to feel abandoned and have unstable relationships with others. The individual is confused and impulsive in ways that could be damaging. There is also a tendency towards excessive spending, sex, substance abuse, reckless driving, and binge eating, regular suicidal behavior, threats, or self-harm, long lasting feelings of emptiness, difficulty controlling anger, getting into fights. It can generate intense, highly changeable moods and paranoid thoughts when stressed. The list is by no means exhaustive. There are ways we can help individuals with EUPD – or ways in which they can help themselves – before the boiler bursts leading to a crash landing into a mental health crisis or worse, rehab. Options that we encourage our service users to consider include: Mindfulness – many online sessions, lots of paper and paperless data available to help manage emotions Cognitive Analytical Therapy (CAT) – helps understand problems in relationships. ‘Switch’ between liking and disliking people. Psychodynamic psychotherapy–focuses on your unconscious. Your unconscious is the part of your mind that controls beliefs, emotions or behaviours without you thinking about them.Therapists think that past experiences, especially those in your childhood, can affect your unconscious. The therapist will try to link your current problems to past events which may help explain why you feel the way you do. Dialectical Behavior Therapy (DBT) – helps you to build skills to deal with distress.Therapists call this ‘emotional regulation’. DBT can help you learn how to control harmful ways of coping with distress, such as self-harming11 or using drugs or alcohol. Most of the above mentioned therapies may appear to be full of medical jargon but it is always plausible to put them out there, since someone suffering silently might consider them a viable option. Mental health remains considerably stigmatized in Pakistan and we see frustration and anxiety reaching alarming heights. Needless to say, it adds more fuel to the fire in a nation that is already roasting in a frying pan of struggles and stress. Having a healthy mind can go a long way, so let’s start addressing these important mental health issues, even if it is one small step at a time.