The Nîmes University Hospital is the first to offer innovative treatment for borderline disorders

Clémentine Estric, psychiatre du CHU, coordonnatrice du centre ressource Hype. Midi Libre – K. H.

Inspiré de la méthode australienne Hype (Helping young people early), le nouveau centre ressource dédié vient d'être créé dans le pôle psychiatrie du CHU. Il est coordonné par la psychiatre Clémentine Estric qui en explique le fonctionnement.

Before talking about this new early care, how do we define borderline emotional disorders ?

This is a personality disorder that can be serious and has a strong impact on the lives of those affected. They experience significant emotional dysregulation and marked impulsivity that lead to low self-esteem, unstable relationships with others, a chaotic social life, and a rigid way of thinking that creates great suffering and isolation.

Around the psychiatrist, the motivated team that starts the Hype program. Midi Libre – K. H.

What are the causes of these borderline disorders ?

These disorders emerge in adolescence, as is the case in various psychiatric illnesses. They have a biopsychosocial origin, that is, the combination of vulnerability genes and a triggering environment. They are most often linked to factors of early adversity in childhood, such as harassment, sexual violence, but also a move that was difficult to cope with. When their emotions are invalidated, not made legitimate, the young person will build themselves with a feeling of shame, inner emptiness, a constant fear of abandonment, a very damaged self-esteem…

When to worry ?

When you are a parent, how can you tell the difference between a “classic” teenage crisis? – even if it is muscular – and worrying symptoms that require a consultation ? “Emotions that yo-yo all the time in extremes, addictions, compulsive eating, putting yourself in danger…”, lists psychiatrist Clémentine Estric. A young person who expresses a lasting malaise, suicidal thoughts must be worried.“A first emergency number is 3114 for suicide prevention that you can call at any time”, she said.
To consult the Hype center of the CHU (psychiatry center, 585 chemin du Mas de Lauze), you must contact the team by email at hypefrance@chu-nimes.fr

What is the prevalence of this disease ?

It is 2% to 6% of the entire population but it is estimated that it affects nearly of one in ten young people aged 16-25. It also affects 20% of patients hospitalized in psychiatry and 50% of people hospitalized after a suicide attempt. It is therefore a real public health issue, hence the establishment of our Hype-France resource center.

What are the daily risks ? 

When we feel terribly empty… we tend to want to fill. But not in the right way. With impulsive behavior, repeated endangerment, addictions, an unbalanced diet … and a very high risk of suicide.  

Why did you create the Hype France center at the Nîmes University Hospital, the first in France ?

We have been working for years in Nîmes to set up the Hype (Helping young people early) program, which was born in Melbourne, Australia, thanks to the psychiatrist Andrew Chanen. There, they are ten or twenty years ahead of us. This method has shown greater effectiveness than psychotherapy alone. The earlier we intervene, the more effective the treatment.

What will the Hype resource center offer ?

We have three care objectives: to offer optimal crisis management (emotional, relational, suicidal) to the young person and their entourage; to help young people enter therapy and stay there; and supporting them to build a stable life, this is the psychosocial rehabilitation part of our work aimed at the personal recovery of the young person. 

A team of seven people

The team – Around the psychiatrist Clémentine Estic, a team of six people support young people in distress: two psychologists, two career coaches, a peer helper to support families (“It's a first here in psychiatry, to hire a peer and close caregiver, the mother of a young girl who suffered from borderline disorders and can share an experience with other families”), and a job coach.

Funding – The Hype-France center of the Nîmes University Hospital, first of its name, was funded thanks to the obtaining of the organizational innovation fund in psychiatry from the ARS in the amount of 474000€.

Help for families – "The active involvement of parents is encouraged, explains Clémentine Estric. They are never left out and are included in the care". Since 2021, a  family psychoeducation group, Connexions Familiales, helps them cope with the disease (12 sessions).

Training – Hype-France also has the mission of training other professionals in this integrative care, medico-social, caregivers, families…

How do you do it ?

We offer multidisciplinary consultations and various integrative tools such as emotional cognitive behavioral therapy (ECBT) groups, brief neurocognitive therapies on the management of impulsivity. Group work allows for real dynamics and we can even offer a group to young people from 12 years old if necessary.

The second step is psychosocial rehabilitation to resume the course of a peaceful life ?

Part of our work is also to help young people find a suitable place in society, consistent with their values, that makes sense. We help them answer these three questions: Who am I? What am I worth ? What do I want ?

This personalized and intensive support of around four months is triggered at the request of the young person. A case manager then visits the place of life or study, helps them move towards autonomy and social and professional integration. It's very innovative.

We can recover from it ?

The evolution of the disorders is very favorable. Thus, ten years after the appearance of the first symptoms, nine out of ten people no longer express them. You can really recover from borderline disorder. What makes the difference is agreeing to seek care and detaching yourself from the stigmatizing prejudices about psychiatry.

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