The states of being and rapidity of switching can be exacerbated by circumstances that intensify attachment wishes and fears, such as abusive relationships, prolonged hospital stays, or poor patient-therapist boundaries (physical touching, multiple contacts per week, extended sessions, etc). Patients can regress and become moody and childlike under these conditions: they react strongly to minor provocations and alternate rapidly between different states of being; their risk of suicide varies as well. The childlike qualities and sudden fluctuations in states contribute to health care providers’ confusion and skepticism.