Working with clients Diagnosed with Borderline Personality Disorder.

By Dudley McBean SUNY It NUR 313

Personality disorder is a general term for a type of mental illness in which your way of thinking, perceiving a situation and relating to others are dysfunctional. Having a personality disorder means that you have a rigid and self destructive pattern of thinking and behaving no matter what the situation .This leads to distress in your life and impairment in your ability to go about your routine function at work , school or social situations. In some cases, you may not realize that you have a personality disorder because your way of thinking and behaving seem natural to you

There are several types of personality disorders but one of the most common, most complex and most difficult to care for in an inpatient psychiatric setting is Borderline Personality Disorder

 Borderline Personality disorder is serious mental illness characterized by a pervasive instability in mood, self image, impulse control and interpersonal relationships

Inpatient Treatment Clients are usually admitted due to selfdestructive events, parasuicide or an actual suicide attempt. The goal of hospitalization is to provide a safe environment that is removed from the life stressors that led to self destructive events. One of the greatest challenge for nurses is providing safe and effective care for hospitalized suicidal patients with borderline personality disorder

 The potential for suicide attempts requires increased observation and intervention to keep them safe. Due to the complexity of this disorder nurses must deal with the clients anger, dependency needs and abandonment issues

Nursing Challenges
Nurses often receive verbal abuse from clients because of the inappropriate and intense anger that is difficult for them to manage. Counter transference is often quickly surface and the nurses must monitor their own reactions of frustration, irritation and anger to avoid non professional response.

Challenges Contd.
In addition to enduring verbal abuse, the nurse may face other challenges. Their instability with interpersonal relationships and lack of emotional control lead to relationship with nurses that are filled with constant confrontation

Challenges Conted.

They also have intense feeling of loneliness and frequently likes to cling to the nurse. As a result of this behavior, nurses frequently struggle with balancing the needs and demands of this client with the other clients on the unit

Manipulation and Splitting

Manipulation and splitting is also another challenge for nurses. They usually categorize nurses into two groups: weak or strong, good or bad, independent or dependent. Only a few nurses are considered good, the good nurses are idealized and the bad ones are ridiculed The good and bad nurses can even shift categories as they may idealize them at first and later devalue them. Nurses usually have to live with this label until the issue is resolved with clinical supervision or treatment team meeting

Negative Judgment
Nurses often label patients with borderline personality disorder as difficult due to manipulation, self-mutilation, violence, patients complain and noncompliance. Negative nursing response often lean to disruption in patient care and ultimately detrimental to both patients and staff.

Traditional Psychotherapy This helps the client to identify stressors, learn to control feelings and impulses without loosing control and gain new perspectives on dealing with identified problems.

Dialectical Behavior Therapy (DBT)

This a cognitive behavior therapy that focuses on mood instability and impulse control by teaching clients how to regulate their emotions. They also learn to work on developing their ability to be comfortable with stress, change their environment and learn positive ways to adapt

Conclusion
Many nurses feel ill equipped to care for these patients due to lack of clinical supervision and professional development