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How can we prevent patients with borderline personality disorder being seen as “just difficult”?

  • Comments (8)

Pack S et al (2013) Management of borderline personality disorder. Nursing Times; 109: 15, 21-23.

“A person with BPD may experience intense bouts of anger, euphoria, depression and anxiety within a very short period (Zanarini et al, 1997). These feelings may lead to impulsive behaviour and confusion, and result in changes to long-term goals, career plans, friendships, gender identity and values. People with BPD may feel unfairly treated or misunderstood, bored or empty, and have little idea of who they are. Symptoms are often most acute when current events trigger memories of feelings from past traumatic and unresolved events.”

 

Let’s discuss…

  • How can we prevent patients with borderline personality disorder being seen as “just difficult”?
  • Have you witnessed patients with BPD being unfairly treated?
  • What problems might you experience in nursing someone with borderline personality disorder?
  • As a nurse, how can you best help someone with this diagnosis?
  • Comments (8)

Readers' comments (8)

  • Anonymous

    I have seen people treated with appauling disregard rather than treated as an individual and as a human being. Some staff have little regard for patients welfare, well being, or indeed for their feelings. I find treating anyone regardless of a label as an individual and with respect and dignity works extremely well with the majority of people. If patients require help and ask for help it, people have a right to be heard and listened too.

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  • Anonymous

    there needs to be far more awareness among nurses and other hc professionals of patients with this condition and especially in services where the patient first presents. They are often confronted with rejection and are reported to have a a tendency to go from one service to another to get their frustrated needs met. they are known to be very high users of the health and especially the MH services.

    HC workers who have more prolonged contact with patients on general wards with all personality disorders would benefit from further specialist training. those with BPD can cause splitting in hc teams through manipulation which can be unintentional and largely subconscious as it may be the only way they know of trying to get their needs met rather than having learned more normal, mature and healthy patterns of behaviour, and ways of relating to others during their development. many come from broken homes or have suffered childhood trauma which may have hampered their development of more 'normal' behavioural patterns. It is a highly complex, but not well understood condition, well outlined above by Zanarini above and with complex care needs.

    Many patients with BPD respond well to treatment such as Dialetical Behaviour Therapy (DBT) which was specially developed for this disorder but previously in the USA it used to be known as the 'Dustbin Diagnosis' because of the way patients often presented to the healthcare services and going from one to another to seek health. Because they did not remain long enough with one therapist for treatment they were considered untreatable.

    Risk of attempted or completed suicide and repetitive of self harm are very high.

    We need to think twice when confronted with an aggressive patient whether they may be suffering from this condition and other personality disorders where sending them away with 'zero tolerance' or not treating them with respect and equal partners may exacerbate their condition and their frustration at their own powerlessness to connect with hc professionals to obtain the care and attention they need and may be desperately seeking.

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  • Anonymous

    further to my comment above, my article written in 2010 my on self-harm also relates largely to those suffering from BPD which is a highly debilitating mental health disorder and the negative attitudes they may be confronted with in health services.
    (Unfortunately NT eitors changed the original title of the article to a less appropriate one).


    https://www.nursingtimes.net/the-distress-increases-until-you-think-you-will-burst/5020491.article

    Further information on the disorder is found in the ICD-10 published by WHO
    and the DSM-IV (DSM-V - in press) by the American Psychiatric Association.


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  • Anonymous

    How about training from the mental health team, having a mental health liasion doctor/nurse available 24/7.

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  • Perhaps a psyche review that day, not 2 weeks after they have been discharged!

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  • Anonymous

    Can't say I have ever thought of patients suffering with BDP as being 'difficult'.
    Do nurses suffer with BDP?

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  • Anonymous

    Anonymous | 20-Apr-2013 11:08 am

    BPD traits or full blown diagnosis occurs accross all sectors of society which includes healthcare professionals

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  • Anonymous

    who said people with BPD were difficult?

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