Borderline Personality Disorder on the Behavioral Unit - page 2

by Thunderwolf 32,419 Views | 22 Comments

Folks with Borderline Personality Disorder or BPD can often be a challenge on a behavioral health unit. When dealing with BPD, here are some cognitive-behavioral tips: 1. Focus on the here and now, not yesterday or the past.... Read More


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    So often we like to "categorize"... because we think it helps us understand (and because of current trends)... and sometimes it does--but more often it is limiting us terribly. Why aren't we referring to the persons as "persons" instead of "BPD"s? These are PEOPLE--with maladaptive behaviors, yes... but PEOPLE!
    They are behaving the way they do because (as Axis II categories state--personality disorders) they have suffered horrendously--for years (and maybe a lifetime). It is NOT that these sufferings even have to be addressed at all on an inpatient unit (if at all)... but that positive change needs to be addressed, and the reasons why--and, as well, the environment to which the person is being discharged evaluated as to the re-inforcement of old coping mechanisms. A history of what brought the patient into THIS inpatient treatment also needs to done (personally, not through the charting of others)... the person needs to be able to give his own "take" on it--because often what is heard by the treatment staff from others is based on assumption and falsely-interpreted behavioral observations (which may or may not be accurate). when someone is treated like a child--they will fulfill the expectations they see! Positive change cannot be made without "focused listening" and the positive support to do so.
    Also, try to avoid using the word "manipulation"--all behavior is goal-directed in one way or another, and often when we are "frustrated" with those in our responsibility, we simply do not understand--or do not know how to convert this into "strength."
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    I ABSOLUTELY LOVE WHAT YOU SHARED HERE. YOUR PERCEPTION IS ON TARGET. THANK YOU.
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    What an amazing post!!! Thank you for all of the information
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    Also, when it comes to this "manipulation", BPD patients are very POOR manipulators. You KNOW whatthey are trying to do. They aren't smooth Ted Bundy-like manipulators that cause you to "fall into the trap" before you realize it.
    You DO realize it.
    They aren't savvy... because they aren't, necessarily, consciously doing it.
    If they want to talk about the past trauma, it's actually better to say, "That was a terrible experience, but we need to stay focused on how we are going correct your RESULTING issues as they they affect you TODAY. Yesterday is done, what can we focus on to help you with your problems NOW?"

    Typically, they don't want to hear that.
    It takes away their "victim" status, which they feed off of.
    IdrilRN and imaginations like this.
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    great info! BPD patients ran me out of my job as a home health psych nurse. I got so tired of dealing with them.
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    Great info on this thread. I am new at psych HH and I know the BPD's are trying to manipulate me. I have been reading up on splitting. I have to find a way to be more patient with these people, one woman in particular. I just want to say "snap out of it" Not very therapeutic, I admit.
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    Hi--I found this thread while searching for a discussion of RNs who have BPD, not those who work in that field. But as one recently diagnosed, I found the original post very helpful.

    I know there is a mental health in nursing thread but I wanted to specifically talk to you all who have experience with BPD.

    I'm trying to decide if I can continue in my field (NICU). I had a breakdown almost a year ago and have been in and out of inpatient units since. I am on my second atttempt to return to work; the first resulted in a psychotic break.

    I know I was a good NICU nurse before I was diagnosed--I didn't make errors, I was thorough, got along with coworkers, got good evaluations--but in looking back I can see there were times during shifts when I was barely holding it together. I took shortcuts sometimes, or I'd call off sick because I would wake up and HATE my job and know there was no way I could go in.

    Last week I was caring for preemie twins. The mom had been through fertility stuff and had waited a long time for these babies. She was nervous about everything. She and her husband had hired a nanny for home and had called ten references for her.

    And I thought to myself, what would they think if they knew about me? If they knew about my suicide attempts in the past year and my break with reality? They would be horrified, is what.

    I don't know if I belong in nursing anymore.
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    This is great information! The borderline personalities on my unit try almost everyones patience. I've been looking for some new ways in dealing with a few of my pts. I usually do pretty well, but there are times when I feel like yanking my hair out. This post is going with me to work tomorrow.
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    Fantastic information!
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    Thanks for the great description and thoughts on how to deal with
    BPD Thunderwolf! I have dealt with patients with this disorder for numerous years now and it only takes one on a unit to destroy the whole milieu! The staff splitting that goes on is usually horrendous if not caught early and the communication between shifts is not adequate. Also, if there is not good support from management, then there is usually trouble. Thanks again!


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