Borderline personality disorder - page 2

by wish_me_luck

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Hey, I want to be a public health nurse. I am great at prevention and promoting healthy lifestyles, med surg type stuff, but I am not that great at psych. So, I am trying to really go through and learn about the psych illnesses... Read More


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    Borderlines alternate back and forth between valuing and devaluing others. If you do what they want, you're the greatest nurse ever. If you don't, you are worthless and against them. There is little, if any, middle ground. True borderlines are among the most diffcult patients to work with. They often have hair-trigger tempers, and you are never quite sure what will set them off. The worst, IMO, are Axis I Bipolar disorder, Axis II borderline personality disorder. Nasty disposition and lots of energy to fuel it.

    As others have said, some are quick to slap the borderline label on any difficult patient. Some may have borderline traits, but they aren't true borderlines. Reviewing the DSM IV can be very useful in giving you insight.
    Meriwhen and KaroSnowQueen like this.
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    Please, please DO NOT start off thinking they are all negative, manipulative, narcissistic, whatever other words people might throw at you.
    Basically, the mind set of a borderline patient is: no-one likes me, I am negative, I want attention because that way I can be helped and will feel better. They want the attention to get...attention! Because they feel that they are not worthy of much, they feel they have to use negative ways, such as manipulation and not honesty, to get what they need. They are often frequent flyers of hospitals because they feel stuck and don't realise that they have a way to get out of their own problems. They feel someone else must fix them, when with psychiatry often the turning point is when they realise it is up to THEM to turn around and get help. They act narcissistic because they want attention, and often can't understand that others need attention too. It is very easy to feel negative of them after a while because they are so demanding and hard to understand.
    Personality disorders are very complex and for most people are life-long. There isn't an easy fix, which is frustrating for us nurses. With health care for them I think what is the common practice is for them to have a psychologist to give them the attention and care they require, and to try and encourage them to stay out of hospitals. Often with BPD they can be prone to bouts of self injury and suicidiality, and feel the need to be "Rescued" so end up in hospital. They need to have someone to call before this occurs, so a psychologist or 24/7 mental health team they need upon discharge.
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    Borderlines- attempt to split staff, highly attention seeking, manipulate people into getting what they want I think because that is how they have learned to survive and get their needs met in the world, have a hard time regulating their emotions. Basically everything everyone already said. However I will add the comment that you should be careful in not believing a borderline. I learned early on that sometimes even the most psychotic patient may be telling you something that actually happened to them, just like when some of the stories you hear seem like they might not possibly be true they actually might be, even if they sound crazy. We tend to approach borderlines with strict boundaries, hold them to the rules of the units, do not allow them to split staff. It might sound mean (that's what I first thought when I saw staff approaching BPD's like that) but I've found that they actually respond pretty well to it and if they are mean to you they 9/10 times will come apologize later. You can't take anything in this business personal. Remember through all their attempts at getting attention, all the things people dislike about the patient that makes them borderline, they are sick. Keep compassion and sympathy in your heart and forgive.
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    Just remember, BPD is an illness just like the other PDs. It can be treated with therapy and your patients might be in therapy. Don't judge the patient by the label automatically.
    Meriwhen likes this.


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