Borderline personality disorder

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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 more than what I learned in class (I don't feel like my instructor was effective at all). I am having an okay time learning most of them. But, personality disorders baffled me; especially, borderline.

    I don't understand it. What are they like? I have read they are manipulative, but I don't understand what kind of stuff they do that is manipulative. I understand the black and white stuff like a person is all good or all bad. Are they cheery people or are they depressed? Do they really lie a lot; have you ever met an honest one? Does that mean I should take what they tell me as being true? Have all of them been abused or are some of them just like that without abuse? Are they able to hold down jobs and what kind of services would I need to refer them to (I know it's on a case by case basis but generally what kind of advocacy/ case management do they need?) How does this differ from Bipolar?

    Any info is appreciated. I had considered joining a psych organization along with the couple other ones I have selected to join just so I can get info and journal articles about psych illnesses, homelessness, etc. in order to learn about and advocate for my future patients. Like I said, I understand med surg slightly better but I am not close minded or think psych patients are crazy or anything.
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    What are they like?

    Extremely Narcissistic.

    I have read they are manipulative, but I don't understand what kind of stuff they do that is manipulative. I understand the black and white stuff like a person is all good or all bad. Are they cheery people or are they depressed?

    They are cheery if they get what they want. However, they use whatever emotion they need to in order to manipulate their media and reach their desired goal.

    Do they really lie a lot; have you ever met an honest one? Does that mean I should take what they tell me as being true?

    Taking in the Concept that Reality is merely a Consensual Perspective, so is a Truth or a Lie. As George Costanza said, "Remember- it's not a lie if you believe it." Diane Ackerman wrote an entire book on the perceptions of the mind, called An Alchemy of Mind.

    Have all of them been abused or are some of them just like that without abuse?

    I tend to lean toward the Predisposed Genetic Template of the Personality Theory. But it is possible that the Borderline Personality is a result of Coping Mechanisms.

    Are they able to hold down jobs and what kind of services would I need to refer them to (I know it's on a case by case basis but generally what kind of advocacy/ case management do they need?)

    Allow the Individual to attain the Highest Level of Functioning they can. Like most of us, they'll follow the Peter Principle and will ascend to the Level of Their Incompetence.

    How does this differ from Bipolar?

    Bipolar is a Mood Disorder. Borderline is a Personality Disorder.

    These answers are merely my perspective and are subject to interpretation and argument, but you asked some very good questions, wish_me_luck!

    I wish you luck!

    Dave
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    They are usually manipulative in the way where they will try and tell you what to do and and in a hospital setting try and tell you they are allowed to do certain things even if they are not. It is never wise to take their word on things and to talk to the nurse in charge or a nurse who knows their care plan. They may also claim to be very sick even when they are not to try and get you to feel sorry for them or other tactics to try and get you to feel sorry for them. In many cases they will act like the nicest person to you but will turn on you as soon as you do not do what they want. Once that happens they can me quite mean. You just have to not take anything personally.
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    so far you've gotten some good info.

    i wanted to add that not every difficult patient you encounter is a borderline personality disorder patient.

    there tends to be a bad habit, especially in non-psych nurses or nurses who don't understand personality disorders, to immediately slap the "borderline" label on any patient who is demanding or difficult, changes their mind a lot, is seeking sympathy, and/or tells staff different stories.

    patient changes their mind about something? must be borderline. not happy with dinner or a medication and wants something else? must be borderline. minimizes pain to the nurse but tells the doctor they are in agony? must be borderline.

    yes, most of these "difficult" patients probably have borderline pd to some degree. but not all do.

    some patients are just indecisive. some are just entitled. some indeed just want a shoulder to cry on. some may tell varying stories, not to split or manipulate staff, but for other reasons: maybe they don't want the doc/nurse know how bad off they really are, maybe they forgot to mention something, maybe they didn't want to bother a busy nurse for pain meds, maybe they are stressed or in crisis and not thinking clearly, maybe they relate better to one staff over another, etc.

    just something to keep in mind.

    that being said, regardless of whether the patient has borderline pd, remember to be consistent with boundaries and unit rules. take what the patient tells you with a grain of salt, and do not let them split staff whether they do it intentionally or accidentally. and definitely learn not to take things they say or do personally.

    the best way to learn about personality disorders (borderline pd is only one of several you will encounter--antisocial pd, narcissistic pd and obsessive-compulsive pd are also common ones). there are lots of good reference books out there. if you want to learn about borderline pd from the patient pov, look for "get me out of here" by rachel reiland.
    Last edit by Meriwhen on Apr 26, '12
    angelalala and Whispera like this.
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    Okay, thanks. I don't think I will be on a unit with them as I want public health. But, in public health, we see a lot of vulnerable populations cases (psych, homelessness, addicts) and I want to know how to deal with them/understand them in order to get an idea how to help them. That's why I was curious also about case management, advocacy, and whether they typically can hold a job...The other psych illnesses seem to be as long as they stay on their medication regimen, they do okay; but when they come off, that's where the problem starts. PDs, from what I know, usually don't benefit from meds.
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    In a nutshell, I would describe borderlines as having the ability to conjure up the emotion necessary to get the results they want. When they do not get the results they want, this leads to the labeling of the person/situation as "bad" for the time being. However, they are often sweet when they feel that you take a personal interest in who they are as a person. At their core, I think they also split themselves into good and bad parts and are extremely tough on themselves when they screw up, and likewise sing their own praises loudest of all when they succeed.

    I have a friend with BPD and she's extremely attention-seeking. She will make up stories, either to brag or for sympathy, and has often come to me with random illnesses (and even a pregnancy once). She goes between loving and hating people...there is rarely an in-between and often if there is, it doesn't stay there long.

    I would say that many patients with BPD traits have a history of abuse, neglect, and/or abandonment in their past, but I do not think that this is what causes the disorder. I believe that it makes it much more obvious to the public though due to an unhealthy environment and learning poor coping skills.

    Remember that each individual is different. You should *always* take what your patients say with a grain of salt, but I would advise against getting into the mindset that because Patient A has Disorder X, she must do Action Y. Therefore, do not assume a BPD is lying until there is clear evidence. In documentation, it is important to use the power of quotation marks and refrain from putting your opinion into it. A phrase that drives me crazy in the psych world is "not interested in treatment" without any supporting evidence. Make sure that you do not pigeonhole your psych patients. They are capable of change and worthy of love just as much as anyone else.
    sharpeimom, VivaLasViejas, and Meriwhen like this.
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    some empathy, clear boudaries and a litle Zen...the how to engage with those borderline very nice people
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    This very website has a great entry on BPD. http://allnurses.com/psychiatric-nur...er-410694.html. Most of what I saw here would agree with my own experience with the disorder.
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    When thinking of personality disorders in general (vs an Axis I disorder), think of the personality being "stunted": a lot of borderline (and other personality-disordered people) behave like a child, throwing "tantrums" (quite literally, or other types of tantrums like self-injurious behavior) in order to get their own way.

    Still, there's another school of thought that isn't even convinced of the existence of BPD: it is, after all, overdiagnosed in females (men with similar behaviors tend to get the Bipolar label). This website is very useful: borderline
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    angelalala... just wanted to follow up one your post by saying that not all who self-injure do it to seek attention/ to get their own way.

    sandanrnstudent


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