alternate ways of treating borderline personality disorder

cat123 · Jul 13, 2006

I have to disagree. Following this rationale, we wouldn't treat any mental illnesses that are manifested by maladaptive behaviors. The goal of treatment is to give patients tools to behave in a way that helps them to function in society. If that isn't a worthwhile goal, I don't know what is.

I don't know why you disagree. I just believe that we have a tendency to label people and force treatments on them at any cost. Borderline Personality Disorder is a very old Dx. and one that I feel maybe over rated. I have also seen diagnosis given at the snap of a finger. Some of these cases may have been on target just from mere luck. Unfornately when we start trying to cure something that really doesn't exist we are not treating anything at all. Many medical diagnosis are not cureable but the symptoms are and I feel this is one of those times. The mind is a very intricate organ and can be destroyed very easily by uncaring, untrained and uneducated people. At this point I will end this with an apology for any unclear statements.

As a nurse I have wittensed too many people that haven't a clue as to what they are talking about give advice. This topic probably should not even be discussed because as nurses we do not make medical diagnosis nor do we order treatments. We do nursing DX and careplanning, big difference.

LydiaNN · Jul 13, 2006

I don't know why you disagree. I just believe that we have a tendency to label people and force treatments on them at any cost. Borderline Personality Disorder is a very old Dx. and one that I feel maybe over rated. I have also seen diagnosis given at the snap of a finger. Some of these cases may have been on target just from mere luck. Unfornately when we start trying to cure something that really doesn't exist we are not treating anything at all. Many medical diagnosis are not cureable but the symptoms are and I feel this is one of those times. The mind is a very intricate organ and can be destroyed very easily by uncaring, untrained and uneducated people. At this point I will end this with an apology for any unclear statements.
As a nurse I have wittensed too many people that haven't a clue as to what they are talking about give advice. This topic probably should not even be discussed because as nurses we do not make medical diagnosis nor do we order treatments. We do nursing DX and careplanning, big difference.

I'll start with your last comment first. We can discuss whatever we want here; we're not offering anyone medical advice. If you're heard a nurse give unwarranted medical advice to a patient, that is really something you should take up in an appropriate venue. It seems interesting to me though that you can say you've seen diagnoses made at a snap of the fingers in the same post in which you feel compelled to remind the rest of us that we don't make medical diagnoses, but perhaps the irony isn't as obvious to others.

As for how I can disagree with you, hoo boy, let me count the ways. Yes, many medical diagnoses aren't curable. That doesn't mean we don't treat them. Shall we also stop providing insulin for incurable diabetes and protease inhibitors for incurable AIDS? For that matter, are we going to stop treating all mental illness, since none of them are curable? I'm not sure how you happened to settle on ignoring treatment for this particular one. Incidentally, the mind is not an organ. The brain is.

cardiacRN2006, ADN, RN · Jul 13, 2006

This topic probably should not even be discussed because as nurses we do not make medical diagnosis nor do we order treatments. We do nursing DX and careplanning, big difference.

This topic shouldn't be discussed??? Are you aware that this is a discussion board? I can discuss anything I want (within the TOS). Besides, most of us in this discussion personally know someone who is a borderliner. If you are uncomfortable discussing this topic, then stop following it.

Nurse Ratched, RN · Jul 13, 2006

Let's try and keep the thread on track. :) Thank you!

cat123 · Jul 13, 2006

I'll start with your last comment first. We can discuss whatever we want here; we're not offering anyone medical advice. If you're heard a nurse give unwarranted medical advice to a patient, that is really something you should take up in an appropriate venue. It seems interesting to me though that you can say you've seen diagnoses made at a snap of the fingers in the same post in which you feel compelled to remind the rest of us that we don't make medical diagnoses, but perhaps the irony isn't as obvious to others.
As for how I can disagree with you, hoo boy, let me count the ways. Yes, many medical diagnoses aren't curable. That doesn't mean we don't treat them. Shall we also stop providing insulin for incurable diabetes and protease inhibitors for incurable AIDS? For that matter, are we going to stop treating all mental illness, since none of them are curable? I'm not sure how you happened to settle on ignoring treatment for this particular one. Incidentally, the mind is not an organ. The brain is.

originally this post was looking for alternate treatments for bpd. and I have seen doctors and nurses give unwarrented labels to many patients to drum up business. But I will leave this alone as I do not want to get into a confrontation. oops my mistake, you're right about the brain vs mind. and I still stick with everything I have said. Not a psych nurse, tried it and found it to be a little too far away from my personality and would find myself fighting for the patients too much.

rn/writer, RN · Jul 13, 2006

originally this post was looking for alternate treatments for bpd. and I have seen doctors and nurses give unwarrented labels to many patients to drum up business. But I will leave this alone as I do not want to get into a confrontation. oops my mistake, you're right about the brain vs mind. and I still stick with everything I have said. Not a psych nurse, tried it and found it to be a little too far away from my personality and would find myself fighting for the patients too much.

If you are not a psych nurse, you have no desire to be psych nurse, and you don't believe borderline personality disorder exists--

Unfornately when we start trying to cure something that really doesn't exist we are not treating anything at all.

--what is your interest in this thread?

cat123 · Jul 14, 2006

If you are not a psych nurse, you have no desire to be psych nurse, and you don't believe borderline personality disorder exists--
--what is your interest in this thread?

I am interested in all forms of nursing. I just haven't been able to specialize or develop an interest in any one particular speacialty at this time. I know many people who have been affected by the mental health sytem, good and bad. Never said I didn't believe that what is refered to as BPD didn't exist. I am more open minded and fully believe in "First do no harm" It is much easier to hurt some one through mental health and get away with it then it is in other nursing areas.

lucianne · Jul 16, 2006

Actually cat123, some of us here are qualified to make medical diagnoses and order treatments. And there is absolutely no need for any doctor or nurse in the psychiatric field to "give unwarranted labels to many patients to drum up business," there is plenty of "business" in mental health. In community mental health settings, there is usually a several week delay before someone can get in for an evaluation. The means to pay for psychiatric treatment in another matter entirely.

As for personality disorders, the whole point of the diagnoses is that certain personality traits are present to such an extent that they interfere with the client's ability to function, hence personality disorder rather than personality trait.

dakota1111 · Jul 16, 2006

I think what cat123 is trying to say is if you label a patient childish and manipulative they aren't going to be treated well by staff. The dif between theory and practice is that humans aren't perfect. Your theory may be beautiful and scientific but the huamans are the one's who practice it. I recently got contact lenses for astigmatism and had to go through several pairs. This is not my fault but I could overhear the doctor and optician making rude comments. In theory doctors and other health prof are suppose to be professional and caring but in practice they are human. Can rn/writer honestly say in all their years of nursing they have never heard a co hort make a rude comment about a borderline personality disorder patient (due to the fact that this patient is seen as childish and manipulative)?

rn/writer, RN · Jul 17, 2006

I think what cat123 is trying to say is if you label a patient childish and manipulative they aren't going to be treated well by staff. The dif between theory and practice is that humans aren't perfect. Your theory may be beautiful and scientific but the huamans are the one's who practice it. I recently got contact lenses for astigmatism and had to go through several pairs. This is not my fault but I could overhear the doctor and optician making rude comments. In theory doctors and other health prof are suppose to be professional and caring but in practice they are human. Can rn/writer honestly say in all their years of nursing they have never heard a co hort make a rude comment about a borderline personality disorder patient (due to the fact that this patient is seen as childish and manipulative)?[/quote]
Where did this question come from? When did I say anything to suggest that I've never heard co-workers make rude comments?
I've heard plenty, let me tell you. I understand why people make the comments they do. Heck, I've made a few myself.
My own personal code is that I'm very careful to vent where patients can't hear. And once I've let off some steam, I try to take another run at the situation. And I'm not even working psych any more. Even in postpartum, we end up with quite a few patients with actual psych needs or pseudo psych behavior that is related to their current stressors.
At any rate, it doesn't help to label patients if you use the label as an excuse to disrespect or dismiss them. Venting CAN help IF blowing off a little frustration in a private area will allow you to take a deep breath and return to the patient with a better attitude.
You're right that clinicians are human. We have to balance our needs to set healthy limits and maintain our own sanity with the patients' needs to receive decent and respectful treatment.
I think the trick in all of this is to make a distinction between the facts and the feelings and handle them separately.
I can FEEL that a patient is acting childish and manipulative. If need be (the behavior is outrageous or has lasted a long time), I can discharge some of my own emotions in the med room or wherever (take my own time out). THEN, when my head is clear enough, I can give a reasoned and reasonable response that is not borne out of frustration. I can get past the label by choice and consideration.
It is also helpful to take some time away from the job to study common BPD behaviors and learn to link them with various emotional needs the patients might be having when they do them. For instance, provoking a fight is often an identity issue. One way to reassure yourself that you're still alive is to generate a negative reaction in someone else.
If you know that about your patient, you can find ways to give them what they really need--reassurance that they do exist and do matter--without being sucked into the false need for a fight.
I'm as human as the next guy. I have worked with the BPD population and have a number of folks in my extended family that are so afflicted. Labels can serve as a kind of short-hand, a means to venting, a perverse kind of humor that keeps you from strangling the person in question, and an invitation to learn what works with certain kinds of behavior and what doesn't.
They can also be used as excuses to avoid doing all of the above, as if certain diagnoses relieve us of the obligation to care about and care for those who have it.
Labels, in and of themselves, are amoral. They have no value until they become linked to a course of action and THAT determines whether they are being used constructively or not.

rn/writer, RN · Jul 17, 2006

I think what cat123 is trying to say is if you label a patient childish and manipulative they aren't going to be treated well by staff. The dif between theory and practice is that humans aren't perfect. Your theory may be beautiful and scientific but the huamans are the one's who practice it. I recently got contact lenses for astigmatism and had to go through several pairs. This is not my fault but I could overhear the doctor and optician making rude comments. In theory doctors and other health prof are suppose to be professional and caring but in practice they are human. Can rn/writer honestly say in all their years of nursing they have never heard a co hort make a rude comment about a borderline personality disorder patient (due to the fact that this patient is seen as childish and manipulative)?

Where did this question come from? When did I say anything to suggest that I've never heard co-workers make rude comments?

I've heard plenty, let me tell you. I understand why people make the comments they do. Heck, I've made a few myself.

My own personal code is that I'm very careful to vent where patients can't hear. And once I've let off some steam, I try to take another run at the situation. And I'm not even working psych any more. Even in postpartum, we end up with quite a few patients with actual psych needs or pseudo psych behavior that is related to their current stressors.

At any rate, it doesn't help to label patients if you use the label as an excuse to disrespect or dismiss them. Venting CAN help IF blowing off a little frustration in a private area will allow you to take a deep breath and return to the patient with a better attitude.

You're right that clinicians are human. We have to balance our needs to set healthy limits and maintain our own sanity with the patients' needs to receive decent and respectful treatment.

I think the trick in all of this is to make a distinction between the facts and the feelings and handle them separately.

I can FEEL that a patient is acting in a childish and manipulative manner. If need be (the behavior is outrageous or has lasted a long time), I can discharge some of my own emotions in the med room or wherever (take my own time out). THEN, when my head is clear enough, I can give a reasoned and reasonable response that is not borne out of frustration. I can get past the label by choice and consideration.

It is also helpful to take some time away from the job to study common BPD behaviors and learn to link them with various emotional needs the patients might be having when they do them. For instance, provoking a fight is often an identity issue. One way to reassure yourself that you're still alive is to generate a negative reaction in someone else.

If you know that about your patient, you can find ways to give them what they really need--reassurance that they do exist and do matter--without being sucked into the false need for a fight.

I'm as human as the next guy. I have worked with the BPD population and have a number of folks in my extended family that are so afflicted. Labels can serve as a kind of short-hand, a means to venting, a perverse kind of humor that keeps you from strangling the person in question, and an invitation to learn what works with certain kinds of behavior and what doesn't.

They can also be used as excuses to avoid doing all of the above, as if certain diagnoses relieve us of the obligation to care about and care for those who have them.

Labels, in and of themselves, are amoral. They have no value until they become linked to a course of action and THAT determines whether they are being used constructively or not.

CharlieRN · Jul 17, 2006

I just had to respond to this one. If you look at the S&S of Borderline Personality Disorder I honestly think most of us would fit the Dx. There is no treatment other than trying to force people into your mold. We all come from certain backgrounds and we all have different experiences that we can either learn from, adapt to or just flip out. People with severe backgrounds are going to be more difficult to "Tx" but what are we trying to "Tx" ? If some one wants "Tx" then you can guide them toward a direction. It would be idiotic to try to literally change some one's personality, especially overnight or with a pill. I have never heard of any one going to a doctor and stating "I want my personality changed" yet that is axactly what they try to do. Why not just hang a sign on them that says " Malfunctioned personality" Oh well just my 2 cents.

Hi Cat,

I see you got a lot of flak about this. The difference between reading about BPD and dealing with it is in intensity. Many people occasionally feel self distructive but the bdp is the one with railroad track scars up both arms. The ER staff know them by name because they have pumped their stomach so often. Many people have emotional conflicts with others but the borderline has them every other day. Many people are occasionally needy, the bdp will suck you dry. Many people have their relationships occasionally hit rough spots but the borderlines life hx is a trail of relationship disasters. They pack more drama into a week than the normal population does in six months. Their lives are chaotic and incredibly and needlessly painfull.

If you actually can get a borderline to see that they need to make changes then, yes, what it is all about is personality growth. You seem to think personality change is a bad thing, but who doesn't want to experience personality growth? Who doesn't want to become wiser and more mature? Who would not like to learn to be serene, well liked, and socially graceful?