alternate ways of treating borderline personality disorder

cat123 · Jul 17, 2006

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?

I have been in nursing a long time and have seen a lot. I agree these people do lead a chaotic life and I just don't think adding more confusion or putting more demands on them will help. I have seen people given the DX of BPD when in fact they had PTSD. For years these people have been mistreated untill the symptoms were intolerable for the pt. Instead of caring and understanding they were forced to endure harsh treatments and ridicule then labeled as too dificult to treat. I can go on and give many examples how these labels can do as much harm as the dx. itself does. This goes on even in the medical field, a pt gets labeled as difficult when she is trying to stick up for her own rights. the charting is usually good to cover every one's butt and gets passed on to the next nurse, dr., facility, untill the pt. ends up on drugs or has been totally mentally whipped that they no longer exist. and yes there are people that drum up business especially if they know the pt. has insurance or can get it. I have recently spoke with some people that left the psych field because of the pt. abuse. enough, this is an area that needs to be handled by very knowledgeable, caring and wise professionals.

andreadrea · Jul 21, 2006

Ugh, I need to vent a little. I usually work well with borderlines. Last night my 3 patients were all borderlines. One of them is a very troubled 18 year old male who also has factitious disorder and had the most traumatic childhood I've ever heard of. He has been in the hospital for the past 9 months, every time we try to place him he hurts himself so he gets sent back to acute care. He's very used to being in the hospital, is comfortable there. He cut himself, then wouldn't let us bandage his dripping arm, started to thrash around and punch himself in the face, bang his head on the wall. This was on a unit that is trying to eliminate restraints/seclusion. Sooo we wrestled him to the floor and held him, while paging the doctor on call to get IM meds. we got the IM meds ready, as he was refusing to accept PO meds, refusing to talk, just screaming and moaning on the floor. As soon as I approached with the IMs, he yelled "no shots I'll take the pills!". So back for the pills, then it took him 5 min to take them....long story short I spent 95% of my night just with him, every time I tried to take care of another patient he would start moaning and screaming, and if that did not get him the attention he wanted he would start to hurt himself. Oh, and while I was on the floor trying to keep him from punching himself or me, another of my borderline patients came over and held out a cup and said "can you get me some ice?" LOL! Sure, I'm going to let go of the bleeding screaming patient to get you some ice.

I have a lot of empathy for these patients, some have truly horrific histories. But some days they drive me nuts. Especially this 18 year old who seems to think he can manage to live at the acute care hospital for the rest of his life. This one unit gets most borderline pts, our hospital has "focus units", there is a women's focus unit, latino focus (with spanish speakers on staff), gay/lesbian focus, yadda yadda yadda. Women's focus tends to get borderlines, anyone who is pregnant, or PTSD. I think out of 22 patients, there are currently 10 borderlines. We have no CNAs or Mental Health Workers, so while 3 patients may not seem like much to some, the nurse does all the care for those patients. Actually its usually 4 or 5 patients, last night we had good staffing. As much as I care about these patients, by the end of last night I wanted to send them to a 3rd world country, maybe just for a day or 2 so I could get a break! Or I could go to the 3rd world country, it would be a nice vacation.

I've been studying Marsha Linehan's books on BPD and its treatment, and some of the stuff works with some patients. But this one male with BPD seems darn near untreatable, nothing works. I don't know what to do with him. Last night the "solution" was to dope him up on Ativan and Thorazine. After 5 hours of hourly doses, he finally nodded off. Oh and put him on low dose oxygen with a mask for the hyperventilation, as he refused a paper bag- not dramatic enough. I'm a float, not a regular on that unit, so maybe they'll float me elsewhere tonight. (crosses fingers) I think I'm a little burnt out on this particular patient, so if I am on that unit tonight I'm going to ask for a break.

cat123 · Jul 24, 2006

I still think these people are just not being treated properly. Their lives are chaiotic for a reason and blaming them isn't going to change that. Look around our world is chaotic and to expect some one that is being abused by this society to know how to cope/function in it is looking though the proverbial rose colored glasses.

rn/writer, RN · Jul 24, 2006

I still think these people are just not being treated properly. Their lives are chaiotic for a reason and blaming them isn't going to change that. Look around our world is chaotic and to expect some one that is being abused by this society to know how to cope/function in it is looking though the proverbial rose colored glasses.

"Treatment" that involves judgment and blaming is not going to help and is not the right way to care for borderline patients.

But keep in mind that, at least on a functional level, borderline patients are developmentally delayed and stuck at a much younger social/emotional stage. Helping them learn to handle responsibility in manageable increments is not the same as blaming. It's part of the maturing process that they have missed out on and it's an essential component of a healthy life.

Many--but not all--borderline patients were abused to the point that they stopped connecting with the people and the reality around them in concrete terms. They kept that input at arm's length and either ignored what they saw or twisted it in some way to make it less intimidating. This distortion is what makes us scratch our heads and wonder if they're living in the same world the rest of us are. The truth is that they are not. They live in a world of their own making and will continue to do so until the consequences of their falsely protective thinking and behavior cause enough pain for them to say, "Enough!" Even then, it takes much time and effort and committment on the part of those who care for them to help them inch forward into self-awareness and new choices.

To help borderline patients recognize their own distorted thinking, to assist them in seeing a connection between cause and effect regarding the choices they have made, to encourage them to try different behaviors with the hope of better outcomes--these are not blaming. They are simply a way of imparting necessary truth to people who are starved for reality.

Granted, these things can be done with an attitude of impatience and condemnation, but they can also be done in a spirit of encouragement and compassion.

The goal here is to reduce the INNER chaos that borderline patients carry around with them. If done correctly, it isn't cruel but kind.

kadokin, ASN, RN · Jul 25, 2006

to rnwriter post #29 - yes that is exactly what i'm saying. and as far as making nasty comments about patients - cancer is very difficult to treat and sometimes not curable - but even though cancer is difficult you still don't make nasty comments about people with cancer. that's because you know it's not their fault. when a practitioner makes nasty comments about a diseased person that means the practitioner holds that patient responsible for their disorder. we had one sad pt who was sent to state who had cut both arms so much they were nothing but 99% red cut marks on her arms. somehow she also got razor blades on the unit and swollowed them. i can't help but think what would happen to this person if she were dropped in a third world country where nobody would have the time or money to pay attention to her. how is it inhumane to put somebody in an enviroment where they get better? a place where people have to put all their energy into keeping themselves and their kids alive. and don't have any energy left over to take care of somebody who says they want to die.wouldn't we ALL be changed by going into such an enviroment?

Maybe we would. Physical/Financial hardship is not ALWAYS healing, though. Sometimes it can bring out the WORST in people. I don't know what the answer is. :uhoh3:

cat123 · Jul 25, 2006

Maybe we would. Physical/Financial hardship is not ALWAYS healing, though. Sometimes it can bring out the WORST in people. I don't know what the answer is.

I agree. There doesn't seem to be any real answers. Why would we want to bring out the worst in people? prevention or catching the disease early is always easier to treat. But, for decades everyone has turned the other way when they could have done something about it and may have even contributed to the problem. Now we want a quick fix, and there isn't one. If the professionals taking care of these people don't want them or don't like them, all they are doing is making the problem worse. Now there are some professional that just want the almighty buck they bring in. Granted we all need to get paid, but I have seen "professionals" actually do things to these people to keep them at their mercy.

CharlieRN · Jul 27, 2006

...
I've been studying Marsha Linehan's books on BPD and its treatment, and some of the stuff works with some patients. But this one male with BPD seems darn near untreatable, nothing works. I don't know what to do with him. Last night the "solution" was to dope him up on Ativan and Thorazine. After 5 hours of hourly doses, he finally nodded off. Oh and put him on low dose oxygen with a mask for the hyperventilation, as he refused a paper bag- not dramatic enough. I'm a float, not a regular on that unit, so maybe they'll float me elsewhere tonight. (crosses fingers) I think I'm a little burnt out on this particular patient, so if I am on that unit tonight I'm going to ask for a break.

This is probably not real helpful, but I'm not sure this pt is correctly dx as borderline. He sounds more antisocial to me. Thinking of him as a manipulative criminal/ con man may be helpful in coming up with a way to deal with him. I'm thinking more in terms of containing the damage to your unit and its staff, than in terms of cure. Most antisocials are "treated" in the crimnal justice system. They are cured when they decide to stop being a**holes.

WillowBrook · Aug 29, 2006

I was diagnosed with Borderline Personality Disorder at the age of 20, I am 33 years old now and whilst I no longer meet diagnostic criteria I do still experience residual problems centred around identity and fear of abandonment.

I can tell you right here, right now that dropping someone in Africa or any other developing country and expecting that they will somehow suddenly become a functioning, stable member of society is just laughably ridiculous. I do believe that is known as "doing a geograhical" removing yourself from a particular environment and expecting that your issues aren't going to come with you. As I read this thread I was imagining myself, back in my early 20's, being placed in Africa to help my development and I must admit it was a highly amusing exercise.

The only thing that worked for me was time and effort and having a good group of friends who I could count on to stand by me and support me throughtout good times and bad times. I needed stability and structure in my life and then gradually over many many years I learnt how to challenge my old patterns of thinking and behaviours. I still have issues, I still self harm occasionally, I still have a lot of trouble with my self identity, I still have a great fear of abandonment and I can still be manipulative in relationships when I am feeling vunerable or insecure, but I am more aware of these things now and more often than not can deal with them in ways that doesn't lead to me neccessarily acting out. These days I am far more likely to ask directly for reassurance rather than manipulate it out of someone by threatening suicide for example.

One thing I think does need to be made clear about someone with Borderline Personality Disorder is that most of us are just as ashamed , embarrassed, annoyed and horrified with our behaviours as other people around us may be. When I am "acting out" there is always a part of me which hates what I am doing but once the process is set in motion it really does feel as if you just can't help yourself. I have had many times when part of me has realised what I am doing and how ridiculous and annoying I am acting and it's like you are just watching yourself act this way thinking omg just shut up this is so embarassing, but you don't know how to stop yourself from continuing. It is a very frightening and helpless feeling. Usually what helped me in this situation was for someone to distract me in a way that also made me feel as if I was getting there full undivided attention (ie not just distracted and being fobbed off at the same time).

rn/writer, RN · Aug 29, 2006

I was diagnosed with Borderline Personality Disorder at the age of 20, I am 33 years old now and whilst I no longer meet diagnostic criteria I do still experience residual problems centred around identity and fear of abandonment.
I can tell you right here, right now that dropping someone in Africa or any other developing country and expecting that they will somehow suddenly become a functioning, stable member of society is just laughably ridiculous. I do believe that is known as "doing a geograhical" removing yourself from a particular environment and expecting that your issues aren't going to come with you. As I read this thread I was imagining myself, back in my early 20's, being placed in Africa to help my development and I must admit it was a highly amusing exercise.
The only thing that worked for me was time and effort and having a good group of friends who I could count on to stand by me and support me throughtout good times and bad times. I needed stability and structure in my life and then gradually over many many years I learnt how to challenge my old patterns of thinking and behaviours. I still have issues, I still self harm occasionally, I still have a lot of trouble with my self identity, I still have a great fear of abandonment and I can still be manipulative in relationships when I am feeling vunerable or insecure, but I am more aware of these things now and more often than not can deal with them in ways that doesn't lead to me neccessarily acting out. These days I am far more likely to ask directly for reassurance rather than manipulate it out of someone by threatening suicide for example.
One thing I think does need to be made clear about someone with Borderline Personality Disorder is that most of us are just as ashamed , embarrassed, annoyed and horrified with our behaviours as other people around us may be. When I am "acting out" there is always a part of me which hates what I am doing but once the process is set in motion it really does feel as if you just can't help yourself. I have had many times when part of me has realised what I am doing and how ridiculous and annoying I am acting and it's like you are just watching yourself act this way thinking omg just shut up this is so embarassing, but you don't know how to stop yourself from continuing. It is a very frightening and helpless feeling. Usually what helped me in this situation was for someone to distract me in a way that also made me feel as if I was getting there full undivided attention (ie not just distracted and being fobbed off at the same time).

Thank you for sharing your insights and experiences. Often, I think, the borderline people who DON'T appear to have your sensitivity and awareness really DO have such inner messages but can't let themselves feel the pain that goes with knowing what they are doing and how people are reacting to them. It takes a great amount of courage and committment to allow yourself even small glimpses of reality when that reality is so frightening, embarrasing, maddening, and sad.

You are to be commended for your honesty, without which you could not have made the progress you speak of, as well as your courage, which enabled you to make small steps toward trust and growth.

Your inner view of this baffling condition is invaluable to those of us who care for and about people with borderline issues. The information itself is useful, but more important, your post is a wake-up call/reminder that behind all the drama and crazy-making behavior is a scared and lonely person who is starved for health and connection.

You have much to be proud of. Thanks again for taking the time (and having the courage) to share your thoughts with us.

I wish you continued progress.

Canadian Princess · Aug 29, 2006

Thank you for sharing. I am reminded by your post to look beyond the illness to the person again. Your tip on distraction I will use.

RPN

WillowBrook · Aug 30, 2006

Thank you for your encouraging responses. I do empathise with what you may be experiencing in caring for a Borderline patient. Thankfully I have never needed in patient care but I know I certainly would have found it difficult to look after someone like me. Distraction techniques do help with me, for example my husband will come over and hug me and stroke me and juat talk to me if I am starting to act out, this may not be appropriate or helpful with everyone though. Please remember that when someone who is Borderline is acting out or being manipulative they are not doing it to be selfish or annoying, they are doing it because they do not trust or believe when people say they will not abandon them and they will be there for them. It is a way of testing you and if you react badly or allow yourself to be sucked into the manipulation then it just reinforces the belief that everyone will leave them and nobody really cares. If you present yourself as someone who is going to be a stable and secure (albeit temporary) part of their life no matter what they do then they will be less likely to continue to act out. Also giving praise and contant reassurance helps as well. as long as it's not done in a patronising way...most Borderlines are incredibly sensitive and can smell insincerity a mile off. Even little things that people are expected to do, such as tidying a room, doing the dishes, clearing the table after dinner, not talking over someone and so on....if you recognise and thank the person for doing the little things it can be very encouarging. Reward the good behaviours, constant reassurance, try distraction for bad behaviours and always present a position of stability and security to the patient. :)

squeakykitty · Jul 31, 2007

Ok, switching gears, have any psych nurses seen sociopaths with antisocial personality disorder successfully treated?

Good question...operationally define "successfully treated". I have seen Forensic patients "successfully" discharged back into the community, and have seen antisocial personality types learn effective coping skills to deal with their maladaptive anger, and I have also seen some who will always be in a mental health facility for the chronically ill because of comorbid diagnoses....would love to hear more on this topic.
psych nurse

I'm not a psych nurse or any nurse, but I have read/studied a lot about various personality disorders.

From what I've read, I don't think antisocial personality disorder can be sucessfully treated. If one was seemingly cured--I have to ask if they really were cured, since they do "charm" and manipulate to get their way, and to get things they want. They also make "model prisoners" when in jail, then go back to what they do when they get out of jail. The structure and self control in their lives is external, not internal.

They learn coping skills, but can they really learn empathy and develop a conscience?

Sorry for the hijack--this really does need it's own thread.

Back to borderline personality disorder.