alternate ways of treating borderline personality disorder

TitaniaSidhe · Jul 3, 2006

Been awhile since I last viewed this post....some excellent info shared & of course also some unproductive & argumentative replies. One thing sprang to mind, one can not learn with a closed mind for a closed mind is unteachable. *sigh* so young into the profession to be so jaded.

Ah well I am working 3 shifts in the span of 5 days so am a bit fuzzy from swinging back & forth. It's evening shift today, busy holiday weekend with admissions.

Happy 4th everyone, hope the BBQ's are enjoyable.

Canadian Princess · Jul 7, 2006

To: hsieh

I am horrified and fascinated about your solution of dropping them off in a desolate area. I query your credentials. Is this not the same talk we have heard prior to the DSM IV-R on homosexuality? Thanks to G-d that was dropped as a disorder. Shame on you. My advice as a Psych nurse is read up on the topic and go to a few inservices...most specifically talk to the author of :Borderline Personality Demystified" ...I am sure after a session with him you hopefully will change your tone.

minulyf4s · Jul 8, 2006

In the years that I have worked with people who carry the diagnosis of borderline personality disorder, I have found that understanding their view of the world as a scary and chaotic place is key to establishing the trust relationship that is critical to working with them effectively. For myself, IMHO, I like to avoid using loaded (judgemental) words like "drama queen" and even "manipulative." Those are words I use when I am tired and frustrated and they are neither helpful to me nor to the client. As hard as it may be to understand, something in the pattern of behavior is meeting an internal need for the client. The client 's view is that this is somehow adaptive in their world, even though it may not appear that way to anyone around them.
The hospital is not the place where anyone is functioning at their best--if they were doing well, they wouldn't be there. It helps me to remember that as well.
In the land of managed care where I have practiced these past couple of decades, I've seen the in-pt focus change from doing exploration and uncovering of past traumas (which usually resulted in extended hospital stays) to rapid stabilization of the crisis and return to out-patient care. Out-patient setting is where the bulk of the work is done anymore.
I have seen remarkable progress in clients who have participated in Dialectical Behavior Training (DBT). It is education and practice in self-care and self-nurture, something that is deeply needed by these clients.
There is so much to say about working with these very challenging people. Kindness, boundaries and consistency on the part of the professional really goes a long way to interrupt the chaos that is often present in the client's daily life.
Thanks for restarting this thread.

You have obviously gained some vary valuable insight, understanding, and compassion from your patients. I couldn't agree with you more. My 21 yr. old daughter has BPD and something that works for us as a result of absolute trust, is our discussions about behaviors that she will exhibit that are self-destructive and alternatives to those behaviors. the only way she can change certain behaviors or reactions to a situation is to make her aware of them in the first place. Because of fearsof abandonment, this has to be done in a non-judgemental and loving way to make sure the lines of communication stay open. Fear of disapproval and abandonment is pervasive with BPD and unconditional love and acceptance by family members needs to be verbalized frequently. This does not mean family members have to tolerate the emotional abuse that is often dished out. Boundries are necessary, just remind them frequently that they are loved and important and accepted for who they are...unconditionally.

Lisa CCU RN, RN · Jul 9, 2006

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

Canadian Princess · Jul 9, 2006

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

Multicollinearity, BSN, RN · Jul 9, 2006

Fascinating. I thought that those with antisocial personality disorder were simply hopeless - because they lack a conscience. I thought all we could do was protect society from them?

editted to ad: :smackingf off topic, never mind.

rn/writer, RN · Jul 9, 2006

Let's keep this discussion focused on Borderline Personality Disorder.

CRNASOMEDAY25, feel free to start another thread on the treatment of antisocial personality disorder. Although there is some overlap between the two disorders, the criminal aspect of APD and the forensic dimension of the care of such patients seem worthy of their own thread.

Woodenpug, BSN · Jul 11, 2006

I believe that current treatment modalities work. Each point of discharge leaves the patient improved as compared to admit. The gap seems to be between sub-acute/long term care and the community.

Though it is not a "novel" approach, if we integrated the health care system, long term outcomes would be improved.

A psych home health nurse should follow the patient with borderline bx in the community. The board and care homes do not provide adequate support.

cat123 · Jul 12, 2006

this thread is made to discuss and debate alternate ways of treating borderline personality disorder. the point is to "think outside the box" and "stirring the pot" is also acceptable and encoraged. please respond to subject only and not the specific member who is posting the subject. for example if somebody says - i think the world is flat - please do not respond with - the reason you think the world is flat is because you're an idiot. i can't wait to read other's ideas of alternate ways to treat boderline personality disorder. let the posting begin.

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.

LydiaNN · Jul 12, 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.

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.

Multicollinearity, BSN, RN · Jul 12, 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.

I must disagree too. Those with borderline personality disorder have a quite specific and markedly different way of relating to the world. I don't think most of us would fit the diagnostic criteria. Most of us do not:

Idiolize or villify, splitting, black and white thinking

Extreme fear of abandonment that affects relationships

Persistant feelings of emptiness

Self-destructive behavior, one example is cutting

Fuzzy sense of self

Episodes of suicidal thinking

Rapid mood swings

These are off the top of my head - I don't remember the DSM criteria. But no, I don't think most of us experience the above in a significant and pervasive manner.

Multicollinearity, BSN, RN · Jul 12, 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. .

I think we can all find traits and smatterings of ourselves by looking at personality disorders in the DSM. Most of us do not actually have personality disorders though. We would have to amplify our negative traits exponentially in order to meet the DSM for a particular personality disorder. For example, if I amplified my trouble spots beyond what they actually are - I would have avoidant personality disorder. I don't have this disorder, but let's just say I can see that is the one I would have if amplified. Maybe this is what you are doing/thinking - but with borderline instead.