BPD Management from you experience.

Specialties Psychiatric

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Hi from Aussie Land,

At my work place discussion is on going of how to best manage borderline personality disorder. There is never an agreement made or a policy put into place. I am wondering from your experience what has being the method in your work place.:imbar

Best Wishes to everyone on allnurses.com. Loray

Specializes in Corrections, Psych, Med-Surg.

Treatments and management are NOT the same, the onset of each can be an early age, and hopefully this resident will learn a few things before "sharing" in the future.

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In this day and age of managed care i have seen BPD's DX'd bipolar alot. sjoe is correct in stating tx is very different for these disorders. I think there is often a "rushed "dx which can be meaningless. After all, the way folks are hospitalized these days it's just for " crisis stabilization " then you are on your own.

At our outpt clinic folks are dxd after an hours intake interview because"WE HAVE TO PUT SOMETHING IN TO THE COMPUTER OR WE WONT GET PAID!!!!" this benevolent computer doesnt take axis II dx as a primary dx any way...

Am I rambling?

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The adolescent unit that I work on sees many females with "borderline personality disorder traits" listed for their Axis II Dx. Once in a while we will encounter bi-polar dx. but our most common for both male and female is conduct disorder. (Mix that with bpd....) And NO... we do NOT treat bi-polar and bpd the same!

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Thank you for the input. I will be back to ask more questions on this interesting topic. Thanks again!

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Look into a therapy called DBT--Dialectical Behavior Therapy. It has been in use for approximately 10-15 years and has a very

good reputation for handling this Axis II disorder. I currently work in a State Psychiatric Hospital where we are just starting to use it. We find that we tend to get alot of patients with Borderline Personality Disorder because--well, frankly--no one else wants to

deal with them. Over the last 5 weeks we had a very short 3-1/2 day course that introduced us to the therapy--we are one of only 7 hospitals currently using this therapy. It will be going into effect hopefully, within the next month or two, knowing State Hospitals probably longer.

There is a family component and a patient component. Marsha Linehan developed the approach and Guilford Press publishes her book, c.1993 called Skills Training Manual for Treating Borderline

Personality Disorder. Hope this helps--Lauren

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What we often do to limit the staff-splitting and manipulation that can occur is to assign a "contact person" for each shift. Then you improve the liklihood the client is getting consistent interaction as well as consistnecy with limit setting. It is also very important to keep staff informed as to the "manipulation" agenda/ behaviors of the day to increase awareness. Another main thing is to ensure staff are given additional support ,education, and modeling on how to set limits assertively without getting dragged into confrontation with the client, and to be able to keep the ball in the clients court...ie

Instead of responding to negative behavior with

"I am going to: put you in time out; give you a zero; cancel your privileges, etc.

Keep in pt behavior related context

you will not earn full points for this time frame because...

if you want to stay in the dayroom you have to...

continuing to_____will result in you losing your privileges, etc.

This provides them with contextual clues about expected behaviors and diminishes their perception of our punishing them like everyone else does!!!

They are a difficult population, but often in true need of positive interaction.

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