Dealing with borderline

Marie_LPN, RN, LPN, RN · Sep 23, 2005

I am not the type of person who just brushes people off, but I really cannot stand people who require constant attention, and constantly talk about their problems, and REPEATEDLY talk about the same problems.

Sounds like a nurse i work with.

Thing of it is, you'll probably have to learn to tune it out.

tencat · Sep 23, 2005

I think boarderlines spend all of their waking time trying to manipulate anyone within range, and if that doesn't work then annoying the hell out of everyone is an ok second option. I think you don't like these people because there's not much there to like. According to them, they don't have the problem, everyone else does. Or they can't help it, they are sick, and you should feel SOOO sorry for them because they are. (and if you feel sorry for them, then maybe they'll get you to do something for them.....) I think you are having a healthy reaction to a boarderline. I've been hoodwinked by a couple of boarderlines in my personal life, and I have a hard time seeing them for what they are.

CharlieRN · Sep 24, 2005

Ok you are speaking to my strength. I have worked with borderlines for years,and I actually like them.

In dealing with patients who have borderline personality disorder the first thing you have to do is protect yourself. Put your back firmly against your institution's policy manuel and stay there! Borderlines have no boundries so you need to maintain yours. You need to give serious thought to what exactly is your role, what are your limits, and legitimate functions.

These patients are not your friends. Neither are they your peers. Yours is a theraputic relationship to them. Hold that boundry. You are actually in less danger if you find the patient annoying, the risk is greater when they engender warmer emotions.

A little about the psychodynamics of borderline. You can think of them as people who have no belief in their own worth and basicly none in the worth of anyone else. Everyone needs to feel self worth. At heart they don't feel they have inherent worth so they feel they must force others to meet their needs. Attention is the most basic need we have. Being annoying is a way to force others to attend to you. The power to annoy is POWER.

It might help to read a bit about "transactional analysis". TA was a pop psych, that enjoyed a fad in the sixties. It focuses of the observable interactions between people rather than asking alot of subjective questions about how they feel. Since that is exactly were the rub is in your case, they may be helpful. Atleast it may be amusing and help you get some distance on the problem. The books I recall are "the Games People Play" and "I'm OK, Your OK"

mgyurzaman · Sep 24, 2005

Patients with Borderline Personality Disorder are some of the least favored in the hospital I work at. Or at least, so it seems.
Lately, we've been getting these patients who insist at talking at the top of their voices, and constantly blab at the nurses' station window. This happens every frigging day. I hate it!! A couple of the RNs say they don't mind the patients doing this, BUT I MIND!!! I find it very distracting, rude, and honestly, I cannot stand these people. There are times when I just want to yell at them to SHUT UP! Part of the problem is, there are a couple RNs who just allow this to happen, and I'm just not sure what to do. I'm a CNA, so I have little power.
What would make things better is if she didn't talk so loudly. Thing is, sometimes I go to the nurses' station to get away from what is going on so I can get some planning done for activities with the patients, but she's still blabbing away and distracting me.
Does anybody have any advice? Sometimes I feel like things are at a critical high with myself and these borderlines. I feel like I just want to yell at them and tell them that I don't care what their problems are. (I would care and feel some empathy for them if they DIDN'T REHASH THE SAME THINGS OVER AND OVER AND OVER!). I am not the type of person who just brushes people off, but I really cannot stand people who require constant attention, and constantly talk about their problems, and REPEATEDLY talk about the same problems.
What can I do to change their behavior? What can I do to change my attitude? Frankly, I just don't even want to deal with these people. Perhaps that may be part of the problem, but I really don't want to sit there all day wasting my time while they talk for hours at a time.

your problem just made me really laugh so hard. i don't mean to laugh at you but just your situation is really funny. sorry, don't really know a lot about borderline people but i could definitely relate. used to know some nut who i jst can't seem to get rid of either. it must be hard working with them but i do hope you'll find ways to get around them. good luck!

EricTAMUCC-BSN, BSN, RN · Sep 24, 2005

I have to agree with Charlie that alot of the borderline patient's issues come down to power issues and controlling the environment. Thursday i had a bordeline patient, part of their problem is related to their underlying disease process. The patient was on the call button 20 times in one night. The patient has no confidence in that they can do simple things like turn on the TV using the remote or wipe themselves after done on the bedside commode.

Now regression is common with disease however I rarely see such a since of helplessnes and victim-like mentality. The MD started this patient on an antidepressant while treating her condition, he also instructed the nursing staff that the patient will not eat from 7p to 7a since they are obese. I have been working with this individual with an almost drill seargent liike mentality, striping down confidence and than building it back. Instructing the patient to try to do simple tasks and than providing positive reinforcement when the objective has been completed. The patient has been on the call button less since family from mexico have come to visit.

Lately I have noticed the patient is doing more for themselves, the other day I saw the indivual paying bills and talking on the phone to family. I have been supporting this person more that they are doing better. My biggest thing at first was limit setting but now that the pt. is more independent and less manipulative I can support them more and interact as I would with other adults.

oramar · Sep 24, 2005

I am just speaking for myself here. When I find that a certain patient or patient type starts to rub it usually means that I am approaching somesort of burn out point. Usually I have to make some changes in my own life or job inorder to get some perspective.

Thunderwolf, MSN, RN · Sep 24, 2005

Boundaries are your friend.

IMustBeCrazy · Oct 6, 2005

SET LIMITS!!!!!!!!!!!

I think of borderlines like a three year old. They need attention, and they are going to get it, whether through positive or negative means. If it means getting cozy with staff (positive to them, bad for us), then they'll do it. But most often, staff are aware of their 'game' and don't participate, forcing them (in their mind) to act out.

When I deal with borderlines, I set specific limits on the amount of time that I spend with them. If I need to interact with them, I estimate how long it should take, and I have no qualms about leaving the room at the specified time. Borderlines have no limits, are not interested in what you have to say, and often get sidetracked because they are mired down in the problems that they are ruminating on in their heads on a daily basis.

Borderlines will monopolize every conversation that you have with them if you let them. I call their behaviors to their attention. "I understand Ms. X that you are talking about your childhood. But "MY" question to you was if you are feeling any physical pain today?"

You cannot use rules of polite conversation with borderlines. For instance, you cannot be polite and wait until they are done speaking so that you can ask them a question because they often don't want to stop fixating on their problems. I talk over them (politely) and repeat what I have to say or my question until they hear me. If I am being ignored, I will state that I will come back at a different time when we can have a two-way conversation, and leave the room.

Most importantly, the entire staff needs to agree and be cohesive when working with a borderline patient. If I was on the unit you described, I would escort that patient back to their room, explain to them that under no circumstances are any patients allowed to talk loudly at the nurses station as it is upsetting to other patients and staff. I would instruct the patient that when they are able to act appropriately at the nurses station, by using a quiet voice and not hanging by the desk all day, they are welcome to come over to ask a question or address a need. Then, ALL the staff need to back the primary nurse and follow up the same way with said patient.

If your staff are not doing this, then they are letting the milieu run them instead of overseeing the milieu. And, as you have seen, it is very difficult and upsetting to work in the former environment.

~IMBC

krisssy · Oct 7, 2005

What does research say causes a borderline personality disorder? How do doctors treat it? Are there specific medications or types of therapy that can help the person who is ill?

krisssy · Oct 8, 2005

I would also like to say that you don't have to have a borderline personality disorder to be annoying. I have seen nurses at the nurses station and teachers in the teacher's room who do not stop talking and talking loud all day long. They are annoying and obnoxious, and some of them are looking for attention. I have also seen patients with borderline personality disorder who are quiet and just need a kind word or a hug to feel better. These people really suffer with their illness. So I am not positive that this "annoying" patient who talks all day at the nurses station is doing it because of her disease or because that is just her way. Some people just can't keep quiet. Personally, being a more quiet person, it drives me crazy when professionals I work with are so annoying like that. I am not sure what the right intervention for this patient would be, but I will find out when I become a psychiatric nurse! I guess my point is that you don't have to have a borderline personality disorder to be loud and obnoxious. I have seen it in the workplace all the time!!

StuPer · Oct 10, 2005

One of the most common causes of BPD is a traumatic childhood, either because of abuse or neglect, leading to a lack of 'normal' understanding of relationships and emotions.

The only real evidenced treatment for the illness is Dialectic Behavioural Therapy, although some would argue psychotherapy is useful. DBT is conducted in an outpatient capacity between the sufferer and a therapist, it involves individual and group work. The aim is educate the sufferer on boundaries, the emotional impact of their behaviours, and effective relationship management.

What doesnt work except in short-term crisis is hospitalisation (creating dependencies), and medication (except with co-morbid mental illness).

Unfortunately people with BPD have to want to change the behaviours they exhibit for any therapy to work, as long as the 'gains' from doing what they do out weigh the potential benefits of therapy you are onto a loser, all you can do is deal with each crisis as it presents and then back off.

regards StuPer