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.
Specializes in LTC, home health, critical care, pulmonary nursing.
I've known some "borderlines" who are nothing like what has been posted about borderlines, however because of that diagnosis, nothing they feel is legitimate, it is all for attention and manipulation, so they don't talk AT ALL about their pain. They are quiet and keep to themselves. They suffer in silence, which I suppose is a method of manipulation. After all, they're just borderlines.
Keep in mind that unless the patient has Axis indicating Borderline Personality Disorder, that they are being labeled inappropriately and unfairly. I have witnessed patients on medical floors being labeled this way by staff because they are on the call light liberally, with no indication of such in their charts.
I am speaking about those that have been legitimately diagnosed.
Specializes in Med-Surg, Geriatric, Behavioral Health.
Borderline personality disorders. The term is from the Freudian area, meaning bordering on neurosis and psychosis. There is some truth to that. Many persons with this disorder can psychologically break down into having psychotic episodes when untreated. However, many persons with this disorder do not as a rule shy away from treatment, but gravitate like a magnet towards it...some to where it becomes their full time job at the exclusion of all else. This is not the frustration, however. It is the inconsistancy in their use of and lack of follow through of their treatment that quite often impedes successful treatment. DBT has been helpful because it teaches and holds the individual accountable for his/her behavior...self sabotaging, poor boundaries, and impulse mismanagement. It helps the individual to begin "self monitoring and self managing" him/herself where it has been previously lacking. This is what jeapordized past progress. Medications are often needed to help with this self regulation due to mood instability and poor impulse control. Cognitive thought distortions (such as the black and white thinking) are also addressed in DBT, as are in other therapies. But it is the process of becoming whole as a person that actually helps the person with this disorder. Boundaries and self boundaries provide structure where quite often they are absent or fragile. Hugging a person with this disorder is not recommended. A clinician can be viewed or emotionally felt as being intrusive. Many persons with this disorder ruminate over this and may question the genuine sincerity of the clinician if hugged...if not during the hug, but afterwards. Again, thought distortions play alot into this. As a clinician, one needs to be very clear in that you are a clinician...not a friend of the patient. That is two very different relationships. A clinician with poor boundaries actually causes more harm than any good to this type of patient. You are not a friend. You are a clinician. Also, hugs can generate severe emotional responses out of this type of patient. One being rage. I knew of one poor social worker who did outpatient treatment and hugged her borderline client and got slapped for it...and yeah, they were on good terms previously. So, boundaries, I say again, is your friend. And not all persons with this disorder are loud and obnoxious (although, they seem to get most of our attention though). However, manipulation is often very present. Again, this is part of the poor sense of self control. Remember, with this disorder, self control and internal structure of personality are often poor. Borderlines thrive and like to generate chaos on the outside (environment/people) because it often reflects what is going on in the inside. So, structure, rules, guidelines are the very thing that the person rebels against but needs so badly for him/herself to make any progress. I hope this helps.
Specializes in Med-Surg, Geriatric, Behavioral Health.
Also speaking of boundaries in relation to new folks considering being a clinician in this field. When the person is discharged, he/she is discharged. Your relationship is terminated. It is not appropriate to call the Borderline, give your home number, your email address, invite them over, or meet at lunch to chat. If you would/do, you do not belong in this field. You are more harm than good.
lol... I recall 1 psychiatrist who gave his mobile number to a BPD, worst mistake he ever made , interesting you talk about the potential for psychosis Thunderwolf, as I have never seen a BPD sufferer without any other co-morbid diagnosis display psychotic symptoms. However I have seen numerous BPD sufferers mimicing psychosis, and have been observed gathering symtoms from genuine psychotic clients, all in an effort to remain admitted and in some cases to get disability payments for being chronically psychotic.
Specializes in Med-Surg, Geriatric, Behavioral Health.
Yes, you speak of the manipulation. Very true. It happens quite often in this group due to the sense of self entitlement. If you notice, the disorders in the Dramatic category of Personality Disorders often have a profound sense of Narcissism...a trait they share (Borderline, Antisocial, Histrionic, and Narcissistic). Many try to USE the system. And yes, it is more common to see several diagnoses on the Axes, not just BPD. Rare, very rare, that you see just BPD. Quite often there are other comorbid conditions...which increases the risk of further breakdown...even psychosis. Most folks think psychosis is just an overt thing. But, psychosis is a mental process, which can be very commonly present, but subtle in presentation. Sometimes, psychosis can present in one's manner of speak, subtle shifts of thought formulation/disorganization, and in behavioral nuances. Think of your Schizophrenic or Bipolar patient, where the only clue you might have that the person is beginning to decompensate is by these very subtle shifts...but, only usually after you have gotten to know this person first....usually after a couple of admits. It is being proactive in assessment...not waiting for full blown decompensation to occur. Assess and intervene early heads off alot of headache.
Unfortunately I rarely get to intervene early as I work as a Consultation/Liaison MH Nurse, usually in our ED (or ER, A&E... take your pick) and in the main hospital. In variably I see people in crisis, but yes I do notice those subtle changes, it comes across as a 'somethings not right' feeling. Once I can pick the problem we can usually intervene and get to work on resolving the problem asap.
Anyway, interesting to hear other's thoughts on the universal problem of dealing with BPD clients.
Specializes in Med-Surg, Geriatric, Behavioral Health.
Yes, your gut twinge is your body's way of saying "Did I miss something here?" It is a good tool to help further your assessment...maybe in a direction not considered. You can further assess at that moment or tuck that intuitive twinge into your back pocket to pull out later to compare and assessment when you meet the person again.
Borderline patients are fascinating, if only for the constant manipulation of their environment. (Oftentimes it can be arduous working WITH them. ) And yes, not all are loud and obnoxious. I once worked with a borderline patient that was formerly in the medical profession, and while I was a student she looked at me and said very quietly, "trust me, I KNOW how to get my way".
When your gut twinges (or in this case, your blood runs cold , you know you are dealing with a borderline-type personality. Like Wolfie stated, it's ALL about limits.
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!!
Great post..... I totally agree ! I know many nurses at my hospital who you could label BPD !
Ok...only 6 now that I thought about it...but still......
I was kind of alluding to this in my original post. Part of the problem is, this person is dealt with inconsistently. Some people act like they don't care how she acts. But what about people like me who are not as patient, and not as WILLING to deal with their ridiculous and unreasonable behavior? The people supervising ME act like it's no big deal. If I have less patience, I'm afraid it's going to make me look bad. And the RNs keep rewarding the rude behavior of these people by PAYING ATTENTION TO THEM!!! And I'm thinking, STOP! She's going to think that if she's annoying to me, she'll get attention the same way she got it from you when she was annoying to you!
I haven't finished reading all the replies yet. I will continue to do so. Thanks for the help!
By the way, some of the worst borderlines recently moved off our unit.
, interesting you talk about the potential for psychosis Thunderwolf, as I have never seen a BPD sufferer without any other co-morbid diagnosis display psychotic symptoms. However I have seen numerous BPD sufferers mimicing psychosis, and have been observed gathering symtoms from genuine psychotic clients, all in an effort to remain admitted and in some cases to get disability payments for being chronically psychotic.
) And yes, not all are loud and obnoxious. I once worked with a borderline patient that was formerly in the medical profession, and while I was a student she looked at me and said very quietly, "trust me, I KNOW how to get my way".
, you know you are dealing with a borderline-type personality. Like Wolfie stated, it's ALL about limits.
HURRAY!!! :bowingpur :smiley_aa 
:balloons: Thank God, praise the Lord!
lovingtheunloved, ASN, RN
940 Posts
I've known some "borderlines" who are nothing like what has been posted about borderlines, however because of that diagnosis, nothing they feel is legitimate, it is all for attention and manipulation, so they don't talk AT ALL about their pain. They are quiet and keep to themselves. They suffer in silence, which I suppose is a method of manipulation. After all, they're just borderlines.