Re: labeling a client as "Borderline."

  1. I have a great deal of trouble with the "looseness" that this Axis II diagnosis gets thrown around with. It's gotten to a point with some associates, that anyone (client/patient) whom scratches themselves or has a difficult personality is instantly labeled with Borderline Personality Disorder, (BPD) or as a "borderline." This is not the case.

    e.g. ( in an inpt setting/ possibly an ER) a client attempting to manipulate or split staff to obtain a cigarette or other item at inappropriate time or possibly just having had obtained the item earlier; Such as splitting staff.

    Some label this instantly as "borderline." Yup, what a borderline, sheesh. God, that client is so borderline...

    It almost starts a strain of Jeff Foxworthy type jokes in my head..."you know you're a borderline when........."

    The problem therein lies now with other staff being inffected by this type of drivel and attitude being passed on in report resulting in treating the client as if they have a stigma. I've witnessed this firsthand and believe it's ridiculous and violates the clients rights not to be discriminated against, plus futher promotes the innacurate conception of what BPD actually is. Clients manilpulating to get their needs met is all too common, but does it actually constitute a personality disorder? I think not.

    Borderline personality disorder as seen in the DSM-IV:
    (pervasive pattern of instable relationships and self image as related to 5 or more of the following) Note: key phrase is relationships.

    1) frantic effort to avoid real or imagined abandonment

    2) pattern of unstable/intense relationships characterized by extremes. All or nothing mentality in relations with others.

    3) identity problems; unstable sense of self

    4) impulsivity in 2 potentially self-harmful areas, like: spending, sex, substance abuse, reckless driving, binging on any substance.

    5) recurrent suicidal behvior, gestures, or self-mutilating

    6) affective instability due to a marked reactivity of mood - these are short episodes rarely lasting more than a few days

    7) chronic feelings of emptiness

    8) inappropriate intense anger of difficulty controlling anger including physical fights

    9) transient, stress-related paranoid ideation or severe dissociative symptoms.

    see a few familair traits? all personality disorders have some overlap of symptoms but the emotional aspects, and self destructive components, for example, can characterize BPD from other diagnoses. No other diagnosis contains all of any five of the above traits, but may have one or two.

    So the key factor may be seeing the traits rather than the diagnoses. As with any diagnosis, time to evaluate generally doesn't happen during one session after a client has had a crisis and attempted suicide. These are traits usually expressed in a relationship and over time... not over the nursing desk or at the counter with one or two interactions. We've all encountered clients that try our patience, but that's why we're the professionals, right?

    So I implore you to judge a client for yourself and not accept the gossipy type labels that some nurses like to throw around so easily, which breed a judgemental-type attitude toward a client. Ok. I'm off my soapbox already.
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    About Granted Fal, MSN, NP

    Joined: Jan '03; Posts: 89; Likes: 17


  3. by   Mary Dover
    OK, but let me add this - with 12+ years of psych experience, I can usually know within 5 minutes of conversation with someone if they're borderline.
  4. by   Granted Fal
    What you are saying is you haven't seen anyone misappropriate the word "borderline" due to them being a difficult client, with 12 years of experience?
  5. by   adrienurse
    I don't think I use the term loosely, but I'm sure it does happen. I realize as a nurse that I can't diagnose, but I have on occasion used the methods used to deal with real "borderline" patients in order to deal with patients who display some of those traits ie. manipulation.
  6. by   oramar
    One teeny weeny questions, could you give more info on "dissociative symptoms"?
  7. by   sjoe
    falcon writes: "It's gotten to a point with some associates, that anyone (client/patient) whom scratches themselves or has a difficult personality is instantly labeled with Borderline Personality Disorder, (BPD) or as a "borderline." "

    Mental health goes through various fads from time to time, where certain diagnoses are "in." The point, however, is the treatment. Are these people getting what is optimal for them?
  8. by   researchrabbit
    When I worked psych, there were a few nurses who used this term loosely...most tried not to label patients.

    Although we DID have a tendency to say someone had OPD (obnoxious personality disorder) when we got irritated (of course, only among us nurses). But the MDs probably got labeled with it more than the patients...

    (BTW for all of you non-psych -- that's NOT an official disorder!)
  9. by   Granted Fal
    no i don't think the partiality is the optimal treatment in a unit/inpt setting. But treating personality disorders is tough business that's generally not done on a short inpatient setting anyway.

    And, Borderline Personality Disorder is an official disorder, however, it's a personality disorder, an Axis II diagnosis in the DSM-IV. But unless you aren't considering personality disorders as valid or "real" diagnoses. They aren't Axis I or 'true' psychiatric disorders.

    dissociative symptoms involve those associated, no pun intended, with Dissociative Identity Disorder as seen in the DSM-IV. check 'em out.