Having some issues with BPD (big shocker!)

CrunchRN, ADN, RN · Jun 11, 2016

They are challenging. Just be kind. It is a horrible condition to have.

nurse lala, BSN, RN · Jun 11, 2016

I get it because I felt the same way as a new psych nurse. I remember being grateful that the senior nurses wanted to work with them. I think most of us felt that way and some of us still do. Over time I changed. Now I look forward to helping these folks figure out how to get better. I suspect you will change too.

oldpsychnurse · Jun 12, 2016

All of the personality disorders can be tough to work with, but I agree BPD's are the hardest. I've learned to basically ignore all the drama and engage them in appropriate conversations. You also have to have a thick skin and not let them push your buttons - or at least not let them know they've pushed a button. I don't know that I've ever helped a borderline. I don't even know if some of them CAN be helped. But always remember that they're just as sick in their own way as your schizophrenic patients. You have to measure their progress using a different stick and it can be a thankless task. One piece of advice I will give you is when your BPD is having a "moment" remove any audience from the scene. Family especially can be a huge trigger and if they're asked to leave the room sometimes you'll be surprised to see the difference in the behavior.

Davey Do · Jun 12, 2016

I don't hate them or anything, but I don't like dealing with them. Is that wrong?

"I feel your pain."

-Bill Clinton

BPD Patients can push buttons with great skill and dexterity, Wannabe. They exhibit with gusto the self-centeredness we all attempt to control in order to be reasonably stable, contributing members of society.

It's not difficult to understand our dislike for another who appears not to even attempt self-examination and growth. We don't have the power to change another Person, let alone an Individual with BPD. However, we can show them boundaries and limitations in their behavior.

A case comes to mind of one BPD Patient I met on his first psych admission at the State Hospital around 1991. He was charming, carried himself well, spoke eloquently, and I thought, "What's this guy doing here?" Within five minutes, he was down on the floor, saying he was having a seizure, running around in a circle like Curly of the Three Stooges. I was direct with him, sternly requested that he get up off the floor, and that he exhibit appropriate behavior.

Then, in 1998, I case managed this Patient as the Nurse on an ACT Team. Again, I didn't feed into his behavior. Although he was charming and complimentary, I was again direct and played Joe Friday with a "just the facts" attitude.

A few years ago this same Patient was admitted to the Hospital where I now work. One night, we were walking the hall chatting, and he began making subtle threats. I let him know, in no uncertain terms, that unless he committed to safety and return to his room that I would be sure he would have to deal with the ramifications of his actions. He did as I requested but not without a "Gosh! You don't have to be so mean!"

Well, yes I did. Because, some time later, a 2 1/2 hour Code Green was implemented due to this Patient putting lotion on himself, causing havoc which resulted in a Police intervention.

The incident happened during the day and the Administrators and Therapists mollycoddled this Patient's aberrant behavior. I told the Department Director, "(This Patient) needs to have limitations and boundaries set from the get go. Once he had your attention, the show was his to run".

"Aversion Therapy" is what I term this approach.

Excuse me.

I have to go now.

vintagemother, BSN, CNA, LVN, RN · Jun 12, 2016

BPD is challenging to deal with. I think most of us, if not all, who've worked with them can agree on this.

As for me, personally: even though I tried to tell myself a certain client with this dx didn't get to me; I found myself getting stomach and neck pains when I worked with her.

It took awhile for me to realize her bx triggered my pain.

Thankfully, she was discharged soon.

Other co workers later shared with me that they got eye twitches, etc when working with this client.

So, yeah, BPD is challenging! For us and for the person afflicted with this.

Penelope_Pitstop, BSN, RN · Jun 12, 2016

They are challenging. Just be kind. It is a horrible condition to have.

I AM pleasant and polite. I'm also to the point though.

I understand living with it must be horrible. I just don't think that means that I can't have some frustration towards this population. I WANT to slam the office door in their faces. I never, ever do...never even close. That's why I came here...to ensure that I wasn't a horrid person for having these feelings, and for revealing my feelings in a safe place vs. to the person's face.

The particular individual who was the "last straw" so to speak to have me write this...well we think she has a bit of Munchaesen's as well. Fun for all.

CrunchRN, ADN, RN · Jun 12, 2016

Be kind like I said, but also have strong boundaries and set limits.

FolksBtrippin, BSN, RN · Jun 13, 2016

I find the personality disorders very interesting. I've worked with a few over the years and enjoyed it very much. I never worked with a patient diagnosed with munchausen, but I would like to. I'm not discounting your feelings, I understand that you are struggling, but I just want you to know there's more than one way to experience this work.

Penelope_Pitstop, BSN, RN · Jun 13, 2016

I never worked with a patient diagnosed with munchausen, but I would like to,

She isn't diagnosed with it officially - but we're very suspicious. It's morbidly fascinating what she has put herself through...I can't be very specific but it's worthy of a case study!

I've worked with two or three Munchausen patients and they weren't too interesting actually. Then again, I worked with them on the medical side so we were dealing with the sequalae of their actions vs. treating their m.o., if you will.

I also knew a nurse who had Munchausen by proxy. Now THAT was an interesting case. She is no longer licensed, for obvious reasons I think. Her victim was her toddler. He is fine now.

Penelope_Pitstop, BSN, RN · Jun 13, 2016

I understand that you are struggling

Perhaps I have not really explained myself well. I'm not quite *struggling* per se. I'm frustrated more than anything, and Friday I had just HAD IT.

Thank you.

beckysue920 · Jun 14, 2016

I, too, do not like working with BPD's...so don't feel bad, you aren't alone. I was fortunate to work with other nurses who didn't mind them, so I could bypass their hysterics. Unfortunately, you don't have that luxury.

Dealing with BPD with acquaintances is another story...gotta just say ***.

When dealing with them, follow some of the good suggestions listed above, and be glad when the shift has ended.