I've been doing Psych now since October. I'm on an ACT team and most of my clientele is of the schizoaffective or schizophrenic variety. We have a handful of Bipolar patients and one or two with major depression. I'm fine with every one of those. I have no issues with psychotic patients, manic patients, et al.
However...
We have a few with Borderline Personality Disorder.
I am a HUGE mental health advocate, not only because of my career but because of my personal experience as a psych patient. I abhor the stigma associated with the diagnoses.
But...
But...
I just - ugh. The borderline folks, I hate to pull the basic white girl card but I can't even. I find it very very difficult to "engage" with them therapeutically. I feel like they're dementors and sucking out my soul. I know they have an illness! But they push my buttons much like those drug seekers pressing their call bells for dilaudid when I worked MedSurg. They had illnesses, too.
I don't hate them or anything, but I don't like dealing with them. Is that wrong? I think we're all entitled to feel this way, right? We all have a subset of our specialities that we really don't like to work with, be assigned, whatever. I've read old posts and I can see how a BPD patient can really disrupt an inpatient unit.
But I don't work inpatient. These folks are my folks. Granted I don't spend twelve hours with them at a stretch but all 100 patients are my patients and right now I'm the only nurse on the team. So it's not like they can be discharged and be gone.
Ugh.
Am I in the wrong field? I really like psych. I just don't want to not help them. We don't do DBT but I wish we did have someone who did that. I know I'm the nurse so I manage other things than therapy anyway but I wish I really knew what to do to help myself so that I can help them. Or at least help myself so I don't want to slam my office door in their faces.
Sorry so long winded. I have a fever and spent hours yesterday involuntarily committing one of the aforementioned folks.
Some people on this forum actually have BPD and are well-aware of what people think of them. It's extremely difficult to get effective treatment and even harder to find compassionate people to provide it. Hence, many people with BPD do not even bother seeking treatment and never get better. Which is sad since there ARE effective treatments available.
They are not behaving this way to annoy you. Their pain and anxiety is so bad they would rather be dead and have NO way to cope with what is going on inside of them. It's like walking around with no skin. Many have endured horrific events in their lives & have serious comorbidities (like complex ptsd). They are coming to you for help, they NEED you. Let them trust you because right now they don't and honestly, I don't blame them.
They are coming to you for help, they NEED you. Let them trust you because right now they don't and honestly, I don't blame them.
I get where you're coming from but although it's taboo to say but many people in healthcare have diagnoses, procedures, tasks that they just don't enjoy working with. I get it nurses are supposed to be empathetic and understanding - and we are, but it's okay to have a preferences. We're human. As long as we're able to remain professional and do our job competently and not let our feelings color our care - it really shouldn't matter. Like I personally don't enjoy monitoring blood sugars on frail diabetics and doing hypoglycemic protocols multiple times a shift. That doesn't mean I don't do it, but it's not my favorite. I'm also not a big fan of placing Foley catheters on morbidly obese patients. Or scrubbing in the GI lab. Yet, I do it with a smile, ignore the smell and provide comfort.
The same goes for Psych. I worked on a max security forensic behavioral stabilization unit for most of my career. A lot of the patients had BPD diagnoses. They can be difficult to work with - it's not my favorite and running code after code after code, dealing with multiple staff injuries, trying to manage staff splitting, and getting assaulted every other shift get's old really fast. I had patient's that were pedophiles, murderers, rapists ect - Yet, I provided competent care, I didn't let my personal feelings show and utilized my skills to the best of my ability to provide these patient's with structure and limits. You don't have to adore a patient to provide great care - you just have to be able to recognize your bias and compensate for it.
Specializes in Medsurg/ICU, Mental Health, Home Health.
Some people on this forum actually have BPD and are well-aware of what people think of them. It's extremely difficult to get effective treatment and even harder to find compassionate people to provide it. Hence, many people with BPD do not even bother seeking treatment and never get better. Which is sad since there ARE effective treatments available.
They are not behaving this way to annoy you. Their pain and anxiety is so bad they would rather be dead and have NO way to cope with what is going on inside of them. It's like walking around with no skin. Many have endured horrific events in their lives & have serious comorbidities (like complex ptsd). They are coming to you for help, they NEED you. Let them trust you because right now they don't and honestly, I don't blame them.
As I have said ad nauseam, I understand that they have a disease! I am not blaming them - dealing with them frustrates me.
Here's an example - if you've ever had to potty train a child...well, it's very frustrating. You want to give up. You still love the child, you don't BLAME the child, but there is nothing wrong with being frustrated about it and venting to other parents. Of course the child can't help his or her situation, and need you for help. And you can provide it. But just as mothers aren't saints and martyrs, neither should be nurses.
And you have no idea if these individuals trust me. You don't know if I have family members and friends with BPD. You no nothing of my history with mental health, nor an inkling of my nursing or therapeutic skills.
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.
THIS!!! Wow Davey, I have been researching and reading and researching and did I say reading? up on BPD as I have recently worked with a young lady who was very challenging. Your description just hit the nail on the head, you've explained BPD extremely well, thank you so much.
OP, I completely understand where you are coming from. I posted a thread myself a little while ago in regards to working with people with BPD. People said the same to me 'they are sick, be kind to them' etc etc and of course we know they are sick and we are professional to them however we are also human as well and need a break from the manipulation sometimes.
How we handled a patient with extreme BPD tendencies is that we ensured all staff communicated with each other. Staff splitting or preying on one staff member (often who the patient perceives as the 'weakest link') was common, however because we all kept the communication open and honest we all knew what had been said/complained about/inferred etc.
As Davey Do discussed, tiptoeing around behaviours also doesn't work. I ended up evicting the particular patient I was dealing with from our service (we had other services and accommodation for her to go to which were more appropriate) because her behaviour was extremely affecting other patients (stealing off them constantly). The mental health team in the hospital kept saying "it's her illness, she can't help it" and that is true however they were patronising her ability to face consequences - as we all have to do in life at some point. When I evicted her, I told her straight "Your thieving is not tolerated here, we have done everything we can to help you however we have to put the collective rights of everyone first and foremost". Remarkably, she appeared relieved something was finally getting done and she may actually be admitted to a service who can help her more appropriately.
I am fairly new to BPD however it seems they don't actually want to be treated with kid gloves. They have a hard time reacting to life stressors without drama but when it comes to facing consequences or being told clearly how their behaviour is affecting other people, the people I've met seem to appreciate it... Am I mistaken?
Anyway OP, always debrief. I've found this helps. Oh and spend time with the BPD patient when they are not completely unwell. You'll find they are often delightful and intelligent people and this can help you stop feeling resentment against them.
I have found many BPD patients to be intelligent and fun. That was a big part of my frustration. How could someone that has been blessed with intelligence and not battling hallucinations, behave so poorly. The lack of caring how they affected those around them and the constant demands for attention was hard for me to get past.
I work for a brilliant Psychiatrist that is constantly researching and coming up with innovative techniques. He put treatment into the hands of the BPD patient and expected them to work hard with DBT skills. If they are actively self-harming, they are area restricted to a glassed in dayroom where other patients can go in, but they cannot take anything into this room. The room is very clean with no items available that can be used for self-harm. Usually the BPD patient is on a 1:1 or 2:1 watch that is noninteractive. Staff can talk to the patient if they are not on their watch, but not while providing safety. They are to study their DBT book, nothing else until dinner time when they can watch TV or interact more with staff and patients. Since we started this and have been able to discharge BPD patients quickly, we stopped getting as many of these patients.
The whole purpose is to rewire the brain to take self-harm off the table.†This has been successful with the patient learning emotional regulation skills and handling anxiety in healthier ways.
Staff is not as burned out with the BPD patient trying to run the show. We have seen some amazing success with some very difficult patients.
"And you have no idea if these individuals trust me".
The sad truth is, they don't. They can't. That is the nature of their maladaptive coping disorder formed by response to trauma so many years ago. I describe BPD to my students as, "they are borderline personalities because they have none of their own. They borrow yours." An old Psych Doc I used to work with told me that is what's so infuriating about working with borderlines, everything they say has a sliver of truth; i.e., 'You're so pretty for a girl your size" or "You look great, except for those shoes, of course".
BPD and Antisocial patients have one big obstacle in their way on an inpatient unit; STAFF COMMUNICATION. It is absolutely critical for staff to survive to keep every member (including ancillary; MHT, housekeeping, lab, dietary, etc.) to be consistent across the patient population and present a united front. The only intervention I have ever seen make a dent in BPD behaviors is Dialectical Behavioral Therapy. And that is NOT going to be offered or even of any use on an inpatient unit.
Hang in there, DeLanaHarvickWannabe. Remember, YOUR ego strength may be the only real, rational glimpse into functional society that your Borderlines get. Support each other and find a PMHNP or PCNS to facilitate debrief. If you are up for it, you may approach nursing administration about schedule time for debriefing, especially when you have all this going on an nowhere to dump it.
Specializes in Medsurg/ICU, Mental Health, Home Health.
"And you have no idea if these individuals trust me".
The sad truth is, they don't. They can't. That is the nature of their maladaptive coping disorder formed by response to trauma so many years ago. I describe BPD to my students as, "they are borderline personalities because they have none of their own. They borrow yours." An old Psych Doc I used to work with told me that is what's so infuriating about working with borderlines, everything they say has a sliver of truth; i.e., 'You're so pretty for a girl your size" or "You look great, except for those shoes, of course".
BPD and Antisocial patients have one big obstacle in their way on an inpatient unit; STAFF COMMUNICATION. It is absolutely critical for staff to survive to keep every member (including ancillary; MHT, housekeeping, lab, dietary, etc.) to be consistent across the patient population and present a united front. The only intervention I have ever seen make a dent in BPD behaviors is Dialectical Behavioral Therapy. And that is NOT going to be offered or even of any use on an inpatient unit.
Hang in there, DeLanaHarvickWannabe. Remember, YOUR ego strength may be the only real, rational glimpse into functional society that your Borderlines get. Support each other and find a PMHNP or PCNS to facilitate debrief. If you are up for it, you may approach nursing administration about schedule time for debriefing, especially when you have all this going on an nowhere to dump it.
I appreciate your input.
Just an FYI, I'm not on an inpatient unit. I work in an office for an ACT team, and there is no nursing administration. I am the only nurse for one hundred patients who live in various facets in the community. My boss is an MSW, his boss is and MSW and HIS boss is a M.Ed.
Some people on this forum actually have BPD and are well-aware of what people think of them. It's extremely difficult to get effective treatment and even harder to find compassionate people to provide it. Hence, many people with BPD do not even bother seeking treatment and never get better. Which is sad since there ARE effective treatments available.
They are not behaving this way to annoy you. Their pain and anxiety is so bad they would rather be dead and have NO way to cope with what is going on inside of them. It's like walking around with no skin. Many have endured horrific events in their lives & have serious comorbidities (like complex ptsd). They are coming to you for help, they NEED you. Let them trust you because right now they don't and honestly, I don't blame them.
Thank you. I was recently diagnosed with BPD. I have spent my whole life wondering why I viewed things so differently than everyone else and why everyone seemed to hate me etc. I am working on my issues, I have to say we usually have other diagnosis as well. I have ptsd from early trauma. I get genuinely suicidal but I am afraid to ask for help because as soon as someone sees the BPD they automatically assume attention seeking. I myself was guilty of this working on the floor until I was diagnosed myself. Most of us don't want this. It is not fun to live with and makes everyone around you miserable even when you are trying not to act like a crazy a$$hole. I just perceive things different. I cant explain how the never ending feelings of emptiness and just not feeling real affect you and your interactions. I am suspicious of everyone. I know we are not easy to be around we can be annoying. But patience goes along way, tap out if we are on your nerves. Most of the time its not intentional unless there is a narcissistic component to it. Thank you Madricka for reminding all of us that we are sick and need empathy as well even if we are not the easiest people to deal with. Trust me I wouldn't wish this on anyone.
madricka, BSN, RN
123 Posts
Some people on this forum actually have BPD and are well-aware of what people think of them. It's extremely difficult to get effective treatment and even harder to find compassionate people to provide it. Hence, many people with BPD do not even bother seeking treatment and never get better. Which is sad since there ARE effective treatments available.
They are not behaving this way to annoy you. Their pain and anxiety is so bad they would rather be dead and have NO way to cope with what is going on inside of them. It's like walking around with no skin. Many have endured horrific events in their lives & have serious comorbidities (like complex ptsd). They are coming to you for help, they NEED you. Let them trust you because right now they don't and honestly, I don't blame them.