Having some issues with BPD (big shocker!)

Posted
by Penelope_Pitstop Penelope_Pitstop, BSN, RN Member Nurse

Specializes in Medsurg/ICU, Mental Health, Home Health. Has 16 years experience.

Hey everyone.

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.

CrunchRN, ADN, RN

Specializes in Clinical Research, Outpt Women's Health. Has 25 years experience. 4,447 Posts

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

nurse lala, BSN, RN

Specializes in Psych. Violence & Suicide prevention.. Has 44 years experience. 110 Posts

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

oldpsychnurse

97 Posts

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

Specializes in Psych (25 years), Medical (15 years). Has 43 years experience. 1 Article; 10,120 Posts

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

vintagemother, BSN, CNA, LVN, RN

Specializes in Critical Care, Med-Surg, Psych, Geri, LTC, Tele,. 2,716 Posts

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

Penelope_Pitstop, BSN, RN

Specializes in Medsurg/ICU, Mental Health, Home Health. Has 16 years experience. 2,365 Posts

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

Specializes in Clinical Research, Outpt Women's Health. Has 25 years experience. 4,447 Posts

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

FolksBtrippin, BSN, RN

Specializes in Psychiatry, Community, Nurse Manager, hospice. Has 6 years experience. 2,071 Posts

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

Penelope_Pitstop, BSN, RN

Specializes in Medsurg/ICU, Mental Health, Home Health. Has 16 years experience. 2,365 Posts

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

Penelope_Pitstop, BSN, RN

Specializes in Medsurg/ICU, Mental Health, Home Health. Has 16 years experience. 2,365 Posts

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

beckysue920

Specializes in Psych, HIV/AIDS. 134 Posts

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.