I'm wondering

[lisabeth]

What is the hardest Psychiatric disorder to work with? We are studying all of them right now, and I really am curious. I am sure each one has some very real challenges.

[Thunderwolf, MSN, RN]

Yes, Charlie.

Fear and anger/aggression are kissing cousins....and are a dangerous combo when stirred.

[lisabeth]

Learn more about the personality disorder(s) and you will understand.

In my previous practice, I found the true Narcissists more trying at times.

Here are a couple links for you.

http://emotional.healthcentersonline.com/personalitydisorders/personalitydisorders.cfm

http://www.4degreez.com/misc/personality_disorder_test.mv

On Narcissists:

Quick Summary:

Narcissistic personality disorder is characterized by self-centeredness. Like histrionic disorder, people with this disorder seek attention and praise. They exaggerate their achievements, expecting others to recongize them as being superior. They tend to be choosy about picking friends, since they believe that not just anyone is worthy of being their friend. Narcissists tend to make good first impressions, yet have difficulty maintaining long-lasting relationships. They are generally uninterested in the feelings of others and may take advantage of them.

Symptoms of Narcissistic Personality Disorder:

• Requires excessive praise and admiration
  
• Takes advantage of others
  
• Grandiose sense of self-importance
  
• Lack of empathy
  
• Lying, to self and others
  
• Obsessed with fantasies of fame, power, or beauty

Additional Information:

Narcissism is most often found in men and is often diagnosed with other mental disorders.

http://www.4degreez.com/disorder/narcissistic.html

On Borderline PD:

Quick Summary:

Borderline personality disorder is characterized by mood instability and poor self-image. People with this disorder are prone to constant mood swings and bouts of anger. Often, they will take their anger out on themselves, causing injury to their own body. Suicidal threats and actions are not uncommon. Borderlines think in very black and white terms and often form intense, conflict-ridden relationships. They are quick to anger when their expectations are not met.

Symptoms of Borderline Personality Disorder:

• Self-injury or attempted suicide
  
• Strong feelings of anger, anxiety, or depression that last for several hours
  
• Impulsive behavior
  
• Drug or alcohol abuse
  
• Feelings of low self-worth
  
• Unstable relationships with friends, family, and boyfriends/girlfriends

Additional Information:

Borderline personality disorder was so-named because it was originally thought to be at the "borderline" of psychosis. The disorder is relatively common, affecting 2% of adults. Women are much more likely to suffer borderline than men. Nearly 20% of psychiatric hospitalizations are due to borderline. With treatment, patients are often able to see their symptoms improve.

Treatment involves therapy in which the patient learns to talk through his or her feelings rather than unleashing them in destructive and self-defeating ways. Medication may be helpful, and treatment of any alcohol or substance abuse issues is required. Brief hospitalization is sometimes required, especially in cases involving psychotic episodes or suicide threats or attempts.

http://www.4degreez.com/disorder/borderline.html

Thank you Thunderwolf. I think it would be best if I read up on topics in the future and not ask questions. I appriciate all of the replies.

[Thunderwolf, MSN, RN]

Asking questions are very fine. This is how we all learn from each other. However, it does help to have some background on the matter before discussing it.

[MarkRN]

hi sir mark ... well, i was just wondering ... how'd u say that patients with bordeline disorded are one of the most diffucult cases to work with? im just curious coz i kinda have this disorder ... =)

By no means do I intend to insult you in any way (if you do in fact have this disorder) by what I am about to write, so please try not to take it personally. I am only speaking from experience in regards to this disorder...

There are several reasons for my answer. People with this disorder tend to be very impulsive and labile in mood and affect. Many frequently engage in self-mutilation (cutting self, burning self, etc.). Furthermore, they can be very manipulative and make frequent attempts at staff-splitting (pitting staff against each other). Persons with this disorder also tend to project what they don't like about themselves onto others. It is a combination of all of these things, along with the fact that personality disorders are chronic, long-term illnesses that are not easily treated with medications, that make patients with this diagnosis difficult to deal with.

[NPAlby]

Borderlines and manic pts - they DONT GET TIRED!!!

[nightingale, RN]

borderline...definately

I TOTALLY agree!

The splitting of staff, severe mood swings to manipulate the atmosphere, and chaos created is what I have experienced. Do I emphathize, yes but, it is still painful.

[StuPer]

I like CharlieRN dont mind dealing with patients with BPD, for the very reasons he listed. I note a number of people emphasising the manipulative aspect of the illness, I had it pointed out to me recently, that while they can indeed be responsible for staff splitting, it isnt out of some malevolent need to cause chaos, and mostly they are not as clever as staff tend to attribute them.

What is going on is that learnt behaviour that has served them (badly, but still served them) so far, so in the case of splitting often it rotates around trying to get a member of staff to agree to something that another has already declined.

This isnt clever manipulation, its trying to get their needs met, if you wont do it then ill ask someone else, black and white, love and hate.

While this does somtimes result in staff friction, the BPD patient will only care if the staff member giving them what they want is no longer accessible or changes to deny them what they did allow them before, and we've all seen what the resultant behaviour is then.

All I can say is thank god for DBT..... it has done wonders for those BPD patients I know who have chosen to participate.

regards StuPer

[GalRN]

Borderlines! I find the male ones more challenging because I never know what they're thinking. I think the reason they are difficult is b/c they can't be helped/cured unless they admit they actually have this issue (rare), and, it takes a big commitment and a lot of motivation to do Dialectical Behavioral Therapy (the only tx that's been proven to help). I'm not even going to go into the countertransference issues!