Personality Disorders and Recovery

[WinterLilac]

I have been promoted to Recovery Coordinator at work (woo!!) This is fantastic and we've implemented a lot of recovery focused practice with great outcomes for the clients.

However, what I am finding difficult is working with people with personality disorders and this is where I would really really appreciate advice/anecdotes/suggestions... Anything from all you lovely psych professionals and those with lived experience.

I've found with a lot of our clients with various personality disorders that they tell me all the things they think I want to hear however they don't back these statements up with actions.

We have one client who says she knows what she needs to do to work towards re-entering the community and living her own life however "can't seem the shake the way I feel towards people and what I do to them". It's even been doubted by her psychiatrist if she even has a mental illness at all or just has learned behaviours. She has many very challenging behaviours however always says she is remorseful when confronted. I feel her borderline personality disorder is verging on psychopathy.

How do you find personality disorders?

Have you had any success with assisting those people with personality disorders recover to the point of being able to function in society and have their signs/symptoms under control?

I value all feedback. I am at a loss and despite a lot of peer reviewed research etc, I highly value the feedback from personal anecdotes and advice from those working in the field. Thanks heaps.

[vintagemother, BSN, CNA, LVN, RN]

Personality disorders suck.

I recall a pt with Borderline Personality.

I didn't know much about the d/o at the the time. I was a new grad and worked in psych where all pts had MI.

I began getting neck pains in the base of my posterior neck at work. Stomach aches, too. Started popping tums.

At a certain point, I realized this occurred when I worked with the Pt with borderline.

I also realized she reminded me of my mother. I wanted to help her, but she literally made me feel ill.

After she was discharged, I talked to other staff members and found out she made others get eye twitches. I lol now, but it was no fun at the time.

You can't Medicate personality disorders. They have developed mal-adaptive ways of dealing with others. You can re-direct and re-Inforce the rules of the unit. You can try to get all staff so be consistent so there's no staff splitting, something they tend to do.

I researched personality disorders, and read that many have a home environment / childhood upbringing that caused this. For ex, mom plays favorites to the kids who behave like this because it gives mom control and authority.

It's probably very hard to be a person living with the mal-adaptive traits that characterize this problem. I have empathy for them.

Nevertheless, I don't want my neck to hurt at work!![emoji38]

[WinterLilac]

@vintagemother I've read that people with personality disorders are extremely draining and I absolutely agree. This particular client had her mother fatally overdose on illicit drugs when she was seven, her boyfriend committed suicide when she was 19 and her father die in a MVA when she was 20. A tough run I agree however she has something different about her, something more than deep grief...a 'the world owes me' kind of attitude.

[vintagemother, BSN, CNA, LVN, RN]

Yup, WinterLilac. I didn't even realize that the pt made my body hurt. I knew she had her challenges, but many pts do.

One day I was at work for computer training and she asked to use the phone. In the special way these pts do: demanding, whining, etc. I happily said, I'll take you to the phone. (She didn't want to use the regular phone on the floor and we have a phone pts can use in one of the meeting rooms, but they have to be supervised)

Like I said, I gladly OFFERED to let her use the phone.

Almost instantly, as I listened to her talk, my neck began to hurt. It was then I realized that her Bx were the cause of my pain! [emoji29][emoji21]

[WinterLilac]

Wow. You poor thing. Do you work mainly in psych? Apparently some PD's can even make seasoned psychologists and psychiatrists second guess their own ability! I'm confused as to how and what I can assist this client with to focus on their recovery. Every avenue they go with it for a while so you think they are making progress, then bang! They throw a spanner in the works and it's back to square one.

[Lev, MSN, RN, NP]

I have a friend with a PD and I can tell you that it takes a very special person and a great level of tolerance to deal with people with PDs. My friend is older and some people grow out of their PDs as time goes on..

[WinterLilac]

Lev, what kind of things do they do to make it a challenge to be friends with them?

How do you maintain a friendship with them?

[Lev, MSN, RN, NP]

It's little things here and there. She is a self proclaimed loner and will shut herself out from time to time. She is also moody and can be very abrupt. Like you are having a totally normal conversation and something ticks her off which wouldn't tick off a normal personal and she will just snap. She is also paranoid about certain things. Like super into security. In general thinks people are not there to help and in some cases ruin things for her. Very hard to read. Beats herself up a lot. Wont answer emails, phone calls, texts for days sometimes. Will flat out ignore questions if not comfortable. Wont say I dont want to talk about it will just flat out ignore that the question was ever asked. Like I said, she is older and has grown out of some of the behaviors of her youth. I maintain my friendship by being tolerant of her behaviors and recognizing that she is a good person underneath her issues. I like her as a person but I do get annoyed at her but I still love her.

[WinterLilac]

Thanks for your insight Lev. I suppose having a friend with a PD is different to having a patient with PD as we can't get so close to them to learn about the good side of them. I mean, I treat them with the respect and friendliness I give everyone. However, with our PD clients, they can be very friendly, charismatic and helpful but they then do something that is the opposite and very hurtful.

Has your friend managed to maintain employment and friendships?

[Lev, MSN, RN, NP]

Yes she has.

[Whispera, MSN, RN]

Try to remember that a personality disorder is an illness. It's not something the person wants to have. It's a big indication that the person has some miserable feelings that can't be changed without huge amounts of work. The disorder is the person's way of coping with life as he sees it, after having lived a whole lot of crud.

[WinterLilac]

Thanks for your POV Whispera and as such, acknowledging that PD is an illness has been at the forefront of our entire discussion. Objective and subjective discussion has been encouraged as people with PD can impact professionally as well as personally. It's a delicate topic due to different perceptions as to what PD can be classed as (illness or learned behaviour) and how best to work with these people to achieve their personal and professional goals.