Personality Disorders and Recovery

Penelope_Pitstop, BSN, RN · Mar 21, 2016

I personally find it very difficult to be empathetic toward patients with borderline personality disorder.

I know it's an illness. But I still find it emotionally draining to deal with these individuals.

On Thursday, a patient of mine with textbook BPD consumed most of my day. When she finally left the office, I almost cried. I was mentally exhausted.

I don't really have much advice for you, just letting you know you're not alone.

vintagemother, BSN, CNA, LVN, RN · Mar 21, 2016

Please don't mistake my words. I think people with PS deserve compassionate, ethical care.

I think I have a few friends IRL with PD. I know that they are doing the best that they can.

As has been said before, "There, but for the grace of G-d, go I."

Mental illness can strike anyone.

Jensmom7, BSN, RN · Mar 21, 2016

I worked Psych for awhile, and always said I would rather be locked in a room with four paranoid schizophrenics than one borderline personality (I actually have a soft spot for schizophrenics, but that's another thread lol).

A patient with BPD can suck the soul out of an entire unit. That's why a psychiatrist once told me the goal is to get them out of the locked unit environment as quickly as possible-they will actively undermine the treatment of the other patients, divide the unit, play the staff, and thoroughly enjoy the havoc they leave in their wake.

Personality disorders can't be cured. The best you can do is give friends and family the means to avoid being sucked into the drama.

Psychcns · Mar 21, 2016

Dialectical behavioral therapy. A kind of cognitive behavioral therapy which teaches 1)mindfulness 2) interpersonal effectiveness 3) emotional regulation and one other thing I cannot remember. You as a caregiver have to maintain your own equilibrium and not get pulled in to any drama. Often people with borderline PD were sexually abused as children. I think they do best with structure to not get too involved in their emotions, and to learn to be more rational than emotional. It is important that staff provide consistency. It seems like a very difficult illness to live with.

WinterLilac · Mar 21, 2016

Thank you for all your honest feedback, I really appreciate them all. Yes I would also prefer to work with people with schizophrenia than BPD. Our current client with BPD is due to start DBT today however yesterday she said she's not going and believes it won't help her, no one helps her that's why she hasn't 'gotten better'. I asked what kind of things can we do to support her more, she snapped "If I knew that, don't you think I'd be doing it already?" Valid point however she seems to want a magic pill to take away all the negative symptoms without making a conscience effort to make changes herself. She is in incredibly bright young lady who could pursue a satisfied life but everything is so complicated.

Psychcns · Mar 21, 2016

Encourage her to try a few classes and see if she learns anything. If she has any addiction issues, she could go to 12 step programs. I might say something like" try one new thing a week" and see what happens. She says she doesn't know what will help. That is why it might be good to give this or something else a try. It's not easy to hang in with someone who wont/can't help themselves. It is her life..it is up to her...Best wishes..

vintagemother, BSN, CNA, LVN, RN · Mar 24, 2016

I also learned from a clinical instructor who was also a psych nurse practitioner that it's important to redirect (people with Borderline) away from their focus on the past.

These people are adept at sucking you in.

When you say, "how are you feeling?"

They'll tell you the saddest story about their past traumas, which are often significant and sad.

But this has no bearing on their current tx.

So, you redirect. "I'm sorry that occurred. How are you today? Have you heard voices/had any SI/AH or attended groups?

Keep them present focused on the current tx goals.

JonniBravo · Mar 28, 2016

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.

Hi Winter,

It is important to remember that PD clients do not have mental health issues in the traditional sense, however, they are in need and do need help, many PD's do not fully understand why they are acting the way they are and often lack self identity. Pd's have problems with emotional dysregulaton that is to say they have difficulties in managing their emotions. It may well be true to say PD's have learned these behaviours as a coping stratergy and this is the only way they know how to get the support and love they crave.

There is a very good book from John G Gunderson called Handbook of Good Psychiatric Management for Borderline Personality Disorder which will be helpful to you. In addition PD requires DBT, psycho analytical or schema therapy treatments. Psychotherapists would usually do this although DBT can be taught to other health professionals, although you should not attempt any DBT therapies without the structured therapy being available with trained staff, you can do things like chain analysis, distress tolerence and self soothing. PD's require specialist therapy work and should be admitted to a specialist rehab ward if possible.

If you require any further help do hesitate to contact me and I will help any way I can.

Farawyn · Mar 28, 2016

JonniBravo, great Username!

nurse lala, BSN, RN · Mar 30, 2016

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.

Whispera is spot on. The client has serious mental illness. The hallmark of a person with Borderline PD is dissatisfying interpersonal relationships, unstable mood and unpredictable behavior. In your case WINTERLILAC, you have substance abuse as well. This is a dual diagnosis patient which means a complicated patient meriting specialized care.

The person with BPD is often miserable and everyone near them is miserable as well. We have a responsibility to educate them about the disease process and treatment options.

When the patient comments on their poor relationships or any other characteristic of BPD, I ask if they are familiar with their diagnosis? I pull up the criteria. And review with them. Not once has anyone denied meeting the diagnostic criteria. By talking about the disease we can help the client understand that the behaviors they learned as a child to survive their upbringing no longer serves them. Most people are relieved to know it is treatable with CBT or DBT. There are great books and websites on CBT.

When working with the BPD you must have boundaries. Set limits on the time spent. Set limits on what you will listen to; QUALITY and Quantity. I refuse to engage in time that is not purposeful and goal directed. I make it clear we are not going to review all their complaints in the world. I refuse to entertain their fantasies. I ask that they identify what is the most important 1-3 issues they want to address. I will practice supportive and active listening for About 15 minutes. Much longer if we have a true crisis/dysregulation. Then we can process. We come up with a plan of action. I ask how likely they will act on their plan of action. I validate their readiness or lack thereof. I make it clear it is their decision. I make it clear that the only person really being hurt by their failures are their self. (No apologies to me dudette. It's your health. Apologize to yourself). I either reinforce decisions or suggest they consider doing things differently later. I refocus on the plan of care if they want to perseverate on fantasies or feel the need to keep talking about what we just finished talking about. I refocus on the goal of treatment and redirect the patient elsewhere. I never spend more than an hour.

One of two things will occur. They usually want and respond to consistent and strong boundaries and keep coming back; or find someone else that will entertain their disease.

newrpn · Apr 3, 2016

Read the book The Buddha and the Borderline: My Recovery from Borderline Personality. It offers great insight from the view point of a person living with BPD and her journey through recovery.

ChildPsych · Apr 4, 2016

Working with pt's with BPD is definitely a weakness of mine. My sister was dx BPD and with therapy she was able to recover. So I *get* it, but working on a unit with personality disorders is difficult. I've read everything I can about them but they literally wear me out. It's like they are always one step ahead of me with their thinking.

So I'm no help here unfortunately.