personality disorders?

Published

Im sort of a bleeding heart when it comes to patients.

My question:

Im thinking the other day, boy I feel so bad for this pt [borderline) because he is so distraught, acting out, crying, etc.

Someone was surprised I felt "bad" for him. Are these people really suffering, or Is their behavior sometimes an ACT?

maybe my perception is off. They seem to suffer greatly

any thoughts?

Up Vote Up Vote ×
Specializes in LTC, ER.

the person probably was surprised because he/she knows that borderlines can be very tiring d/t their acting out.

Up Vote Up Vote ×
Specializes in Psychiatric, Med Surg, Onco.
Im sort of a bleeding heart when it comes to patients.

My question:

Im thinking the other day, boy I feel so bad for this pt [borderline) because he is so distraught, acting out, crying, etc.

Someone was surprised I felt "bad" for him. Are these people really suffering, or Is their behavior sometimes an ACT?

maybe my perception is off. They seem to suffer greatly

any thoughts?

It sounds like the response came from someone who is "burned out" with patients who have BPD...which is pretty common.

It helps me to remember that most people who develop BPD do so as a result of horrific and repetitive childhood trauma. They develop coping skills which allowed them to survive...but don't work and cause great dysfunction with the day to day issues of life as an adult.

You are absolutley right though. People with BPD due suffer a great deal...although differently than others due to severe distress intolerance. At the hospital where I work, they are often written off as med seekers, etc., However, I made that point that a person with BPD can be in pain...something so simple, but per co-worker reports...something that they had not taken the time to consider...

If you haven't already, you should check out Marcia Linehan's book and related workbook r/t treatment of BPD with DBT-the only thing that seems to work to date...

Up Vote Up Vote ×

Hello Cherilee,

RN2begin ofers excellent advice and in order to get a good insight into BPD the DBT books are gold. Just some words of caution though, people surrering with BPD can be very very needy and will happily soak up any sympathy and 'understanding', this is not a malicious act, but a 'need' that comes as a result of the traumatic events which led to the BPD.

Unfortunately filling this 'need' is the primary driver around their actions, and the risks, or inappropriate nature of some of the behaviours escapes them. This could potentially lead to a well meaning nurse giving of themsleves in order to 'help' a sufferer, but finding ultimately that the sufferer rejects them when the nurse tries to steer them towards a theraputic goal.

I guess what I'm saying is that this client group are in need of help, their behaviours are largely a consequent of maladaptive coping strategies developed when the BPD was formed. But.... in order to help this group the sufferer MUST be ready to change their behaviours, and recognise the catastrophy which their life has become. Then they will be prepared to put in the work required to succeed at DBT, but they honestly have to be in that space before they can be helped.

The best thing you can do to help is to really familiarise yourself with the illness and then offer help that guides sufferers on the path of help. There will be many times that sufferers will reject that help, but eventually they will recognise the need to change and remember the help that has been offered.

I have personally seen many BPD sufferers, some of whom had been totally written off, who completed a DBT program and have regained a sense of normality in their lives, to their great relief.

StuPer

Up Vote Up Vote ×
Specializes in Med-Surg, Psych.

What is DBT?

Up Vote Up Vote ×
Specializes in Psychiatric, Med Surg, Onco.
What is DBT?

Dialectical Behavioral Therapy

Up Vote Up Vote ×

At my hospital, if a patient is in a DBT program outpatient, we are not supposed to even have 1:1 with the patient. We are just supposed to pass meds, address immediate needs, and encourage the patient to refer to their workbooks. I think they are even supposed to stay out of group therapy. And I think this is great, because I don't want their short stay in the hospital to unwind any progress they have made in DBT. Too many of the staff that I work with don't know much about DBT, and a new charge nurse is leading the way to develop a protocol that the psychiatrists will initiate on admission (supposing we know they have BPD dx). I haven't seen the preliminary yet, but something needs to be done so that there is consistency between shifts for the patients who need it most!

Up Vote Up Vote ×
Specializes in Psychiatric, Med Surg, Onco.
At my hospital, if a patient is in a DBT program outpatient, we are not supposed to even have 1:1 with the patient. We are just supposed to pass meds, address immediate needs, and encourage the patient to refer to their workbooks. I think they are even supposed to stay out of group therapy. And I think this is great, because I don't want their short stay in the hospital to unwind any progress they have made in DBT. Too many of the staff that I work with don't know much about DBT, and a new charge nurse is leading the way to develop a protocol that the psychiatrists will initiate on admission (supposing we know they have BPD dx). I haven't seen the preliminary yet, but something needs to be done so that there is consistency between shifts for the patients who need it most!

That is absolutely perfect protocal! Because people with BPD tend to split staff to gain power and meet needs (divide and conquer)...a true therapeutic DBT environment prohibits any treatment (other than essential needs) by anyone other than their DBT therapist and perhaps any other person that that therapist works in conjunction with. DBT is a HUGE commitment for people with BPD, in fact, they usually have to sign a one year contract to participate in it. It is a behavior/consequence based cognitive therapy with the goal of learning new and effective coping skills...I can remember when I worked as a case manager, if a person with DBT called emergency services over the weekend due to unsafe behaviors...or they missed an appointment with their DBT therapist, they were forbidden to make an emergency appointment with their DBT therapist, they saw them as scheduled with no exceptions. It is believed by most BPD specialists that suicide is extrememly rare among indiviudals with BPD and if it does occur, it is most often an accident... self harm is the ultimate negative coping skill and these individuals must learn the skill of accepting responsibility for their own safety....

Up Vote Up Vote ×
Specializes in Psychiatric, Med Surg, Onco.

Dear here_kitty,

I would absolutely love to here about the protocal once it is posted for you all. The hospital where I work is in DESPERATE NEED of this as most staff, including nurses know what BPD is, but have no idea what DBT is...as a whole, my hospital just "feeds the beast" so to speak...Ideally I would love to have a specific unit for people with BPD completely reliant upon the DBT model...if we don't we might as well install a turnstile in the admissions suite...

Please feel free to send me a personal message...I am unbelievably curious as to what hospital you work at and how your model could help us...

Up Vote Up Vote ×
+ Join the Discussion