Violent Borderlines

Leahr · May 14, 2009

sounds like you are unhappy with the profession.

aloevera · May 15, 2009

we have meds to control bi-polar, schizo, and many others.....sad thing is, there is not a whole lot we can do with borderlines,.......we must not feed in to their manipulations....that is the utmost thing to keep in mind....

rn/writer, RN · May 16, 2009

we have meds to control bi-polar, schizo, and many others.....sad thing is, there is not a whole lot we can do with borderlines,.......we must not feed in to their manipulations....that is the utmost thing to keep in mind....

It is important avoid playing games with borderline patients and resist "feeding into their manipulations," but it is equally important to do this without anger or malice. I run across so many health care folks who express deep hostility and great impatience with this population. I know their behavior can be extremely challenging, and I don't always keep my cool when dealing with a borderline person, but it doesn't help anyone, including me, to lock horns and do battle. Limits do need to be set, but, as I said, the boundaries need to be laid down because the situation calls for them, not because So-and-so ticked me off by being self-centered and demanding.

My least favorite aspect of dealing with borderline people is that they have an uncanny knack for bringing out the worst in those around them. It takes so much energy to dodge the "blows" and keep from engaging. Maintaining that kind of focus can leave you drained at times, but it's better than getting drawn into a power struggle and feeling crummy afterward. And sometimes, if the circumstances are right, you can actually make a connection and see a little bit of progress.

To me, the utmost thing to keep in mind is that there is a person in there somewhere and the only way to get to that person is to build a bridge of trust, molecule by molecule. Vent to your heart's content away from the borderline person so you can be the caregiver they need when you're with them. Good things can happen, even if it takes a lot of time and effort.

aloevera · May 16, 2009

rn/writer...........I couldn't agree more.....my favorite and most used saying to all my techs and even other nurses is "DON'T TAKE ANYTHING SAID TO YOU PERSONALLY"........so many take things personally and get angry...you cannot do that...these people are ill.....you have to understand the source and not take anything personally and you will manage fine.......

Thunderwolf, MSN, RN · May 16, 2009

these patients often escalate in reaction to the responses of others, who sometimes escalate right along with them.

emphasis mine

one positive thing about patients with bpd on the unit is that they are folks that react...having that incredible knack in finding inconsistency on the unit. this is a good thing to know. people do not do things for no reason...there are usually reasons...and in the case of bpd...inconsistency in milieu, protocol, staffing, et cetera can often be a trigger for behavioral escalation. so, a positive staff reframing regarding bpd is to consider him/her like a thermometer/barometer of your unit....so, where are the cracks occurring on your unit?...the person with bpd will let you know. this is actually valuable information....because cracks in your system actually makes your unit less safe. although folks with bpd thrive in inconsistency and chaos, they are often threatened by it also...therefore they may often seek it out to see if it is there...sort of like a milieu testing of limits. structure is safe...inconsistency is not. so, when inconsistency occurs, it is time for some unit repairs.

Thunderwolf, MSN, RN · May 16, 2009

we have meds to control bi-polar, schizo, and many others.....sad thing is, there is not a whole lot we can do with borderlines

This is the difference between Axis I and Axis II.

Axis II includes personality disorders (and MRDD, but that is a whole different issue)...which are pervasive ineffective personalities...a life time in development and a life time in reduction of symptoms. Despite best efforts with medicine, you can't change a personality with pills...you can only dampen it. Meds are primarily effective in reducing the acute symptoms of these disorders, but it doesn't change the personality or make it (ineffectiveness) go away. Folks with personality disorders truly benefit from and need the concurrent use of psychotherapy for genuine progress. Typically, however, most personality disorders begin mellowing out in mid life (allowing for some individual differences of course)...a major difference from Axis I disorders.