Working with BPD and IED pt.'s, any tips??

[New Angel]

I have been a psychiatric nurse for a short while and find my most challenging patients to be those with diagnosed 1>Borderline Personality Disorder & 2> Intermittent Explosive Disorder.

It is especially difficult when the pt. has both diagnoses....If you add a polysubstance dependence diagnosis to the mix, then we are talking huge difficulties in providing therapeutic communication & milieu to these patients.

Any tips from your experiences for dealing with these two categories of patients that have these diagnoses?

I have found 1:1 to be one of the only tools that really works, but it is not always realistic in all situations to have that staffing available.

[Meriwhen, ASN, BSN, MSN, RN]

Unfortunately, CD or another addiction disorder (eating, gambling, sex) often runs hand-in-hand with Axis II.

Those with Borderline PD see the world in black and white--there is no gray. And everything is perceived as personally directed at/towards/affecting them even if it's not.

You (well, your whole staff) needs to set clear and uniform limits, and consistently enforce them. Patients can quickly ferret out who is the weakest link.

[Psychcns]

Agree with meriwhen

Also consider that people with borderline PD often have problems with emotional dysregulation and I think the challenge is to help people get more in their head. To see things more without emotion as a way to manage their emotions. Often these folks are victims of childhood trauma. Read Marsha Linnehan dialectical behavioral therapy. Structure helps too.

I don't know about intermittent explosive disorder?? Could be a seizure disorder of sorts I suppose. Or impulsivity. I would probably get people to try to talk about it--are there triggers, etc. could just be the impulsivity of borderline pd.

Read up on PTSD. I think Borderline is seen now as the manifestation of PTSD.

Re: substance abuse. People use substances to manage uncomfortable emotions. Find out what they use and why. How does it help, etc

Complicated stuff. And interesting. Trick is to get people interested in their own lives, recovery, etc.

[wish_me_luck, BSN, RN]

I will be brutally honest--having BPD, I went through and did NCLEX style questions about BPD and what they tell nursing students/nurses in nursing school on how to deal with a person with BPD is quite wrong. I think that is why people with BPD are frequent fliers. I do agree they need boundaries, but making boundaries without explaining why or showing them why...they do not understand. It is like dealing with a small child...telling them no and expecting them to understand why they cannot do whatever. Showing a person with BPD or allowing them to do a behavior to a certain extent that does not hurt anyone can help them learn/understand why it does not work. Also, people with BPD do not have depression...depression is part of the BPD (it is a combo between psychosis from schizophrenia, and neurosis, which is present day anxiety disorder and depression). So, they would not have BPD and depression...just BPD.

Just my two cents...

[Dhalia27]

this may not directly answer your question, but from what I know those who suffer from BPD truly "suffer" from it. There is no relief from the suffering as in a manic phase for someone with bipolar disorder, or a "preference" for it as in depression where some people say they prefer to be depressed. it is truly a terrible, terrible thing to experience and those who have it suffer tremendously. they are "emotional burn victims"... the points about them needing lots of structure are well-mentioned

[New Angel]

To see things more without emotion as a way to manage their emotions.............. Trick is to get people interested in their own lives, recovery, etc.

Wonderful responses, thank you!