treating borderline personality disorder

[hsieh]

i do get tired of taking care of a borderline persoality that everyother day is either having a heart attack or is going to kill themselves. i've finally decided that every time she says she's going to kill herself i'm just going to call 911 and let them take care of it. we don't have enough staff (1) to deal with this constant problem. but being a person who often looks critically at those who label people (usually in an unflattering way) i can't help but make these observations: experts say borderlines are "needy" - well - all rich people are "needy" - they need to be rich and that's a lot of need. experts say borderlines are manipulative - well - many college professors are manipulative (especially in the arts and science category) - they desire to stand in front of a crowd of people and try to sway them to see things their way. my point - i don't think describing personality disorders in "characteristic" ways is appropriate. i think they should be defined by what makes them "disordered" ie faking a heart attack, yelling suicide etc not "needy" or "manipulative". what do you think?

[hppygr8ful]

I've got one for you! He's been on my unit for 30 days now. Very much a borderline and just a little developmentally disabled. He will tell you he's not feeling well and that he thinks he's going to die! When you tell him he's ok he'l will gently lower himself to the floor and say I'm Dying I'm Dying. We try not to give him any secondary gain from this behavior. But at the same time I have 17 high acuity psych patients who are very annoyed with him. I'm not sure what we are goining to do. I really think the doctor is just running out his medicare days something that really pisses me off.

Do you see a lot of this at your facility?

Hppygr8ful

[hsieh]

no. most of the people who live where i work suffer from schizophrenia. most "borderlines" who live there don't last long becaus we don't have the staff or enviroment to give them all the attention they desire. they either leave or they live at the local not for profit psych hosp (same company) and wait for placement at the state hospital. we're not a locked facility so it's hard to hold people "hostage" - as "borderlines" thrive on - so they go elsewhere - an enviroment where they can hold people "hostage". i think it's sad we live in an enviroment that enables people to act this way. basically they waste their life away holding people hostage because we have a system that rewards that behavior - ie state hospital. i understand these people are in emotional pain but out system doesn't help them just enable them. what do you do when you're in emotional pain? what "rewards or punishments" do you experience in your life that determines how you're going to express your emotional pain? we all have pain in life but expressing that pain in a self destructive way shouldn't be enabled. remember that episode of the tv show mash where a soilder said he couldn't walk and he could and hawkeye said if you want to eat you're going to have to crawl out of bed? in other words hawkeye didn't want the man to waste his life away claiming he can't walk.

[hsieh]

i hope i don't seem uncaring in my thoughts of this disorder but i'm fed up with the mental health system not helping these people. people who behave this way need to have it drilled in their head just like the rest of us that they are responsible for their actions and they are the one's who choose to behave the way they
do. every thing you feel or do is your choice. if anything could they be put in a "classroom" where they hear it over and over - you choose to feel or act the way you do. you're responsible for your life and choices". i was around one of my borderline residents yewsterday thinking "you must have a really stupid therapist". this woman's been in the system at least 10 years and she's still thinks other people cause her to do things. that's like malpractice on the therapist level.

[hppygr8ful]

You are preaching to the choir! I have one (a cutter) who has been coming to our hospital since she was 12 years old. She's 20 now and still believes that her cutting is her family's fault. She came in with superficial cuts and scratches all over her arms. Was on 1:1 (within arm's reach) supervision for 8 days because she wouldn't contract for safety and continued to harm herself even while in session with a therapist. I do believe that cutting is an addictive OCD behavior but I also believe it can be treated on a 12-step model. As the Big Book of AA says - "there are some who suffer from grave emotional and mental disorders , but many of us still recover if we have the ability to be honest with ourselves."

I just hate to see patients who really don't want to be helped wasting resources that could be used for patients that want the help.

Hppy

[hsieh]

i don't think it's nessasarily that they don't want help. they've had it drilled in their head by the mental health profession that they have a disease they can't control. if a doctor tells you you're sick are you going to then feel sick? i've heard people say well these people have the emotional state of a toddler. so does that mean they NEVER grow up? they have the ability to "grow up" but the stupid mental health system doesn't assist them in doing that. instead of sitting around complaining about your difficult borderline patient why not actually teach them to think like a non borderline? is that so hard? it's like - i don't care if your dad molested you or your mom beat you - you are responsible for choosing the way you feel and act - you can't blame the way you feel or act on anybody but yourself. if you cut yourself or harm youself in any way that is your choice and your responsibility. then go from there. therapy should be based around the patient taking responsiblility for the choices in both thought and behavior. that's how a non borderline thinks.

[hppygr8ful]

i don't think it's nessasarily that they don't want help. they've had it drilled in their head by the mental health profession that they have a disease they can't control. if a doctor tells you you're sick are you going to then feel sick? i've heard people say well these people have the emotional state of a toddler. so does that mean they NEVER grow up? they have the ability to "grow up" but the stupid mental health system doesn't assist them in doing that. instead of sitting around complaining about your difficult borderline patient why not actually teach them to think like a non borderline? is that so hard? it's like - i don't care if your dad molested you or your mom beat you - you are responsible for choosing the way you feel and act - you can't blame the way you feel or act on anybody but yourself. if you cut yourself or harm youself in any way that is your choice and your responsibility. then go from there. therapy should be based around the patient taking responsiblility for the choices in both thought and behavior. that's how a non borderline thinks.

For the most part I agree with you - My comments are based on a treatment modality that I think could work for these patients which is based on the 12 step approach. Basically a person would admit that in their current state his/her life was unmanageable. Then through a series of steps that stresses healing of resentments and taking personal responsibility for your life. I believe that iif there were 90-120 treatment programs that stress behavioral changes rather than the traditional approach of anti-anxiety meds and hand-holding. We would see more recovery from this disorder."

Just my humble opinion
hppy

[Dutchesslaura]

This is a 2 part response & question. First of all I lived with a Boarderline for 4 years. Oh my God! Constant drama!!!! I'm lucky I had the guts to leave. I literally had to go into hiding for 6 months!!! My family wouldn't tell her where I was. I even had to leave my job. Which brings me to part B. How can I get into pshych nursing? I have no professional experience but lots of personal. And I find the field fascinating. I live near San Francisco.:o

[hsieh]

go apply to a psych hosp or clinic or long term care facility. they always have openings because of the stigma of mental illness many don't want to work with them. people with schizophrenia are usually quite nice. i think due to their disease they don't have the ability to be "mean". as for boderlines you just have to set the limits. for example where i work i won't allow borderlines to come in the nurse station unless there is a nursing reason. i don't feed into their borderline cycles - i'm sorry - i hate you - you hate me etc. i just ignore them. if they threaten suicide i call 911 and let them handle it. you don't have to be "mean" you just have to set limits and don't get emotionally involved with their behavior. i am a nurse not a therapist or case manager. it's not in my scope to be a therapist or case manager. it would be against the nurse code of my state if i tried to be a therapist or case manager. if you're interviewed for a psych position i wouldn't tell them about your experience with a borderline because they may not want you due to your personal feelings or proximity to a person like that.

[RN turned Recruiter]

I understand your frustration. While I never had to treat one in my profession I had one as a friend. She was very demanding, needy, innocent and affectionate all at the same time. Because I moved states we lost contact. Yes, she wore me down yet I knew she was at the mercy of her disease. I read "I hate you, don't leave me". That helped me to have compassion and cope. Best of luck.