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Understanding Borderline Personality Disorder
Borderline Personality Disorder (BPD) is a significant psychiatric disorder that you may encounter frequently in your nursing career and clinical practice. Broadening your understanding as a healthcare professional of what this disorder is, its triggers, and effects are essential.
Definition: What is Borderline Personality Disorder?
Borderline Personality Disorder, often shortened to BPD, is a mental health disorder that impacts the way you think and feel about yourself and others, causing problems functioning in everyday life. It includes self-image issues, difficulty managing emotions and behaviour, and a pattern of unstable relationships.
A hypothetical example of a person suffering from BPD in your nursing practice might start a new job and initially view their boss as the best boss ever. However, upon making a minor mistake and being corrected, they then view their boss as the absolute worst boss ever. This encompasses the unstable relationships aspect of BPD.
Causes and Common Triggers of Borderline Personality Disorder
The precise causes of Borderline Personality Disorder are still unknown, but the most widely accepted theory is that a combination of genetic, environmental, and social factors contribute to its development.
- Genetic Factors: Certain genes may make you more susceptible to developing BPD.
- Environmental Factors: Unstable, neglectful, or abusive home environments might increase the risk of developing BPD.
- Social Factors: Repeated exposure to traumatic events or situations could play a role in BPD development.
Research suggests that certain neurobiological factors, such as irregularities in the brain areas that control emotions and impulses, may be involved in the development of BPD. However, further research is needed to fully understand these connections.
Effects of Borderline Personality Disorder on Mental Health Nursing
Caregivers and nursing staff play a crucial role in the lives of individuals with BPD.
It's important to understand the strain that BPD can place on the relationship between a healthcare provider and a patient. This disorder can lead to challenging behaviours, including emotional instability, impulsive decisions, and tumultuous relationships.
Consider a scenario where a patient with BPD forms a strong attachment to a specific nurse and becomes distressed when they're not on duty. This attachment can lead the patient to manipulate or become hostile towards other staff members. This scenario illustrates the challenging behaviours of BPD.
Effective management strategies like Dialectical Behaviour Therapy (DBT) and Cognitive Behavioural Therapy (CBT) can be used to manage these behaviours. DBT was specifically developed for BPD and has been shown to be effective in containing self-harm behaviour and regulating emotions. CBT can likewise help patients challenge and change harmful beliefs and behaviours.
Specific Symptoms of Borderline Personality Disorder
Patients with Borderline Personality Disorder (BPD) often display a variety of characteristic symptoms. These can be differentiated into emotional, behavioural, and physical symptoms. As a healthcare provider, familiarising yourself with these symptoms can help you provide more effective care.
Emotional Symptoms of Borderline Personality Disorder
The emotional symptoms of BPD often cause significant distress and impact daily life. The following signs characterise these emotional symptoms:
- Extreme mood swings:Patients with BDP typically experience intense and unstable moods.
- Impulsive behaviour: An impulse-control disorder involving difficulty controlling impulses can be a major symptom.
- Intense fear of abandonment: People with BPD may have an intense fear of being left alone.
You might notice these symptoms during your interactions with patients, such as sudden anger outbursts or intense reactions to perceived abandonment.
For instance, a patient might have an outburst or breakdown in response to being left alone even for a short while. The fear of abandonment feels real to them, and it's essential to manage these feelings with care.
Behavioural Symptoms: Borderline Personality Disorder vs Bipolar
Behavioural symptoms of BPD can often be confused with those of Bipolar Disorder (BD) due to some overlap. Here's a comparison that differentiates the two:
| Signs of BPD | Signs of BD |
| Incessant fear of abandonment | Periods of high energy (mania or hypomania) |
| Unstable, intense relationships | Depressive episodes |
| Chronic feelings of emptiness | Changes in sleep patterns and activity levels |
Understanding these differences can assist you in making an accurate diagnosis and providing effective care.
While there is overlap, a key differentiation lies in the length and progression of episodes: In BPD, mood instability usually happens within minutes or hours, whereas, in BD, they persist over weeks, months, or even longer.
Physical Symptoms associated with Borderline Personality Disorder
Although BPD primarily impacts mental health, it can also manifest in multiple physical symptoms:
- Self-harming Behaviours: Some patients resort to self-harming behaviours such as cutting or burning themselves.
- Suicidal Behaviours: Thoughts of suicide, threat of suicide or actual attempts of suicide are common amongst patients with BPD.
- Physical illness due to stress: Chronic stress associated with BPD can lead to a variety of physical health issues, including heart disease, respiratory disorders, and gastrointestinal issues.
Remember that chronic stress is prolonged stress that remains unresolved over an extended period. It can lead to many serious health problems across various body systems.
A patient with BPD, for instance, may show unexplained signs of high blood pressure or respiratory issues due to the chronic stress they are under. This clearly showcases the physical side of a primarily psychological disorder.
Treatment and Therapy Options for Borderline Personality Disorder
While there is no cure for Borderline Personality Disorder (BPD), various treatment options can help manage and reduce its symptoms. These treatments are not uniformly effective for everyone, and often, a combination of methods proves most beneficial for individuals suffering from BPD.
Mental Health Nursing Approaches: Borderline Personality Disorder Treatment
As a mental health nurse, your role in caring for BPD patients requires a comprehensive understanding of certain treatment approaches.
- Patient Education: Educating patients about BPD can help them understand their condition better, enabling them to cope more effectively. It's essential to provide this education in a supportive and non-judgemental manner.
- Supportive Therapy: Supportive therapy can be a significant part of treating BPD. It involves aiding individuals to navigate through daily life challenges, deal with interpersonal issues, and manage their emotions better.
- Behavioural Interventions: Behavioural interventions in BPD focus on helping patients modify their behaviour. This can involve helping them develop positive coping strategies and finding alternatives to self-harm or other detrimental behaviours.
Supportive therapy is a type of psychotherapy that uses a nurturing and encouraging approach to help patients deal with life's problems and enhance their well-being.
For example, as a mental health nurse, you might help a patient identify their emotional triggers and collaboratively brainstorm strategies or activities to manage these triggers. This is an example of conducting a behavioural intervention with a BPD patient.
Psychological Therapy for Borderline Personality Disorder
Another crucial aspect of BPD treatment is psychological therapy. Two types of therapy, in particular, have been found effective:
- Dialectical Behaviour Therapy (DBT): DBT is a cognitive-behavioural approach specifically designed to treat BPD. It focusses on imparting skills to manage stress, regulate emotions, and improve relationships.
- Schema-Focused Therapy (SFT): SFT aims to change unhelpful ways of thinking that are often at the root of BPD. It's based on the idea that we tend to fit our experiences into patterns or 'schemas', and unhealthy schemas can lead to BPD symptoms.
Dialectical Behaviour Therapy (DBT) combines cognitive-behavioural techniques to change unhelpful behaviour with concepts from Eastern mindfulness practices.
For instance, in DBT, you might work with a patient on mindfulness exercises to help them focus on the present and manage their response to stress calmly. This shows how therapy can equip patients with self-regulation tools.
Medical Management in Borderline Personality Disorder Treatment
While medications can't cure BPD, they can be effective at managing specific symptoms. Some options include:
- Antidepressants: Can potentially reduce symptoms like depression, anger, impulsivity, and anxiety.
- Mood Stabilisers: These medications are generally used to treat bipolar disorder and can help control mood swings in BPD.
- Antipsychotics: Can be used in low doses to help with distorted thinking.
Mood stabilisers are medications that even out the mood swings characteristic of bipolar disorder. Some commonly used mood stabilisers include lithium and certain anticonvulsant medications.
Consider a patient who presents with significant mood swings and impulse control problems. The consulting psychiatrist might prescribe a mood stabiliser medication like lithium, aiming to reduce the intensity of these mood fluctuations and help the patient gain better control over their behaviour.
It's important to know that medication alone isn't usually the answer for BPD. The use of medicines in BPD should always be closely monitored, as patients may have a higher risk of experiencing side effects due to the nature of their condition. Any drug treatment should be part of a comprehensive treatment plan that includes psychological therapy and other care strategies.
Borderline Personality Disorder - Key takeaways
- Borderline Personality Disorder (BPD) is a mental health disorder that affects how individuals perceive themselves and others, leading to issues with self-image, emotional and behavioural management, and unstable relationships.
- Causes of BPD are unknown but may include genetic, environmental, and social factors. Neurobiological factors could also be involved.
- BPD can significantly affect mental health nursing, causing challenging behaviours like emotional instability and impulsive decisions. Treatment strategies like Dialectical Behaviour Therapy (DBT) and Cognitive Behavioural Therapy (CBT) can be employed.
- BPD presents varying symptoms which can be categorised as emotional, behavioural, and physical. BPD can be differentiated from Bipolar Disorder (BD) by the nature and duration of these symptoms.
- The treatment for BPD includes patient education, supportive therapy, behavioural interventions, psychological therapy like DBT and Schema-Focused Therapy (SFT), and medication management. These should be part of a comprehensive treatment plan.
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