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Borderline Personality Disorder

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Cess Claire Salac

on 27 August 2013

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Transcript of Borderline Personality Disorder

Borderline
What is Borderline Personality Disorder?
A pattern of unstable ways of seeing oneself, feeling, behaving, and relating to others.
problems with regulating emotions and thoughts
impulsive & reckless behaviour
unstable relationships with other people
What are its
characteristics?
Frantic efforts to avoid
real or imagined abandonment
A pattern of unstable & intense
interpersonal relationships
Identity disturbance
Impulsivity
Recurrent
suicidal behaviour
Emotional instability
Chronic
feelings of emptiness
Inappropriate,
intense anger
Transient, stress-related
paranoid thoughts
Relevant Issues
10 year history of
self-injurious behaviour
Drug & alcohol abuse
Poor relationship with
other people
Poor treatment compliance
Sexually promiscuous
Aggressive behaviour
Pseudohallucinations
Contributing factors to the cause of BPD
Statistics
Ashika & Princess
Puneet & Sheena
Maria & Millie
Personality
Disorder
Unique CM clients with a borderline personality disorder
diagnosis, by ethnic group (2005)
Suicide
attempt:
60-70%
youth and
young women
rate: 8-10%
Environmental
Biological
Stress-related events
Early trauma and stress
affect the hippocampus
Poor parenting
separation
unsupportive
abuse
RACHEL's STORY
Nursing Process
HEALTH EDUCATION
Nursing Diagnosis 1
ASSESSMENT
- Rachel has a 10 year history of self injurious behaviour (overdosing, cutting and excessive alcohol use)
DIAGNOSIS
Rachel is at risk for self-mutilation to provide relief from tension or emotions due to emotional dysregulation caused by past sexual abuse.
PLANNING
Short term:
- Rachel eliminates self-mutilation behaviour.
IMPLEMENTATION
1.) Assess Rachel for self-harming or suicide thoughts.
Nursing Diagnosis 2
ASSESSMENT
- Rachel has a 10 year history of excessive use of alcohol and drug overdosing
DIAGNOSIS
Rachel abuses drugs and alcohol which exaggerates her emotional dysregulation and increases her impulses to self-harm.
PLANNING
Short Term:
- Rachel will participate in her treatment plan for drug and alcohol therapy at least once within 24-48 hours.
IMPLEMENTATION
1.) Assess Rachel’s substance use of alcohol and drugs.
Nursing Diagnosis 3
ASSESSMENT
- Violent altercation with nurse
DIAGNOSIS
Rachel displays aggressive and intimidating behaviour towards staff members, family and other patients.
PLANNING
Short Term:
Rachel will reduce aggressive and intimidating behaviours while in hospital.
IMPLEMENTATION
1.) Observe Rachel for signs or triggers for aggressive or intimidating behaviour.
Past
Sexual Abuse
Separation
from Family
Substance Use
Self
Harm
Aggressive
Behaviour
Risk Behaviours
Root Problems
Coping Strategies
- Rachel made several laceration to her wrists and forearm
- Razor blade hidden in her room
- Rachel was sexually abuse and was taken into
care at the age of 11
Long term:
- Rachel will eliminate self-injurious behaviour and demonstrate alternative coping techniques when feeling the impulse to self-harm or to release tension.
2.) Place Rachel in the room near the nursing station, remove all potentially harmful objects and initiate safety round checks every 15-30 minutes.
3.) Begin to develop a therapeutic rapport with Rachel.
4.) Explore Rachel's reasons for engaging in self-mutilation.
5.) Use Dialectical Behaviour Therapy techniques for Rachel and help her to develop positive coping strategies such as mindful meditation, deep breathing and self-soothing.
- Cannabis and Ecstacy use
- Rachel was found drunk and disorderly, and returned to the ward by police after altercation with the nurse
- Rachel engage in self-harm while under the influence
of alcohol and drugs
Long Term:
- Rachel will reduce her alcohol and drug use so she is not at risk of harming herself or others.
2.) Use Dialectical Behaviour Therapy techniques for Rachel.
4.) Teach Rachel the problem solving process:
(Identifying problems, exploring alternatives, making decisions, and evaluating success.)
3.) Help Rachel identify her strengths and any successful coping behaviour.
5.) Attend drug and alcohol therapy.
6.) Refer Rachel and her mom in psychoeducation
about Borderline Personality Disorder.
- Rachel is verbally aggressive particularly if she has been in contact with her mother
- Rachel has a recent complaint from a patient regarding her intimidating behaviour
Long Term:
Rachel to identify triggers causing aggressive outbursts and to develop appropriate ways of dealing with frustration and emotions to eliminate aggressive behaviour.
2.) Teach Rachel and her family to recognise early signs of escalating agitation (yelling, cursing, threatening, pacing, intrusiveness)
3. Encourage Rachel to express frustrations or emotions verbally.
4.) Use verbal de-escalation techniques when Rachel becomes aggressive.
5.) Have a family meeting with Rachel and her mother.
6.) Use Dialectival Behaviour Therapay techniques for Rachel.
Emotional
Dysregulation
Offers counseling and psychotherapy for a wide range of psychological, emotional, and behavioural issues by working individually with their client.
Health
Initiatives
Available
Treatments
Community Resources
A community alcohol and drug service that provides counselling for individuals that have severe alcohol and drug addiction by developing a plan and supporting their
client to achieve their desired outcomes.
Mental Health Foundation of New Zealand
Addresses and takes action to embed a positive mental, physical and spiritual existence, improving people’s wellbeing.
A national suicide prevention information service provided by the Mental Health foundation that helps increase New Zealanders’ knowledge on suicide prevention by offering quality information and resources.
An online service that provides early intervention for people with psychological distress by talking freely whilst keeping safety, confidentiality, and anonymity. It combines principles of social networking with other choices of clinically informed interventions in order to enhance mental health, and support with self-management.
A service that aims to raise public awareness, provide education, and promote research on Borderline Personality Disorder, as well as enhance the quality of life of those affected by this serious mental illness.
1.) Mindful meditation
“Paying attention in a particular way: on purpose, in the present moment and non-judgmentally”
2.) Grounding exercises
3.) Deep breathing
4.) Self-soothe
5.) Self-help emotional processing and expression
References:
- Keltner, N., Schwecke, L., & Bostrom, C. (2007). Psychiatric nursing. (5th ed.). St. Louis, MO: Mosby-Elsevier.
- Lindsay, G. (2007). Mental health and addiction in Counties Manukau health needs assessment. Manukau City, N.Z: Counties Manukau District Health Board
These exercises to help focus attention on the present moment
Simple exercise that can be used for mild distress or on everyday basis
Used during moments of distress to help them relax
Some people find that processing or expressing emotions on their own can be very useful way to engage in self harm
- Big White Wall. (2013). What's on your mind. Retrieved from http://www.bigwhitewall.com/my-account/login.aspx?ReturnUrl=/
References:
- Auckland Therapy - Counselling and Psychotherapy Issues. (2011). Retrieved from http://www.aucklandtherapy.co.nz/Counselling+issues/Counselling+issues.htm
- Spinz. (2013). Suicide prevention: Information new zealand. Retrieved from http://www.spinz.org.nz/page/5-home
- Schultz, J. M., & Videbeck, S. L. (2013). Lippincott's manual of psychiatric nursing care plans. Philadelphia, PA: Wolters Kluwer Health | Lippincott Williams & Wilkins.
- Community Alcohol and Drug Services (CADS) - Auckland Home. (2013). Retrieved from http://www.cads.org.nz/
- Mental Health Foundation. (2013). Making mental health everybod'ys business. Retrieved from http://www.mentalhealth.org.nz/page/5-home
- National Education Alliance for Borderline Personality Disorder. (2013). Retrieved from http://www.borderlinepersonalitydisorder.com/
- Ogrodniczuk, J., & Hernandez, C. (2010). Borderline personality disorder. In International Encyclopedia of Rehabilitation. Buffalo, NY: Center for International Rehabilitation Research Information and Exchange.
- Friedel, R. (2012). Borderline personality disorder demystified: A message of realistic hope. Retrieved from http://www.bpddemystified.com/what-is-bpd/causes
- Invalidating family environments during childhood have been found to contribute to the development of emotional dysregulation.
Serotonin levels have been implicated in the causality of BPD. Dysfunction in this neurochemical has been linked to emotional instability, suicidal behaviors and impulsivity behaviors evidenced in people with the disorder.
International data suggests that diagnosed BPD occurs in about 1-2% of the general population and the majority of those diagnosed are women.
- Elder, R., Evans, K., & Nizette, D. (2010). Psychiatric and mental health nursing (2nd ed.). NSW, Australia: Elsevier.
- PsychCentral. (2013). An overview of dialectical behavioural therapy. Retrieved from http://psychcentral.com/lib/an-overview-of-dialectical-behavior-therapy/0001096/2
- Salters-Pedneault, K. (2010). Coping skills borderline personality disorder. Retrieved from http://bpd.about.com/od/livingwithbpd/a/Coping.htm
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