Question

Rob has been admitted to the Psychiatric Unit after being arrested for assault on a colleague at his workplace. The police were called when Rob, after a verbal altercation with a female co-worker, pushed the co-worker very aggressively against a wall, causing her to fall. The co-worker, Janice, says that Rob has threatened her on multiple occasions, a claim that has been confirmed by others at the company. Although the nurses on the unit are aware of the events leading to the arrest, Rob consistently denies any responsibility for the incident. At one point, he pulls one of the nurses, Colleen, aside and says, “This is in confidence, but I know that I can trust you with it since you’re obviously an ethical person. Janice has been trying to get me fired for years. She’s jealous that I do better work than she does. We were both up for a promotion last week, and she spread terrible lies about me to get it. I only pushed her because she taunted me about getting the promotion, and I’ve been under so much stress.” He ends the conversation by adding, “You’re so easy to talk to. I really feel like I can trust you. The last time I was hospitalized, the nurses were all idiots.”

               Later, during a staff team meeting about Rob’s plan of care, Colleen learns that he has attempted to gain the “confidence” of several other staff members with flattery as well. Several of them have heard Rob’s story about Janice, the woman he assaulted—and they have noticed how callous Rob seems toward his other co-workers, as well as other patients on the floor. Furthermore, he does not seem anxious or to be suffering from any depression. Everyone agrees that Rob’s actions are manipulative and that although he claims to be under “enormous” financial and personal stress, his actual demeanor and behavior are quite calm.

1. What type of personality disorder does Rob seem to be displaying? explain why you think this.

1. Creating a therapeutic relationship with a patient who has this type of personality disorder can be a difficult balancing act. Describe the main challenges Colleen will have doing this with Rob. what will you do to overcome the challenges you have listed?

Answer 1

Borderline Personality Disorder

The borderline personality is the other personality disorder that has genetic inheritability. With a prevalence of 2% of the population, it accounts for 10% of patients seen in outpatient mental health centers. It is also five times more common in first-degree relatives of those with borderline personality disorder. The characteristics of the borderline personality include a marked and persistent identity disturbance, chronic feelings of emptiness and boredom, and intense unstable personal relationships. The borderline tends to have difficulty tolerating being alone, and will fear abandonment. They are highly impulsive, and may engage in self-mutilating behavior, have recurring suicidal threats, and manipulate others to meet their immediate needs. The borderline also tends toward having an intense unstable affect mood, display inappropriate anger, have perceptual distortions, and under great stress may depersonalize. They see the self as justified; since they feel intolerably bad, they are entitled to go by impulse instead of common sense, and entitled to soothe themselves. Their fictitious goal is to do whatever they want as they cannot be happy by how others do it. Their methods are protean, and include splitting, primitive idealization, projective identification, denial, and devaluation. The borderline personality is not a cooperator. Their impairments include affective instability, anxiety and panic, and engaging in self-harmful behaviors. These impairments may cause significant interference in social or occupational functioning. Because the borderline uses others to meet their needs, they can often be the “problematic patient” that medical offices dread.

Borderline Personality Disorder (BPD) is one of the most complicating disorders for mental health professionals and researchers. BPD is complicated based on many factors such as the environment , temperament, genetic predisposition, age at which BPD was identified and treated, treatment recommendations, etc. So much goes into identifying, understanding, and coping with BPD. What makes matters more complicated is the unraveling of convoluted symptoms by family, caregivers, friends, and mental health professionals. Treating and helping a loved one with BPD symptoms requires internal strength, patience, and knowledge.

some of the core symptoms of BPD that often confuses family, friends, and even mental health professionals:

1) Dysphoria: Dysphoria is a state of general dissatisfaction with life or things around you. It is a depressive-like state that leads to negative self-talk, low self-esteem, feelings of inadequacy, and sometimes confusion over one’s identity. It is a pervasive or chronic feeling that isn’t so easy to “shake off.” For some clients, dysphoria feels like a low-grade depression that sticks around no matter what. Nothing seems to pacify the “stubborn nature” of dysphoria. Some individuals abuse alcohol and/or drugs and self-harm to cope with the dysphoria.

2) Attention-seeking, manipulating, or controlling: not for all individuals with BPD behave or think the same. Some individuals may come across as manipulative, controlling, or attention-seeking because these behaviors are the only behaviors they believe help them get their needs met.

3) Emotional chaos and storms: Emotional chaos and storms may include incorrect, skewed, or paranoid thinking patters and emotional reasoning.Some individuals with BPD, primarily when stressed, experience paranoid and delusional beliefs.

4) Internal emptiness and loneliness: One of the articulate and emotionally astute teen clients say that they often feel empty and lonely when away from friends because “I have to sit with all of my unresolved emotions, anxious thoughts, and memories of irrational behaviors.”

5) Denial, anger, and rage: Denial of symptoms, anger around minor things, and rage when triggered are all things that make BPD difficult to deal with and cope with. Many individuals struggle with BPD as a diagnosis. The stigma, the misconceptions, the judgments, the internal fear of oneself are all barriers to acceptance. Without acceptance, the roller-coaster emotions continue.