Question

Teagan is a 21-year-old woman and living with her partner, Amita. Teagan and Amita have been together for 15 months; their relationship is volatile, and they have separated a number of times. Last night, Teagan broke up with Amita again in a fiery exchange of insults and anger. Teagan believed that Amita was about to leave her and fearing this relationship breakdown, she thought she would ‘get in first’. Amita admits things have been tumultuous between them for months now, and that neither is happy, but wanted to work things out by seeing a relationship counsellor. Amita is also concerned about Teagan’s use of cannabis. Amita claims that Teagan’s responses to small indiscretions are extreme and that she is quick to make judgements about people or situations with little information. Recently, Teagan decided that a friend of Amita’s wasn’t allowed to come to their house because she had made some ‘throwaway’ comments about their dog. Amita says Teagan does this often, liking people quickly for frivolous reasons, and disliking others for similar reasons. Teagan has been cutting herself since she was 13 years old. She finds it difficult to articulate why she does it, only that she gets relief from cutting. On a few occasions she has contemplated suicide, and many more times she has threatened it. Amita finds this aspect of their relationship very difficult to deal with and frequently feels as though Teagan’s threats to self-harm or suicide are a way of manipulating her.

1. Referring to the different diagnostic criterial and symptoms of BPD, identify specific symptoms Tegan exhibits.
2. Borderline personality disorder is associated with ‘a pattern of unstable and intense interpersonal relationships characterised by alternating between extremes of idealisation and devaluation’ (APA, 2013, p. 663). What do you think this means?
3. Discuss the phenomena of transference and countertransferenceand discuss ways in which the nursing team, and nurses individually, can minimise the impactof these phenomena when caring for the person who experiences BPD;
4. Develop three questions you would ask Teagan during an interview to complete an MSE. They could be from any MSE area.
5. Complete a risk assessment;
6. Discuss the current treatment plan and strategiesused in developing a crisis plan for Teagan;
7. Outline the psychological and pharmacologic interventionsthat may be offered to Teagan.

Answer 1

1) Borderline personality disorder symptoms in Teagen are as follows:

• Impulsivity and destructive behaviors
• Self harm and self mutilation
• Unstable relationships pattern
• Explosive Anger issues
• Abandonment fears
• Constantly shifting self image
• Co morbidity with Substance abuse

2) 'a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealisation and devaluation’

• In Bipolar personality disorder, the instability and intensity of interpersonal relationships is a major trait in people.They tend to follow idealisation and devaluation as defense mechanisms to cater to their anxiety issues and external stress causing factors.Idealisation revolves around extreme exaggeration of a person's qualities to view them as 'perfect'.In BPD, the idealisation of any friend or relative is shaped just as to have close proximity feelings.Since they have impulsive and unstable relationships , which  transforms 'idealisation' to ' devaluation'.Devaluation is the directed towards intense anger , flawed personality and exaggerated negative feeling towards the person.Generally, these mechanisms take place subconsciously for increased anxieties.In other words, a BPD person will shift his/her focus from extremely idealising someone to devaluating in a quick and rigrous manner, which is one of the main reasons of heightened interpersonal conflicts.

Pl ask rest questions separately.

Good luck!