Nursing care of inpatients with borderline personality disorder

Determination of First Object Relations and Emotion Regulation Difficulties in Borderline Personality Disorder with Objective and Projective Methods

Evaluation of the disorders in the personality organization of the individual is only possible by examining the object relations functions, and it is known that the elimination of emotion regulation difficulties (ERD) has a central role in the treatment of borderline personality disorder (BPD). Therefore, this study, in which objective and projective methods were used together, was designed to determine the ERD of BPD patients and the relationship between the patients' object relations and emotion regulation difficulties. It is thought that the results of the study can be useful in the psychotherapy processes of BPD patients. For this purpose, the Sociodemographic Data Form, Rorschach Test, and Emotion Regulation Difficulty Scale developed by the researchers were applied to 37 individuals diagnosed with Borderline Personality Disorder according to DSM-5 criteria and 37 individuals who did not have any psychiatric diagnosis as a result of their psychiatric examination by a psychiatrist. As a result of the study, it was determined that there was a significant relationship between BPD and ERD, and this relationship could be determined through the Rorschach test, and it was determined that BPD constituted 55% of the variance of ERD. ERD, which can have significant disruptive effects on the lives of borderline patients, was associated with the patients' lack of satisfaction and inclusion in their relations with their first object, which is usually their parents, and it was determined negative qualities of first objects accounted for 23% of the variance of difficulty in emotion regulation. It is thought that the results of the study may contribute to the acceleration of the solution of interpersonal problems, which have a close relationship with ERD, of the patients and the standardization of the Rorschach Test.

Transference-Focused Psychotherapy and Trust Processing in BPD: Exploring Possible Mechanisms of Change

Individuals with borderline personality disorder (BPD) struggle to identify whom they can safely trust, and this struggle contributes to profound emotional turmoil in their close relationships. Transference-focused psychotherapy (TFP) is an application of object relations theory (ORT) that posits that polarized mental representations of self and other define the personality organization of BPD. TFP aims to utilize a clear treatment frame coupled with an analysis of the therapeutic relationship (i.e., the transference) to help individuals with BPD integrate their polarized mental representations. Improvement in the capacity to trust others is inherent in the mechanisms of change in TFP. In this article, a social cognitive model of trust processing provides a new lens through which we formulate how TFP may enhance trust processing in BPD. Recent evidence from randomized clinical trials supports the argument that TFP may intervene with BPD in a way that is concordant with uniquely improved trust processing.

Palliative Care for Terminally Ill Individuals With Borderline Personality Disorder

Individuals with borderline personality disorder (BPD) exhibit persistent patterns of instability in mood, impulse control, self-image, and interpersonal relationships. These issues complicate quality end-of-life care for this population and are of particular concern for hospice and palliative care nurses and health care providers. This article presents case studies of terminally ill individuals with BPD as a series of vignettes that present common clinical issues encountered by the palliative care team. Interventions suggested in the literature as well as approaches used by team members when working with terminally ill individuals with BPD are discussed. [Journal of Psychosocial Nursing and Mental Health Services, 57(9), 24-31.].

Uncovering the mask of borderline personality disorder: knowledge to empower primary care providers

PURPOSE

This manuscript will provide a review of the literature and a report on the findings of a qualitative study that explored the lived experiences of people with borderline personality disorder (BPD). It also offers resources designed to empower healthcare professionals to provide timely and accurate referrals, diagnosis, or collaborative management of BPD in primary care.

DATA SOURCES

Review of the literature examining background, epidemiology, pharmacotherapy, psychotherapy, and available resources regarding BPD. Content analysis conducted on data obtained from 1109 postings on three different public online forums/blogs specifically for BPD.

CONCLUSIONS

BPD is characterized by unstable moods, behaviors, and relationships. While navigating a healthcare system fraught with health disparities, BPD sufferers may have their feelings of abandonment and hopelessness reinforced. Four core themes emerged (a) a reliance on online blogging to cope; (b) a quality of life that is impacted by debilitating effects of condition; (c) coping mechanisms that encompass healthy and destructive measures; and (d) social injustices that include stigmatization, prejudice, delayed diagnosis, misdiagnosis, limited healthcare access, and lack of cure.

IMPLICATIONS FOR PRACTICE

Knowledgeable, nonjudgmental primary healthcare providers can play a key role in providing BPD sufferers and their loved ones with accurate and timely diagnosis, referral, treatment, resources, and support. Internet blogging may have important implications in care.

Evidence base and components of Brief Admission as an intervention for patients with borderline personality disorder: a review of the literature

PURPOSE

To review the available evidence-based literature on the components of brief inpatient psychiatric hospital admission as an intervention for patients with borderline personality disorder.

DESIGN AND METHOD

Systematic literature search, narrative literature review. Content analysis.

FINDINGS

Five key components of brief admission as an intervention were identified: discussion of goals; organization of Brief Admission; clear admission procedure; specification of any other interventions during Brief Admission; and stipulation of conditions for premature (i.e., forced) discharge.

RESEARCH AND PRACTICE IMPLICATIONS

Brief Admission can be effectively used to prevent self-harm and suicide in patients with borderline personality disorder. During the Brief Admission, psychiatric nurses can support these patients achieving an active coping in dealing with their symptoms.

Borderline personality disorder: clinicians' accounts of good practice

People with a diagnosis of borderline personality disorder are relatively high users of inpatient and community services. There is concern, however, that mental health nurses feel negative about working with this group of people, are often socially distancing and feel under-skilled. The purpose of this research was to explore the experiences of good practice among mental health professionals working in a service that provided specialist treatment for this group of service users. The research was undertaken through semi-structured interviews and identified four key themes: shared decision making, social roles, peer support and open communication. These themes are discussed in the context of research in this field, the need for recovery-focused services, and through drawing on the Winnicotian notions of disillusionment and mirroring as key developmental processes.

Exploring Registered Psychiatric Nurses' Responses towards Service Users with a Diagnosis of Borderline Personality Disorder

This study explored registered psychiatric nurses' (RPNs') interactions and level of empathy towards service users with a diagnosis of borderline personality disorder (BPD). A qualitative approach was used, and 17 RPNs were interviewed using a semistructured interview schedule incorporating the “staff-patient interaction response scale” (SPIRS). Four themes emerged following data analysis: “challenging and difficult,” “manipulative, destructive and threatening behaviour,” “preying on the vulnerable resulting in splitting staff and other service users,” and “boundaries and structure.” Additionally, low levels of empathy were evident in the majority of participants' responses to the SPIRS. The findings provide further insight on nurses' empathy responses and views on caring for service users with BPD and further evidence for the need for training and education for nurses in the care of service users diagnosed with BPD.

Preventive psychiatric admission for patients with borderline personality disorder: a pilot study

PURPOSE

The purpose of this study was to establish the preliminary effects of preventive psychiatric admission of patients with severe borderline personality disorder (BPD) on the rate of agreement over treatment, patient service use, and patient views on the intervention.

DESIGN AND METHODS

A retrospective pre-post test design with quantitative measures and qualitative interviews was used.

FINDINGS

Agreement over treatment increased substantially and significantly, and services use decreased substantially, yet not significantly. Patients were highly content with the intervention.

PRACTICE IMPLICATIONS

Preliminary results indicate that preventive admissions may be easy to use and cost effective with severe BPD patients in mainstream psychiatric services, but more research into the intervention is needed.