Cluster B: Borderline Personality Disorder Characteristics (Nursing)

00:01 So, let's now look at borderline personality disorder.

00:05 And as I'm talking about borderline personality disorder, I really want you to have in the background of your brain, the idea of bipolar disorder.

00:18 When we shorten borderline personality disorder, we call it BPD.

00:26 And when we shorten bipolar disorder, we call it BPD.

00:34 And where we can treat bipolar disorder, and we can use our medications, and cognitive behavioral therapy, and dialectic therapy.

00:47 When we are talking about someone with a borderline personality disorder, usually, there's not as much hope.

00:56 And so I want you to take a step back, and remember that these are characteristics that reflect a person who's in crisis.

01:06 As nurses, we are not diagnosing a disorder, a disease.

01:12 As nurses were treating an individual, a human being who's in crisis, and who's struggling to have a good life.

01:19 And borderline, when you hear oftentimes, especially in middle and high school, you may hear people saying, "Oh, she's so borderline." It is a terrible thing to say.

01:34 So, let's take a breath before I have, as you can see, I have great respect for persons who are struggling with this disorder.

01:46 They really don't function well at all in life.

01:50 They are constantly fluctuating between really wanting to be loved.

01:55 And as soon as they start getting that kind of love, they are afraid of losing themselves, and they put up walls.

02:04 And then when the wall goes up, and the person walks away, they run after them apologizing.

02:11 "It will be better the next time. I swear." And the person turns around, and starts falling back in love, or liking them again.

02:20 And once they get close, that wall goes up, And it doesn't go up because the individual is trying to keep them out.

02:27 It goes up because this disorder had its roots.

02:33 This fear of someone getting in close enough and hurting them.

02:38 So what else do we see? Just as what I just said, this emotional lability.

02:45 So, one minute, they're really happy.

02:47 The world is great.

02:49 This is like the best day of their life.

02:51 And then all of a sudden, they have a thought, a thought, that maybe what they just said, was something that's going to make you not like them.

03:01 And immediately, you see the change from when they're talking to you.

03:05 And just imagine, "Let's think about, when we're gonna go to, you know, Six Flags.

03:17 I'm so sorry, I mentioned Six Flags.

03:20 What a terrible thing.

03:22 You probably don't want to spend time with me at Six Flags, I probably just ruined our whole relationship.

03:30 I'm so sorry." Meanwhile, the person who's in front of them, they were at Six Flags with them.

03:35 And now all of a sudden this has changed.

03:38 So being a friend to a person who has this disorder can be very confusing.

03:45 In fact, it might make people who are friend to say, "This is too much for me. I can't be on this roller coaster." So these people end up having multiple relationships that are wonderful, and then terrible, and then wonderful again, and then terrible.

04:03 So, I'd like you to take a second to think about a person who has personality disorder like this a borderline personality disorder.

04:12 They might become the victim of another person who wants to control, who won't mind when they feel terrible, because it actually gives them a better chance to manipulate.

04:24 And these are very frightening situations because they may become an abused person.

04:31 Serially, abused person because of a disorder that other people are sort of looking at as a label.

04:41 Some of the other characteristics of person, a borderline personality, these self-destructive behaviors because they feel worthless.

04:49 The moment that they lose what they think they want it, They think that they are worthless, and why not just end it.

04:58 We have to be very careful for suicidal ideation with patients who have borderline personality disorder.

05:07 They may be very antagonistic.

05:09 They may find that once they like a person, they're going to start finding everything that's wrong with them because they have to build up this arsenal to protect themselves in case this person disappoints them in the future, which they actually bring in because they start making the accusations.

05:29 They start being antagonistic, and the other person responds in kind.

05:36 There is something that goes on that's called splitting.

05:40 Splitting with the person with borderline personality disorder.

05:44 And also with the person who has bipolar disorder, is when a person has an inability to see both the positive and negative aspects of another person.

05:55 They're not able to see the fact that some days, I might be very nice, other days, not so much.

06:05 So for them, either you are the God or you are the devil.

06:09 Either the you are the perfect person, or you are the worst person in the world.

06:14 And so they end up not being able to connect with the real person.

06:20 The person who has all of the middle of the spectrum.

06:25 Where we have our own ups and downs.

06:28 If they think you are great, they hold you on a pedestal that is so impossible, that the second you take a step off that pedestal, you have fallen into terrible.

06:40 So, it's difficult as you're listening to them, as a nurse, when they talk about someone to be able to step back and understand that just the way they're talking about somebody is really actually going to make it more difficult for them to be able to connect in a realistic, and giving and taking relationship.

07:04 So unfortunately, when they are patients, when we have patients with borderline personality disorder, what happens is that they stir up conflict.

07:15 Because if you are the best person and you are their person, then you better not talk to anybody else.

07:21 Because when you do, you're not their person anymore.

07:25 And what they're going to start saying about you is not going to be pretty.

07:29 And you're going to have to be able to understand, it's not about you.

07:33 So, I'm going to share one little piece with you that I learned from an eight year old young lady, who had a very bad anxiety disorder.

07:42 And she said to me, "Dr. Marshall, do you know those Q-Tips that people use to clean their ears?" I said, " I sure do." And she said, "Well, I use those Q-T-I-P, to help me now.

07:55 Because you had said, "Oh stop taking everything so personally." She said, "And now I carry a Q-Tip.

08:03 And whenever someone says something to me, that makes me upset, I look at my Q-Tip and I say, "Quit taking it personally, Q-tip." And so now I, whenever I go into the unit, I carry a Q-tip with me because my patients are struggling.

08:23 They are in crisis.

08:24 If they weren't, they wouldn't be on a psychiatric unit.

08:27 And I have to remember, it is never about me.

08:30 It is about me being able to keep them safe, about me being able to assess them.

08:35 It is about me being able to focus on their needs and evaluate what works.