Borderline Personality Disorder PP Flashcards
Aetiology [CAUSE] of BPD?
Early Life Experiences;
“ Emotional dysregulation arises from biologically vulnerable patients being exposed at an early age to invalidating environments”
Invalidating environments during childhood fail to teach child how to label and regulate emotions, how to tolerate emotions and how to trust that they accurately reflect events.
Crisis Assessment for BPD - what would be involved in this assessment
Client and family need to be clear about risk management and crisis plans
Clear, concise and precise documentation
A long term perspective needs to be held
Comprehensive holistic assessment
Identification of stressors, context and protective factors
MHA can be legally used but ideally avoided
Find out what strategies and supports they have used to deal with previous crises
Ask about alcohol and other drug use
Help the person manage their anxiety and distress by focusing on the current problem
Encourage them to work with staff to identify short-term changes they can make
Crisis Assessment for BPD - what would be involved in this assessment
Client and family need to be clear about risk management and crisis plans
Clear, concise and precise documentation
A long term perspective needs to be held
Comprehensive holistic assessment
Identification of stressors, context and protective factors
MHA can be legally used but ideally avoided
Find out what strategies and supports they have used to deal with previous crises
Ask about alcohol and other drug use
Help the person manage their anxiety and distress by focusing on the current problem
Encourage them to work with staff to identify short-term changes they can make
BPD interventions. Explain DBT and Mentalization
Crisis intervention and stabilisation - first priorities. actively involve the person in all decision making and person is encouraged to various treatment
Limit setting - firm, fair limit-setting, ppl w BPD have under-developed self-control so they need to know what behaviors are expectable
Self-management - nurses to manage their own responses to working with people with BPD
Interactive therapies – CBT, DBT, Mentalisation. DBT is dialectical behavior therapy which is self regulating emotions and overcoming self defeating behaviors.
Mentalisation aims to teach ppl to recognize, understand and name emotional states in themselves to address their difficulties with affect. e.g. when you think ‘why did i do that’ thats an example of your ability to mentalize and enables you to make sense of that behavior.
Team nursing approach
Pharmacological interventions
Self-harm, difference between acute and chronic self harm
Acute – serious imminent and realistic plans to suicide/self-harm
Chronic – suicide/self-harm as repetitive attempts to deal with life’s stressors and difficulties
Psychological Characteristics of self harm?
Hugely associated with BPD! Strongly dislike/invalidate themselves Hypersensitive to rejection Chronic anger, usually aimed at themselves, irritable Suppression of anger and aggression Impulsivity, tend to act in accordance with their mood of the moment Depressed, Self-destructive Chronic anxiety Do not see themselves skilled at coping Poor control over their lives Avoidant Disempowered
p.s this relates to the aetiology of BPD if you think about it
What are the 3 reasons for self harm.
Affect Regulation: trying to bring the body back to equilibrium in the fact of turbulent or unsettling feelings
Communication: A way of expressing things they cannot say
Control/punishment: trauma re-enactment, bargaining and magical thinking (if I hurt myself then the bad thing I am fearing will be prevented)
Nursing Interventions for self harm?
Collaborative care planning!
Encourage identification of thoughts that precede injurious acts and link them with past (abuse) experiences
Observe for wounds/scars + ASK ABOUT OLD SCARS
Encourage verbal communication of feelings
Assist in identifying/expressing anger
Development of coping skills
Work with self-esteem, identify and set achievable goals
Consider behaviour contracts for sense of safety
Reduce social isolation
Cultural considerations
