Borderline personality disorder

description about BPD

1. Submitted to :- Ashley petis submitted by:- jagroop kaur kulbir kaur LOVELEEN MANPREET KAUR PARMINDER KAUR RAWANDEEP KAUR SUKHDEEP KAUR

2. What is borderline personality disorder? Borderline personality disorder is a mental illness that affects the way to relate to other people and the way you relate to yourself. If you’re living with borderline personality disorder, you might feel like there’s something fundamentally wrong with who you are—you might feel ‘flawed’ or worthless, or you might not even have a good sense of who you are as a person. Your moods might be extreme and change all the time, and you might have a hard time controlling impulses or urges. You may have a hard time trusting others and you may be very scared of being abandoned or alone.

3. Definition Borderline personality disorder (BPD) is a serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self-image, and behaviour. This instability often disrupts family and work life, long-term planning, and the individual's sense of identity. Prevalence In Canada About 1% to 2% of the general population has BPD. It’s usually diagnosed in teens and young adults, though it may also be diagnosed later in life. It seems to affect more women than men.

4. PATHOPHYSIOLOGY of borderline Personality Disorder: In patients with personality disorder, abnormalities may be seen in the frontal, temporal, and parietal lobes. These abnormalities may be caused by perinatal injury, encephalitis, trauma, or genetics. Personality disorders are also seen with diminished monoamine oxidase (MAO) and serotonin levels.

5. Causes of Borderline Personality Disorder As with other mental disorders, the causes of borderline personality disorder aren't fully understood. Experts agree, though, that the disorder results from a combination of factors. Factors that seem likely to play a role include : Genetics. Some studies shows personality disorders may be inherited or strongly associated with other mental disorders among family members . Brain abnormalities . Some research has shown changes in certain areas of the brain involved in emotion regulation, impulsivity and aggression. In addition, certain brain chemicals that help regulate mood, such as serotonin, may not function properly . Family members —You are five times more likely to develop BPD if a close family member like a parent or sibling has BPD. You also have a higher risk of BPD if a close family member has an impulse control disorder like a substance use disorder or antisocial personality disorder.

6. Cont…. Childhood trauma & Environmental factors —Abuse, neglect, loss and other hurtful events that occurred in your childhood increases your risk of developing BPD. Age —BPD is more likely to be diagnosed in your 20s. This is also the time with the highest suicide risk. Many people find that their symptoms become more manageable as they get older ,  and many people recover by the age of 50.Researchers aren’t completely sure why people often feel better as they get older. One theory is that people become less impulsive as they get older. Another theory is that certain brain structures related to emotion change as we age. Other mental illnesses —Many people living with BPD have other mental illnesses. This can make it hard to diagnose BPD properly. The illnesses most often associated with BPD are mood disorders, anxiety disorders, substance use disorders, attention-deficit/hyperactivity disorder, eating disorders, dissociative disorders  and other personality disorders.

7. C linical Manifestations of Borderline Personality Disorder: Instability of mood, interpersonal relationships and self-image. Impulsive, reckless behaviour that is often self-demanding, such as substance abuse, spending binges, heightened sexuality, or binge eating. Uncontrolled, inappropriate, or frequent anger episodes. Fear of rejection and being alone; feels empty; frantically tries to avoid being abandoned. Behaviour undermines goal achievement, leading to job loss, chaotic relationships, and quitting education programs. Self-injury and suicide threats are common.

8. TYPES OF BPD DISCOURAGED SELF-DESTRUCTI-VE BODERLINE PETULANT BODERLINE IMPULSIVE BODERLINE

9. Cont… DISCOURAGED BODERLINE IMPULSIVE BODERLINE PETULANT BODERLINE SELF DESTRUCTIVE BODERLINE Includes avoidant, depressive or dependent behaviours Operating in Abandoned child mode Frantic efforts to avoid the end of or disturbance of any relationship, black and white thinking or unstable sense of self Includes antisocial or approval seeking behaviours Poor impulse control Constant conflict with society Seek approval at any cost Includes passive aggressive behaviours Operates in an angry child mode Unstable sense of self A frantic fear of abandonment, inability to express his or her needs World is a problem not him Relationship seems to be a game Includes depressive or self destructive behaviour Popular cultural image of person ‘Gath’ or ‘emo’ Often suffers from depression as a co occurring diagnosis and is a self injurer Two criteria – emotional instability and self injurious behaviour-are enough to merit a diagnosis of abandoned child mode

10. DIAGNOSTIC EVALUATIONS History taking Mental status examination CT scan Electroencephalogram (EEG ) https://www.youtube.com/watch?v=s_3Iq5F95Xg

11. DSM-3-R and DSM-4 diagnostic criteria for borderline personality disorder 1. a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of (over) ideation and devaluation. 2. frantic efforts to avoid real or imagined abandonment (do not include suicidal or self-mutilating behaviour) 3. chronic feelings of emptiness (or boredom) 4. affective instability (marked shifts from baseline mood to depression, irritability, or anxiety) due to marked reactivity of mood ( e.g.. intense episode of dysphoria, irritability, or anxiety usually lasting a few hours and only rarely than few days)

12. Cont… 5. Inappropriate, intense anger or lack of control of anger 9frequent displays of temper, constant anger, recurrent physical fights) 6. impulsivity in at least two areas that are potentially self damaging. E.g. spending, sex, substance abuse, reckless driving, binge eating (do not include suicidal or self- mutolating behaviour) 7. Recurrent suicidal behaviour, gestures, or threats, or self mutilating behaviour .

13. Cont… 8. Identity disturbance ( uncertainty about a least two of the following; self image, sexual orientation, goals or career choice, type of friends, values); marked and persistently unstable self image and/ or sense of self 9 . Transient, stress-related paranoid ideation or severe dissociative symptom NOTE:- Text in italics is significant text that was not in DSM-3-R (American psychiatric association 1987) but was introduced in DSM-4 (American Psychiatric Association 1994). Text in brackets is significant text that appears in DSM-3-R but does not appear in DSM-4

14. medications Selective seretonin reuptake inhibitors Atypical antipsychotics Anticonvulsants Paxil Effexor prozac Risperdal Seroquel Zyprexa Clozaril abilify Lamictal Topamax Depakote Trileptal Zonegan Neurotin gabitril

15. Other drugs Borderline Personality Disorder coupled with manic depressive disorder can be treated using  Zyprexa ,  Seroquel , and  Risperdal . Omega-3 fatty acids  - They can supplement Borderline Personality Disorder drugs by reducing aggression and depression. Naltrexone –it is another well-known drug used in the treatment of Borderline Personality Disorder.

16. Cont…. Side effects Weight gain Hyperlipidemia Prolongation of QTC interval Extrapyramidal side effects Abnormalities of blood count Dizziness Drowsiness Diarrhoea or constipation Excessive sweating

17. TREATMENT:- Borderline personality disorder treatment may include medications, psychotherapy, or hospitalization. Many personality disorders are difficult to treat with medications because of client’s self denial . The Two Classes of Medications Most Useful in Reducing Specific Core Symptoms of Borderline Disorder:- Antipsychotic Agents:- For those who have cognitive-perceptual symptoms such as a suspiciousness, paranoia, split (all-or-nothing) thinking, and dissociative episodes.

18. Mood stabilizers:- This medication significantly reduce the certain symptoms include impulsivity, anger, anxiety, depressed mood, and general level of functioning . For example:- opiramate (Topamax) and lamotrigine ( Lamictal ). OTHER MEDICATIONS:- SSRIs:- the treatment of co-occurring major depressive disorder, obsessive thoughts, anger, irritability, and unstable mood. MAOIs:- to decrease self harm and impulsive acts. Antianxiety agents and sedatives :- Anxiety and poor sleep .

19. Psychotherapy Psychotherapy :- also called talk therapy — is a fundamental treatment approach for borderline personality disorder . Dialectical behavior therapy (DBT ) :- focuses on the concept of mindfulness, or paying attention to the present emotion. DBT teaches skills to control intense emotions, reduce self-destructive behavior, manage distress, and improve relationships. Cognitive behavioral therapy (CBT ) :- can help people with BPD recognize and change both their beliefs and the ways they act that reflect inaccurate or negative opinions of themselves and others. This therapy can help people see difficult situations and relationships more clearly and find better ways to deal with them. .

20. Cont.. Mentalization - based therapy (MBT ) :- is a talk therapy that helps people identify and understand what others might be thinking and feeling. MBT emphasizes thinking before reacting. Schema-focused therapy (SFT). SFT combines therapy approaches to help you evaluate repetitive life patterns and life themes (schema) so that you can identify positive patterns and change negative ones. Transference-focused psychotherapy (TFP). Also called psychodynamic psychotherapy, TFP aims to help you understand your emotions and interpersonal difficulties through the developing relationship between you and your therapist .

21. Community resources Canadian mental health association Walk-In Counselling Counselling and Therapy Day treatment programs Drop-in centres Housing and Home Supports Assertive Community Treatment (ACT) teams Self-help, Mutual Aid and Support Groups Finances and Money Community Health and Resource Centres General Community Mental Health Services

22. other 1-800-SUICIDE If you are in distress or are worried about someone in distress who may hurt themselves, call 1-800-SUICIDE 24 hours a day to connect to a BC crisis line, without a wait or busy signal. That’s 1-800-784-2433. Outreach Support Services of Niagara (OSSN):- A non-profit agency with 3 offices in the Niagara Region (Niagara Falls, St. Catharine's and Welland) providing mental health counselling services to clients living in the Niagara Region. 5017 Victoria Avenue, Niagara Falls, ON, L2E 4C9 905-371-6776 Niagara Counselling Services (NCS) 5017 Victoria Avenue, Niagara Falls, ON, L2E 4C9 905-988-5748

23. Working with People that have Borderline Personality Disorder People with boarder line personalities can be quite challenging to work with, as they are highly manipulative; treating them can require a tremendous amount of energy It’s important to be firm, consistent, empathetic, matter-of-fact and to avoid arguing or power struggles Staff must also be diligent in avoiding staff-splitting Set limits and boundaries When patients begin to act out, they may threaten suicide Be aware when patients begin to display a sense of entitlement and narcissism.

24. Nursing diagnosis Risk prone health behaviour related to negative attitude toward health behaviour evidenced by failure to achieve optimal sense of control

25. GOALS SHORT TERM GOALS 1 . Client will discuss with primary nurse the kinds of lifestyle changes that will occur because of the change in health status. 2. With the help of primary nurse, client will formulate a plan of action for incorporating those changes into his or her lifestyle. 3. Client will demonstrate movement toward independence, considering change in health status. LONG TERM GOALS Client will demonstrate competence to function independently to his or her optimal ability, considering change in health status, by time of discharge from treatment

26. INTERVENTIONS Encourage client to talk about lifestyle prior to the change in health status. Discuss coping mechanisms that were used at stressful times in the past Encourage client to discuss the change or loss or fear and particularly to express anger associated with it Provide assistance with activities of daily living (ADLs) as required. Help client with decision making regarding incorporation of change or loss into lifestyle Use role-playing to decrease anxiety as client anticipates stressful situations that might occur in relation to the health status change.

27. CONT… Ensure that client and family are fully knowledgeable regarding the physiology of the change in health status and its necessity for optimal wellness. Encourage them to ask questions, and provide printed material explaining the change to which they may refer following discharge Help client identify resources within the community from which he or she may seek assistance in adapting to the change in health status. Examples include self-help or support groups and public health nurse, counsellor, or social worker. Encourage client to keep follow-up appointments with physician, or to call physician’s office prior to follow-up date if problems or concerns arise.

28. Outcome criteria Client is able to perform ADLs independently. Client is able to make independent decisions regarding lifestyle considering change in health status. Client is able to express hope for the future with consideration of change in health stat

29. Nursing diagnosis Ineffective coping related to low self esteem Goals/Objectives Short-term Goal:- By the end of 1 week, client will comply with rules of therapy and refrain from manipulating others to fulfil own desires. Long-term Goal :- By time of discharge from treatment, client will identify, develop, and use socially acceptable coping skills.

30. Interventions 1.Discuss with client the rules of therapy and consequences of noncompliance. Carry out the consequences matter-of-factly if rules are broken 2.Do not debate, argue, rationalize, or bargain with the client regarding limit-setting on manipulative behaviours 3.Encourage discussion of angry feelings. Help client identify the true object of the hostility. Provide physical outlets for healthy release of the hostile feelings (e.g., punching bags, pounding boards). 4.Take care not to reinforce dependent behaviours. 5.Help client recognize some aspects of his or her life over which a measure of control is maintained 6.Identify the stressor that precipitated the maladaptive coping. 7.Provide positive reinforcement for application of adaptive coping skills and evidence of successful adjustment

31. Outcome criteria Client is able to verbalize alternative, socially acceptable, and lifestyle-appropriate coping skills he or she plans to use in response to stress. 2. Client is able to solve problems and fulfil activities of daily living independently. 3. Client does not manipulate others for own gratification

32. Refrences Borderline Personality Disorder (BPD): Ontario: Mental Health Services, Help and Support:  eMentalHealth.ca . ( n.d .). Retrieved 20 July 2015, from http://www.ementalhealth.ca/Ontario/Borderline-Personality-Disorder-BPD/index.php?m=heading&ID=176 Borderline Personality Disorder. ( n.d .). Retrieved 20 July 2015, from  http://www.nimh.nih.gov/health/publications/borderline-personality-disorder/index.shtml Gunderson, J. G. (2009).  Borderline Personality Disorder: A Clinical Guide .  Google Books . American Psychiatric Pub. Retrieved from https:// books.google.ca/books?id=PlcmXG9GFIoC&printsec=frontcover&dq=personality+disorder&hl=en&sa=X&ved=0CGAQ6AEwCGoVChMIu-6est_lxgIVRg-SCh0wMAY3 Mobascher , A., Mobascher , J., Schmahl , C., & Malevani , J. (2007). Treatment of borderline personality disorder with atypical antipsychotic drugs. Der Nervenarzt , 78(9), 1003

33. r efrences Marshall- Henty , J., Sams , C., Bradshaw, J., & Cheryl, R. S. (2009a).  Mosby’s comprehensive review for the Canadian RN exam  (1st ed.). Toronto: Mosby-Year Book. Morrison- Valfre , M. (2013).  Foundations of mental health care  (5th ed.). St. Louis, MO: Elsevier/Mosby. Nursing Care Plan for Ineffective coping, antisocial behavior and narcissistic personality disorder. ( n.d .). Retrieved 20 July 2015, from http://www.pterrywave.com/Nursing/Care%20Plans/107.aspx Oberg, B. (2012, January 13). Subtypes of Borderline Personality Disorder | More Than Borderline. Retrieved 20 July 2015, from http:// www.healthyplace.com/blogs/borderline/2012/01/becoming-more-specific-subtypes-of-borderline-personality-disorder Schultz , J. M., & Videbeck , S. L. (2009).  Lippincott’s Manual of Psychiatric Nursing Care Plans  (8th ed.). Philadelphia: Lippincott Williams and Wilkins .