Borderline Personality Disorder

Question: Shayne (23 year-old first-generation Australian from European immigrant background) is a well- known frequent admission to the inpatient mental health unit. She has had a mental health case manager since she was 15 years old, and is currently on a management plan with the local community mental health team. In the past, she has been diagnosed with depression, bipolar disorder, anxiety disorder, dyslexia and other learning difficulties. She has frequently been admitted in crisis, with suicidal ideation and a range of self-harm issues including cutting, overdose, and pulling out her hair. She has previously disclosed a history of childhood sexual assault by a relative, and has yet to press charges against her abuser, despite frequently discussing the idea with her psychologists. When not in hospital, Shayne is a full time university student completing an honours program in Creative Arts (photography and design). She is from a wealthy family, and has access to housing and transport provided by her parents, but currently lives with an older brother in accommodation near university. Shayne has recently been diagnosed with Borderline Personality Disorder. Write a Case Study which assumes they have been accepted as a client by a NSW Health Community Mental Health Team. Answer: Brief Borderline Personality Disorder or BDP is a type of mental illness which makes people hard to feel safe when they are in the company of other people. They also fear having healthy beliefs and thoughts about themselves. The individuals who are suffering from BDP are unable to control their impulses and emotions. These people experience distress in family, social life and in their work and they might even try to harm themselves. The individuals suffering from BPD does not have any physical ailments, rather it is just a condition of the mind and the brain (Borderline Personality Disorder, 2015). The researchers are not able to find out the reason of this mental disorder. The researchers have shown that the disease is due to a combination of biological factors or the genetic factors and also the experiences that the person gains while growing up. The experiences can be anything from trauma in early life to severe loss. It is estimated that at any point in time, 1.8% of the general popula tion experience BPD. About 75% of these are females (males are more likely to be diagnosed with other disorders). Spectrum the BPD service Victoria. The DSM-IV-TR categorizes personality disorders into 3 behavioral clusters: a. odd or accentric; b. dramatic, emotional or erratic and c. anxious and fearful. The symptoms of this mental disorder start arising during the adolescence or at the early adulthood of the person and it is seen that this disease tends to get better with time as the person grows up (Gunderson, 2015). Symptoms of Borderline Personality Disorder The symptoms of this disease can be discussed as below: Emotions which are out of control- people who are suffering from BPD often show symptoms of changeable feelings of hate and love. They sometimes tend to depend fully on others and sometimes they tend not to depend at all on others. People suffering from this condition easily trigger various levels of emotions and they have problems controlling their emotions of anger or love. Behavior which can cause self damage- it means that the people who are suffering from this mental disorder are more likely to cause self harm or may attempt suicide (Aguirre Galen, n.d.). The person indulges in this sort of actions as this often helps in temporarily relief from the sufferings. It may also tend to make the individual addicted to alcohol or drugs. Concerns about their abandonment- the individual may show certain behavior or they may react to criticism or rejections. They have problems coping with separations from people and losses (Health.qld.gov.au, 2015). Their unstable self esteem and interpersonal relationship- the person suffering from this disease is always in an urge to find self esteem and identity. Maintaining the thoughts and feelings is very difficult for them and it sometimes makes them feel vulnerable. Sudden depression, anger, anxiety and rage- past problems related to trauma, deprivation and abuse can lead to depressions, nightmares, panic symptoms like anxiety and rage. The people also tend to become more impulsive in this condition (Nimh.nih.gov, 2013). Diagnosis of Borderline Personality Disorder There are various ways by which the disorder can be diagnosed. The diagnosis can be done if the person shows certain disorders like dyslexia, depression, anxiety, bipolar disorder, and other difficulties. It needs to be seen that the patient in this case Shayne needs to be treated in the community mental health setting whereby she will be treated outside the hospital in a friendly environment. In this type of treatment the person does not have to stay in the hospital to get the care and the treatment. it is seen that the people will get the required treatment in the community. Legal Status according to the Mental Health Act (2007) The objectives of the mental health act 2007 are: The consumers civil rights are protected. The act aims to provide appropriate care to the people who are mentally disordered or ill. To facilitate treatment, control and acre through the community facilities. To provide hospital care on involuntary and voluntary basis. A voluntary mental patient is one who chooses to get admitted to mental health facilities. The person is under care from their guardians and has been admitted with the guardians approval. If the medical officer feels that the person is either mentally disordered or ill then he can retain the patient. But the patient can at any time discharge himself or the medical officer can discharge that person if he feels so (MENTAL HEALTH ACT (2007) GUIDE BOOK, 2015). An Involuntary mental patient is the one who has been taken into care against their will. Such a case happens when the person has committed an offence in the state of mental disturbance. Moreover if the person has tried to risk his life, or made an attempt to kill someone else then they can be taken into care against their will as well. This type of individuals are taken to welfare centers and dealt under the mental health legislation and not under criminal laws. Impact of the disorder on the individual A person suffering from borderline personality disorder is not clear about his sense of self, and frequently feels fundamentally flawed or worthless. Inexplicable anger, mood swings and impulsivity generally drive others away, even though the suffering person wants to have loving relationships. BPD affects how someone feels about himself, how he behaves and how he relates to others (Chapman Gratz, n.d.). A person suffering from BPD often suffers from insecurity and sometimes changing sense of who he is and it is called as identity diffusion. A person may see himself as bad or evil, and sometimes they may feel that he doesnt exist at all. This unstable state of mind often leads to frequent changes in friendships, jobs, values, and goals. It is also one of the most common causes of the risk-taking behaviors and self-harming behavior associated with this mental disorder (Krawitz Jackson, 2008). Impact of the disorder on the family The people who are diagnosed with BPD may be at risk and it also affects the family members of the person (Roberts and Roberts, 2007). Their career, family, property and also their own life are in constant risk of being affected. People with BPD also affect their near and dear ones; their friends, family and partners. The family members are in stress when they see that the person is suffering. They may feel helpless watching the person suffer and engage in destructive behaviors. Often the family members also experience psychological trauma when they experience the high risks of the mental disorder (BPDFamily, 2015). Often the level of stress can lead to tension in marriage and also divorce and separation. It is often seen that some of the family members move away from the family to avoid the stress of having a BPD in the family. Impact of the disorder on their careers BPD often affects the careers of a person. The problem arises when the person suffers from identity crisis. It makes an individual hard to settle or focus on a career path. The person jumps from one job to another and does not build a successful career on a particular job (Roberts Roberts, 2007). It is known that interaction is very important in any job but it may be difficult for a person to socialize with the people around them in this condition (Bateman Fonagy, 2004). They cannot operate within deadlines and also cannot tolerate anyone dictating them and it often leads to losing their jobs. The risks associated with their diagnosis Several studies have been performed on people to find out the reasons as to why a certain person is prone to BDP. The studies have found that there are several childhood incidents that may lead to the mental disorder. Socioeconomic deprivation, stressful life and trauma are some of the reasons of the increased BPD. Moreover bad parenting and psychiatric disorders may also lead to this disorder (Spectrumbpd.com.au, 2015). Risk factors related to genes The individuals who have a sensitive genotype are at a greater risk of having BPD. When these people are disposed to the environment of serious tension and trauma, they may accumulate the disorder. This mental disorder has the risk of recurring illness and may even lead to adverse life events (Sutton, 2010). Risk factors related to the environment The adverse experiences of childhood like abuse, trauma, and neglect and other interpersonal difficulties may lead to the mental disorders. The maladaptive parenting and schooling experiences as well as low family income, low socioeconomic status and single parent upbringing are some of the risks associated with the persons mental disorders when they grow up. The individuals who have a history of mental disorder like for example our client Shayne who was having the disorder when she was 15 years and have been undergoing constant treatment from since then. She was diagnosed with bipolar disorder and recently been diagnosed with BPD. The cause of her mental disorder was a childhood sexual abuse by a relative against whom she has not taken any step (Dsm5.org, 2015). She was unable to cope up with that trauma and has constant mental breakdown and tendency to hurt her repeatedly. Moreover she is from a rich family background and her family is not bothered about her wellbeing and has given he all the luxuries but not the mental care and support that she needed. Often the problem recurs when the person goes through the same phase in the life. Maybe there is a tense situation in workplace or an assault from some person. The BPD person will face difficulty in coping with the new addition of mental pressure and might lead to a breakdown. How the problem can be assessed The mental disorders can be assessed by the American Psychiatric Associations DSM (Diagnostic and statistical manual of mental disorders). It is very difficult to diagnose the BPD as it sometimes overlaps the conditions of psychiatric disorders as well as bipolar disorders. Thus it is a challenge to identify the disease with experience. It is always necessary to consult an expert on this matter for the diagnosis. The early symptoms of this disorder are that the person shows repeated unstable and intense behaviors with other people in a relation to him. The persons may be sent to a psychiatrist for counseling if they are found to be self harming and emotionally instable (Davidson, 2012). If the person constantly feels empty and emotionally low then also the people around him needs to consult to an expert. Often the treatment is also very distressing for the person. The doctor or the expert needs to be careful while treating the person not to traumatize him any further. The thing that needs to be handled is how the person is functioning socially and psychologically. The family also needs to ensure that the person is safe and causing no harm to him and the people surrounding him (Kristalyn Salters-Pedneault, 2015). A treatment plan There are various psychological theories that are effective in the treatment of the people suffering from BPD. The people who are suffering from this disease must be given a structured psychological treatment by professionals and experts. The doctors should not choose to treat the person with medicine as medicines make fewer improvements or show no improvements at all. The expert who treats the persons with mental disorders needs to handle the person with respect. The doctor must be caring and compassionate; he needs to be reliable and consistent also (Understanding borderline personality disorder, 2015). The doctors must pay attention to the BPD people while listening to him so that the person clearly communicates with the doctor. The doctor must admit the person with acute mental problem if he feels so; but he must also make sure that the person doesnt stays in the hospital for a long time since it may be very stressful for the person. The most useful and helpful treatment plan for the people suffering from BPD is to let them have a normal life with the care of their family. The doctors also must acknowledge the role of the family in healing the patients mental condition to a great extent. The doctors must involve a care plan for the person by involving the family, friend and others who care for the person. The doctors must educate the family and the friends of the person in order to support the person mentally. The doctors should also educate the families to deal with suicidal attempts as well as self harm behaviours. The family is also given advises on how they should interact with the person on a day to day basis. How the family can be involved The family of Shayne as in this case must bear with her. They need to be supportive and show care and love towards her. They must stay calm and guide her in her journey. The family must speak to her and find out how she is dealing with her difficulties keeping in mind not to put pressure on her mind. Her family must try and keep her happy not only by giving her all the luxuries but also by showing that they are there to support her and that they care for her well being. The family needs to take her to outings and associate her in works so that she is away from mental stress. Moreover the family can act as the guide for her and must help her in her needs. Medication Shayne had overdose her self Naloxone should be used in the diagnosis and treatment of opioid overdose associated with impaired consciousness and/or respiratory depression (NICE CG16, 2004. While medications do not cure BPD, some medication may be helpful in managing specific symptoms. Some medication can reduce symptoms of anxiety, depression or aggression. (national institute of mental health) Omega-3 fatty acids can reduce the symptoms of aggression and depression. Services to help her combat her disorder Skill-based training- A skill-based training group is designed to augment the capabilities and problem-solving skills of the individual, and it allows for practice of same in the form of role playing within the group which comprises of approximately 2hours per week. Individual psychotherapy- Individual psychotherapy, delivered on a weekly basis for 6090min, with its function to relate the skills learned in the group to the clients personal circumstances. It also allows time for addressing commitment to the therapy and aims to reduce identified problem behaviors. Telephone calls- Telephone consultation is designed to briefly assist clients to utilize appropriate skills to overcome obstacles in an effective manner. Also, it aims to maintain the therapeutic relationship and help the individual ask for help. Consultation team meetings- Meeting between the therapy team on a weekly basis to facilitate case discussion and enhance the therapists skills and provide support and motivation. It also helps therapists adhere to the treatment plan and helps to prevent therapist burnout. Useful services by the nurse Nurses should involve patient in all decision making so that decisions are based on an explicit, joint understanding and the person is encouraged to consider the various treatment options. The mental care health professionals include the general practitioners, nurse practitioners, clinical psychologists and aboriginal health workers. These people helps and support the person suffering from the problem as well as the family, so that the person may overcome the BPD. They conduct mental health assessments for the patients who have repeatedly faced the problem and also indulged in risk taking attitudes. After discharging the patient from the treatment, the nurses provide a brief consultation to the patients and their family (Garber, Gross Slonim, 2010). The nurse also sees that whether any other service providers have been provided or not. They re-access the services if it is needed in future. The nurse and other health attendant also see that the rules are maintained by the patient and re-engage with the patient if they do not follow so. Thus the nurses constantly keep in touch with the family and the patient to ensure that the patient is enjoying a healthy life. Conclusion It can be concluded by saying that the disease is a serious mental disorder and needs to be treated with care. The patient in this case needs to have proper care outside the hospital or the community health care centre (Understanding borderline personality disorder, 2015). The family needs to support her in the recovery process as well as she must take the initiative to be stable and look at the fact that she does not become too excited. More over it needs it be seen that the family needs to know how to support her and she needs to take medication as well as psychology treatment. References Aguirre, B. Galen, G. (n.d.).Mindfulness for borderline personality disorder. Bateman, A. Fonagy, P. (2004).Psychotherapy for borderline personality disorder. Oxford: Oxford University Press. Borderline Personality Disorder. (2015). 1st ed. [ebook] National Institute of Mental Health. Available at: https://www.nimh.nih.gov/health/publications/borderline-personality-disorder/Borderline_Personality_Disorder_508_141959.pdf [Accessed 24 Feb. 2015]. BPDFamily, (2015).BPDFamily. [online] Available at: https://bpdfamily.com/ [Accessed 24 Feb. 2015]. Chapman, A. Gratz, K. (n.d.).Borderline personality disorder. Davidson, D. (2012).CHIEF PSYCHIATRISTS REVIEW OF CLINICAL PRACTICE. 1st ed. [ebook] Available at: https://www.chiefpsychiatrist.health.wa.gov.au/docs/Admissions_and_Discharges_of_Mental_Health_Presentations_Report_June_2012.pdf [Accessed 24 Feb. 2015]. Dsm5.org, (2015).Home | APA DSM-5. [online] Available at: https://www.dsm5.org/Pages/Default.aspx [Accessed 24 Feb. 2015]. Garber, J., Gross, M. Slonim, A. (2010).Avoiding common nursing errors. Philadelphia: Wolters Kluwer Health/Lippincott Williams Wilkins. Gunderson, J. (2015).An Introduction to Borderline Personality Disorder. 1st ed. [ebook] Available at: https://www.borderlinepersonalitydisorder.com/documents/A_BPD_Brief_REV2011.pdf [Accessed 24 Feb. 2015]. Health.qld.gov.au, (2015).Mental Health Psychoeducational Factsheets, Mental Health Services, Royal Brisbane and Women's Hospital. [online] Available at: https://www.health.qld.gov.au/rbwh/services/mh_factsheets.asp [Accessed 24 Feb. 2015]. Krawitz, R. and Jackson, W. (2008).Borderline personality disorder. Oxford: Oxford University Press. Kristalyn Salters