A mental health condition called borderline personality disorder (BPD) affects how people think and feel regarding themselves and others, which makes it difficult to function in daily life.
It includes issues with self-image, trouble controlling emotions and conduct, and a history of unstable relationships.
Borderline personality disorder manifests itself commonly in early adulthood. It gets worse during early adulthood and may progressively become better as people age.
Signs and Symptoms of Borderline Personality Disorder
Symptoms of borderline personality disorder improve over time and occasionally even go away completely in most cases. They may include:
- Fear of abandonment. People with BPD experience extreme panic or rage when they believe they are being mistreated or abandoned. Patients might keep track of their loved ones’ whereabouts or prevent them from departing. To prevent rejection, pushing individuals away before being attached is their defense mechanism.
- Unstable relationships. Due to their inclination for abrupt and drastic changes in how they perceive others, people with BPD find it difficult to maintain meaningful interpersonal connections. Patients are capable of switching abruptly between idealizing and undervaluing other people. Their connections with friends, spouses, and family members are frequently erratic and unstable.
- Unstable self-image or sense of self. Individuals with BPD may abruptly and radically change their goals, opinions, jobs, or friends, as well as have a skewed or confusing self-image, frequently feel guilty or humiliated, and perceive themselves as their antagonist. Patients frequently obstruct their progress.
- Mood swings. BPD patients may experience sudden changes in their feelings about other people, the outside environment, and themselves. Irrational emotions, which include excessive rage, fear, anxiety, hatred, melancholy, and love, vary frequently and abruptly. These swings rarely continue longer than a few days and typically just last a few hours.
- Impulsive and dangerous behavior. People with BPD experience numerous episodes of risky driving, arguing, gambling, substance usage, binge eating, and dangerous sexual conduct.
- Repeated self-harm. BPD patients may cut, burn, injure themselves, or even threaten to do so. They might even contemplate suicide. These self-destructive behaviors are typically brought on by being rejected by, perhaps being abandoned by, or being let down by a guardian or lover.
- Persistent feelings of emptiness. Many persons with BPD feel depressed, bored, unfulfilled, or empty. A sense of inadequacy and self-loathing are also prevalent.
- Anger management issues. Individuals with BPD frequently experience extreme rage and have a hard time managing it. They could use cutting sarcasm, bitterness, or angry outbursts to show their anger. Shame and remorse are frequently experienced after these episodes.
- Temporary paranoid thoughts. Elevated stress can result in dissociation periods, paranoid thoughts, and occasionally hallucinations. The fear of abandonment is a common source of extreme stress. The majority of the time, these symptoms are temporary and not severe enough to be classified as a separate condition.
All of these symptoms are not observed in every person with borderline personality disorder. Symptoms might range in intensity, frequency, and length depending on the person.
Causes of Borderline Personality Disorder
The etiology of borderline personality disorder is not entirely understood yet. Healthcare workers believe BPD may be linked to:
- Genetics. Personality disorders may be inherited or be closely related to other mental health issues according to some research on twins and families.
- Brain changes. In people with BPD, the parts of the brain that control emotion and behavior don’t communicate effectively. These abnormalities impair the manner their brain functions.
- Childhood abuse and trauma. Up to 70% of patients with BPD report having been the victims of sexual, emotional, or physical abuse as children. BPD is also linked to parental substance use disorder, maternal separation, poor maternal bonding, unsuitable family boundaries, and other factors.
Risk Factors to Borderline Personality Disorder
The risk of borderline personality disorder can increase due to some personality development-related factors. A few of these include:
- Hereditary predisposition. If one of the immediate family members—mother, father, brother, or sister—has the condition, the patient might be more susceptible.
- Stressful childhood. Many patients with the condition indicate that they experienced physical, sexual, or mental abuse or neglect as children. Some people lost a parent or a close guardian when they were young, or they had grandparents or other relatives who misused drugs. Some have experienced aggressive fighting and dysfunctional family connections.
Complications of Borderline Personality Disorder
Patients with borderline personality disorder may experience complications that can affect their daily activities. These include:
- Engaging in risky behavior
- Drug abuse
- Job loss
- Not completing education
- Suicide attempts
- Unstable relationship
- Multiple legal issues
Furthermore, the patient may have other mental health disorders:
- Depression
- Substance abuse
- Anxiety disorder
- Eating disorder
- Bipolar disorder
- Post-traumatic stress disorder
- Attention-deficit hyperactivity disorder
Diagnosis of Borderline Personality Disorder
Borderline Personality Disorder is diagnosed just like other personality disorders. Diagnosis may be thru:
- An in-depth discussion with the physician or mental health professional
- Medical history and exam
- Discussion of signs and symptoms manifestation
- Psychological assessment that can involve answering questionnaires
Mental health experts frequently consult with the patient’s family and friends to gain a deeper understanding of his actions and past.
Treatment for Borderline Personality Disorder
The main types of treatment for borderline personality disorder are psychotherapy and medication.
- Psychotherapy. A key component of treating borderline personality disorder is psychotherapy, commonly known as talk therapy. To better meet the patient’s needs, the therapist could change the therapy’s format. Types of effective psychotherapy include:
- Dialectical behavior therapy (DBT). DBT is a therapy approach that addresses borderline personality disorder by combining group and one-on-one sessions. DBT teaches the patient how to control their emotions, tolerate discomfort, and strengthen relationships using a skills-based approach.
- Schema-focused therapy. Schema-focused treatment can be done alone or in a group. It can assist the patient in identifying unmet needs that have given rise to unhealthy life habits that are now destructive in many aspects of their life. The goal of therapy is to support healthy ways for the patient to meet their needs to encourage good life patterns.
- Mentalization-based therapy (MBT). MBT is a form of talk therapy that enables the patient to recognize their current ideas and emotions and develop an alternative viewpoint. The core of MBT is the idea of thinking before acting.
- Systems training for emotional predictability and problem-solving (STEPPS). Working in groups, STEPPS is a 20-week therapy program that includes the patient’s loved ones, caregivers, friends, or significant others. STEPPS is employed in combination with other forms of psychotherapy.
- Transference-focused psychotherapy (TFP). TFP, which is also known as psychodynamic psychotherapy, attempts to improve the patient’s understanding of their emotions and interpersonal issues by fostering a close bond between the patient and therapist. The patient then uses these realizations in ongoing circumstances.
- Good psychiatric management. This method of treatment emphasizes case management and focuses treatment on the expectation of engagement in work or school. It focuses on comprehending emotionally challenging circumstances by considering the interpersonal context of sentiments. It is possible to combine medication, groups, family education, and one-on-one therapy.
- Medications. Although the Food and Drug Administration has not yet approved any pharmaceutical medications, especially for the treatment of borderline personality disorder, some drugs may be able to help with symptoms or co-occurring conditions like depression, impulsivity, aggression, or anxiety.
- Hospitalization. A patient may need more-intense treatment in a psychiatric hospital or clinic. A stay in a hospital may help a patient avoid self-harm or deal with suicidal thoughts and actions.
Nursing Diagnosis for Borderline Personality Disorder
Nursing Care Plan for Borderline Personality Disorder 1
Risk for Self-mutilation
Nursing Diagnosis: Risk for Self-mutilation related to the desperate need for attention and feelings of depression secondary to borderline personality disorder.
Desired Outcome: The patient will be able to be free from self-inflicted injury and the patient will able to participate in impulse control training and coping skills training.
Borderline Personality Disorder Nursing Interventions for Risk for Self-Mutilation
Assess and evaluate the patient’s history of self-mutilation, including the type of mutilation behaviors, frequency of behaviors, and stressors that cause the behavior. Assessing and evaluating the patterns and circumstances that affect the patient’s behavior can help the nurse or the caregiver plan interventions and strategies that would suit the patient.
Ask the patient about his or her feelings experienced before and around the act of self-mutilation. The patient’s feelings serve as a guideline for the nurse’s future intervention.
Instruct the patient to secure a written or non-verbal contract and identify specific steps including the person who can be notified when prompted to self-mutilate. The nurse should encourage the patient to take responsibility for healthier behavior. The nurse should talk to others and learn alternative coping skills that will help reduce the frequency and severity until such behavior ceases.
Nursing Care Plan for Borderline Personality Disorder 2
Nursing Diagnosis: Chronic Low Self-esteem related to lack of realistic ego boundaries, shame, and guilt secondary to borderline personality disorder as evidenced by hesitation to try new things and rejecting positive feedback and exaggeration of negative feedback about himself or herself.
Desired Outcomes: The patient will be able to set realistic goals with the nurse and he or she will state a willingness to work on future realistic goals.
Borderline Personality Disorder Nursing Interventions for Chronic Low Self-Esteem:
Assess and evaluate the patient’s self-perception and target different areas of the patient’s life including his or her strengths and weaknesses. The nurse should identify the patient’s strengths and weaknesses so that the nurse can work on the realities of the patient’s self-appraisal.
Ask and discuss with the patient his or her plans for the future and work with the patient to set a realistic short-term goal. Discussing and looking toward the future minimizes dwelling on the past and will reduce self-rumination.
Give the patient honest and genuine feedback about his or her strengths, and areas that could help him or her have additional skills. The nurse’s feedback may help the patient to have a more accurate view of self, strengths, and areas that he or she can work on.
Nursing Care Plan for Borderline Personality Disorder 3
Impaired Social Interaction
Nursing Diagnosis: Impaired Social Interaction related to difficulties with emotional regulation, poor impulse control, and unacceptable social behavior secondary to borderline personality disorder as evidenced by destructive behaviors towards self or others and observed use of unsuccessful social interaction behaviors.
Desired Outcome: The patient will be able to identify and will be able to express his or her feelings as they occur and the patient will state willingness to continue in follow-up therapies.
Borderline Personality Disorder Nursing Interventions for Impaired Social Interaction:
Set and maintain limits on the patient’s manipulative behaviors such as arguing or begging, angry, demanding behaviors, instilling guilt, clinging, constantly seeking attention, and frequently disregarding the rules. Manipulative behaviors of the patients should be limited and it needs to be clear because the nurse should expect that the patient’s manipulative behaviors will be seen repeatedly.
Explain to the patient the expected behaviors and limits respectfully and neutrally during the sessions. Clearly state and identify the rules and regulations of the institution and the possible consequences when the rules are not adhered to. From the beginning of the intervention the patient should be advised about the guidelines and boundaries for his or her expected behaviors and the patient should be asked about what he or she expects from the nurse.
Collaborate with the patient and the multidisciplinary team in establishing a reward system for compliance which include clearly defined expectations. The patient’s positive behaviors can be strengthened through tangible reinforcement and meeting expectations.
Nursing Care Plan for Borderline Personality Disorder 4
Nursing Diagnosis: Ineffective Coping related to uncertainty or fear of the future lack of motivation to change behavior and lack of confidence in the ability to cope secondary to borderline personality disorder as evidenced by anger, extreme distrust of others, manipulation of others, and poor judgment.
Desired Outcome: The patient will be able to express needs directly without ulterior motives and he or she will be able to talk about his or her feelings and perceptions.
Borderline Personality Disorder Nursing Interventions for Ineffective Coping:
Assess and identify the patient’s behavioral limits and behaviors that are expected of the patient. The nurse should assess the client’s needs and the nurse should maintain limits with the patient that can enhance feelings of safety in the patient.
Avoid and refrain from sharing or giving personal information to the patient. Giving personal information to the patient will open up areas for manipulation and will undermine professional boundaries.
Explain briefly and be very clear about the consequences if the patient does not follow policies and limits. This will help in enforcing that the patient is responsible for his or her actions.
Nursing Care Plan for Borderline Personality Disorder 5
Nursing Diagnosis: Self-care Deficit related to the inability to concentrate on one thing at a time and racing thoughts and poor attention span secondary to borderline personality disorder as evidenced by the inability to eat, bathe, toilet, dress, and groom self independently.
Desired Outcome: The patient will be able to perform self-care and he or she will be able to eat each meal properly and the patient’s weight will return to its normal limit.
Borderline Personality Disorder Nursing Interventions for Self-Care Deficit:
Advise and encourage the patient to have frequent rest periods during the day and encourage warm baths, soothing music, and medications at night when indicated. This intervention will help in promoting relaxation to the patient; lack of rest and sleep can lead to exhaustion and death.
Advise and encourage frequent high-calorie protein drinks and finger foods such as sandwiches, fruit, and milkshakes. A patient with borderline personality disorder needs constant fluid and calorie replacement and should be allowed to have finger foods because she might be too active to sit at mealtime.
Provide simple step-by-step reminders to the patient regarding hygiene and dressing. Simple and concrete instructions are important because the patient may experience distractibility and poor concentration.
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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