Question

Lana, age 32, was diagnosed with Borderline Personality Disorder when she was 26 years old. Her...

Lana, age 32, was diagnosed with Borderline Personality Disorder when she was 26 years old. Her husband took her to the emergency department when he walked into the bathroom and found her cutting her legs with a razor blade. At that time, assessment revealed that Lana had a long history of self-mutilation, which she had carefully hidden from her husband and others. Lana began long-term psychoanalytical psychotherapy on an outpatient basis. Therapy revealed that Lana had been physically and sexually abused as a child by both her mother and her father, both now deceased. She admitted to having chronic depression, and her husband related episodes of rage reactions. Lana has been hospitalized on the psychiatric unit for a week because of suicidal ideations. After making a no-suicide contract with the staff, she is allowed to leave the unit on pass to keep a dental appointment that she made a number of weeks ago. She has just returned to the unit and says to her nurse, “I just took 20 Desyrel while I was sitting in my car in the parking lot.”

  1. The nurse is well acquainted with Lana and believes this is a manipulative gesture. How should the nurse handle this situation?
  2. What is the priority nursing diagnosis for Lana?
  3. Lana likes to “split” the staff into “good guys” and “bad guys.” What is the most important intervention for splitting by a person with borderline personality disorder?
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Answer #1

Borderline Personality Disorder. This disorder is characterized by a pervasive pattern of unstable interpersonal relationships, self-image, and affect, as well as marked impulsivity; borderline personality disorder is the most common personality disorder found in clinical settings.

Q

nurse can give a surprise expression and make the patient settled in bed by a friendly manner, nurse can make use of this time educate more about the consequences of suicide and for counselling aspect.

Q

NURSING DIAGNOSIS

have to check primarily in all this aspect

  • Risk for suicide related to low frustration tolerance.
  • Risk for self-mutilation related to impulsive behaviour.
  • Risk for other directed violence related to lack of feelings of remorse.
  • Ineffective coping related to failure to learn or change behaviour based on past experience or punishment. Social isolation related to ineffective interpersonal relationships.

splitting is psychological mechanism seen in borderline personality disorders which allows the person to tolerate difficult and overwhelming emotions by seeing someone as either good or bad, idealised or devalued. to easier management the emotions that they are feeling, which on the surface seem to be contradictory.

e.g.,

  • perfect or evil
  • always right and never right
  • always loving and never loving
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