Question

Personality Disorder Case Study

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.”

Answer the following questions related to Lana:

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?

Answer 1

The nurse should respond in an optimistic way at the same time making sure the patient diverts herself from the manipulative behavior and concentrates on the present thing. This can be done through conversation with the patient in therapeutic way,listening ,not arguing ,etc. , Encouraging to use defence mechanism will work best for patient .

The most impotyant intervention in these type of behavior is using talk therapy and behavioural dialectal therapy,nonpunitive care. can help patient to come out of splitting .