Borderline Personality Disorder (BPD) - A Mental Health Clinician’s perspective

As a Mental Health Clinician working at Mentis Assist under the Mental Health Complex Care program, I would like to share my experiences and knowledge of working alongside clients that have a diagnosis of Borderline Personality Disorder (BPD). 

BPD is a serious mental illness characterised by persistent instability in moods, interpersonal relationships, self-image, and behaviour. This instability often disrupts family and work life, long-term planning, and an individual's sense of identity.

I see clients of all ages that present with many different diagnoses, many clients with BPD usually have another co –existing mental illness mostly Depression and Anxiety.   

It is easy to look at clients as a diagnosis or a set of symptoms, but what I see, is a person that is suffering and in need of compassionate support. Unfortunately, I also often witness the stigma that is prevalent within the community associated with BPD.  Each person has a unique story that has brought them to the attention of mental health services; identifying the diagnosis is absolutely necessary, and the key to receiving the right treatment.  Finding health professionals and services that the client is comfortable with can take time and requires exploration, encouragement and a collaborative approach - this is a significant part of my role.

As a Mental Health Clinician, I use evidence based practices and skills that are specific to BPD. Some clients’ do not feel comfortable with certain therapies such as, the gold standard Dialectic Behavioral Therapy (DBT).  It is important to remember that one size does not fit all with BPD and the client must be ready to receive the right treatment at the right time in their recovery.

Building a trusting therapeutic relationship is paramount. This helps the client identify how their illness affects their lives and what tools they need to build resilience.  Having trust allows exploration of what works and what doesn’t work.  This relationship supports the client as they move through specialist services or need a referral to a new Psychiatrist or Psychologist.  It is important for the client to be ready to engage with specialist services.  The Clinician can support this process by advocating and providing collateral information so the client does not have to keep repeating their story again and again.

The following are symptoms of BPD:

  • Chronic intense sadness
  • Feelings of emptiness
  • Impulsivity
  • Ongoing thoughts of suicide
  • Brief periods of psychological dissociation
  • Intense psychological pain, sense of shame
  • Deep seated inner sense of badness about self
  • Self-loathing
  • Fears of abandonment

 

To ensure the client accesses the appropriate services, a collaborative approach and finding a supportive GP is essential in this journey.  The GP and Mental Health Clinician should provide consistency, understanding and assistance with navigating an often complex system, which can be daunting for the client and their families. The importance of this relationship cannot be understated.  Many clients have expressed their disappointment with their fragmented experience in accessing the right services, more often than not, in a crisis situation, exacerbating their feelings of abandonment. 

In my role as clinician, it is important to:

  • Listen and validate the client while focusing on their mindset rather than behaviours
  • Provide education about BPD, its causes, treatments and challenges
  • Advocate on behalf of the client, particularly during crisis situations
  • Work with families to ensure they understand the complexities of BPD and the supports available to them.

When a loved one is in crisis, it can be daunting for their family and significant others.  The following tips may be of assistance when dealing with someone with BPD:

  • Stay as calm as possible – avoid expressing excessive emotions (eg; anger, frustration)
  • Remember that the person’s emotional centre of the brain has taken over their thinking brain when they are in crisis.
  • Keep your emotional brain under control and use your thinking brain to help them. 

Developing a Crisis Plan with the client and their significant others is a great way to be prepared when a crisis occurs and should be done early in the recovery journey to help identify warning signs and triggers.  In some cases, it can be confronting when identifying a trigger event, but working with the client after a crisis, can be beneficial and provides an opportunity for the client to self—reflect, learn new coping skills and allows the clinician to identify a client’s strengths.

I have found that working within this program in a community setting the most rewarding and have seen positive health outcomes.  Providing consistent timely care promotes optimal wellbeing and forges strong relationships with other health professional providers. It is a collaborative team approach.

If you are feeling suicidal, experiencing a crisis or in need of immediate help, contact these 24/7 services for help immediately.  In an emergency call 000

https://www.mentalhealthonline.org.au/pages/useful-resources/crisis-services