by Phil Evans

Created on: May 29, 2007   Last Updated: September 26, 2007

BPD, There is a spectrum for everything, and if you are lucky enough fall on the lower end of it, and many BPD's do, then over time, with therapy, drugs for acute crisis, and the internal will for change, there is a chance, you can come out of that black tunnel and live functionally.

My experience over many years as a Nurse, we do not see those folk on the lower end of the spectrum, we see those folk, who were near the top of the que when the disorder was handed out by some higher power.

Most certainly, no one would chose to have BPD, the hallmarks being extreme emotional instability with themselves and others, possibly pseudo hallucinations, and a propensity to self harm for a hundred different reasons, stress release, secondary gain. etc.
I can say and many will not agree, but tough, in my experience, very few BPD's will become well, the main will either become one of 4 things.
1)Kill them self by design
2)Kill them self by accident, usually as an attention seeking gesture.
3)Achieve some degree of normality in todays society and with years of therapy, learn to co exist with the rest of us and hopefully never see the inside of a psych ward again. - this is the ideal result.
4)Or burn out over many years, and become dry cadaverous shells of their former selves, and the diagnosis shifts to a depressive/ Dsythmic disorder.
over nearly 20 years in acute psych wards this is what i have seen.
What i have also seen, been involved with, and still continue to do, is BPD's are the most destructive and challenging of any patient who walks through the doors.
The birth of a BPD is usually born from terrible abuse, and trauma as a young person and these personailty traits are slowly but surely incorporated within nthe individual, and i have not yet met one whose story would not bring tears to your eyers if you let it, and believe me if you do, it is the worst thing you could do as nurse or any other person in a caring role.
Any psych service worth its salt should have a community based team specifically set up to deal with BPD's, mine doesn't, where i worked once in new zealand that did and was successful, staffed with only the most experienced staff,
I am sorry if my insights etc, upset those whose try ot paint some picture that this is some noble disorder, it is not, quite simply BPD's in the psych ward are clearly the hardest patients to manage, and burnout of staff is extremely high, you will be quite literally emotionally sucked dry if are not experienced enough to be able

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