Improving Communication with Borderline Personality Disorder Patients

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Improving Communication with Borderline Personality Disorder Patients

By CareerSmart® Learning Contributor, April 26, 2016, as published by Healthcare Hot Spot

Dr. Antonia New’s psychiatric focus is working with people diagnosed with Borderline Personality Disorder (BPD).  While working in hospitals, she saw the stigma that medical staff attached to the diagnosis and recognized that “the worst thing you could call a patient was borderline.” 

Working with patients diagnosed with BPD can be especially challenging because they display dysfunction in four areas of their lives: relationships, impulse control, self-image, and emotions. The combination of these four dysfunctional areas often translates to erratic and demanding behavior that can be difficult to manage.  Three approaches to better work with people diagnosed with BPD include:

1. Set limits. Set limits on both positive and negative behaviors to reinforce appropriate behaviors that team members and the patient understand.  These limits can involve frequency of visits, phone calls, or emails.  For example, if a patient exceeds the agreed upon number of phone calls to the office for the day, then the consequence is team members terminate any additional calls initiated by the patient for the remainder of the day.  On the other hand, if the patient visits the office only during the allotted times, then the patient gets a corresponding reward.  The challenging part is ensuring the team understands that the consequences, good and bad, must be consistent.  People diagnosed with BPD will often call or visit a number of different team members, so having a single point person can help resolve this issue.

1. Validate emotions.  People diagnosed with BPD typically react to situations and people inappropriately.  Validate the appropriate emotions and interactions but “don’t validate the invalid” emotions.  Empathetic care and listening will foster a trusting relationship that is based on appropriate interactions and truth.  Listen to the patient, confirm the truths, and correct assumptions.

1. Support positive coping abilities.  It is common for people diagnosed with BPD to think that shouting the loudest gets things done faster.  This is an inappropriate coping mechanism that should not be encouraged, even if it worked well in the past.  Instead, encourage the appropriate behaviors by giving patients additional attention when they communicate and cope through constructive means. ²

Approximately 2% of the population has BPD, making it more prevalent than schizophrenia.  Healthcare professionals shouldn’t stigmatize people or particular diagnoses; instead, providers should strive to focus on empathetic care and communication styles that better suit the patients’ needs.

¹Moran, Mark.  Her Studies Uncovered BPD’s Neurological Secrets.  Retrieved from http://psychnews.psychiatryonline.org/doi/10.1176/pn.46.8.psychnews_46_08_4_1

² Care for the Homeless Council Clinicians’ Network.  (2003).  Patients with Borderline Personality Disorders Challenge HCH Clinicians. Retrieved from http://www.nhchc.org/wp-content/uploads/2012/02/hh-0903.pdf