Borderline personality disorder (BPD) is a mental illness characterized by instability in moods, behavior, and relationships. It is caused by a combination of genetic and environmental factors such as childhood trauma. People with BPD may experience extreme mood swings, impulsivity, feelings of emptiness, fear of abandonment, and unstable self-image. Treatment involves medication to reduce symptoms like anxiety and depression as well as psychotherapy approaches like dialectical behavior therapy which teach skills for managing emotions and improving relationships.

1. SUBMITTED TO :- ASHLEY PETIS
SUBMITTED BY:- JAGROOP KAUR
KULBIR KAUR
LOVELEEN
MANPREET KAUR
PARMINDER KAUR
RAWANDEEP KAUR
SUKHDEEP KAUR

2. WHAT IS BORDERLINE PERSONALITY
DISORDER?
 Borderline personality disorder is a mental illness that
affects the way to relate to other people and the way you
relate to yourself. If you’re living with borderline personality
disorder, you might feel like there’s something
fundamentally wrong with who you are—you might feel
‘flawed’ or worthless, or you might not even have a good
sense of who you are as a person. Your moods might be
extreme and change all the time, and you might have a
hard time controlling impulses or urges. You may have a
hard time trusting others and you may be very scared of
being abandoned or alone.

3. DEFINITION
Borderline personality disorder (BPD) is a
serious mental illness characterized by
pervasive instability in moods,
interpersonal relationships, self-image,
and behaviour. This instability often
disrupts family and work life, long-term
planning, and the individual's sense of
identity.
Prevalence In Canada
About 1% to 2% of the general population has
BPD. It’s usually diagnosed in teens and
young adults, though it may also be
diagnosed later in life. It seems to affect more
women than men.

4. PATHOPHYSIOLOGY OF BORDERLINE
PERSONALITY DISORDER:
In patients with personality disorder,
abnormalities may be seen in the
frontal, temporal, and parietal lobes.
These abnormalities may be caused
by perinatal injury, encephalitis,
trauma, or genetics. Personality
disorders are also seen with
diminished monoamine oxidase
(MAO) and serotonin levels.

6. CAUSES OF BORDERLINE
PERSONALITY DISORDER
As with other mental disorders, the causes of borderline
personality disorder aren't fully understood. Experts agree,
though, that the disorder results from a combination of factors.
Factors that seem likely to play a role include:
 Genetics. Some studies shows personality disorders may be
inherited or strongly associated with other mental disorders
among family members.
 Brain abnormalities. Some research has shown changes in
certain areas of the brain involved in emotion regulation,
impulsivity and aggression. In addition, certain brain
chemicals that help regulate mood, such as serotonin, may
not function properly.
 Family members—You are five times more likely to develop
BPD if a close family member like a parent or sibling has BPD.
You also have a higher risk of BPD if a close family member
has an impulse control disorder like a substance use disorder
or antisocial personality disorder.

7. CONT….
 Childhood trauma & Environmental factors—Abuse, neglect, loss
and other hurtful events that occurred in your childhood increases
your risk of developing BPD.
 Age—BPD is more likely to be diagnosed in your 20s. This is also
the time with the highest suicide risk. Many people find that their
symptoms become more manageable as they get older, and many
people recover by the age of 50.Researchers aren’t completely sure
why people often feel better as they get older. One theory is that
people become less impulsive as they get older. Another theory is
that certain brain structures related to emotion change as we age.
 Other mental illnesses—Many people living with BPD have other
mental illnesses. This can make it hard to diagnose BPD properly.
The illnesses most often associated with BPD are mood disorders,
anxiety disorders, substance use disorders, attention-
deficit/hyperactivity disorder, eating disorders, dissociative
disorders and other personality disorders.

8. CLINICAL MANIFESTATIONS OF BORDERLINE
PERSONALITY DISORDER:
 Instability of mood, interpersonal relationships and
self-image.
 Impulsive, reckless behaviour that is often self-
demanding, such as substance abuse, spending
binges, heightened sexuality, or binge eating.
 Uncontrolled, inappropriate, or frequent anger
episodes.
 Fear of rejection and being alone; feels empty;
frantically tries to avoid being abandoned.
 Behaviour undermines goal achievement, leading to
job loss, chaotic relationships, and quitting education
programs.
 Self-injury and suicide threats are common.

9. TYPES OF BPD
DISCOU
RAGED
SELF-
DESTRUCTI
-VE
BODERLIN
E
PETUL
ANT
BODER
LINE
IMPUL
SIVE
BODER
LINE

10. CONT…
DISCOURAGED
BODERLINE
IMPULSIVE
BODERLINE
PETULANT
BODERLINE
SELF
DESTRUCTIVE
BODERLINE
Includes avoidant,
depressive or
dependent
behaviours
Operating in
Abandoned child
mode
Frantic efforts to
avoid the end of or
disturbance of any
relationship, black
and white thinking or
unstable sense of
self
Includes antisocial
or approval seeking
behaviours
Poor impulse
control
Constant conflict
with society
Seek approval at
any cost
Includes passive
aggressive
behaviours
Operates in an
angry child mode
Unstable sense of
self
A frantic fear of
abandonment,
inability to express
his or her needs
World is a problem
not him
Relationship
seems to be a game
Includes
depressive or self
destructive
behaviour
Popular cultural
image of person
‘Gath’ or ‘emo’
Often suffers from
depression as a co
occurring diagnosis
and is a self injurer
Two criteria –
emotional instability
and self injurious
behaviour-are
enough to merit a

11. DIAGNOSTIC EVALUATIONS
History taking
Mental status examination
CT scan
Electroencephalogram
(EEG)
https://www.youtube.com/wat
ch?v=s_3Iq5F95Xg

12. DSM-3-R AND DSM-4 DIAGNOSTIC CRITERIA FOR
BORDERLINE PERSONALITY DISORDER
1. a pattern of unstable and intense interpersonal
relationships characterized by alternating between
extremes of (over) ideation and devaluation.
2. frantic efforts to avoid real or imagined
abandonment (do not include suicidal or self-
mutilating behaviour)
3. chronic feelings of emptiness (or boredom)
4. affective instability (marked shifts from baseline
mood to depression, irritability, or anxiety) due to
marked reactivity of mood ( e.g.. intense episode
of dysphoria, irritability, or anxiety usually lasting
a few hours and only rarely than few days)

13. CONT…
5. Inappropriate, intense anger or lack of
control of anger 9frequent displays of
temper, constant anger, recurrent
physical fights)
6. impulsivity in at least two areas that
are potentially self damaging. E.g.
spending, sex, substance abuse,
reckless driving, binge eating (do not
include suicidal or self-mutolating
behaviour)
7. Recurrent suicidal behaviour,
gestures, or threats, or self mutilating
behaviour.

14. CONT…
 8. Identity disturbance ( uncertainty about a least
two of the following; self image, sexual orientation,
goals or career choice, type of friends, values);
marked and persistently unstable self image and/ or
sense of self
 9. Transient, stress-related paranoid ideation or
severe dissociative symptom
 NOTE:- Text in italics is significant text that was not
in DSM-3-R (American psychiatric association 1987)
but was introduced in DSM-4 (American Psychiatric
Association 1994). Text in brackets is significant
text that appears in DSM-3-R but does not appear in
DSM-4

15. Selective
seretonin
reuptake
inhibitors
Atypical
antipsychotics
Anticonvulsants
Paxil
Effexor
prozac
Risperdal
Seroquel
Zyprexa
Clozaril
abilify
Lamictal
Topamax
Depakote
Trileptal
Zonegan
Neurotin
gabitril

16. Other drugs
Borderline Personality Disorder coupled with
manic depressive disorder can be treated
using Zyprexa, Seroquel, and Risperdal.
Omega-3 fatty acids - They can supplement
Borderline Personality Disorder drugs by
reducing aggression and depression.
Naltrexone –it is another well-known drug
used in the treatment of Borderline Personality
Disorder.

17. CONT….
SIDE EFFECTS
 Weight gain
 Hyperlipidemia
 Prolongation of QTC interval
 Extrapyramidal side effects
 Abnormalities of blood count
 Dizziness
 Drowsiness
 Diarrhoea or constipation
 Excessive sweating

18. TREATMENT:-
 Borderline personality disorder treatment may include
medications, psychotherapy, or hospitalization.
 Many personality disorders are difficult to treat with
medications because of client’s self denial.
 The Two Classes of Medications Most Useful in
Reducing Specific Core Symptoms of Borderline
Disorder:-
 Antipsychotic Agents:- For those who have
cognitive-perceptual symptoms such as a
suspiciousness, paranoia, split (all-or-nothing)
thinking, and dissociative episodes.

19. • Mood stabilizers:-This medication significantly reduce
the certain symptoms include impulsivity, anger,
anxiety, depressed mood, and general level of
functioning . For example:- opiramate (Topamax) and
lamotrigine (Lamictal).
• OTHER MEDICATIONS:-
• SSRIs:- the treatment of co-occurring major depressive
disorder, obsessive thoughts, anger, irritability, and
unstable mood.
• MAOIs:- to decrease self harm and impulsive acts.
• Antianxiety agents and sedatives :- Anxiety and poor
sleep .

20. PSYCHOTHERAPY
 Psychotherapy:- also called talk therapy — is a
fundamental treatment approach for borderline
personality disorder.
 Dialectical behavior therapy (DBT):- focuses on the
concept of mindfulness, or paying attention to the
present emotion. DBT teaches skills to control intense
emotions, reduce self-destructive behavior, manage
distress, and improve relationships.
 Cognitive behavioral therapy (CBT):- can help people
with BPD recognize and change both their beliefs and
the ways they act that reflect inaccurate or negative
opinions of themselves and others. This therapy can
help people see difficult situations and relationships
more clearly and find better ways to deal with them..

21. CONT..
 Mentalization -based therapy (MBT):-is a talk therapy that
helps people identify and understand what others might be
thinking and feeling. MBT emphasizes thinking before
reacting.
 Schema-focused therapy (SFT). SFT combines therapy
approaches to help you evaluate repetitive life patterns and
life themes (schema) so that you can identify positive
patterns and change negative ones.
 Transference-focused psychotherapy (TFP). Also called
psychodynamic psychotherapy, TFP aims to help you
understand your emotions and interpersonal difficulties
through the developing relationship between you and your
therapist.

22. COMMUNITY RESOURCES

23. OTHER
 1-800-SUICIDE
If you are in distress or are worried about someone in distress who
may hurt themselves, call 1-800-SUICIDE 24 hours a day to
connect to a BC crisis line, without a wait or busy signal. That’s 1-
800-784-2433.
 Outreach Support Services of Niagara (OSSN):- A non-profit
agency with 3 offices in the Niagara Region (Niagara Falls, St.
Catharine's and Welland) providing mental health counselling
services to clients living in the Niagara Region. 5017 Victoria
Avenue, Niagara Falls, ON, L2E 4C9 905-371-6776
 Niagara Counselling Services (NCS)
5017 Victoria Avenue, Niagara Falls, ON, L2E 4C9
905-988-5748

24. WORKING WITH PEOPLE THAT HAVE BORDERLINE
PERSONALITY DISORDER
 People with boarder line personalities can be quite challenging to work with, as they
are highly manipulative; treating them can require a tremendous amount of energy
 It’s important to be firm, consistent, empathetic, matter-of-fact and to avoid arguing
or power struggles
 Staff must also be diligent in avoiding staff-splitting
 Set limits and boundaries
 When patients begin to act out, they may threaten suicide
 Be aware when patients begin to display a sense of entitlement and narcissism.

25. NURSING DIAGNOSIS
Risk prone health behaviour
related to negative attitude
toward health behaviour
evidenced by failure to achieve
optimal sense of control

26. GOALS
SHORT TERM GOALS
1. Client will discuss with
primary nurse the kinds of
lifestyle changes that will
occur because of the change
in health status.
2. With the help of primary
nurse, client will formulate a
plan of action for
incorporating those changes
into his or her lifestyle.
3. Client will demonstrate
movement toward
independence, considering
change in health status.
LONG TERM GOALS
 Client will demonstrate
competence to function
independently to his or
her optimal ability,
considering change in
health status, by time
of discharge from
treatment

27. INTERVENTIONS
 Encourage client to talk about lifestyle prior to
the change in health status. Discuss coping
mechanisms that were used at stressful times in
the past
 Encourage client to discuss the change or loss or
fear and particularly to express anger associated
with it
 Provide assistance with activities of daily living
(ADLs) as required.
 Help client with decision making regarding
incorporation of change or loss into lifestyle
 Use role-playing to decrease anxiety as client
anticipates stressful situations that might occur in
relation to the health status change.

28. CONT…
 Ensure that client and family are fully
knowledgeable regarding the physiology of
the change in health status and its necessity
for optimal wellness. Encourage them to ask
questions, and provide printed material
explaining the change to which they may refer
following discharge
 Help client identify resources within the
community from which he or she may seek
assistance in adapting to the change in health
status. Examples include self-help or support
groups and public health nurse, counsellor, or
social worker. Encourage client to keep
follow-up appointments with physician, or to
call physician’s office prior to follow-up date if
problems or concerns arise.

29. OUTCOME CRITERIA
1. Client is able to perform ADLs
independently.
2. Client is able to make
independent decisions
regarding lifestyle considering
change in health status.
3. Client is able to express hope
for the future with
consideration of change in
health stat

30. NURSING DIAGNOSIS
 Ineffective coping related to low self esteem
 Goals/Objectives
 Short-term Goal:-
By the end of 1 week, client will comply with rules
of therapy and refrain from manipulating others to
fulfil own desires.
 Long-term Goal :-
By time of discharge from treatment, client will
identify, develop, and use socially acceptable
coping skills.

31. INTERVENTIONS
1.Discuss with client the rules of therapy and consequences of
noncompliance. Carry out the consequences matter-of-factly if rules
are broken
2.Do not debate, argue, rationalize, or bargain with the client regarding
limit-setting on manipulative behaviours
3.Encourage discussion of angry feelings. Help client identify the true
object of the hostility. Provide physical outlets for healthy release of
the hostile feelings (e.g., punching bags, pounding boards).
4.Take care not to reinforce dependent behaviours.
5.Help client recognize some aspects of his or her life over which a
measure of control is maintained
6.Identify the stressor that precipitated the maladaptive coping.
7.Provide positive reinforcement for application of adaptive coping skills
and evidence of successful adjustment

32. OUTCOME CRITERIA

33. REFRENCES
 Borderline Personality Disorder (BPD): Ontario: Mental Health
Services, Help and Support: eMentalHealth.ca. (n.d.). Retrieved 20
July 2015, fromhttp://www.ementalhealth.ca/Ontario/Borderline-
Personality-Disorder-BPD/index.php?m=heading&ID=176
 Borderline Personality Disorder. (n.d.). Retrieved 20 July 2015,
from http://www.nimh.nih.gov/health/publications/borderline-
personality-disorder/index.shtml
 Gunderson, J. G. (2009). Borderline Personality Disorder: A
Clinical Guide. Google Books. American Psychiatric Pub.
Retrieved
fromhttps://books.google.ca/books?id=PlcmXG9GFIoC&printsec
=frontcover&dq=personality+disorder&hl=en&sa=X&ved=0CGAQ
6AEwCGoVChMIu-6est_lxgIVRg-SCh0wMAY3
 Mobascher, A., Mobascher, J., Schmahl, C., & Malevani, J. (2007).
Treatment of borderline personality disorder with atypical
antipsychotic drugs. Der Nervenarzt, 78(9), 1003

34. REFRENCES
 Marshall-Henty, J., Sams, C., Bradshaw, J., & Cheryl, R. S.
(2009a). Mosby’s comprehensive review for the Canadian RN
exam (1st ed.). Toronto: Mosby-Year Book.
 Morrison-Valfre, M. (2013). Foundations of mental health care (5th
ed.). St. Louis, MO: Elsevier/Mosby.
 Nursing Care Plan for Ineffective coping, antisocial behavior and
narcissistic personality disorder. (n.d.). Retrieved 20 July 2015,
fromhttp://www.pterrywave.com/Nursing/Care%20Plans/107.aspx
 Oberg, B. (2012, January 13). Subtypes of Borderline Personality
Disorder | More Than Borderline. Retrieved 20 July 2015,
fromhttp://www.healthyplace.com/blogs/borderline/2012/01/beco
ming-more-specific-subtypes-of-borderline-personality-disorder
 Schultz, J. M., & Videbeck, S. L. (2009). Lippincott’s Manual of
Psychiatric Nursing Care Plans (8th ed.). Philadelphia: Lippincott
Williams and Wilkins.