QUESTION:

Dear Dr. Heller,

I am a psychiatric nurse and I work with a female who is BPD.2008-01-06 She is 19 years old. Her father abused her sexually. She wants to die. She has been in the hospital since age 13. She has been on a one to one with staff for over a year. She has ingested batteries, nail clippers, razors and other metal objects. The staff have been accused of abuse by her. She has lied about some things. I know this is common. The thing is, the other day I was in charge of the floor she is on. Her one on one person asked me to get nail clippers to cut her nails. I gave the nail clippers to the staff member and she gave them to the patient. The patient was cutting her nails then all of a sudden popped the nail clippers in her mouth and was going to swallow them. This was so frightening for me. She wants to die. I cried with her. I stated I was scared for her. (One thing to let you know, I am very fond of this patient, and I tend to be emotional when it comes to her. This girl is in so much pain and I feel she isn't getting what she needs in our hospital. We don't have the treatment she needs. We don't treat BPD very well at our hospital).

She did give up the nail clippers. I was so relieved, but then again, I felt so guilty. Here, I knew this girl wants to die, I gave the staff member the clippers, and I should have known she would do that. It was like handing her a gun. I feel this girl is making some progress. The staff do not want to work with her, and the patient knows this. How do you deal with this? How can staff realize this pain she feels is real. Her self injurious behavior makes her pain go away. We as staff, have to protect her. When she does go off, we have to restrain her and give her medication. (What I mean by going off, is that she is self injurious to herself). I guess I just need help with how to deal with the patient. I love to read about BPD. I know it is real. I feel for this patent. I can't imagine her pain. It makes me sad. People say I have a good rapport with her. Her doctor even asks me to talk with her. I listen, I absorb it all , trying to think how she is feeling. Am I too close? Should I back away?

Thank you.

DR. HELLER'S ANSWER:

I agree with you completely that she is in enormous pain, and her "going off" is a technique designed to make the pain lessen.

I believe totally that the BPD is a medical problem that needs to be treated medically and that may be of help in this regard.

Without the right medications she is unlikely to feel much better. It's important to not blame yourself for her condition and for not considering every possibility. You're human also.

Whether to "back off" or not is a spiritual and emotional issue. If you can't handle her self-destructiveness and it's destroying you, backing off may be the wise approach. If you can make peace with the concept that you can't control the outcome, but can only control what you do, then doing your best is it's own reward and you'll know in your heart that you did everything you could. This is how I approach the BPD.

People like her are indeed suffering, and it's not their fault that they have the BPD. Making that message known clearly can be of great help. The BPD is a medical problem.

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