What Is Borderline Personality Disorder Nursing Essay

Personality disorders are described as conditions that have some deviation from the considered normal personality state and is characteristically associated with a “range of psychiatric symptoms and aberrant behaviours” (Sansone & Sansone 2009:17). Personality disorder traits (Appendix 1) can be seen to be exaggerated normal human traits (APA 2000) which is a criticism of the concept of personality disorder in that a normal human behaviour can be labelled as deviant when it does not adapt into a particular situation or environment (Baker et al 2011). However it is the use of maladaptive coping strategies means that people with this diagnosis are disproportionately represented within the criminal justice and mental health systems (McVey & Murphy 2010) with studies indicating between 45.7% and 47.4% of prisoners in the UK having a diagnosis of borderline personality disorder (Fazel 2002, Sansone & Sansone 2009).

Borderline Personality disorder is a condition that can generate a large amount of distress not only for the people who have the disorder but also those who nurse them. Serious psychological distress is experienced by people with this disorder, which is usually managed by the use of dysfunctional coping mechanisms such as drug addiction, risky sexual encounters, violence, self harm and suicide (McVey & Murphy 2010). The diagnosis of personality disorders remains controversial, as does the questions whether the condition is treatable or not (McVey & Murphy 2010) and whether the person qualifies for a diagnosis of disorder or simple personality trait.

Diagnostic criteria.

Personality disorder is classified within the World Health Organisations International Statistical Classification of Diseases and Related Health Problems (ICD-10) (WHO 2010) as being characterised by a tendency towards impulsivity without considering the possible consequences for their actions. It also explains that mood may be unpredictable and liable to aggressive emotional outbursts which can lead to conflict with others. Borderline type also has the characteristics of disturbance in self-image, chronic feelings of emptiness abandonment and rejection, unstable interpersonal relationships, an impairment of psychosocial functioning and by a tendency towards self-destructive behaviour, including self-harm and suicide (National Institute for Health and Clinical Excellence (NICE) 2009, WHO 2010).

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders: 4th edition: Text Revision (DSM-IV-TR) (APA 2000) criteria for personality disorder defines borderline personality disorder as instability of interpersonal relationships, frantic efforts to avoid abandonment, a disturbance of self image, transient paranoid ideation and mood instability with a marked impulsivity that begins in early adulthood (APA 2000). Both the ICD-10 and DSM-IV-TR are “well reasoned and scientifically researched nomenclatures” (Widiger 2001: 60) that are used to describe the current understanding of disorders of personality. However, differences within the diagnosis criteria are prominent. In the ICD-10 there is no specific category for borderline personality disorder, instead it is classified as subtype under emotionally unstable personality disorder, which is comparable to the DSM-IV-TR personality disorder criteria. The inclusion of quasi-psychotic features is another difference within both diagnostic criteria with the ICD-10 not classing this as a symptom of borderline personality disorder (National Collaborating Centre for Mental Health (NCCMH) 2009) and the DSM-IV-TR stating it as one of nine diagnostic criteria (APA 2000). NICE, in collaboration with The British Psychological Society and The Royal College of Psychiatrists, endorses the DSM-IV-TR diagnosis of Borderline Personality Disorder (NCCMH 2009) and in keeping with UK guidelines, any reference to diagnosis in this dissertation shall follow suit.

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