This paper analyses the Borderline Personality Disorder. The analysis is based on the movie " Girl Interrupted". This movie is based on a true story of Susanna Kaysen. The paper presents the description of disorder based on DSM-IV-TR and The National Institute of Mental Health [NIMH]. Borderline personality disorder (BPD) is characterized by impulsivity, unstable and intense interpersonal relationships, an unstable self-image, frantic efforts to avoid perceived abandonment, inappropriate anger, self-destructive threats and behavior, transient paranoid ideation, dissociative symptoms, affective instability, or some combination thereof. The paper compares typical symptoms of the disorder to the ones the main character exhibits. It also talks about the possible treatments: medication , psychotherapy. Finally the paper talks about teaching proper for a patient suffering from Borderline …show more content…
Personality Disorder and gives an example of a nursing care plan for this specific patient.
Borderline Personality Disorder; Analysis based on "Girl Interrupted"
I chose to watch “Girl Interrupted”.
It is a true story based on the memoir by Susanna Kaysen. In 1960s Susanna tried to commit suicide by taking a whole bottle of aspirin. Soon after, she was diagnosed with borderline personality disorder and sent to spend eighteen months in psychiatric facility. This movie relates her experience during the stay in a mental institution. The main character played by Winona Ryder is eighteen years old; she has just graduated from high school and is an aspiring writer. The movie begins with Susana reflecting back on the events that led up to her visit with the psychologist. She has flashbacks of attempting suicide. The psychologist came to conclusion that Susanna needed some rest and sent her to a private mental institution. In the institution, the psychiatrist diagnosis’s Susanna with borderline personality disorder. While in the institution Susanna meets various other women with disorders ranging from eating disorders to psychopaths. After almost two years she is declared healthy and released from the
institution.
DSM-IV-TR (2000) defines borderline personality disorder as a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts. Furthermore DSM states that to be diagnosed with borderline personality disorder a person has to meet five or more of the following criteria: 1. frantic efforts to avoid real or imagined abandonment, 2. a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation, 3. identity disturbance: markedly and persistently unstable self-image or sense of self, 4. impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, Substance Abuse, reckless driving, binge eating), 5. recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior, 6. affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days), 7. chronic feelings of emptiness, 8. inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights), 9. transient, stress-related paranoid ideation or severe dissociative symptoms. (DSM-IV-TR, 2000)
The Borderline Personality Disorder (BPD) causes people to have a pattern of developing unstable relationships with others. People affected with BPD have some problems with the way they see themselves, and are often very impulsive (DSM-IV-TR, 2000). The cause of BPD is not exactly known, but many psychologists tend to believe that individuals who develop Borderline Personality Disorder have experienced some type of childhood trauma, usually abuse or neglect. The other theory explains BPD as an extreme sensitivity in the part of the brain that control emotions (Hunt, 2007).
To be diagnosed with Borderline Personality Disorder a patient has to meet at least five of the above mentioned criteria. The main character in the movie definitely meets those criteria. Susanna displayed many of the symptoms of BPD. One of the leading symptoms was the attempt of suicide which we in the opening scene. In her out reach for attention Susanna overdosed on a bottle of aspirin along with a bottle of vodka. She also made few comments about suicide when talking to her friend Toby. Susanna displayed self-mutilating behavior and showed dysphoria, feeling of sadness and sorrow. When talking to a taxi driver she admitted that she was being institutionalized because she was “sad,” she also told Dr. Potts in a therapy session that she had “not exactly been a ball of joy”. She also claimed that she had no bones in her hand, which could have been further self-mutilation or another delusional disorder. In addition we can see a flashback of her intimate relations with the father of a girl from her high school, along with another man she meets at a club.
In the mental institution Susanna develops a very close relationship with Lisa, who is also a patient there. This strong desire to always be in a relationship is another prime symptom of this particular personality disorder. Sometimes people with Borderline Personality disorder have patterns of intense, stormy, and unstable relationships with others, along with difficulty maintaining intimate, close connections. BPD can cause frequent displays of inappropriate anger (Zanarini & Frankenburg, 1997). Individuals with Borderline Personality Disorder often seem to “latch on” to other. They see their relationships in quite different way than what may be considered normal by others and tend to consider others with extreme emotions such as idolizing them. At the same time they can quickly go to feelings of extreme dislike or even hate. Most of Susanna 's relationships fit this description. The reasons why Susanna developed Borderline Personality Disorder may be traced to her childhood. Both of Susanna’s parents were more focused on leading the perfect suburban life, than paying attention to her. Being concentrated on themselves they never realized that she was being sexual abused by their neighbor. This caused Susanna to become unable to differentiate what was correct and what was not, further leading her to have the inability to distinguish right from wrong. Susanna’s past experiences such as sexual abuse by an older man, promiscuity, feelings that she did not fit in, and her relationships with friends are all significant symptoms of borderline personality disorder.
According to The National Institute of Mental Health [NIMH] (2007), people with BPD often exhibit impulsive behaviors, such as excessive spending, binge eating and risky sex. These impulsive acts are usually due to fears or threats of separation, rejection, or abandonment Susanna’s promiscuous behaviors are an example of impulsive behaviors that were present in her life. Borderline Personality Disorder can also cause negative thoughts, such as undermining worth and abilities. These experiences often occur when individuals with BPD feel a lack of meaningful relationships, nurturing, and support (DSM-IV-TR, 2000).
The National Institute of Mental Health [NIMH] (2007) also states that PBD sufferers may experience intense episodes of anger, depression, and anxiety that may last only hours, or at most a day. These may episodes may be accompanied by impulsive aggression, self-injury, and drug or alcohol abuse also suicide threats and attempts when faced with abandonment and disappointments. Susann recently graduated from high school. She didn’t have any desire to go to college. Instead she wanted to take a break. Her attempt of suicide seemed to come from stressors and overwhelming feelings of not knowing what to do in life. Individuals with Borderline
Personality Disorder are very sensitive to their environments, and are often fearful of change. Finishing high school and moving to the next stage of her life is an example of a change in Susanna 's life. Furthermore NIMH describes PBD as distortions in cognition and sense of self. Often people with borderline personality disorder feel unworthy and helpless and have highly unstable patterns of social relationships. In Susanna’s case this was true. She did not have any stable or close friendships in her life. She was however able to form some sort of relationship with fellow patients after she began her treatment. People with Borderline Personality Disorder usually have a hard time separating from others, especially family, friends, and loved ones. Even when faced with realistic, time-limited separation or unavoidable changes in plans, individuals with BPD may believe that the separation implies that they are “bad” (DSM-IV-TR, 2000). Any type of separation is viewed by them as “abandonment. Often times, when faced with separation, rejection, (real or imagined), individuals with Borderline Personality Disorder make hysterical efforts to get people to stay and may display extreme impulsivity when they feel like they are being abandoned(DSM-IV-TR, 2000). Sometimes people with Borderline Personality Disorder engage in behaviors that are harmful to themselves to avoid abandonment and get people to stay with. This behavior may look like they are manipulative in their efforts to get people not to leave them (Hunt, 2007). Susanna 's attempt of suicide, self-mutilation, and risky behavior were all examples of cry for attention.
Fortunately there are treatment options available for people suffering with Borderline Personality Disorder. One treatment option is medication. Some medications that may help individuals with BPD are mood stabilizers which can help alleviate some of the frantic, desperate feelings often associated with Borderline Personality Disorder. Therapy is other important supplement when dealing with BPD. One of the best treatments for borderline personality disorder is psychotherapy which allows the patient to talk about both present difficulties and past experiences in the presence of an empathetic, accepting and non-judgmental therapist.
The therapy needs to be structured, consistent and regular, with the patient encouraged to talk about his or her feelings rather than to discharge them in his or her usual self-defeating ways.
(Hunt, 2007). In Susanna 's case seems like psychotherapy was very successful. At first she was very resistant to receive help but with time she realized that is the only way to be able to leave the institution and took the advantage of the therapy. She decided to participate actively and the positive effects were seen right away. The diagnosis of Borderline Personality Disorder had an enormous effect on Susana’s life. She was placed in a mental institution, where she was constantly monitored and checked on. She had to undergo therapy, take medication and was not allowed to do certain things for or by herself, such as lighting a cigarette or shaving her legs, even though she was perfectly capable of doing these things. It also affected her parents. They seemed to be feeling responsible for her condition and became embarrassed by it. They were anxious to know when she will be released most likely because they didn’t t want to explain everyone where she was and why. “Girl Interrupted” offers a glimpse into borderline personality disorder. Susanna’s struggles represent many young adults’ battle with mental illness. At first she denied her condition, however she soon realized that she needs the help that is offered to her. This realization allowed her to heal mentally and emotionally.
Teaching Guide For Susanna
Therapy The goals of treatment for individuals with Borderline Personality Disorder should include increased self-awareness with greater impulse control and increased stability of relationships. One of the possible treatments for people with BPD is therapy. In case of Susana therapy should focus on being able to tolerate distress, changing unclear beliefs. It would be also helpful to introduce some new social and relationship problem solving skills to Susanna. Allowing her to talk about present difficulties and past experiences in the presence of a therapist have can have some positive effects. I think that goals of treatment in case of Susanna should include increased self-awareness, greater control of impulses and increased stability of relationships. Susanna would definitely benefit from one of the most successful and effective psychotherapeutic approaches which is Dialectical Behavior Therapy. In this kind of therapy patients learn how to better take control of their lives, their emotions, and themselves through self-knowledge, emotion regulation, and cognitive restructuring. Since BPD is difficult to treat, treatment can be somewhat lengthily in duration, typically lasting at least a year for most. Susanna should remember that the tendency towards intense emotions, impulsivity, and intensity in relationships is often lifelong but with therapeutic intervention she will most likely often show improvement during the first year . Through psychotherapy Susanna will be able to learn new coping skills and regulation of emotions.
Nursing Care Plan for Susanna
Nursing Diagnosis 1
Ineffective coping evidenced by inability to use available resources.
Assessment Data
At the beginning of the movie Susanna showed inadequate skills for daily living. She was getting frustrated easily and had poor control over impulses.
Outcome
Susanna will be free of injury and will demonstrate decrease in manipulative, attention-seeking behaviors. She will also demonstrate adequate daily living skills and make decisions and solve problems independently.
Nursing interventions * Assess Susanna’s immediate environment for potentially dangerous objects. Her safety is a priority. * Provide adequate supervision while she is involved in activities. * In case of destructive behavior take her to a secluded, safe area. Immediate isolation minimizes the attention she receives. * Encourage to express feelings verbally or by writing, drawing. * Give positive feedback when she is able to express anger in non destructive manner. Positive feedback will give her confidence and incentive to continue the positive behavior.
Nursing Diagnosis 2
Risk for Self-Mutilation
Assessment Data
Susana came to the mental institution with bruises on her wrists. She also had history of suicidal behavior.
Outcome
Susanna will be safe and free from injury. Will eliminate acting out behaviors and participate in a treatment plan. She will also independently control urges for self-harming behavior.
Nursing Interventions * Place her in a room near nursing station. She will be easier to observe and have less chance to leave are undetected. * Assess Susanna’s use of substances. * Encourage her to identify a problem or life situation that led to hospitalization. * Teach Susanna the problem solving process: identifying problems, exploring alternatives, making a decision, and evaluating result. She may be unaware of logical process for solving problems. * Observe how she functions in various situations. How she interacts with others. Necessary to assess what she can do and what skills she needs to develop.
References:
American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders
(4th ed. text revision). Washington, DC Borderline personality disorder [The National Institute of Mental Health (NIMH). ]. (n.d.). Retrieved October 20, 2011, from http://www.nimh.nih.gov/health/publications/ borderline-personality-disorder/index.shtml
Hunt, M. (2007). Borderline personality disorder across the lifespan. Journal of Women and
Aging, 19(1-2), 173-191.
Zanarini, M.C., & Frankenburg, F. R. (1997). Pathways to the development of borderline personality disorder. Journal of Personality Disorders, 11(1), 93-104.