Personality and Mood Disorders Q 45
A hospitalized client, diagnosed with a borderline personality disorder, consistently breaks the unit’s rules. This behavior should be confronted because it will help the client:
A. Control anger
B. Reduce anxiety
C. Set realistic goals
D. Become more self-aware
Correct Answer: D. Become more self-aware.
Client’s must first become aware of their behavior before they can change it. Occurs after the client is aware of the behavior and has a desire to change the behavior. Review with the client the types of cognitive distortions that affect self-esteem (e.g., self-blame, mind reading, overgeneralization, selective inattention, all-or-none thinking). These are the most common cognitive distortions people use. Identifying them is the first step to correcting distortions that form one’s self-view.
Option A: Maintain a neutral, calm, and respectful manner, although with some clients this is easier said than done. Helps the client see himself or herself as respected as a person even when behavior might not be appropriate. Keep in mind clients with personality disorders might defend against feelings of low-self-esteem through blaming, projection, anger, passivity, and demanding behaviors. Many behaviors seen in PD clients cover a fragile sense of self. Often these behaviors are the crux of clients’ interpersonal difficulties in all their relationships.
Option B: Focus questions in a positive and active light; helps client refocus on the present and look to the future. For example, “What can you do differently now?” or “What have you learned from that experience?”. Allows the client to look at past behaviors differently, and gives the client a sense that he or she has choices in the future.
Option C: Set goals realistically, and renegotiate goals frequently. Remember that a client’s negative self-view and distrust of the world took years to develop. Unrealistic goals can set up hopelessness in clients and frustrations in nurse clinicians. Clients might blame the nurse for not “helping them,” and nurses might blame the client for not “getting better”.