Both APD/BPD: genetic factors passed on to children

decreased serotonin levels (anxiety,depressed)

environmental factors: history of abuse/trauma, inconsistent parenting and/or abandonment

Biological/physical factors in..

APD: frontal-lob injury, EEG abmormalities (Electrical Impulses in the brain),decreased gray matter (where we think)

BPD: innate oversensitivity, anatomical differences in amygdala (feelings) and prefontal cortex

Safety and Security needs r/t violence and judgement problems

Higher Level Needs most evident (love and belonging)

They never have felt succesful, or completed many things in life

They DO KNOW how to attract attention (physical looks)

Inability to follow social/legal norms resulting in:

• Property destruction
• Legal and illegal substance abuse/dependency
• promiscuity
• legal problems (DWI, Prostitution, thefts)
• Spouse/child abuse
• Lying, truancy, fights, thefts, animal abuse as a child(conduct disorer)

• Poorly developed superego(morals) and strong ID tendencies
• onset before 15
• persuasive and charming personality ("your the only one that understands me")
• articulate, verbal, convincing arguments
• "Con artists" who don't seem to care about people, have no empathy and exhibit lack of remorse regarding their behaviors
• involded in legal, criminal activities

• Denial: "I don't have a problem, you do!
• Projection: blaming, "they make me act that way"
• Rationalization: "well, you just have to take justice into your own hands."
• Undoing: sorry, let me do this for you..

• weak, unstable ego causing poor sense of self and identity confusion (different with different people)
• Demanding and needy
• fear of abandonment
• Inability to sublimate causing chronic boredom and feelings of "emptiness"

SUBLIMATION: using social acceptable action with their emotion

• borderline referes to "border"between moderate and severe mental illness
• Individual cannot cope with stress of young/middle adulthood
• recurring crises of chronic boredom, anger, depression, self-destructive acts and transient psychosis
• substance/people abuse may occur
• Instable: not knowing who they are
• They get angry when plans change
• successful with suicide

primitive idealization: unrealistic views others outside the self as "all good".."this relationship will last forever"

Splitting: others viewed as fluctuating between being good or bad.(good nurse/bad nurse)

 Projective identification:projection with behaviors that control others and reinforce the projected thought ("I told you she was a "bad nurse", she wouldn't let me..

Risk for other directed violence

Risk for self-mutilation

Risk for self directed violence

Risk for suicide

communication

socialization

coping

self-esteem

• Demonstrate increased responsibility and enhanced role performance
• Demonstrate frustration tolerance
• Demonstrate problem-solving to meet needs
• Express feelings appropriately (eg. talk before acting out)
• Identify and seek out appropriate support persons/resources

• Maintain consistent and structured approach to decrease "staff splitting"
• Encourage client to work with and seek out one appropriate staff member who is working with him/her (assigned to them)
• set limits and boundaries in relationship (meeting every hour with pt)
• clarify client distortions and misinterpretations

Utilize medications for symptom relief

Help client cope with/control emotions

Signs and symptoms

-dramatic, emotional, erratic and impulsive behavior

-mood disturbances, depression, anxiety, rage, self-directed

Employment and interpersonal issues

-can't keep for very long

Self-awareness and communication skills

crisis intervention

long term therapy and follow up

group therapy

medication teaching

assistance for substance abuse problems