Nursing Process

Assessment
History
Individuals diagnosed with borderline personality disorder often report dysfunctional
relationships with those close to them. Obtaining a history can give insight into the underlying
cause for the onset of the disorder; whether it be verbal or physical abuse or alcoholism.
General Appearance and Motor Behaviour
Clients have varying degrees of dysfunction, ranging from severe to mild. Depending on a
client's current situation, his or her initial behavior and presentation may differ greatly. Clients
with severe dysfunction may appear unkempt and difficult to sit still, or they may exhibit
extremely volatile emotions. In certain circumstances, the outward look and motor behavior may
appear normal at first. A client who threatens suicide or self-harm in the emergency room may
appear out of control, whereas a person seen in an outpatient clinic may appear calm and
rational.
Mood and Affect
The prevalent mood is dysphoric, characterized by unhappiness, restlessness, and malaise.
Clients frequently report intense loneliness, boredom, frustration, and a sense of "emptiness."
They rarely have periods of contentment or well-being. Although there is a general sense of
depression, it is unstable and erratic. Clients may become irritable, even hostile or sarcastic, and
report panic attacks. They have strong emotions such as rage and anger, but they rarely express
them productively or usefully. They are typically hypersensitive to the emotions of others, which
can easily set off reactions. Minor changes, such as changing an appointment from one day to the
next, can cause a severe emotional crisis. When their therapists go on vacation, these clients
frequently experience severe emotional trauma.
Self Concept
Clients have an unstable self-image that shifts dramatically and abruptly. They may appear needy
and dependent one minute and then become angry, hostile, and rejecting the next. Sudden shifts
in opinions and plans regarding career, sexual identity, values, and friend types are common.
Clients believe they are inherently bad or evil and frequently report feeling as if they do not exist
at all. Threats, gestures, and attempts to commit suicide are common. Self-harm and mutilation
are common, such as cutting, punching, or burning. These behaviors must be taken seriously
because these clients are more likely to commit suicide, even if previous attempts have not been
life threatening. These self-inflicted injuries are excruciatingly painful and frequently necessitate
extensive treatment; some result in massive scarring or permanent disability, such as paralysis or
loss of mobility, due to damage to nerves, tendons, and other vital structures.