Working with Challenging Behavior: Using Borderline Personality Disorder as an Example

Health care settings are structured, complex environments often plagued with inconsistent communication and ever-changing clinicians, leading to decreased autonomy or diminished control for many patients and their families. These settings, especially hospitals, create chaos for many but are especially challenging for individuals with coping needs who require control and don’t manage well with ambiguity—both key behavioral styles for borderline personality disorder (BPD).

In light of these challenges, the responsibility to understand, identify, and mitigate challenging encounters becomes even more critical for anyone working in the health care field, especially palliative care. We must understand human behavior during difficult moments to best communicate and support our patients and their families, even when this is particularly challenging. While it is not our role to engage those with BPD in psychotherapy or behavioral therapy, we must identify the situation and understand their experience.

In this Interprofessional Grand Rounds, David Buxton, MD, FAAHPM, and Vickie Leff, MSW, LCSW, APHSW-C will explore the characteristics of BPD through a case study. They will examine typical behavior patterns and defense mechanisms associated with BPD, and offer interventions and strategies to a) assist those with this personality structure and b) enable staff to work together to mitigate potential chaos and countertransference. Finally, the presenters will identify realistic strategies and expectations to support both patients and staff in these challenging encounters.