Navigating Borderline Personality Disorder: A Journey of Mindfulness and Healing

 Case Study on BPD

This is a story  about Lakshya, who has been diagnosed with Borderline Personality Disorder (BPD). She's 23 years old and faces a lot of ups and downs in her emotions. Sometimes, she feels really low, and other times, she struggles with addiction. Despite facing many challenges, Lakshya's journey shows us how mindfulness helps her heal and discover herself better.

Lakshya's diagnosis was confirmed based on the DSM-V criteria for Borderline Personality Disorder (BPD), which requires individuals to exhibit at least five symptoms from a specified list. Her mother was interviewed to provide further insight into Lakshya's symptoms, which aligned with the diagnostic criteria for BPD. Lakshya's case history revealed her admission to the hospital following a suicide attempt, triggered by the recent breakup with her partner. She exhibited intense mood swings, anxiety, irritability, and engaged in impulsive behaviors such as excessive drinking and smoking. Her mother reported that Lakshya often felt empty and disconnected from herself, confiding in her about these feelings. Lakshya also struggled with intense anger and aggression, which was observed during her ward stay. Her history of child abuse at the age of seven contributed to her difficulty in trusting others. The prevalence of child sexual abuse among individuals with BPD further underscored its impact on Lakshya's developmental trajectory. A comprehensive suicide risk assessment was conducted to determine the level of risk and identify appropriate interventions for Lakshya's treatment.  

Lakshya wasdiagnosed with BPD and she was suggested for DBT therapy. A recovery-oriented approach centered on empowering Lakshaya to develop coping strategies and interpersonal skills. Dialectical Behavioral Therapy (DBT) was recommended, focusing on mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation. Lakshaya's treatment plan integrates individual therapy with group skill-building activities. Nurses played a vital role in facilitating these sessions, fostering a supportive environment, and monitoring Lakshaya's progress. 

 Her recovery goals included skill development through individual therapy and skill training in the following four major areas.

• Mindfulness: the technique of being completely conscious and be in the present moment
• Distress Tolerance: how to bear pain/hurt in demanding circumstances, without transforming it.
• Interpersonal Effectiveness: how to request what one wishes for and articulate no, without risking self-respect and relations with other people
• Emotion Regulation: how to transform feelings and emotions which one aspire to change.

Central to Lakshya's journey is the pivotal role of mindfulness—a practice rooted in the cultivation of present-moment awareness, non-judgmental acceptance, and compassionate self-reflection. In the realm of BPD treatment, mindfulness serves as a guiding compass, offering solace, insight, and a pathway toward inner healing. In embracing mindfulness, Lakshya embarks on a journey of self-discovery—a journey characterized by the gentle exploration of her thoughts, emotions, and inner landscapes. Through mindfulness practices such as meditation, breath awareness, and body scanning, she learns to anchor herself in the present moment, transcending the tumultuous currents of past traumas and future anxieties. 

Though the individual therapy is given by the DBT therapist. Skill training is a group activity with a collaborative approach between trainers, therapist and nursing staff Based on the assessment of Lisa, the risk of suicidal behavior and acute mood swings is considered as some major issues for Lakshya. In the treatment of Lakshya, recovery led consumer-centered approach was taken. In this type of care plan, the patient is the central concentration of the treatment plan. She was recommended for Dialectical behavioral therapy (DBT) as a counseling modality to address symptoms of BPD by replacing maladaptive behaviors with healthy coping skills.DBT is based on the development of two types of skills in consumers: The acceptance-based skills, which include mindfulness and distress tolerance; and change-oriented skills including emotional regulation and interpersonal effectiveness.

The first step was to establish a therapeutic relationship with Lakshya and then change her thought pattern to promote adaptation of functional and problem solving coping skills. 

Using the principles of DBT, the skill group training sessions were arranged for Lakshya to address the issues of impulsivity and aggression. Initially, as a nurse, I participated with the therapist during the training sessions and helped her learning skills through various activities. Meditation skills are also taught to assist patients in becoming more mindful, that is, patients learn how to observe themselves non-judgmentally and to accept “what is” or reality in order to position themselves so that they can change. These training sessions mainly focused on developing skills of interpersonal effectiveness in Lakshya. 

The first activity arranged for Lakshya was to participate in a game with other groups of people. The game was an introduction game where the group’s members pair up with a person sitting next to them and get to know the person. Then each person was asked to introduce his or her partner. As chronic difficulties in the interpersonal relationship is a core dimension of BPD, the progression of the session helped in developing positive interpersonal skills of Lakshya besides being in the present moment an important aspect of mindfulness.  As a nursing intervention, I used to listen to Lakshya and demonstrating an interest in her thoughts and behaviors. This leads to the validation of her feelings and built a therapeutic relationship. While preparing a care plan for Lakshya, the focus was on adopting a recovery-oriented approach to care so that her unique needs are identified and necessary interventions are provided to her accordingly. The recovery-oriented approach was considered because this approach leads to the empowerment of consumers and support entering into a collaborative relationship by identifying the unique needs of consumers. 

Consumers are more likely to respond to treatment to if their unique needs and concerns are appropriately identified. The therapist and Lakshya had a session in which the first step was to build rapport with her. She felt rejected as her relationship was broken. Hence, it was planned to enroll her in a skills training group so that her impulsivity and feelings of hopelessness could be addressed. 

These training mainly consisted of core mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance training. Core mindfulness elements helped her to develop skills that supported her to be in the present moment .This helped her to control emotional triggers while feeling upset. Skills in acceptance and mindfulness have proven to be effective in BPD, therefore she was motivated to regularly take skill training sessions. She was given pharmacotherapy as well to control her impulsivity for addiction to smoking and alcohol. 

Another major issue for Lakshya was that she was socially isolated and she stopped interacting even with her mother. Hence, the interpersonal effectiveness component of DBT was implemented to support Lakshya to build a good social relationship.  As she trusted her mother, nurses encouraged her to always ask for any help from her mother and share any issues with her. Both she and her mother were engaged in activities that narrowed down their interpersonal gaps and this helped Lakshya to cope with her interpersonal conflict. She could identify a meaningful relationship in her life. 

As a part of her group based skill training, Lakshya was encouraged to increase her mindfulness practice as part of the treatment. As she was anxious about her relationships, acceptance and mindfulness were found to be important tools to deal with the issue.  To distract her from these emotions Lakshya was encouraged to participate in various activities which included games, mimicry, and discussion about favorite food and other things she like the most. She was addicted to alcohol consumption and smoking, so as a nurse I also constantly monitored her for withdrawal symptoms and aggressive behavior. Prescribed medicines were given as the symptoms of impulsiveness arise. 

With regular sessions and training, Lakshya was able to learn skills such as acceptance and mindfulness that prevented her from entering into a vulnerable situation in life.

The family members were encouraged to be involved in therapy to improve her interpersonal and social skills. This would also help her family to learn the necessary skills to cope up when she becomes impulsive and aggressive. As Lakshya has the problem of anger and depression, meditation was used as an intervention to reduce this problem. As she was in severe trauma due to her relationships she was given motivational sessions. Her dignity and self-respect needs were addressed by informing her about the treatment and her preference regarding any care options.

In her medication process, the suggestions from Lakshya and her family members were included so that her family can know the treatment plan completely. This helped in taking a patient-centered approach towards decision-making. Motivational sessions should be included in the recovery plan  and it will be quite effective if the family members spent times with Lakshya. This approach would change bias from her mind. 

 The main advantage of this plan is that the patient and her family are directly involved in this and the requirement of the patient is best expressed by the patient themselves or their family members. Moreover, direct communication will help to address the problem more clearly. The safety of Lakshya and other persons like the family members, the nursing personnel, the doctors of Lakshya is very much crucial as Lakshya is very much aggressive and she also had self-harming nature. So a continuous monitoring of her behavior and avoiding triggers of aggression and impulse is an important nursing intervention. 

It has been found that through continuous monitoring of Lakshya, the risk of the suicidal attempt of Lakshya reduced considerably and after admission. The motivational sessions also helped Lakshya to increase interest in her life. It was also seen that she seldom talks about her relationships after the motivational sessions and it was a great sign of Lakshya's health condition. These interventions are quite successful in reducing the self- harming nature of Lakshya. The medication sessions, as an interventions were very effective for Lakshya, as she became calmer and her aggression reduced considerably. As Lakshya is improving, she could be engaged in various activities, for instance, she should be given more responsibilities related to her treatment such as taking medicines. Nurses can go for a walk with Lakshya to spend more time with her and understand her issues better. Walking in the garden can improve her condition as a nature walk brings one in the present moment. She was encouraged to talk to her parents or any other close person, and a phone was provided to speak with them whenever required. To help Lakshya in gaining a normal life the above interventions were implemented by the nurse. 

In the above narrative we can se mindfulness was a part of the treatment and proves that the transformative power of mindfulness extends beyond the confines of therapeutic interventions, permeating every facet of Lakshya's life. With each mindful breath, each moment of present-moment awareness, she cultivates a deep sense of self-compassion, resilience, and emotional equilibrium.

In the realm of nursing interventions, mindfulness emerges as a cornerstone of compassionate care—a beacon of hope amidst the complexities of BPD treatment. Through the gentle guidance of mindfulness-based interventions, caregivers foster an environment of safety, trust, and unconditional acceptance—a sanctuary where individuals like Lakshya can embark on a journey of self-exploration and healing.

The journey of mindfulness in BPD treatment underscores the profound interconnectedness of mind, body, and spirit—a holistic approach to healing that honors the inherent dignity and resilience of every individual. Through mindfulness practices, individuals learn to cultivate a deeper sense of self-awareness, emotional regulation, and interpersonal connection—a journey of transformation that transcends the confines of diagnosis and pathology.  As Lakshya's journey unfolds, she discovers that mindfulness is not merely a therapeutic tool but a way of being—a way of embracing life's inherent complexity with grace, equanimity, and profound acceptance. With each mindful step, she navigates the labyrinth of BPD with courage, resilience, and unwavering determination—a testament to the transformative power of mindfulness in fostering healing and wholeness. In the realm of BPD treatment, let us embrace the transformative potential of mindfulness as a catalyst for healing, growth, and self-discovery. Through the gentle practice of mindfulness, may individuals like Lakshya embark on a journey of profound self-discovery, resilience, and inner peace—a journey illuminated by the transformative power of present-moment awareness and compassionate self-reflection. As we journey forward, may we walk alongside individuals grappling with BPD with empathy, compassion, and a steadfast commitment to healing. For in the realm of mindfulness, hope shines brightest as we embrace the journey of self-discovery, resilience, and inner healing—a journey guided by the gentle whisper of mindful awareness and the boundless potential of the human spirit.

Bibliography

Grambal, A., Prasko, J., Kamaradova, D., Latalova, K., Holubova, M., Sedláčková, Z., & Hruby, R. (2016). Quality of life in borderline patients comorbid with anxiety spectrum disorders – a cross-sectional study. Patient Preference and Adherence, 10, 1421–1433. http://doi.org/10.2147/PPA.S108777

Kroenke, K., Yu, Z., Wu, J., Kean, J., & Monahan, P. O. (2014). Operating characteristics of PROMIS four-item depression and anxiety scales in primary care patients with chronic pain. Pain Medicine, 15(11), 1892-1901.

Kroons, C. R. (2008). Dialectical behavior therapy. Social Work in Mental Health, 6(1-2), 109-132

Kroons, C.R., Chapman, A.L., Betts, B.B., Morse, N. and Robins, C.J., (2006). Dialectical behavior therapy adapted for the vocational rehabilitation of significantly disabled mentally ill adults. Cognitive and Behavioral Practice, 13(2), pp.146-156. 

Linehan, M. M., Korslund, K. E., Harned, M. S., Gallop, R. J., Lungu, A., Neacsiu, A. D., ... & Murray-Gregory, A. M. (2015). Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: a randomized clinical trial and component analysis. JAMA Psychiatry, 72(5), 475-482.

Lis, S., &Bohus, M. (2013). Social interaction in borderline personality disorder. Current psychiatry reports, 15(2), 338.

May, J. M., Richardi, T. M., & Barth, K. S. (2016). Dialectical behavior therapy as a treatment for borderline personality disorder. Mental Health Clinician, 6(2), 62-67.

Menon, P., Chaudhari, B., Saldanha, D., Devabhaktuni, S., & Bhattacharya, L. (2016). Childhood sexual abuse in adult patients with borderline personality disorder. Industrial Psychiatry Journal, 25(1), 101–106. http://doi.org/10.4103/0972-6748.196046

Nathan, P. E., & Gorman, J. M. (Eds.). (2015). A guide to treatments that work. Oxford University Press.

O'connell, B., & Dowling, M. (2014). Dialectical behavior therapy (DBT) in the treatment of borderline personality disorder. Journal of psychiatric and mental health nursing, 21(6), 518-525.

Prochaska, J. O., & Norcross, J. C. (2018). Systems of psychotherapy: A transtheoreticalanalaysis (9th ed.). New York, NY: Oxford University Press.

Sansone, R. A., & Sansone, L. A. (2010). Emotional Hyper-Reactivity in Borderline Personality Disorder. Psychiatry (Edgemont), 7(9), 16–20.

Sauer-Zavala, S., Bentley, K. H., &Wilner, J. G. (2016). Transdiagnostic treatment of borderline personality disorder and comorbid disorders: A clinical replication series. Journal of personality disorders, 30(1), 35-51.

Sperry, L., Brill, P. L., Howard, K. I., & Grissom, G. R. (2013). Treatment outcomes in psychotherapy and psychiatric interventions. Routledge.

Wetzelaer, P., Farrell, J., Evers, S. M., Jacob, G. A., Lee, C. W., Brand, O., ... & Lavender, A. (2014). Design of an international multicentre RCT on group schema therapy for borderline personality disorder. BMC Psychiatry, 14(1), 319.