Towards understanding some complex borderline behaviours

This article aims to explore and explain some possible antecedents to behaviours revealed by consumers in mental health settings who evoke strong and often negative responses in nurses and other health professionals. The contemporary exemplar par excellence is people who are diagnosed as having a borderline personality disorder. The paper discusses four different but overlapping domains that may contribute to understanding the difficulties many nurses face in relation to working with consumers whose behaviours are complex and distressing. Firstly, these begin with a brief discussion of psychiatric labelling and stereotyping associated with borderline personality disorder. Secondly, the connections between trauma in childhood and psychiatric vulnerability are explored, as nurses and other health professionals sometimes do not appreciate the debilitating and long-term consequences of the survival of childhood abuse or sexual assault. Thirdly, some unconscious defence mechanisms are outlined to partly explain behavioural interactions often displayed by people with a diagnosis of borderline personality disorder. Finally, behavioural concomitants of projection, splitting and projective identification are discussed: they include identity diffusion, self-mutilation and suicide attempts. All of these topics are explored to encourage nurses to support consumers to express pain in more constructive ways.