I’m a mental health nurse working on locked ward with females with personality disorder - ask me anything

[Dino90]

Please ask away if there’s anything you’d like to know

@niceupthedance Are there any particular therapies which help?

Yes, loads. CBT, DBT, schema focused therapy, EMDR and so on

(To clarify I meant women with ADHD being misdiagnosed with a PD)

I'm loving the love for Jessica Taylor. I follow her on Twitter and think she's great.

Thanks for your answers, op, really interesting. It must be an incredibly hard job despite your coping mechanisms. But a very important one..

How do the women come to be on the ward in the first place (as it’s so hard to get decent psychiatric help for personality disorders). Have they been sectioned?

@ShirleyPhallus @BadgertheBodger I’ll look into this

Actually a further question (sorry 😳) would be, do you ever get an inpatient who you think “wow you really shouldn’t be here”? As in, that it’s the wrong dx or that the facility isn’t the best treatment for them

@DevonHoliday20 Very interesting thread. Do you find it depressing working with severely affected mental health patients?

No, not depressing as such. If anything, I feel better about and more grateful for my lot in life doing what I do. I do find it all very frustrating though

How often are you worried for your safety?

Often

How long have you been in this kind of role and what changes have you seen in mental health care in this time?
What made choose this career and what kind of personal attributes do you look for when hiring for your kind of role?

@AfterSchoolWorry What is the most common one?

Borderline personality disorder

Do you think many autistic women are misdiagnosed as having things like EUPD?

Not by the time they reach our specialist service as they will have undergone so many prior assessments and likely had multiple hospital admissions

I have a female relative detained in a mental health unit with recently diagnosed PD. I have no idea how or if she will manage to come back from it and less a normal life.

She’s very manipulative, she’s faking seizures to get hospital attention & faking chest pains.. she’s such a challenge and she thinks she’ll only be in there a week or 2.

Realistically, how long do PD patients stay in ?

How do you desensitise? I'm looking for ways to cope with addict, demented parents. Entirely unapologetically, too - they're biting chunks out of their adult DC and we need a path to maintain contact.

And the big one; how damaging are the patients to others? Is it all bad news?

How do you feel about facilities like yours operating on a self id gender basis rather than sex?

I know this topic comes up a lot and some posters will think oh here we go so sorry about that. There was a story in the news about a woman who was in this situation and was told to put up and shut up though so it has happened.

What advice would you give to relatives impacted by the trauma of dealing with your patients? Would you recommend to those relatives to walk away for the sake of their own mental health or is there always hope?

Do you think your patients can have enjoyable lives with treatment, even if they can't live "normal" lives?

@RUOKHon thank you, I will

You said in one post that most patients won't recover or cope well in the 'real world', and in another that they typically stay 1.5 - 2 years. What happens to them then? Is there suitable supported living (for want of a better term) or do they go back to 'normal life', fail to cope and end up with you again? What would be the ideal solution?

@LastFirstEverything Do you ever feel any of your patients should not be on the locked ward? I ask as have worked in this area myself and don't any longer because of various concerns, including this one.

No

@Shayisgreat Do you find that your patients try to play manipulative games with you? How do you protect yourself from this?

Yes, all of the time. Sometimes they don’t even know they’re doing it, such as when they inadvertently push you away before desperately trying to claw you back when they feels there’s a risk of rejection or abandonment. As a team we’re very insightful into these sorts of behaviours and discuss them regularly at formulation sessions, debriefs and supervisions

Are people with personality disorders aware that they have them?

I'm interested in the line drawn between recognising someone is extremely traumatised and at the same time, not thinking it's acceptable for that traumatised person to go on to abuse and traumatise others. Where do you draw the line, between compassion for how terrible the person with BPD/EUPD feels, understanding they can't help how they are while recognising you can no longer be their lifelong punchbag?

@Saltyauntiepoop Do you ever feel like what's the point they will never get better or be able to function safely and productively in society?

Yes, I often feel frustrated and lacking in job satisfaction. I’ve learned to set my expectations lower than I used to. Instead of thinking on the scale of ‘ability to function normally in society’, I now think more along the lines of minimising distress, better managing crises and so on

Do you ever fear your safety?

Yes, often

@annabel85 What's the typical tipping point that sends someone from the outside world to a locked ward?

Community teams being unable to safely contain their increasing risk behaviours outside of a hospital setting

When you say 'safely contain their risk behaviours', can you give some detail around what these behaviours tend to be?

@SingToTheSky OP, do you find yourself spotting PD symptoms in friends/family/acquaintances? Like a sort of sense/radar?

We all have ‘good’ and ‘bad’ personality traits. Personality only becomes disordered when the unhelpful personality traits interfere with normal life and must be able to be described as ‘problematic’, ‘persistent’ and ‘pervasive’