I've noticed that patients with personality disorders (mostly BPD or NPD) seem to respond better to women. Is that just my small sample size or do other people have similar experience?
Do Pts with Personality d/o's respond better to females?
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I haven't noticed this. I have noticed that in some situations the sex of the provider does make a difference but not in regards to treating borderline PD.
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I haven't seen any difference. It really has to do with the patient's own transference. Having difficulty with the gender of the provider can cut (no pun intended) both ways depending on the patient's issues and developmental background. I've certainly seen pt's with BPD have a really hard time with female figures.
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One of the only times where I saw the sex of the doctor make a difference in psychiatry as a whole and not in respect to individuals was during my time on an all-female forensic unit. These patients had a very strong Axis II disorder in addition to an Axis I.
The Axis II disorders I usually saw were combined antisocial and borderline PD. So even when I stabilized their Axis I, they still were a handful. I hate saying this but this was actually accurate, it was as if I had a unit full of female Jerry Springer guests. Whatever is going on in your imagination with that statement is likely not too far off, especially given that Springer's show was taped in Cincinnati.
They seemed to be more compliant with a male doctor. While I may seem biased, most of the staff on that unit agreed including the nurses, the majority of whom were female.
The Axis II disorders I usually saw were combined antisocial and borderline PD. So even when I stabilized their Axis I, they still were a handful. I hate saying this but this was actually accurate, it was as if I had a unit full of female Jerry Springer guests. Whatever is going on in your imagination with that statement is likely not too far off, especially given that Springer's show was taped in Cincinnati.
They seemed to be more compliant with a male doctor. While I may seem biased, most of the staff on that unit agreed including the nurses, the majority of whom were female.
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It's easy to get patients with Cluster B and C personality disorders to like you, at least temporarily. But the question is, are you willing to do what's necessary to be liked at the expense of some other priorities?
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From my experience cluster Bs can form a lovefest for a small length of time lasting at the most a few weeks, and then expect that love to turn into intense hate.
I remember there were two residents (I'm not being sarcastic) that both had cluster B disorders and they had the lovefest for weeks. One of these had falsely accused other people of the program of raping her. The other wrote a letter to the faculty in total support of this other resident because she knew the first resident was put under a microscope due to her false claims.
A few weeks later, they were bitter enemies, and now the resident that wrote the letter was claiming I had a sexual relationship with the other resident. (Wasn't true and the only evidence she had to back this up was that I was telling other people to not get involved with this and let the faculty deal with this).
The 2nd resident several months later is now back into love mode with me and is telling me how she hates a bunch of other residents, then is telling an attending that I got a personality disorder.
The first resident was kicked out, the 2nd ended up going to a namebrand fellowship.
When dealing with a borderline, you have to set your boundaries and stick to them. IF they're pissed with you, too bad. Don't put so much weight that they're mad at you. Put more focus on you sticking to the boundaries and doing something that is therapeutic without giving in to the lovefest, when they do happen.
I remember there were two residents (I'm not being sarcastic) that both had cluster B disorders and they had the lovefest for weeks. One of these had falsely accused other people of the program of raping her. The other wrote a letter to the faculty in total support of this other resident because she knew the first resident was put under a microscope due to her false claims.
A few weeks later, they were bitter enemies, and now the resident that wrote the letter was claiming I had a sexual relationship with the other resident. (Wasn't true and the only evidence she had to back this up was that I was telling other people to not get involved with this and let the faculty deal with this).
The 2nd resident several months later is now back into love mode with me and is telling me how she hates a bunch of other residents, then is telling an attending that I got a personality disorder.
The first resident was kicked out, the 2nd ended up going to a namebrand fellowship.
When dealing with a borderline, you have to set your boundaries and stick to them. IF they're pissed with you, too bad. Don't put so much weight that they're mad at you. Put more focus on you sticking to the boundaries and doing something that is therapeutic without giving in to the lovefest, when they do happen.
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I have noticed this general trend as an outpatient psychiatrist in an urban situated clinic on the east coast.
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Repeat to yourself 5 times before every appointment:
"It's not my job to have them like me. It's my job to help them function better." Then help them figure out what they really want out of life, and give them a couple of tools to get there. Set limits, stick to them, and bid them farewell as they walk out the door.
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Transference and countertransference. Who loves you and who do you love?
Knowing that certain personality disorders have strong tendencies to manipulate others puts us at only a slight advantage. I think the years of experience in the residency setting (under supervision) dealing with borderlines, dependents, antisocials etc really helps.
They don't respond better to women as a whole although individuals may have reasons to respond to certain genders. Also, I have noticed certain people are better at taking care of personality disordered people while at the same time others are magnets for them but end up creating havoc. Often the 2 are difficult to distinguish early on and it really depends on how well they set boundaries because usually both care and want to help.
Knowing that certain personality disorders have strong tendencies to manipulate others puts us at only a slight advantage. I think the years of experience in the residency setting (under supervision) dealing with borderlines, dependents, antisocials etc really helps.
They don't respond better to women as a whole although individuals may have reasons to respond to certain genders. Also, I have noticed certain people are better at taking care of personality disordered people while at the same time others are magnets for them but end up creating havoc. Often the 2 are difficult to distinguish early on and it really depends on how well they set boundaries because usually both care and want to help.
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Jack: It's a game. If he gets the money he wins, if the bus blows up he wins.
Annie: What if you win?
Jack: Then tomorrow we'll play another one.
That's a quote form "Speed" and it captures how I feel about bpd/aspd/npd fairly often. I think mindfulness is key. Know your own reactions (countertransference), frustrations, hopes and wishes, etc. These folks may have an average IQ and act childish in so many ways but they're masters at detecting reactions. Before you know it, you're pulled into something and you don't even know how that happened.
Develop a clear image of who they are and what potential they have, and hang on to it all the time.
And expect to play games...day in and day out.
Annie: What if you win?
Jack: Then tomorrow we'll play another one.
That's a quote form "Speed" and it captures how I feel about bpd/aspd/npd fairly often. I think mindfulness is key. Know your own reactions (countertransference), frustrations, hopes and wishes, etc. These folks may have an average IQ and act childish in so many ways but they're masters at detecting reactions. Before you know it, you're pulled into something and you don't even know how that happened.
Develop a clear image of who they are and what potential they have, and hang on to it all the time.
And expect to play games...day in and day out.
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Think of those teachers that make the best students.
They did not give the student the easiest of times, but they did hold students accountable, gave support (not flattery or indulgent love fests), and told it like it was.
You need to stick to your rules. Borderlines in particular (and this is even written in Linehan's books with DBT) cannot stand it when someone throws in arbitrary rules. What's that? That's when someone does something and pulls some arbitrary bull excuse for the act. (E.g. the typical wifebeater "Why did you make me hit you?" excuse."
Borderlines respond better to people who set boundaries based on rules they can understand that are consistent. If you expect them to be on time, you better not be late. Come to think about it, that's just plain human respect but borderlines will react in much more extremes when they feel they are somehow maligned unfairly.
They did not give the student the easiest of times, but they did hold students accountable, gave support (not flattery or indulgent love fests), and told it like it was.
You need to stick to your rules. Borderlines in particular (and this is even written in Linehan's books with DBT) cannot stand it when someone throws in arbitrary rules. What's that? That's when someone does something and pulls some arbitrary bull excuse for the act. (E.g. the typical wifebeater "Why did you make me hit you?" excuse."
Borderlines respond better to people who set boundaries based on rules they can understand that are consistent. If you expect them to be on time, you better not be late. Come to think about it, that's just plain human respect but borderlines will react in much more extremes when they feel they are somehow maligned unfairly.
