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Borderline personality disorder (BPD) is a pervasive pattern of instability of self-image, interpersonal relationships, and mood, beginning by early adulthood and presenting in a variety of contexts. These individuals have inflexible traits that impair social and occupational functioning throughout their lives (Wester, 1989). Individuals exhibiting this complex condition present profoundly difficult treatment issues not only for nurses and other health care providers, but also for the individuals with this disorder. In long-term care, where most nursing staff do not have the understanding and expertise needed when interacting with older adults with BPD, the challenges are immense. Furthermore, literature on the relationship between age factors and BPD is scant, with little attention being paid to what symptoms these individuals exhibit later in life (Rosowsky & Gurian, 1991). Yet, staff who treat older adults with BPD in long-term care faculties often have health repercussions such as tension, exhaustion, and burnout.
Margaret Mahler, a developmental theorist, describes the psychological birth and development of the human being in her discussions of the separation-individuation theory (Mahler, Pine, & Bergman, 1975). Understanding the separation-individuation developmental process has relevance in understanding BPD. Mahler emphasizes the Rapprochement subphase of separation-individuation as significant in the possible development of individuals with BPD. If the relationship between mother and child is inconsistent and the mother is not attuned to the child's needs, dysfunction can occur. Exploring this component of Mahler's theory can assist in better understanding elderly individuals with BPD. This article discusses the theoretical perspectives of Mahler's separation-individuation process and its relatedness in understanding and working with elderly individuals with BPD in long-term care. An actual case study will be presented to illustrate ways for nurses and other team members to effectively work with individuals with BPD in an institutional setting.
SEPARATION-INDIVIDUATION PROCESS
Separation-individuation refers to the development sequence through which human infants move from "the twilight state of neonatal life to a tuning into the world of reality and the achievement of a sense of separate individual entity" (Edward, Ruskin, & Turrini, 1981, p. 3). Separation signifies differentiation, distancing, boundary formation, and disengagement from die mother. Individuation denotes evolution of the intrapyschic autonomy, psychic structure development, and personality characteristics. Mahler (1972) describes an objecdess phase of development preceding separationindividuation, which she calls "normal autism...