Case Study: Borderline Personality Disorder
Evaluation and Definitive Diagnosis
KK is a woman presenting with a history of cutting her wrist with a razor, a history of drug addiction, and previous hospitalization for a drug overdose. Additionally, she is hostile, demeaning, and caustic to her caretakers, with a track record of unstable personal relationships at work. Based on the symptoms described above, such as self-harm, poor interpersonal relationships, unstable mood, and self-damaging acts such as substance abuse, are suggestive of borderline personality disorder as the definitive diagnosis.
The DSM-V bipolar personality disorder diagnostic criteria are as follows: Self-damaging acts such as unsafe sex and substance abuse, unstable personal relationships, self-harm, suicidal behavior, unstable mood, feelings of emptiness, fear of abandonment, intense anger that can be difficult to control, paranoid, and dissociative episodes (Chapman et al., 2022). Other assessment instruments, including the personality diagnostic questionnaire and the Minnesota borderline personality disorder scale, are available for diagnosis.
Differential Diagnoses
According to DSM V, bipolar or depressive disorders often occur concurrently. The presentation of other personality disorders, especially those in cluster B, including antisocial, histrionic, and narcissistic personality disorders, commonly overlap with a borderline personality disorder. Additionally, non-suicidal self-injury disorder and substance use disorder are also differentials of borderline personality disorder. Hormonal disorders, especially hyperthyroidism and alcohol withdrawal, exhibit similar features as borderline personality disorder.
Neurobiology of Borderline Personality Disorder
The condition has been linked to a strong genetic link. It is approximately five times more common among the first-degree biological relatives of those with the disorder than in the general population. It is also associated with an increased familial risk not only for bipolar and depressive disorders but also for substance use disorder.
Additionally, serotonin dysregulation in the brain reduces the sensitivity of the 5HT-1A receptor, which may contribute to borderline personality disorder. Some studies further implicate estrogen in the causation of borderline personality disorder (the University of Illinois at Chicago, 2018). A fundamental explanation for the high prevalence in females compared to males.
Culturally, the affected young adults and adolescent population may present with unstable moods accompanied by irritability, anxiety, and intense anger that can be difficult to control, especially when associated with substance use.
Management Plan of Borderline Personality Disorder
A borderline personality disorder is mainly treated using psychotherapy, but medication may be added. However, before treatment, it is essential to test the hormonal blood levels of thyrotropin-releasing hormone and cortisol levels to rule out depression. Moreover, toxicological studies, including drug levels, are important to distinguish borderline disorder from symptoms that may develop in association with persistent substance use.
Evidence-based care effective for patients with borderline personality disorder includes dialectical behavior therapy (DBT), which combines interpersonal and emotion regulation skills with mindfulness practices. Mentalizing-based therapy (MBT) helps patients control their emotional lability by feeling understood and enabling them to learn about the intentions of the people around them (Chapman et al., 2022). Finally, transference-focused psychotherapy (TFP) focuses on internalized images of self and others that organize the patient’s interpersonal experience and sense of self.
Pharmacologically selective serotonin re-uptake inhibitors (SSRIs) are preferred over other classes of antidepressants. Fluoxetine 20mg PO qDay may be effective. However, this drug is associated with adverse effects such as insomnia, nausea, headache, nervousness, impotence in men, and decreased libido. Recovery from this disorder seems complicated and varies from patient to patient, requiring a long-term follow-up and psychotherapy. Once recovery is attained, the patient can remain stable over some time.
Conclusion
Mental health is a crucial aspect of a person’s overall well-being. The world health organization includes mental health as a component in its’ definition. In that case, borderline personality disorder causes significant impairment and distress and psychiatric co-morbidities. Psychotherapy remains the fundamental treatment approach for borderline personality disorder. However, medications may include antidepressants, antipsychotics, or mood-stabilizing drugs. Hospitalization is also important to keep patients safe from self-injury or address suicidal thoughts or behaviors.
References
Chapman, J., Jamil, R. T., & Fleisher, C. (2022). Borderline Personality Disorder. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430883/
University of Illinois at Chicago. (2018, May 31). Symptoms worsen around menses for people with borderline personality disorder. Science Daily. https://www.sciencedaily.com/releases/2018/05/180531143106.htm
Case Study Instructions: Borderline Personality Disorder
KK is a 22-year-old African American woman who presents with a history of non-suicidal self-injury, specifically cutting her arms and legs, since she was a teenager. She has made two suicide attempts by overdosing on prescribed medications, one as a teenager and one six months ago; she also reports chronic suicidal ideation, explaining that it gives her relief to think about suicide as a “way out.â€
After cutting her wrist with a razor, KK is transported to the emergency room. She has a history of addictions and has previously been hospitalized for a drugs overdose. When someone tries to take care of her, she might be hostile, caustic, and demeaning. She has a track record of having trouble at work with interpersonal interactions.
Do a psych evaluation, make a Diagnosis based on DSM-5 and Treatment Plan: Definitive diagnosis, Differential diagnosis: and other Include neurobiology of disorder(s). (Include genetics, neurotransmitters, neuroanatomical changes, current theories of causation, cultural factors);
Rationale for each part of management plan (labs; meds: why this med, what is neurochemistry action of med, side effects to monitor, expected benefits, contraindications; counseling-goals, rationale for this type of therapy, expected benefits, teaching, referrals, follow-up).