borderline personality disorder case study paper

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Borderline Personality Disorder (BPD): In the Midst of Vulnerability, Chaos, and Awe

Filiz kulacaoglu.

1 Department of Psychiatry, Cerkezkoy State Hospital, Tekirdag 59500, Turkey; [email protected]

2 Department of Psychology, Hasan Kalyoncu University, Gaziantep 27000, Turkey

3 University of Texas Medical School of Houston, Houston, TX 77065, USA

4 Center for Neurobehavioral Research on Addictions, Houston, TX 77054, USA

Borderline personality disorder (BPD) is a chronic psychiatric disorder characterized by pervasive affective instability, self-image disturbances, impulsivity, marked suicidality, and unstable interpersonal relationships as the core dimensions of psychopathology underlying the disorder. Across a wide range of situations, BPD causes significant impairments. Patients with BPD suffer considerable morbidity and mortality compared with other populations. Although BPD is more widely studied than any other personality disorder, it is not understood sufficiently. This paper briefly reviews the recent evidence on the prevalence, etiology, comorbidity, and treatment approaches of borderline personality disorder (BPD) by examining published studies, and aims to offer a more coherent framework for the understanding and management of borderline personality disorder.

1. Introduction

Borderline personality disorder (BPD) is a chronic psychiatric disorder characterized by pervasive patterns of affective instability, self-image disturbances, instability of interpersonal relationships, marked impulsivity, and suicidal behavior (suicidal ideation and attempt) causing significant impairment and distress in individual’s life [ 1 ]. Patients with BPD suffer considerable morbidity which complicates medical care compared to other individuals. BPD was initially defined in 1978 followed up with the publication of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III) in 1980 [ 2 ] and International Classification of Diseases (ICD-10) [ 3 ] 10 years later. It has become a diagnosis based on the systematic identification of clinical features and identified as emotionally unstable personality disorder [ 2 ]. Both the DSM-5 [ 4 ] and ICD-10 [ 3 ] highlighted the affective instability as an essential criterion for BPD. Individuals with BPD have an underlying vulnerability to emotional hyperarousal states due to abnormalities in neurobiological systems sub-serving emotional regulation and stress responsibility. They also have an underlying vulnerability to social and interpersonal stressors due to abnormalities in neurobiological systems mediating social cognition, attachment, and social reward. Under stressful conditions, BPD patients are unable to regulate their emotions and quickly return to their baseline emotional states.

Since BPD is associated with receiving clinical attention and causes psychosocial impairments, it is more widely studied than other personality disorders [ 5 , 6 ]. In this brief review, we aim to elucidate epidemiology, pathogenesis, clinical features, comorbidity, and treatment approaches to BPD by critically examining published studies.

2. Epidemiology

The lifetime prevalence of BPD is approximately 5.9% and the point prevalence of BPD is 1.6% [ 6 , 7 ]. Although the prevalence of BPD is not higher than other personality disorders in the general population, BPD has a high prevalence in treatment settings; BPD was present in 6.4% of primary care visits, 9.3% of psychiatric outpatients and 20% of psychiatric inpatients according to the studies in clinical settings [ 4 , 8 , 9 ]. However, the ratio of females to males with the disorder is also greater in the clinical population. The ratio is 3:1 in clinical settings cited in the DSM-5 [ 4 ]. In contrast to the clinical setting ratio, in two epidemiologic surveys of United States general population, the lifetime prevalence of BPD was found to be similar in males and females [ 6 , 7 ]. This result can be interpreted as women with BPD are more likely to seek treatment than men. About 80% of patients who receive treatment for BPD were reported to be women.

3. Pathogenesis

The cause of BPD is not known and it is suggested that BPD is the product of an interaction between genetic, neurobiological, and psychosocial influences that affect brain development [ 10 ].

Although studies are rare and different values have been reported, there is at least moderate evidence for the genetic transmission and heritability of BPD. According to two studies, the concordance rate for BPD was found to be higher in monozygotic twins compared with dizygotic twins (36 and 35% versus 19 and 7%) [ 11 , 12 ]. However, a third twin study reported that a common genetic influence has little contribution to the development of BPD compared to environmental influences (42% versus 58%) [ 13 ]. In sum, constitutional predisposition to emotional dysregulation with a non-supporting environment leads to the development of BPD [ 14 ]. Future studies are needed to focus on interactions of specific endophenotype and environmental factors.

According to neurobiological research data, it has been suggested that neuropeptide functions may predispose to interpersonal problems of BPD patients [ 15 ]. The hypothalamic pituitary adrenal (HPA) axis dysfunction has a central role in the development of BPD. Increased levels of stress hormones, such as basal cortisol, and reduced feedback sensitivity were reported in BPD patients [ 16 ]. However, maladaptive behaviors of self–others and relationships with others are believed to be modulated by the oxytocinergic system [ 17 ]. Increased HPA activity and decreased peripheral oxytocin levels are correlated with a history of early life maltreatment and insecure attachment in patients with BPD [ 18 ]. Moreover, few studies also reported increased testosterone levels in female and male patients with BPD [ 16 ].

Neuroimaging studies that have compared BPD patients with healthy controls have reported bilateral reductions in the hippocampus, amygdala, and medial temporal lobe [ 19 , 20 ]. The neurobiology of BPD can be conceptualized as abnormalities in the top-down control, provided by the orbitofrontal cortex and the anterior cingulate cortex, and the bottom-up control drives generated in the limbic system such as amygdala, hippocampus, and insular cortex. Top-down control provides cognitive control areas and bottom-up control provides salience detection [ 21 ]. In this circuitry, serotonin regulates the prefrontal regions by acting on 5-HT2 receptors in a different role [ 22 ]. Impulsive traits, a major component of BPD, are associated with deficits in central serotonergic functioning. More specifically, increased 5-HT2A receptors and decreased 5-HT2C receptors are related with impulsivity [ 21 ]. Impulsivity is a core feature of BPD and it is related with reward and control circuits and deficient behavioral inhibition in prefrontal areas [ 23 ]. However, left amygdala hyperactivity was found in unmedicated patients with acute BPD. This feature is consistent with negative environmental stimuli [ 24 ]. Intense and variable emotions of BPD patients are related with amygdala hyperactivity. The role of the amygdala also reflects maladaptive top-down processes in evaluating negative environmental stimuli [ 25 ]. However, an enlarged hypothalamus and dysregulated HPA axis, and a reduced volume of the amygdala and hippocampus are found in patients with a history of early trauma and posttraumatic stress disorder (PTSD) [ 26 , 27 , 28 ]. In addition, the finding of reductions in gray matter volume of amygdala in older BPD patients has been interpreted as reflecting a reversible progressive pathology [ 29 ]. Emotional regulation difficulties of BPD patients are related with insufficient capacity of cognitive processes of prefrontal cortex (PFC) activity [ 30 ]. Koenigsberg et al. reported hypoactivity in orbitofrontal cortex, ventrolateral cortex, and dorsal anterior cingulate cortex (ACC) in BPD patients compared with healthy individuals [ 31 ]. This result is related with maladaptive affective regulation in BPD patients. However, lower prefronto-limbic connectivity within the affect regulation circuitry was reported to be normalized after successful psychotherapy [ 32 ]. In sum, numerous studies that have compared BPD patients with healthy controls reported a serotonergic dysfunction and reductions in amygdala, hippocampus, and medial temporal lobe volumes [ 19 , 20 ]. However, since these studies enrolled adult BPD patients, it is not clear that these neurobiological defects are the sequelae or etiologic causes of the disorder.

Life experiences are also known to be associated with the development of BPD [ 33 ]. Childhood trauma is the most significant risk factor for development of BPD [ 34 ]. Since childhood trauma is not always present in BPD, and individuals who had trauma do not always necessarily develop BPD, this relationship between childhood trauma and BPD is not clear. It can be interpreted that childhood trauma is not a mandatory precondition for the development of BPD. Childhood trauma in BPD patients can take many forms in prospective studies including sexual abuse, physical abuse and neglect, verbal abuse, and early parental separation or loss [ 35 ]. According to a prospective study with 500 individuals, more physically abused and/or neglected children met the criteria of BPD as adults. Interestingly, sexual abuse history is not found as a risk factor for BPD. However, having a parent with alcohol or substance use problems, having a diagnosis of drug abuse, major depressive disorder, and post-traumatic stress disorder have all been associated with the development of BPD but are also non-specific factors [ 36 ]. Another prospective, longitudinal study with 639 children reported that childhood abuse/neglect was significantly associated with BPD in adulthood [ 37 ]. Meta-analyses have also found that only small effect sizes for the relationship between development of BPD and childhood maltreatment [ 38 , 39 ]. As with most psychiatric disorders, no single factor can explain the development of the disorder, multiple factors can help in explaining the development of BPD. Although, there were studies that reported that childhood trauma did not play a significant role in the development of BPD, it still remains an important risk factor for BPD and more studies are needed to elucidate this relationship.

4. Clinical Features and Comorbidities

BPD is a psychiatric disorder, which was initially thought to emerge during adolescence and continue into adulthood [ 40 ]. It has also been stated that a diagnosis starts from adolescents in DSM-5 [ 4 ]. According to DSM-5 Section II, the diagnostic criteria of BPD are divided into four dimensions: (a) Interpersonal instability dimension, which has the features of fear of abandonment and intense unstable relationships; (b) cognitive and/or self-disturbance, which consists of paranoid ideations, dissociative symptoms, and identity disturbances; (c) affective and emotional dysregulation; and (d) behavioral dysregulation dimension, which has impulsivity and suicidal behavior [ 4 ].

Affective instability has been shown to be the most specific, sensitive criteria for BPD [ 41 ]. Patients with BPD are emotionally labile, react strongly, and express dysphoric emotions such as depression, anxiety, and irritable mood [ 42 ]. However, a study that examined the associations of age with affective instability of BPD patients showed an inverse relationship between age and affective instability in patients with BPD [ 43 ]. Patients with BPD have unstable and conflicted relationships. They tend to view others as all good and bad which is labeled as ‘splitting’. They can easily become dependent on others but they can also have dramatic shifts in their feelings toward others. Cognitive dysfunction in BPD patients has also been shown in a meta-analysis, where BPD patients scored poorer on tests of attention, cognitive flexibility, planning, learning, and memory [ 44 ].

Impulsive behavior is a core feature of BPD and might take many forms. Substance abuse, impulsive spending, binge eating, reckless driving, and self-damaging behavior are very common and put the patient at risk of harm [ 45 ]. Previous studies suggested that impulsivity, emotional dysregulation, and self-harm behaviors during childhood are predictive features of BPD [ 46 ].

Suicidal attempts and ideations are common manifestations of BPD and are one of the diagnostic criteria of DSM-5 [ 4 ]. In retrospective studies, the rate of suicide is found to be 8%–12% in BPD individuals [ 47 ]. Suicidal tendency is most common at age 20 [ 48 ], and completed suicide attempts are more common after the age of 30 years in patients with BPD [ 48 ]. Patients may also engage in suicidal behaviors, such as cutting themselves. These behaviors, ideation or acts might be conceptualized as non-suicidal self-injury [ 49 ]. Since non-suicidal acts and suicide attempts are so common in BPD patients, it is quite difficult to assess the current risk of a patient’s suicidal intent. Patients who have attempted suicide more than once have an increased risk for completed suicide. According to prospective studies, the predictors of suicide in patients with BPD were reported as co-occurring symptoms of dissociation, affective reactivity, self-harm, depression comorbidity, family history of suicide, and history of childhood abuse [ 50 , 51 ]. According to a recent study, which examined gender differences and similarities in aggression, psychiatric comorbidity, and suicidal behavior in patients with BPD, men with BPD were found more aggressive, impulsive and more impaired than women with BPD. Men with BPD were found at higher risk of dying due to a suicide attempt compared to women with BPD [ 52 ].

Comorbid psychiatric disorders are common in patients with BPD [ 53 ]. According to an epidemiologic survey, 85% of BPD patients have at least one comorbid psychiatric disorder [ 6 ]. Mood disorders, especially depressive disorder, bipolar disorder, anxiety disorder, posttraumatic stress disorder (PTSD), substance use disorder, or other personality disorder and neurodevelopmental disorder such as attention-deficit/hyperactivity disorder (ADHD), might be present in patients with BPD [ 54 ]. According to several large patient samples, the rate of lifetime depression comorbidity ranges from 71% to 83%, and anxiety disorder comorbidity is as high as 88% in patients with BPD [ 55 , 56 ]. More recently in a genome-association study by Witt et al., genetic overlap has been found between BPD and bipolar disorder, major depressive disorder, and schizophrenia [ 57 ]. Their findings supported the role of genetic factors having a role in the development of BPD.

4.1. Borderline Personality Disorder and Bipolar Disorder

Borderline personality disorder (BPD) and bipolar disorder can co-occur in 10%–20% of cases and since symptomatology of these disorders is very similar, many patients with BPD have been mistakenly diagnosed with bipolar disorder [ 58 ]. It has also been suggested that BPD should be conceptualized as a part of the bipolar spectrum [ 59 , 60 ]. Smith et al. reported that a significant percentage of patients with BPD were in the bipolar spectrum [ 61 ], while Paris et al. reported that no empirical evidence supported BPD’s link to the bipolar spectrum [ 62 ]. By reviewing neuroimaging studies, Sripada and Silk reported that there were both overlap and differences in certain brain regions between BPD and bipolar disorder individuals [ 63 ]. A higher but not significant prevalence of BPD in patients with bipolar II disorder was reported [ 56 ] and Vieta et al. reported that BPD was diagnosed twice as frequently in patients with bipolar II disorder and bipolar I disorder [ 64 ]. Zimmerman et al. reported that patients with major depressive disorder (MDD) and BPD had excess psychosocial morbidity compared to MDD patients without BPD, and that BPD was the third most frequent diagnosis in patients with bipolar disorder after obsessive-compulsive disorder and histrionic personality disorder, respectively [ 65 ]. In sum, these results can be interpreted as each disorder is diagnosed in the absence of the other and these findings challenge the notion that BPD can be conceptualized as the part of the bipolar spectrum [ 66 ].

4.2. Borderline Personality Disorder and Early Trauma History

Trauma history is a central feature of both PTSD and BPD. The neurobiological impairments associated with the development of BPD can be conceptualized as the predisposing factor for BPD. Both environmental and neurobiological factors contribute to the development of BPD. Genetic predisposition becomes activated during environmental experiences of trauma history. It has been reported that trauma and neglect might exacerbate both biological and behavioral tendencies [ 67 ]. However, sufficient maternal care may buffer these vulnerabilities. These results might explain why some emotionally dysregulated individuals do not develop BPD despite their genetic tendencies. There is also evidence for a strong association between traumatic events and dissociative symptoms in BPD [ 68 ]. According to retrospective studies, borderline patients have high rates of childhood abuse and dissociation [ 69 ]. Depersonalization/derealization are core symptoms of BPD and dissociation can be a prominent feature in some individuals with BPD. Research in the dissociative subtype of PTSD and depersonalization suggested that dissociation might be a form of emotional over-modulation, promoting trauma-related stressful emotions [ 70 ]. Dissociation severity was predicted by the childhood traumas such as inconsistent caretaking, sexual abuse, adult rape, emotional neglect [ 71 ].

4.3. Borderline Personality Disorder and ADHD

The comorbidity of ADHD has been reported in 20% of BPD patients in several studies [ 72 ]. Since impulsivity is considered to be a central feature of BPD and ADHD, impulsivity has been examined as part of adult ADHD symptomatology in BPD patients. According to Philipsen et al., ADHD should be considered as a potential risk factor in patients with BPD with impulsivity [ 73 ]. In a recent study that has examined the association between impulsivity and ADHD in BPD patients, we reported higher comorbidity of ADHD in BPD group, and motor impulsiveness has been shown as a potential predictor of ADHD symptoms in BPD group [ 74 ]. In terms of the relationship between BPD, ADHD, and impulsivity, BPD-ADHD has been considered a severe, more impulsive and homogeneous subtype of BPD [ 75 ].

In sum, since BPD has been associated with chronic course of other psychiatric disorders, clinicians should carefully evaluate comorbid psychiatric conditions in patients with BPD in order to plan appropriate treatments.

5. Treatment

Since patients with BPD suffer considerable morbidity and mortality, BPD causes a therapeutic challenge for clinicians. First-line treatment for BPD is psychotherapy [ 76 ]. However, symptom targeted medications have also been found effective [ 77 ].

The psychotherapies that have been adapted to treat patients with BPD are; Dialectical behavior therapy (DBT), Mentalization-based therapy, Transference-focused therapy, Cognitive-behavioral therapy (CBT), and Schema-focused therapy [ 78 ]. These therapies provide active and focused interventions that emphasize current functioning and relationships. These therapy modalities also provide; (a) a structured manual that supports the therapist and provides recommendations for common clinical problems; (b) they are structured so that they encourage increased activity, proactivity, and self-agency for the patients; (c) focus on emotional processing, particularly on creating robust connections between acts and feelings; (d) increased cognitive coherence in relation to subjective experience in the early phase of treatment by including a model of pathology that is carefully explained to the patient, and encouraging an active stance by the therapist, which invariably includes an explicit intent to validate and demonstrate empathy and generate strong attachment relationships to create a foundation of alliance. Psychoeducation is also an important part of BPD treatment. It includes informing patients and families about the disorder, signs and the symptoms of the disorder, and also possible causes and treatment options [ 79 ]. According to a 2017 systematic review and meta-analyses of 33 clinical trials with 2256 participants that examined the efficacy of psychotherapies for BPD, DBT and psychodynamic approaches were found more effective compared to other psychotherapy modalities [ 80 ]. An earlier 2012 systematic review and meta-analyses had reported DBT, mentalization-based, transference-focuses and schema-focused therapies are effective for BPD treatment. But the results for CBT have mixed results [ 81 ]. DBT is a well-studied form of CBT that puts emphasis on impulsive behavior and affective instability, and aims to regulate emotional lability using group or individual sessions. According to a clinical study that consisted of 101 women with BPD and self-injurious behavior who received DBT over a two-year period, fewer patients treated with DBT attempted suicide and required psychiatric hospitalization (23% versus 46%) compared with patients received community treatment [ 80 ]. DBT focuses on improving coping skills, self-destructive behavior and acting out. Mentalization-based and transference-focused therapies are primarily psychodynamic therapies. Mentalization therapy also includes cognitive techniques. For example, the patient is supported to observe her mind and create alternative perspectives of her thoughts to others. Transference-focused therapy includes confrontation, exploration and transference interpretations for the relationships of the BPD patients with other individuals. Schema-focused therapy is a form of CBT that includes skills training. Family education can be used adjunct to other therapies for BPD treatment [ 78 ].

According to the literature, the pharmacological treatment for BPD is limited. It is suggested that the patient with BPD who continues to experience severe, impairing symptoms (for example affective dysregulation, impulsive-behavioral dyscontrol, perceptual symptoms) despite receiving psychotherapy, should receive symptom-focused, adjunctive medication treatment [ 42 ]. According to the clinical surveys and meta-analyses, low-dose antipsychotic drugs are more effective for cognitive and perceptual symptoms such as dissociation, paranoid ideation, and hallucinations compared with antidepressants or mood stabilizers. Mood stabilizers are found to be more effective for impulsivity, aggression, and behavior control in BPD [ 77 ]. Mood stabilizers in the meta-analyses were lamotrigine, topiramate, valproate, and lithium. Lithium is also found to be effective in preventing suicide in BPD patients as reported by a retrospective study. But lithium has a limited usage due to significant side effects [ 82 ]. However, according to preliminary evidence, omega-3 fatty acids are suggested as adjunct to primary medication treatment, with mood stabilizers to prevent recurrent self-harms [ 83 ]. Meta-analyses have also found that mood stabilizers and low-dose antipsychotics are more effective for affective dysregulations in BPD compared to antidepressants [ 77 ].

Since BPD has a high rate of psychiatric comorbidity, clinicians should be aware of co-occurring mood and anxiety disorders, and substance use disorder for treating patients with BPD. For mood and anxiety disorders, clinicians should be careful to prescribe higher doses of antidepressant drugs for treating subthreshold symptoms. Thus, clinicians should focus on BPD treatment and effective treatment should be organized for comorbid psychiatric situations for patients with BPD. However, when it comes to substance use disorder, bipolar disorder comorbidity and treatment of the substance use disorder should take precedence over BPD for safety [ 84 ]. There is no evidence supporting the use of polypharmacy in personality disorder. According to the US FDA, no medication is approved and no class of psychoactive medication is dramatically effective [ 85 ]. However, The National Institute for Health and Care Excellence (NICE) guidelines have reported that psychotropic medication should not be used to treat the BPD and may be prescribed for symptoms of co-occurring disorders for a short period of time [ 86 ]. In sum, treatment of BPD is multimodal. Psychotherapy is the first line treatment and adjunctive, symptom focused pharmacotherapy is essential. Comorbid psychiatric disorders should be assessed. A positive therapeutic alliance with patient and family, as well as psychoeducation about the nature of the disorder, are useful to maintain the treatment.

6. Conclusions

Borderline personality disorder (BPD) is a psychiatric disorder that causes significant impairment with a high prevalence occurring in adolescence and early adulthood. The disorder is associated with more clinical attention than other personality disorders and has a risk for higher suicidality. The etiology is still unknown. According to the literature, a combination of genetic factors, neurobiological abnormalities and childhood trauma history can cause development of BPD. BPD can be conceptualized as a chronic and persistent disorder. However, according to prospective studies, higher rates of remission and recurrence have been reported. There is still a lack of information on which factors lead to the development of BPD. Further studies are necessary to understand the pathology of BPD and to help reach the best choices of treatment for clinicians. Most psychotropic medications were found to be effective in treatment of symptoms of affective dysregulation and impulsive aggression, which have been the core dimensions of underlying psychopathology. Polypharmacy practice is not evidence-based and is unnecessary in the management of patients with BPD.

Author Contributions

Both authors contributed to the manuscript equally.

This manuscript received no external funding.

• DOI: 10.3233/JVR-170874
• Corpus ID: 149105098

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Case Conceptualization and Treatment Planning: Sara’s BPD Case

Case conceptualization, the goal for treatment and intervention, multicultural factors and environmental issues, therapeutic relationship.

When Sara was between six and ten years old, her older brother sexually abused her. Sara’s mother did not believe Sara and emotionally distanced herself from her daughter. As a result, Sara developed a fear of being abandoned, thinking that “everyone will leave me” and “others hate me.” In relationships, Sara experienced great distress during breakups, and she has engaged in self-harm. Recently, these issues have been exacerbated by her being laid off and her husband rekindling his relationship with his daughter from the previous marriage. Now, Sara engages in self-harm and suspects that her husband wants to leave her.

Currently, Sara’s knowledge and acceptance of the problem allow the client to work on their relationship and be receptive to the therapist’s advice. Sara appears to be a smart, capable woman who is currently unemployed due to the company’s restructuring. She does not seem to think about her job performance in a negative way. In attachments, Sara’s core belief is that her partner will abandon her – an end of a relationship appears devastating, which led to Sara attempting suicide before. Her automatic thought of the husband’s infidelity may be tied to her being abandoned by her family (classical conditioning).

The present symptoms and signs suggest a borderline personality disorder (BPD) and a strong fear of abandonment, and the chosen strategy is Cognitive Behavioral Therapy (CBT). This condition is characterized by strong emotional responses, fear of abandonment, intense anger, paranoid ideations, self-mutilating behavior, and chronic feelings of emptiness (American Psychiatric Association [APA], 2013).

In CBT for BPD, one of the specialized approaches is dialectical behavior therapy (DBT). According to Cattane et al. (2017), sexual abuse and abandonment in childhood often manifest in the development of BPD. Thus, the main goal of DBT for Sara is to address her emotional dysregulation and coping mechanisms (anger, jealousy, and self-harm). This goal includes smaller aims – Sara needs to learn to navigate relationships with her husband and his daughter and recognize how her jealousy affects the relationship. One of the objectives is to avoid unhealthy coping actions (self-harm) and replace them with self-affirmation and mindfulness (Cancrini & De Gregorio, 2018).

The approach of DBT is chosen as one of the highly researched strategies for clients with BPD. The goal of emotional regulation seems to be the most important since Sara’s jealousy and her anger toward David’s daughter seem to be at the center of the couple’s conflict. Sara experiences intense anger that she cannot control, and jealousy that leads her to disrupt David’s work. The proposed intervention would be performed individually with the client to maximize her openness about her feelings about her husband and his child. The sessions should include mindfulness exercises, cognitive restructuring, and change behavior practices.

DBT is a type of CBT that focuses on the person’s emotions at the moment, teaching individuals to cope with distress and regulate responses. According to Niedtfeld et al. (2017), DBT has also been successful in helping persons overcome their need to self-harm. Thus, this particular subtype is chosen for the client’s specific issues. The strength of this strategy is its attention to the present – during sessions, the client will use her current relationships to understand her emotions. She will also learn to regulate them using exercises that she will be able to use outside of the office. However, as DBT requires the client to accept that a behavior change is necessary, it may be unhelpful if the client is not responsive.

The client’s cultural background may be a barrier to the program’s effectiveness. As Castellanos et al. (2019) find, DBT can be highly effective for Hispanic individuals if treatment content is adjusted to reflect the client’s values and traditions. For example, her relationship with family and religion may be explored to see their importance. In regards to environmental issues, the client’s current unemployment and her support network can be addressed. Sara’s layoff had a great impact on her mental health and relationship. It is possible to consider how financial issues may occupy her mind, lowering the effect of therapy.

A therapeutic relationship is vital for CBT; however, it is also essential to establish strong boundaries when working with clients with issues of emotional dysregulation. For example, the balance between quiet responses and positive, empathetic responses is crucial not to discomfort the client (Kazantzis et al., 2018). Moreover, in initial sessions, it is necessary to allow the client to express her emotions to establish a bond and see the potential for future case formulation.

A potential barrier lies in Sara’s belief that therapy is the “last resort.” This has to be overcome through discussion and attentiveness to the client’s needs. My experience with CBT and my specialization in working with adults can be helpful in this case. I am aware of people’s common resistance behaviors, and I can use this knowledge to address Sara’s use of therapy to engage her in DBT and mindfulness.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5 th ed.). American Psychiatric Publishing.

Cancrini, L., & De Gregorio, F. R. (2018). Borderline personality disorder storyboard from the systemic family therapist’s perspective. In R. Pereira & J. L. Linares (Eds.), Clinical interventions in systemic couple and family therapy (pp. 15-29). Springer.

Castellanos, R., Spinel, M. Y., Phan, V., Orengo-Aguayo, R., Humphreys, K. L., & Flory, K. (2019). A systematic review and meta-analysis of cultural adaptations of mindfulness-based interventions for Hispanic populations. Mindfulness , 1-16.

Cattane, N., Rossi, R., Lanfredi, M., & Cattaneo, A. (2017). Borderline personality disorder and childhood trauma: Exploring the affected biological systems and mechanisms. BMC Psychiatry , 17 (221), 1-14.

Kazantzis, N., Dattilio, F. M., McGinn, L. K., Newman, C. F., Persons, J. B., & Radomsky, A. S. (2018). Defining the role and function of the therapeutic relationship in cognitive behavioral therapy: A modified Delphi panel. International Journal of Cognitive Therapy , 11 (2), 158-183.

Niedtfeld, I., Schmitt, R., Winter, D., Bohus, M., Schmahl, C., & Herpertz, S. C. (2017). Pain-mediated affect regulation is reduced after dialectical behavior therapy in borderline personality disorder: A longitudinal fMRI study. Social Cognitive and Affective Neuroscience , 12 (5), 739-747.

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Borderline Personality Disorder Case Report Essay

Introduction.

Borderline personality disorder (BPD) refers to a personality disorder in which the patient demonstrates extended alterations of personality functions, unstable mood, and split personalities. As a result, the disorder appears in several episodes of idealization and devaluation, unstable interpersonal interactions, and disturbances in one’s self-image.

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Conversely, the characteristics of patients with BPD can sometimes graduate into extreme cases of dissociation, self-harm, violence, and suicidal tendencies. Also, studies show that BPD arises from diverse and complex factors such as childhood abuse, genetics, and some developmental factors (Arntz, 2005, p. 167).

Furthermore, BPD co-occurs with other mental disorders such as depression and other conditions such as post-traumatic stress disorder (PSTD). Therefore, the BPD diagnosis entails different clinical assessments and observations. Thus, most clinical assessments use the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the differential diagnostic approach (Arntz, 2005). Also, there are several therapeutic options for BPD, which include psychotherapy, medications, and the use of support groups.

This essay presents a case report based on the case history and observations involving a female client suffering from BPD. As a result, this essay uses a set of questions regarding the client and her current condition to present an overview of the client’s background information. Also, the essay describes the major observations made during the interview and the most appropriate therapeutic interventions for the client.

Background Information

Outline the major symptoms of the disorder discussed in the case.

According to the DSM, the major symptoms of BPD entail the prevalence of two or more identities of personality states in a patient. As a result, each personality state has to express unique ways of viewing the world. Also, the personality states take control of the patient always.

Therefore, different personality states in patients with BPD should be unaware of each other, and this amnesia should not be as a result of another medical condition. Consequently, patients with BPD show variability of moods, splitting, dissociation, and other unstable behaviors (Arntz, 2005).

Briefly describe the client’s background

The client’s name is Becky, who is a 24-year old Caucasian woman. According to the information provided in the case history video, Becky lives with her father, attends a local university, and works as a customer relations officer with a large corporation. Also, Becky is the first-born in a family of five children and divorced parents.

Describe any factors in the client’s background that predisposes her to the disorder

The client shows self-destructive behaviors, such as instances of self-mutilation and suicide threats. She also experiences splitting episodes, acts impulsively, and displays behaviors that are potentially harmful to her and other people. Also, Becky demonstrates other impulsive behaviors such as drinking alcohol, drug abuse, compulsive spending, chaotic relationships, fighting with family members and friends, and makes frantic efforts to avoid abandonment.

Observations

Describe the symptoms that you observed that support the diagnosis of the individual.

The client is a bright and ambitious woman who has trouble believing in her sense of self and what other people see in her. As an adolescent, she remembers getting into vicious fights with her family members and friends. Furthermore, she has been in and out of relationships because she is fond of idealizing people and then scorning them after some time. Conversely, Becky was raised in a Mormon faith in which she once found great meaning and pleasure. However, she now renounces the Mormon faith.

Therefore, Becky has a very little sense of self, and she believes that her persona is a fraud. For instance, she currently works in customer relations for a large corporation whereby she is quite good at her work, and she often receives compliments and promotions, but Becky thinks that she is not legitimate. Furthermore, even when people like and admire her, she still feels disingenuous and believes that she fools them in one way or another.

Describe the symptoms or observations that are inconsistent of the disorder

Client assessment and observations show that Becky demonstrates several impulsive behaviors and actions such as drinking alcohol, drug abuse, and violence. However, despite that these behaviors and actions strongly relate to BPD, they can also qualify as the symptoms of other medical conditions, which cause behavioral disturbances. For instance, alcoholism causes encephalopathy, which in turn damages the limbic system in the brain (Stone, 2006). Therefore, some symptoms that are as a result of the limbic damages may be confused with those caused by BPD. Furthermore, some frontal lobe syndromes are risk factors in the development of impulsive behaviors and actions.

Describe any information you observed about the development of the disorder

The case history shows that Becky has been experiencing chaotic relationships at home and at the workplace. These relationships, coupled with the trauma and separation from the caregivers (parents) can lead to the development of BDP.

Therapeutic Interventions

In your opinion, what are the appropriate short-term goals for this intervention.

In this case, the short-term goals for the therapeutic intervention should involve ameliorating both the major symptoms, which dominate the clinical aspect of the disorder and the personality disturbances, which are apparent long after the symptoms disappear (Stone, 2006, p. 15). Therefore, the intervention should address different symptoms relative to their level of seriousness.

In your own opinion, what are the appropriate long-term goals for this intervention?

The long-term goals for the intervention should aim at fostering the long-ranging skills, which entail psychic integration and cultivation of other personal aspirations regarding work, friendship, and partner choices. Here, several therapeutic options such as Schema-Focused Therapy for borderline personality disorder play a pivotal role in helping the patient to confront the maladaptive beliefs, which develop as a result of early life events (Stone, 2006).

Which therapeutic strategy seems most appropriate in this case? Why?

By definition, personality is an integral part of a person, which defines one as an individual with a distinctive sense of self and self-perception.

Therefore, most treatment strategies for BPD focus on promoting various coping skills and interpersonal relationship skills through different behavioral therapeutic options. As a result, these treatment options are appropriate in the management of BPD because studies show that most patients who have undergone behavioral interventions experience less anger and reduced instances of self-harm (Stone, 2006).

Additionally, therapists have identified several general strategies for treating individuals with borderline personality disorders. First, because individuals with BPD have difficulty trusting people, therapists strive to maintain open, honest, and clear communication. As a result, anytime a misunderstanding arises, it is addressed as soon as possible.

Secondly, as we have seen, people suffering from BPD often express a range of challenging and even aggressive behaviors. Therefore, experienced therapists anticipate these behaviors and maintain an emotional distance from the client. Also, therapists may establish a behavioral contract that limits the client’s behavior during therapy (Stone, 2006).

Thirdly, the therapist should also anticipate that the client will express “splitting”, alternatively idealizing and then rejecting the therapist. While most therapists discourage splitting, a recent treatment model points out that splitting is an entrenched, adaptive strategy for the client, therefore rather than discouraging it, this model recommends incorporating it into the therapeutic process.

The process involves using two co-operating therapists who meet with the client separately when the client feels frustration toward one therapist, he or she can express it to the other.

Conversely, two therapeutic approaches commonly used to treat BPD are drug therapy and dialectical-behavioral therapy, both of which have shown modest degrees of success. Psychiatrists sometimes prescribe medications to address specific behavioral and emotional issues.

For instance, clients who express dangerous impulsive behaviors might be given serotonin re-uptake inhibitors. Likewise, depression and anxiety symptoms can be treated with appropriate medications. However, such medical treatments have had mixed success rates (Stone, 2006).

Which therapeutic modality seems most appropriate in this case? Why?

Relative to the therapeutic strategy described above, the most appropriate therapeutic modality for the current case should be Dialectical Psychotherapy Behavior Therapy. This treatment method is appropriate in this case because some empirical studies show that it is effective in terms of reducing anger and instances of self-mutilation in patients with BPD.

Conclusions

This essay presents a case report regarding the case history and observations made on a female client suffering from BPD. Therefore, the essay describes the client’s background information, the observations made during the interview, and the most appropriate therapeutic interventions for the client’s condition.

From the discussions above, it is notable that there are several therapeutic options in the management of BPD. As a result, there is a need to develop appropriate therapeutic strategies, which individualize the therapeutic modalities available to address the diverse conditions in different patients.

Reference list

Arntz, A. (2005). Introduction to special issues: Cognition and emotion in borderline personality disorder. Behav Ther Exp Psychiatry , 36 (3), 167-172.

Stone, M. H. (2006). Management of borderline personality disorder: A review of psychotherapeutic approaches. World Psychiatry , 5 (1), 15-20.

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Borderline Personality Disorder Case Study Paper Example

Borderline Personality Disorder affects 2% of the population, 75% being female, which is an equivalent of 10 million people in America. The film BACK FROM THE EDGE features the stories of three individuals who have recovered and are living with the BPD and also some leading specialists in the field. Most of the therapists share the universal stigma that surrounds the BPD patients. Some of them avoid working with these patients claiming that they are very difficult to deal with. Another reason why most of the psychiatrists and psychologists avoid treating or dealing with the BPD patients is the fact that they are either incompetent or they have limited training. However treating protocols for treating these patients have been researched and developed. In the film, Dr. Marsha Linehan personal struggles with the BPD patent shows an exclusive commitment and attachment to the client is much appreciated. From her psychology expert point of view, we learn that BPD is treatable and even curable.

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In fact it has been wise for the clinicians ethically not to treat disorders they arent competent with or adequately trained on. Mental therapists who work with these clients should be very good at upholding the professional boundaries so as to successfully treat this personality disorder. Although maintaining this kind of therapeutic alliance as well as the fact that the whole process is time consuming, its still possible to treat this disorder once established. Moreover other conditions underlying the BPD such as the trauma, physical childhood or sexual abuse or eating disorder can effectively be dealt with. Setting a consistent and clear therapeutic boundary nonetheless, takes a lot of patience, compassion and time. Although taking these clients as part of the clinicians caseload is rather time consuming and requires the expert to push beyond the boundaries, an efficient clinician can help the patient in managing their levels of distress without altering the actual amount of work.

As an expert there are a number of issues that one has to have in mind when attending a client with Borderline Personality Disorder symptoms who comes in seeking psychotherapy services. To begin with the therapist should be ready to work with absolute commitment throughout the process with both the patient and the family. Its important to make the client understand that the short term therapy may be a short term solution but its not the best way to go when one needs to accomplish it. Identify a criterion that extricates the normal from abnormal behaviors including the criteria of distress, deviance and dysfunction. The therapist can distinguish such abnormal behaviors using the following methods or activities: social-cognitive perspective questions, positive psychology, trait perspective questions or using a quiz. Compare the clients symptoms from those of anxiety disorder, schizophrenia and mood disorder and analyze the challenges allied to the labeling of the BPD and the impact of the diagnosis to the patient. Then you may compare the psychoanalytical, cognitive behavioral and the biomedical approaches of treating the disorder.

An experienced expert ought to know that the client with such a disorder is not manipulative by choice. In most cases he or she might be experiencing extreme pains and emotional suffering and only tries to get the attention by in self-destructive and other dramatic ways as an approach of alleviating such suffering. Although not done intentionally, these patients do not commiserate with the therapist as they do not understand their constant need for attention is time consuming, cause great deal of stress and drain a lot of energy from the therapist. In a similar way the parents sets the boundaries with the children, the rapists needs set the margins with the BPD patients as they too are inordinately demanding. Therefore, a combination of the compassionate response and firm expectation, a protocol for treating BPD, is quite effective and in most cases leads to a behavioral change.

According to the DSM-IV-TR, for an expert to diagnose a client, he or she must have five of the nine major symptoms. Some of the symptoms include: chronic feeling of emptiness, frantic effort to avoid imagined or actual abandonment, identity disturbance, paranoid ideations, and recurrent suicidal behaviors among others.

In conclusion Borderline Personality Disorder affects 2% of the population, 75% being female, which is an equivalent of 10 million people in America. In the film BACK FROM THE EDGE, Dr. Marsha Linehan personal struggle with the BPD patent shows an exclusive commitment and attachment to the client is much appreciated. From her psychology expert point of view, we learn that BPD is treatable and even curable. . The therapist can distinguish such abnormal behaviors using the following methods or activities: social-cognitive perspective questions, positive psychology, trait perspective questions or using a quiz.

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Borderline Personality Disorder Case Study Sample

Type of paper: Case Study

Topic: Emotions , Biology , Violence , Bullying , Nursing , Disorders , Sexual Abuse , Psychology

Published: 12/15/2019

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The word borderline was a common term in the 19th century used to delineate a condition that was bordering two distinct types of psychiatric conditions that were by the time broadly categorized into major groups; neurosis and psychosis (Chapman and Gratz 9). As Chapman and Gratz assert, this delineation was probably due to the fact that a limited number of patients had been observed to warrant a precise description of the disease. Findings from the researches point to the fact the Borderline Disorder could be described far much differently. Chapman and Gratz uphold that Borderline Disorder, conventionally known as Borderline Personality Disorder (BPD), is a grievous mental disorder that principally manifests itself in the form of affective aggression, impulsive self- deleterious behavior as well as other superfluous cognitive perceptual symptoms (11). Experts have always concurred that there are several factors that jointly constitute the causative factors of BPD (Krawitz and Jackson 32). These factors include; biological factors, physical factors and socio-cultural factors. Assertively, biological factors are statistically more probable to influence how the brains of an individual functions, specifically in BPD victims. Citing a study of people diagnosed with a depressive disorder, Krawitz and Jackson Krawitz and Jackson report that the biological factors contribute predominately to self-harm- one of the overarching symptoms of BPD (32). The authors pinpoint that genetics have a strong influence in the causation of BPD. The authors refer to a recent that affirmed that, between identical and non identical twins of people with BPD, identical twins exhibit 35% more chances of developing BPD, as opposed to the non identical twins who have only 7% chances of developing a similar disorder (Krawitz and Jackson 32).

Physiological factors, just like biological factors have a role to play in the causation of BPD. To this effect, it has been corroborated that the environment in which a person is brought up plays a substantive role in causing BPD. Krawitz and Jackson contend that if a person is brought up in an opprobrious environment, the chances of the person developing BPD are greatly heightened (33). Further, sexual abuse is a notable risk factor in light of the fact that a multitude of BPD patients oft admit having a sexual abuse chronicle (Krawitz and Jackson 32). It is noteworthy, though, that sexual abuse that do not always culminate to BPD.

Besides biological and physical factors, social-cultural factors are yet other factor that role-plays in the causation of BPD. BPD has been found to have an overly reduced prevalence in societies with stringent rules defining the roles of an individual in the society. Societies always have laws that define what the society expects of any society member. For instance, societies have prescripts that dictate what an individual should do with reference the matters such as love and punishments for rapists. It can be clearly instituted that social-cultural factors intermingle with other factors, inclusive of biological and psychological factors to cause BPD.

There the various ways in which BPD is symptomatically manifested. As Chapman and Gratz assert, people with BPD are known to be unstable in their emotions, thinking and above all behavior (11). In the same way, BPD patients have always form unstable relationships; they form rocky relationships that are characterized by a pronounced fear of being desolated (Chapman and Gratz 11). Additionally, they have very poor control over their anger and might end up having dangerous anger out bursts with some being excessively afraid of anger (Chapman and Gratz 11). Most importantly, people with BPD are impulsive and most of the times make unjustified decisions when they are upset (Chapman and Gratz 11). Sadly, a very big proportion BPD victims have a history of suicide attempts and self-harm (Chapman and Gratz 11). To enable the understanding of the symptoms easily, Chapman and Gratz refer to Dr Marsha Linehan’s categorization of the symptoms into five easily apprehensible categories that he calls dysregulations; Dr Marsha Linehan refers to these symptoms as “dysregulation” because they are not easily controlled (11). The five dysregulations according to Dr Marsha Linehan’s are emotional dysregulation, interpersonal dysregulation, behavioral dysregulation identity dysregulation and cognitive dysregulation (Chapman and Gratz 12). The DSM-IV-TR Diagnostic Criteria for BPD is the most common diagnostic method for BPD. The criteria principally seeks to institute the pervasive pattern of instability with regards emotional, identity, interpersonal and cognitive cues that point to one suffering from BPD. Essentially, the criterion is centered towards the identification of any symptom that might warrant the one is indeed suffering from BPD. Available treatment options for BPD encompass; psychotherapy, pharmacotherapy, family interventions, group therapies, and hospitalization. It is of importance to note that psychotherapy is the main treatment option for BPD. This therapeutic procedure can be further divided into; Dialectical Behavior Therapy aimed at instilling skills of emotional control to the patient, Mentalization based therapy aimed at helping the patient know how to understand his or her mental state and Transference focused psychotherapy that is aimed at helping the patient understand relationships (Gunderson 9).

Works Cited

Chapman, Alex and Gratz, Kim. The Borderline Personality Disorder: Everything You Need to Know about Living with BPD. Oakland, CA: New Harbinger Publications, Inc., 2007. Print. Gunderson, John G. “An Introduction to Borderline Personality Disorder (Diagnosis, Origins, Course, and Treatment).” Bpd Brief (2011): 1-12. Print. Krawitz, Roy and Jackson, Wendy. Borderline Personality Disorder. New York, NY: Oxford University Press, 2008. Print.

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Borderline Personality Disorder: Case Study

Lukenotes, summer 2021.

Sr. Rita was angry and frustrated after being asked to step down from a third committee in two years. She was informed that she was being removed from the welcoming committee because she was not very friendly or hospitable and might deter potential members from joining the community. Sr. Rita huffed off in disbelief and worked to control her rising anger. She marched to mother superior’s office prepared to plead her case.

How did Sr. Rita get here? Why has she been removed from yet another committee?

Sr. Rita struggles with fear of rejection and abandonment and insecurity about not being good enough. She has a history of impulsivity, aggression, and self-injurious behavior. At age sixteen, after an intense argument with her best friend, Sr. Rita attempted suicide by ingesting a bottle of pills. She briefly engaged in therapy but did not believe there was anything she needed to work on.

Sr. Rita has been in religious life for 22 years. As a child, she did not consider pursuing a religious vocation. In college Sr. Rita joined a Catholic youth group, volunteered at the local monastery, and sought guidance from a family friend in a religious community. Immediately following college, she joined a community in the Midwest and started her religious journey. Sr. Rita is happy with her decision and shows her love for religious life by getting involved, planning activities for the community and neighborhood, and suggesting ways to improve community living.

Initially, Sr. Rita embraced the quiet time for prayer and found the structure and routine helpful. More recently, however, she balks at not being able to coordinate her own schedule and does not always participate in community activities. She does not enjoy sharing a kitchen or car with other sisters and often fails to adhere to established rules. Some community members are afraid of Sr. Rita and shared their concerns with the superior. Sr. Rita seems unaware of her impact on the other sisters and becomes irate when concerns are expressed about her behavior. She was encouraged to utilize additional support and reluctantly agreed to meet with a Saint Luke Institute therapist.

Sr. Rita felt scared, yet relieved, when she received the diagnosis of borderline personality disorder. The diagnosis helped explain years of chaotic behavior. Although therapy was challenging, every day Sr. Rita gained new insight and skills. Most notably, through her work at Saint Luke Institute, Sr. Rita finally opened up about her traumatic upbringing. Sr. Rita lost her father in a car accident when she was eight years old. Her mother battled depression and stopped taking care of Sr. Rita and her siblings. One day Sr. Rita’s mother dropped her siblings and she off at church and never came back to pick them up. Sr. Rita still remembers the feeling and the moment when she realized her mother was not coming back to get them.

Sr. Rita’s traumatic and unstable childhood shaped the way she navigated the world. She was sensitive to any hint of abandonment due to feeling discarded by both of her parents. She existed in a state of hypervigilance as a means of self-protection and shut down her feelings to avoid reliving the terrible experiences from growing up in the foster care system.

With the support of trauma therapy, group counseling, and psychoeducation workshops, Sr. Rita slowly recognized how much pain she carried around and masked all those years. She replaced unhealthy coping skills with mindfulness and distress tolerance skills and identified triggers to create a process for difficult moments. Sr. Rita still struggles with managing expectations and receiving feedback, but continues to work with her therapist to better understand her behavior. Sr. Rita also creates more balance in her life by exercising, setting boundaries, and building time in her schedule for self-care.

As Sr. Rita continues the therapy work and practices therapeutic tools, her style of relating to others will improve, she will respond instead of reacting, and she will have greater control over her thoughts and feelings. Every day Sr. Rita reminds herself that healing is a process and a lifelong journey.

For confidentiality, reasons, names, identifying data, and other details of treatment have been altered.

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The Borderline Patient - A Case Study

What's it like living with Borderline Personality Disorder? Read therapy notes of female diagnosed with Borderline Personality Disorder, BPD.

• Watch the video on Therapy notes of a Borderline Patient  

Notes of first therapy session with T. Dal, female, 26, diagnosed with Borderline Personality Disorder (BPD)

Dal is an attractive young woman but seems to be unable to maintain a stable sense of self-worth and self-esteem. Her confidence in her ability to "hold on to men" is at a low ebb, having just parted ways with "the love of her life". In the last year alone she confesses to having had six "serious relationships".

Why did they end? "Irreconcilable differences". The commencement of each affair was "a dream come true" and the men were all and one "Prince Charming". But then she invariably found herself in the stormy throes of violent fights over seeming trifles. She tried to "hang on there", but the more she invested in the relationships, the more distant and "vicious" her partners became. Finally, they abandoned her, claiming that they are being "suffocated by her clinging and drama queen antics."

Is she truly a drama queen?

She shrugs and then becomes visibly irritated, her speech slurred and her posture almost violent:

"No one f***s with me. I stand my ground, you get my meaning?" She admits that she physically assaulted three of her last six paramours, hurled things at them, and, amidst uncontrollable rage attacks and temper tantrums, even threatened to kill them. What made her so angry? She can't remember now, but it must have been something really big because, by nature, she is calm and composed.

As she recounts these sad exploits, she alternates between boastful swagger and self-chastising, biting criticism of her own traits and conduct. Her affect swings wildly, in the confines of a single therapy session, between exuberant and fantastic optimism and unbridled gloom.

One minute she can conquer the world, careless and "free at last" ("It's their loss. I would have made the perfect wife had they known how to treat me right") - the next instant, she hyperventilates with unsuppressed anxiety, bordering on a panic attack ("I am not getting younger, you know - who would want me when I am forty and penniless?")

Dal likes to "live dangerously, on the edge." She does drugs occasionally - "not a habit, just for recreation", she assures me. She is a shopaholic and often finds herself mired in debts. She went through three personal bankruptcies in her short life and blames the credit card companies for doling out their wares "like so many pushers." She also binges on food, especially when she is stressed or depressed which seems to occur quite often.

She sought therapy because she is having intrusive thoughts about killing herself. Her suicidal ideation often manifests in minor acts of self-injury and self-mutilation (she shows me a pair of pale, patched wrists, more scratched than slashed). Prior to such self-destructive acts, she sometimes hears derisive and contemptuous voices but she know that "they are not real", just reactions to the stress of being the target of persecution and vilification by her former mates.

This article appears in my book, "Malignant Self Love - Narcissism Revisited"

next: Adolescent Narcissist ~ back to: Case Studies: Table of Contents

APA Reference Vaknin, S. (2009, October 1). The Borderline Patient - A Case Study, HealthyPlace. Retrieved on 2023, May 29 from https://www.healthyplace.com/personality-disorders/malignant-self-love/borderline-patient-a-case-study

Medically reviewed by Harry Croft, MD

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12 Borderline Personality Disorder

• Published: February 2013
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Chapter 12 covers Borderline Personality Disorder (BPD), and includes definition and history of the condition, description and background of dialectical behavior therapy (DBT) used to treatm BPD, background history of the patient, assessment strategy, case formulation and treatment approach, course of treatment, treatment transfer specific to this case, relapse prevention, avoiding common mistakes in therapy, and case conclusions.

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Home / Essay Samples / Nursing & Health / Psychiatry & Mental Health / Borderline Personality Disorder

Borderline Personality Disorder: a Case Study

Essay details

Nursing & Health

Psychiatry & Mental Health

Borderline Personality Disorder , Mental Disorder

• Words: 1061 (2 pages)

Please note! This essay has been submitted by a student.

Table of Contents

Presenting symptoms, background information & personal history, assigned diagnosis, rationale for diagnosis, potential differential diagnoses, treatment recommendations.

• Barlow, D. H., Durand, V. M., & Hoffmann, S. G., & Lalumière, M. L. (2018). Abnormal psychology: an integrative approach. Boston, MA: Cengage Learning.
• Links, P. S., & Stockwell, M. (2001). Is Couple Therapy Indicated for Borderline Personality Disorder? American Journal of Psychotherapy, 55(4), 491-506. doi:10.1176/appi.psychotherapy.2001.55.491
• Mercer D., Douglass, A. B., & Links, P. S. (2009). Meta-analyses of mood stabilizers, antidepressants and antipsychotics in the treatment of borderline personality disorder: Effectiveness for depression and anger symptoms. Journal of Personality Disorders, 23(2), 156-174. doi:10.1521/pedi.2009.23.2.156
• Neacsiu, A. D., Rizvi, S. L., & Linehan, M. M. (2010). Dialectical behaviour therapy skills use as a mediator and outcome of treatment for borderline personality disorder. Behaviour Research and Therapy, 48(9), 832-839. doi:10.1016/j.brat.2010.05.017

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NUR2488 Module 07 Borderline Personality Disorder Case Study

  S.is a 48-year-old divorced woman with one adult daughter and three grandchildren. She is currently working as an LPN part-time in a nursing home and works at a convenience store one or two days per week. She has had many jobs over the last 22 years, usually changing every one or two years to a new job. S notes that she has been called less often to work in the convenience store and worries that they don’t like her anymore. She reports being written up several times for arguing with customers. She also reports that she liked her supervisor at; first; she says, “Now I hate her; she’s trying to get me fired.” S. reports that she has tried to get full-time jobs five times in the last four years was hired for three but only lasted one or two weeks at each one.

S. reports that she is currently not talking to her daughter because “she is mean to me and she needs to apologize, or I won’t talk to her again.” She is upset that she hasn’t seen her three small grandchildren in about a year. She sends them presents and cards frequently that say “I still love you! Grandma” but hasn’t called them since she stopped talking to her daughter. She is considering reporting to the county that her daughter is keeping her grandchildren from her.

S. is very unhappy that she isn’t in a relationship. She was abused by her ex-husband and had a pattern of meeting and dating men who eventually abused her. She states that her last relationship was very good; the man was not abusive, and “I loved him very much.” The relationship ended for reasons that S. doesn’t understand. However, she does report many arguments that ended in “scenes,” such as her throwing chairs, stomping out of the house, making crank phone calls to his family, and calling the police with false reports. But S. also reports that she “couldn’t have loved him more, and I showed it.” She gives examples of going to her boyfriend’s place of work with flowers, buying him expensive presents, surprising him with tickets to Mexico at the last minute – she was very upset that he wasn’t willing to drop everything and go with her. S. reports asking him why he didn’t love her and what she was doing wrong regularly. When the boyfriend asked to break up, S. reported sitting outside his house for weeks, crying; she called his mother, called his boss, and called and texted him until he filed a restraining order. This occurred about four months ago.

S. admitted herself to the mental health unit when she felt suicidal. She reports that she had stopped her psychotherapy three months ago and stopped going to DBT. She also stopped her anti-depressant at that time, as she felt it wasn’t working, and missed her last two psychiatrist appointments.

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