Patient Borderline Personality Disorder Case Study

Kathryn Merteuil, the primary antagonist in Cruel Intentions, is the master at manipulating both men and women. She is the most popular girl at her school and bases the entirety of her self-worth on her perception that everyone either wants her or wants to be her. In order to maintain her appearance, Kathryn binges and purges and has a heavy cocaine addiction. Although well liked and popular, Kathryn holds no stable relationships and is easily upset and irritated when things do not go her way. Although this film’s focus is not Kathryn’s mental health diagnosis, Kathryn’s actions and unstable emotions are arguably that of a patient with Borderline Personality Disorder.

Katie Young is a 15 year old Caucasian female that was referred to my agency from the Virginia Family Assessment Planning Team and Colonial Behavioral Health due to the issues of stability with the intensive in home services. Her family history consists of rapid cycling Bipolar Disorder. Along with the bipolar II disorder, Katie suffers from PTSD that includes panic attacks 1-2 times per week, intrusive thoughts, flashbacks, high reactivity to being touched by others and trauma echoes regarding interaction with staff at school. She attends a school that is supposed to use behavior interventions with children with emotional disabilities. She has had an IEP on file since the age of 7 for ADHD and mood related needs. She is unfortunately uninformed of how to return to the public school in her city of residence or her current grade, which is possibly the 9th or 10th.

Assessment of the patient with borderline personality disorder is inclusive of the patient's: (1) physical; (2) emotional; (3) cognitive; (4) social; and (5) spiritual characteristics. These are assessed based on the patient's: (1) subjective reports; (2) interview records; and (3) behavioral

binge eating, ex, i saw a snapchat of my ex wih what appears to be anoher girl (new love interest) and i ended up eating half a bag of chips and three pieces of french toast.

Borderline Personality disorder is one of the most commonly diagnosed and functionally disabling mental disorders. The central characteristic of this disorder is impulsivity and instability in mood, relationships and self-image. People who suffer with borderline personality disorder usually experience severe feelings of depression, emptiness, and intense fear of abandonment. They also engage in destructive behaviors such as sexual promiscuity, drinking, gambling, and eating sprees. These people may also attempt suicide and sometimes engage in self-mutilation. Those with Borderline personality disorder seek approval and acceptance where ever they go; they might also irrupt in anger at any sign or disapproval. This disorder is usually marked by a long

The third is Separation insecurities and with this comes the fear of rejection or separation from friends and family; they have a fear of being dependant on others for ever but also experience a loss of autonomy (American psychiatric Association: 2013). Jordan’s case: Jordan’s parents tell of how Jordan has separation anxiety regardless of her now being older, she often screams when her mother leaves the room as previously mentioned, however she also often runs away from home especially after having an argument with her parents or friends. The fourth is Depressivity where the person is frequently feeling down and hopeless; they struggle to remove or change these thoughts or moods; they have a pessimistic view of the future, inert shame feeling,

Though several personality disorders are highly complex and a challenge to treat, there are effective treatments available (“Treating Borderline” 1). The various treatments are broken down by method, the first of which being cognitive behavioral therapy, which attempts to alter the conscious thoughts and behavioral patterns of patients (Daniel); (“Treating Borderline” 2). Cognitive behavior therapy itself is broken down into two therapies, dialectical behavioral therapy and schema-focused therapy (“Treating Borderline” 2). Dialectical behavioral therapy, developed by Dr. Linehan, is centered on the basis that personality disorders are formed when hypersensitive patients are in situations which lack the emotional support they require, therefore leading to their “inability to regulate emotions” (“Treating Borderline” 2). Thus, the treatment serves to help the patient gain control over their emotion and behavior (“Treating Borderline” 2). The treatment itself consists of group and individual sessions and typically lasts approximately one year (“Treating Borderline” 2). During the group sessions, patients learn to become more aware of their behaviors and emotions through sessions pertaining to “problem solving, mindfulness meditation, and breath training“(“Treating Borderline” 2). In personal sessions, referred to as psychotherapy, the psychiatrist explains to the patient how the lessons from the group therapy sessions are applicable

According to SAMSHA, early detections and interventions are possible to detect in children and adolescents and if treated early the likelihood of successful treatment is high. If BPD can be seen is children and adolescents I propose the idea of educating guidance counselors, teachers, and staff members on a training of the signs of Borderline Personality Disorder and recommending parents and caregivers of these children to seek counseling to find out the diagnosis, also educate the parents on the particular signs and if there is any knowledge of family members with this disorder. There has been controversy between researchers upon actually diagnosing BPD among adolescents. According to Kaess et al (2014) there are four reasons for the controversy, one side states that BPD isn’t effective in adolescent years. Second, the features of BPD are consider normal in adolescents. Third, in adolescent years children have an instability in personality which professionals see that as hard to distinguish between growing through adolescent years

Borderline Personality Disorder (BPD) is characterized by fluctuation of self-image, lack of stable interpersonal relationships and pronounced and unpredictable impulsivity. The Diagnostic and Statistical Manual of Mental Disorders 5 (2013) also lists fear of abandonment, suicidal or self-harming behaviors, intense or inappropriate anger that is difficult to control as well as paranoid ideation or dissociative symptoms. Morcos and Morcos (2016) wrote that patients with BPD are often misdiagnosed with other trauma related disorders, such as PTSD, depression or bipolar disorder. According to Beatson, et al. (2016) there are additional issues in diagnosing older patients, as the criteria indicates that symptoms would have been seen early in the patient’s life, not later. Beatson, et al. (2016) also noted that there is a considerable lack of studies and literature concerning BPD in older patients, making the diagnostic process more difficult. In this case study we will be working with an older patient, one that was well into midlife before Borderline Personality Disorder was included in the DSM, to see if she fits the criteria for BPD and what treatment options might be available.

According to the DSM-5, Personality Disorders are characterized by “impairments in personality functioning and the presence of pathological personality traits”. Borderline Personality Disorder is one of ten personality disorders listed in the DSM-5. The DSM-5 lists several criteria that must be met in order for someone to be diagnosed with Borderline Personality Disorder. They are quoted as follows:

The history of BPD can be traced back to 1938 when Adolph Stern first described the symptoms of the disorder as neither being psychotic nor psychoneurotic; hence, the term ‘borderline’ was introduced (National Collaborating Centre for Mental Health, 2009, p. 15). Then in 1960, Otto Kernberg coined the term ‘borderline personality organization’ to describe persistent patterns of behavior and functioning consisting of instability, and distressed psychological self-organization (National Collaborating Centre for Mental Health, 2009, p. 15).

I currently do not have any experience working with those suffering from addiction or with those suffering from personality disorder; therefore, I would find working with individuals who abuse substances and who have also been diagnosed with a borderline personality disorder to be very challenging. According to Goldstein (as cited in Miller, 2015), individuals suffering from addiction as well as bipolar disorders are difficult to treat as BPD individuals experience more issues including self-injurious behaviour and suicidal thoughts and/or tendencies. There are also many difficulties when working with BPD individuals as they are known to be confusing and unpredictable.

A personality disorder is characterized by a distinct pattern of behavior that does not meet normal standards of behavior within one’s culture. This pattern is ingrained as the norm to the person affected, and the characteristics of the affected person deviate markedly from societal standards (Hebblethwaite, 2009). The two main features that help to identify a personality disorder are chronic interpersonal difficulties and persons with one’s identity or sense of self (Livesly, 2001). Within this set of mental health disorders lie several other subsets, including one of the most prominent personality disorders - Borderline Personality Disorder (BPD). BPD is a severe, long-lasting disorder that has an incidence of occurrence approximately equal to that of bipolar disorder and schizophrenia combined (Grant, Chou, Goldstein et al., 2008). BPD also puts those affected at risk for damage in many areas of their life if not properly diagnosed and treated, including personal relationships, school, work, and self-imagine. Furthermore, this disorder has a high co-morbidity with other disorders such as depression, substance abuse, eating disorders, and social phobia, among many more (Hebblethwaite, 2009). Misdiagnosis of borderline personality disorder can have serious clinical implications. This paper looks to identify the risk factors associated with BPD, the affects on various aspects of the person’s life, treatments, and give recommendations as to how to properly identify and

“Personality disorders have been documented in approximately 9 percent of the general U.S. population” (Angstman, Rasmussen, 2011). Emotional dysregulation disorder or its common name borderline personality disorder is a very serious and chronic disorder. The Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) describes borderline personality disorder as “a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity that begins by early adulthood and is present in a variety of contexts” (Gardner, 2006). Within the last 20 years, psychologists and other mental health professionals have made tremendous strides in research on what exactly borderline personality disorder, some of its triggers and possible effective treatment options. Borderline personality disorder is defined as a disorder that generates severe emotional instability which can be a springboard that can lead to other stress induced mental and behavioral problems.

Over the past few units, I have greatly expanded my knowledge about several different psychological topics. Though many of the topics that were discussed sparked my interest, there were two types of disorders that furthered my knowledge, but also eliminated some stereotypes that I had about them. The two main areas that I learned more about regarding these disorders were characteristics of the disorders and different methods of treatment. A common theme that has been discussed in multiple different units is that several psychological disorders can have similar symptoms and characteristics. It is crucial to understand what makes one psychological disorder different than another one. Determining what type of disorders an individual might have can lead to better and more accurate treatment options; treatments methods are important because they help individuals manage their disorders. The two disorders that I found to be the most important and most interesting are borderline personality disorder and schizophrenia.