Borderline Personality Disorder Case Report

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Table of Contents

Introduction
Background Information
Observations
Therapeutic Interventions
Conclusions
Reference list

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.

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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