Understanding Borderline Personality Disorder: A Case Study Of Chloe Smith

Symptoms of Borderline Personality Disorder

Chloe Smith is a 25-year-old woman who was admitted to the hospital after she tried to commit a suicide by trying to jump from a cliff. However, the visitors had reached there on time to save her and got her back to the apartment where she stays with her roommate. Her roommate revealed that Chloe been always like this with extreme mood swings where she conducted many impulsive actions. Last week, she had a break up with her boyfriend after a public fight where she had even slapped him in front of public. She was very angry and disappointed at that time. The next morning she was not found absent in her room and therefore her friend had called her many times to which she did not pick up. In the afternoon, she came back upset and told that her partner did not want to renew the relationship even when she had apologised. She had been upset for two days where she had frequent bouts of anger where she broke up things in the house and even shouted at herself in the mirror. However, as days passed her friend thought that she was gradually healing as she found her engaging herself in her leisure activities like gardening, painting and going to her job regularly. All of a sudden, the day before, she was gain found to be disappointed and upset when she found her partner being engaged into a new relationship. Her friend tried to help her with the emotions and thought that she was gradually able to pick herself up. Chloe asked her friend to make her coffee, as she wanted to get over the stress. As her friend had gone to the kitchen, she heard the door shut, where she found that Chloe had left taking the keys of the car. From then, she had no news of her until this morning; she was called at the hospital where Chloe was admitted after the visitors rescued her when she tried to commit suicide.

From the above case scenario, it can be stated that Chloe suffered from borderline personality disorder (BPD). It can be described as a mental disorder that impact the ways an individual think about herself as well as that of the others and thereby causing various kinds of problems in functioning in their everyday lives. The events in their lives include a pattern of unstable intense relationships as well as distorted self-image, extreme emotions as well as impulsiveness (Bateman et al., 2015). Chloe often had bouts of impulsive actions where she slapped her partner in public, tried to commit suicide and many others. Chloe had repeatedly failed to control her emotions and she has been always found to have mood swings where she was angry at one moment, depressed, and withdrawn at the other moment.

Risk Factors for Borderline Personality Disorder

Reviews of literature have stated that when individuals suffer from borderline personality disorder, they have an intense fear of abandonment as well as instability.The proposed DSM-V (2013) diagnostic criteria had put forward many symptoms that help in identifying patients with BPD (Benson et al., 2017). Individuals find it difficult to tolerate in being alone. The participants of the studies who are caregivers of people suffering from borderline personality disorder have revealed that anger, frequent mood swings as well as impulsiveness of the patients push them away from others when though they want to have lasting as well as loving relationships with others (Linehan, 2018). Another symptom found among such patients just like Chloe is a pattern of unstable intense relationships like that of idealizing someone at one moment and then suddenly believing that the person does not care or is cruel (Paris, 2018). At first, Chloe slapped her partner thinking that he was trying to hurt her or betray her but the next morning she had a mood swing where she went to her partner with an apology. Fonagy et al., (2016) have stated another symptom like rapid changes in self-identity as well as self-image that include shifting values and goals as well as seeing oneself as bad or as if he or she is not present at all. Others include period of stress related paranoia as well as loss of contact with that of the reality that last for few minutes or to even few hours (Baer, 2015). Chloe was often seen talking with herself in the mirror where she used to reveal all her agitation, disappointment, and felt completely cut out from reality. Impulsive and risky behaviours like that of gambling, risky and unsafe sex, rash driving binge eating, drug abuse or sabotaging success by suddenly quitting or ending of a positive relationships are some other symptoms (Bateman et al., 2016). Chloe had ended her relationship based on doubts only. She also engaged in rash driving and even stopped hoping to her job all of a sudden. All these symptoms helped in identifying that she was suffering from borderline personality disorder. She also showed suicidal threats, behaviour, or self-injury in response to fear mainly of separation or that of rejection, which is yet another symptom of the disorder.

Choi et al., (2016) has stated that stressful childhood can be one of the contributing risk factor for BPD. It has been found that people who suffer from this disorder have been sexually as well as physically abused and neglected during childhood. Many of the individuals with this disorder are found to have been separated from their parents as well as close caregiver when they were young or had parents who were involved in substance abuse and other mental health issues (Harned et al., 2018). Others were found to have been exposed to different types of hostile conflicts as well as unstable family relationships. Another important risk factor is called the hereditary predisposition where they might be at a higher risk of their close relatives like that of father; mother, sister as well as brother had the same disorder (Sauer-Zavala et al., 2016). As per the information disclosed by Chloe’s roommate, Chloe had a stressful childhood where his father was alcoholic and often used to engage in domestic violence affecting both Chloe’s mother and Chloe. Chloe’s mother later fled from her husband and engaged in small job downtown. However, there had been instances where their property owner physically abused Chloe when her mother was at work. Though the police had later caught and punished the perpetrator, the incidences had left a deep mark on Chloe as a child. All these might have accumulated in making Chloe develop the disorder of BPD as she has grown up.

Treatments for Borderline Personality Disorder

Previously, BPD was considered to be difficult to treat but nowadays, with the help of evidence based treatments, most of the people with the disorder experienced fewer as well as less severe symptoms and improved quality of their lives (Zanarini et al., 2018). Psychotherapy is found to be the first line of treatments for the people suffering with the disorder. Chloe can be provided dialectical behaviour therapy called the DBT. This therapy mainly utilises the concepts of mindfulness and acceptance or being aware of and even attentive to the current situation and the emotional stages. This therapy also teaches the affected individuals in controlling emotions, reduction in the self-destructive behaviours as well as improvement of the relationships helping individuals to gain emotional and mental stability in their lives (Fonagy et al., 2015). Another therapy that can be also provided to Chloe is the cognitive behavioural therapy. This type of therapy has been found to be helpful in patients suffering with BPD as it helps them in identifying and even changing their core beliefs and behaviours that underlie the various types of inaccurate perceptions  of themselves and that of the others and even help in gaining mental stability in managing problems that occur when interacting with others. CBT is also found to be helpful in reduction of the range of mood and anxiety symptoms as well as reduction in the number of suicidal as well as self-harming behaviours (Paris, 2018). Medication therapy is the next set of interventions that can be provided to the patients who suffer from the disorder just like Chloe. However, medications are not used typically for the disorder as the benefits are found to be unclear. Still, in some of the cases, the psychiatrists might be seen recommending medications that help in treatment of the disorder mainly for the symptoms like mood swings, depression as well as for the other co-occurring mental disorders (Bateman et al., 2016). Some of the BPD therapies are also seen to include caregivers, family members as well as loved ones in the treatment sessions.  This type of therapies are seen to help by allowing the relative as well as the loved ones in developing skills for better understanding as well as supporting a person with BPD. The therapies also help in focusing on the needs of the family members for helping them to understand the obstacles as well as the different strategies that help in caring an individual with BPD. Although more studies are required to find out the effectiveness of the family therapies in BPD, researches on other mental disorders have suggested that including family members can indeed help in treatment of patients (Benson et al., 2017). The psychotherapists can utilise these therapies to help Chloe get over the disorder and live quality life.

References:

Baer, R. A. (Ed.). (2015). Mindfulness-based treatment approaches: Clinician’s guide to evidence base and applications. Elsevier.

Bateman, A. W., Gunderson, J., & Mulder, R. (2015). Treatment of personality disorder. The Lancet, 385(9969), 735-743.

Bateman, A., O’Connell, J., Lorenzini, N., Gardner, T., & Fonagy, P. (2016). A randomised controlled trial of mentalization-based treatment versus structured clinical management for patients with comorbid borderline personality disorder and antisocial personality disorder. BMC psychiatry, 16(1), 304.

Benson, K. T., Donnellan, M. B., & Morey, L. C. (2017). Gender-related differential item functioning in DSM-IV/DSM-5-III (alternative model) diagnostic criteria for borderline personality disorder. Personality Disorders: Theory, Research, and Treatment, 8(1), 87.

Choi-Kain, L. W., Albert, E. B., & Gunderson, J. G. (2016). Evidence-based treatments for borderline personality disorder: implementation, integration, and stepped care. Harvard Review of Psychiatry, 24(5), 342-356.

Fonagy, P., & Luyten, P. (2016). A multilevel perspective on the development of borderline personality disorder. Developmental psychopathology, 1-67.

Fonagy, P., Luyten, P., & Bateman, A. (2015). Translation: Mentalizing as treatment target in borderline personality disorder. Personality Disorders: Theory, Research, and Treatment, 6(4), 380.

Harned, M. S., Gallop, R. J., & Valenstein-Mah, H. R. (2018). What changes when? The course of improvement during a stage-based treatment for suicidal and self-injuring women with borderline personality disorder and PTSD. Psychotherapy research, 28(5), 761-775.

Linehan, M. M. (2018). Cognitive-behavioral treatment of borderline personality disorder. Guilford Publications.

Paris, J. (2018). Clinical features of borderline personality disorder. Handbook of Personality Disorders: Theory, Research, and Treatment, 2, 419.

Sauer-Zavala, S., Bentley, K. H., & Wilner, J. G. (2016). Transdiagnostic treatment of borderline personality disorder and comorbid disorders: A clinical replication series. Journal of personality disorders, 30(1), 35-51.

Zanarini, M. C., Conkey, L. C., Temes, C. M., & Fitzmaurice, G. M. (2018). Randomized Controlled Trial of Web-Based Psychoeducation for Women With Borderline Personality Disorder. The Journal of clinical psychiatry, 79(3).