Borderline Personality Disorder Case Study Paper Format

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

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"



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Last Updated: 06 July 2016
Reviewed by Harry Croft, MD

Like many examples of borderline personality disorder (BPD), the example presented here is fictionalized. "Jordan" is not an actual person, and any resemblance between this fictional person and any actual person is coincidental. The symptoms and behaviors described, however, are very typical of a person with BPD.

Infancy

Even when Jordan was a tiny infant, there was something very different about her.

She reacted intensely to most things. She was easily upset, she didn't adjust easily to new people or places, and she was hard to comfort.

But she was just a baby; it seemed too soon to become concerned. Her parents assumed that all babies are different and that this behavior of Jordan's was just a phase she'd grow out of. 

Childhood Behavior

As Jordan got older, she didn't grow out of her phase. She continued to be easily upset and hard to comfort, and she had very severe separation anxiety. If her mother left the room, Jordan would scream until she returned.

Still, her parents weren't too concerned. They'd heard that separation anxiety is pretty typical in young children, and Jordan had so many sweet qualities. At times, she could be the most loving child. They often had really wonderful times together.

The Teenage Years

Things started to change when Jordan hit her early teens. There were fewer and fewer good times.

She became increasingly sullen and angry. She started acting out more and more—yelling at her parents and teachers and engaging in impulsive behaviors, like running away from home.

Sometimes, for a while, Jordan would have a close friend or two at school, but they weren't friends for long. Conflicts always occurred, and the friendships would end.

Jordan talked about how alone and bored she felt, how no one understood her. Her parents were starting to become concerned about her, but what if the way Jordan was acting was just typical adolescent behavior? They weren't yet ready to seek help.

By the time Jordan turned 17, her home life was starting to get seriously out of control. She experienced severe emotional instability, her mood changes were totally unpredictable, and she could switch moods from one minute to the next. She was fighting with her parents almost daily, usually yelling and throwing things. At times she seemed terrified to be without her mother; at other times she would leave the house in a fit of intense rage and not return for days.

One day, her mom noticed scars on Jordan's arms. When her mother first confronted Jordan about them, Jordan told her the cat had scratched her. But then she admitted that she was self-harming, cutting herself because she felt so lonely and bored and this was "the only thing that makes me feel better."

Now her parents knew: They needed to find help for Jordan.

A Misdiagnosis

Jordan's parents were able to find a psychiatrist in their area who accepted their family health insurance and they brought Jordan to see her.

The psychiatrist spent time talking to Jordan and asking her and her parents about her symptoms. Based on this brief assessment, the psychiatrist diagnosed Jordan with bipolar disorder and prescribed a mood-stabilizing medication.

The new medication seemed to help, and Jordan and her parents were hopeful that things were getting better. Wanting to understand her disorder better and get information on helping her recover, Jordan's parents read about bipolar disorder. What they read, however, didn't always fit their daughter's symptoms. For example, Jordan's moods seemed to change quickly and often, whereas the mood changes in bipolar disorder were described as infrequent.

A Correct Diagnosis

One day, while still being treated for bipolar disorder, Jordan went online and stumbled on a description of borderline personality disorder (BPD). As she read about the symptoms of BPD, she realized that, for the first time, someone else seemed to understand what was going on inside her head. She called her mom and read her the page she had found. Her mother agreed with Jordan—it looked as though they might finally have an answer.

Jordan's mother found internet resources that led her to a list of experts in BPD in their area. They made an appointment with a psychiatrist, who met with Jordan several times. After their third meeting, the new psychiatrist confirmed that Jordan met the diagnostic criteria for BPD. The psychiatrist then explained the treatment options that were available, including medications and psychotherapy.

Gradually Regaining Control

At 23, Jordan still has many symptoms of BPD. However, treatment with a combination of medication and dialectical behavior therapy (DBT) has markedly reduced her symptoms. She no longer harms herself, she's working part-time, and she has several close friends.

Jordan still has times when she feels overwhelmed and has problems with anger and relationships. Fortunately, she's learning coping skills that can help her get back in control and manage those symptoms when they occur.

Jordan's BPD Experience: Summing Up

Jordan's case is only one of many examples of borderline personality disorder, which varies widely among the people who have it. For example:

  • Some people with BPD have supportive families, like Jordan's, while others grow up in traumatizing environments (a life experience that's linked to the development of BPD symptoms).
  • Some, like Jordan, start showing signs of BPD in early adolescence, while others don't have any symptoms until they are in their late teens.
  • Not everyone with BPD responds as well to treatment as Jordan did, although many do. 

Source:

National Institute of Mental Health (NIMH). Borderline Personality Disorder. Updated December 2017.

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