Dealing With Borderline Personality Disorder : Case Study With Management Strategies

Cluster A Personality Disorder

Borderline personality disorder is a condition where the person’s behaviors, thoughts and actions are not aligned and pose an issue for their daily functioning and occupational efficiency.

Today, we discuss X’s case, that will enlighten us on another aspect of BPD as a psychological condition and how it can be managed using expert interventions and techniques.

Today’s case is about X, who is a 31 year old female who has separated from her husband. She belongs to a middle socio-economic status family and is currently unemployed.

The case was brought to our attention by her father and brother, and an adequate personal and family history was obtained.

The duration of her illness and symptoms was reported to be from the last 15 years, for which she had prior consultations, but with no improvements due to discontinuation of treatment on the client’s part. The problem aggravated in the last 2-3 years with-

Mode of onset- Insidious

Course- Continuous

Progress- Deteriorating

Predisposing factor-  Family history of Bipolar Affective Disorder in grandfather and brother and depression in sister.

Perpetuating factor- Interpersonal conflicts in family and expressed emotions

Precipitating factor- Nil

X’s Journey of Mindful Transformation

X had a difficult journey of 15 years with the issue of borderline personality disorder, and could not realize the root cause behind it. When she visited a psychiatrist, she was prescribed-

  • Zenoxa tab
  • Olimelt tab and
  • Etilaam tab

She only consumed the medicines for 5 days, before discontinuing the process. As her condition was already deteriorating, this was aggravated by a sudden discontinuation.

After this, she visited Tulasi health care for an in-depth consultation from one of the best psychiatrists in Delhi, and her transformation was a spectacle to behold.

 

History of Present Illness

  • -The client’s history clearly dictated their problem’s onset. From the age of 16 years, she experienced mood fluctuations and a demanding behavior. On top of this, as this was adolescent period, it was taken as a passing symptom and ignored.
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  • -Over the next 2-3 years, she became highly defiant towards her parents, as she had progressed towards her engineering degree.
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  • -She found herself extremely irritable, angry and restless during this period.
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  • -X felt she was disconnected from self and others, which disrupted her functionality.
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  • -She reported being lonely, which was often short lived. Which was compensated with an indulging of shopping and baseless roaming.
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  • -Her dynamics with her family were very turbulent and unstable.
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  • -X’s financial dynamics were also very indecisive, where she would overspend and had also taken a huge loan which was spent on luxury goods and items that were not needed.
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  • -X also had a history with substance abuse (tobacco and cannabis), during her college time.This behavior continued till and after she was married.
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  • -Due to dwindling relations with her in-laws, she separated from her husband within 3 months of marriage
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  • -During this time, she also changed over 8-9 jobs in a span of 6.5 years. She felt dissatisfied one day and motivated the other.
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  • -All the mentioned disturbances led her to partake in the BPD management plan under the experts of Tulasi healthcare.
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Mental Status Examination

Appearance- Thin built, looks younger than stated age, well kept.

Awareness- Conscious

Cooperated with the experts

Oriented to time, place and person

Felt anxious and restless

Rapport- easily established

Psychomotor activity- increased

Speech- Relevant, audible and normal rate, tone and volume. Spontaneous, coherent and goal directed

Mood and affect- subjectively she did not feel fine. Objectively she felt anxious and raged.

Reactivity- decreased and restricted to anxious pole

Attention- aroused and sustained

Memory- recent and remote memory were adequate.

Insight- partial, attributes behavioral changes to external factors

Chief Complaints

  • -Excessive mood swings and irritable at all times
  • -Enraged quite easily
  • -Interpersonal relations with friends and family are unstable
  • -Feels lonely and fears being alone
  • -Disturbed routine
  • -Failure to concentrate, form goals and aspirations
  • -Inability to understand emotions and commit to any task

Diagnostic Formulation

With an insight level of grad 3, X was diagnosed with Emotionally Unstable Personality disorder according to the ICD-11 criterion.

The points that dictate this diagnosis include-

  • -Unstable and interpersonal relationships
  • -Impulsive spending and substance consumption
  • -Affective instability
  • -Chronic feeling of emptiness
  • -Explosive anger episodes
  • -Feelings of abandonment
  • -Identity disturbance- unstable self image

Assessment Tools and Criteria

X was tackled with various assessment tools to confirm her diagnosis and supporting symptoms.

The assessments included-

  • Sack’s Sentence Completion test (SSCT)
  • Million Clinical Multiaxial Inventory 3 (MCMI-3)
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  • Her scores on the tests indicated towards borderline personality disorder, which indicats that she experiences intense endogenous moods with recurring periods of dejection and apathy often interspered spells od irritability.

 

Management Strategies Applied : Specialized For Various Domains

The management routine was highly specialized, given that the client faced the condition for more than 15 years and needed interventions that provided immediate relief to her.

The strategies included-

  • Activity scheduling– Since the client faced problems in concentrating and making goals, activity scheduling was an appropriate option. Cognitive remediation training to improve attention and concentration, recreational, yoga and indoor sports.
  • Psychoeducation– Education regarding harmful effects of substances, NA literature, discussions and addiction group sessions were organized.
  • Dialectical Behvaioral Therapy- Mindfulness, interpersonal effectiveness, distress tolerance and emotional regulation.
  • Family therapy– This identified the communication barriers, and balanced out the disturbed family dynamics as well. She was encouraged to travel her hometown and take part in family celebrations to enhance her feelings of belongingness.
  • Financial responsibility– Finacial indecisiveness was a major part of her jounrey, and this was tackled with education on financial targeting, and keeping track of expenditure. This exercise helped in maintaing her goals.

 

Conclusion

With some of the best psychiatrists in Delhi, X’s recovery was a spectacle to behold. It was possible due to the keen observation and personalized attention that she received which translated into a transformational journey of a life time for X. Her condition improved drastically and she felt that she was starting her life anew.

If you want your loved ones to live a life that is healthy and mentally well, don’t hestaitate to connect with us today.

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