Patients with Borderline Personality Disorder are often initially seen in emergency department because of impulsive self-harm behaviour. However, the most pressing question is whether she needed to be admitted in a Psychiatric Hospital. Since it becomes a life threatening situation quite often, so the patient needs to be admitted in a structured setup. In the case of Ms D, her traits turned into disorder because of frequent triggers, which were her impulsivity and unstable pattern of relationships. Often it is observed that Borderline Personality is misdiagnosed with Bipolar Affective Disorder due its acute onset however after a thorough assessment and evaluation, the clinical team can start structured psychotherapy with the help of simultaneous pharmacological treatment in a Psychiatric Hospital.
Over the past two decades, the most effective psychotherapy is Dialectical Behaviour Therapy, as patient with chronic Borderline Personality Disorder needs specialized treatment conducted by a team of psychotherapist, which is possible only in a Psychiatric Hospital.
The primary therapist started working on Ms D’s sources of emotional dysregulation which indicates her ‘dramatic behaviour’ or ‘attention seeking behaviour’ and the temporary relief aka poor coping skills aka self-harming behavior. She had toxic relationships because of ‘always being on extremes’ that was- either being too involved in a relationship or to abruptly breakup with them. DBT is a strict hierarchy of treatment targets, and the life threatening behavior will be on the top of the list. Ms D started getting individual session once in a week and weekly life-skill group session. These sessions taught her how to on work on skills in these domains– mindfulness, distress tolerance, regulation of emotions and interpersonal effectiveness. Her therapist was also available over the phone for all hours, as the protocol of DBT, her case was also discussed among the group of her clinicians every week to see the progress.
The aim was to make her independent and have cognition that how her brain works and how she can manage her symptoms on her own. Her parents were psycho-educated about her illness, however they couldn’t accept what was going on but later on with continuous psycho-education they were able to understand that what was going on in their daughter’s life. Ms D stayed in the Psychiatric Hospital for 2 months, and continued the therapy as an outpatient for 1 year.
So in real Ms D wasn’t a “drama queen”, but a helpless person who was unable to regulate her emotions, and “seeking attention” was an unconscious cry for help.