KK is a woman presenting with a history of cutting her wrist with a razor, a history of drug addiction, and previous hospitalization for a drug overdose. Additionally, she is hostile, demeaning, and caustic to her caretakers, with a track record of unstable personal relationships at work. Based on the symptoms described above, such as self-harm, poor interpersonal relationships, unstable mood, and self-damaging acts such as substance abuse, are suggestive of borderline personality disorder as the definitive diagnosis.
The DSM-V bipolar personality disorder diagnostic criteria are as follows: Self-damaging acts such as unsafe sex and substance abuse, unstable personal relationships, self-harm, suicidal behavior, unstable mood, feelings of emptiness, fear of abandonment, intense anger that can be difficult to control, paranoid, and dissociative episodes (Chapman et al., 2022). Other assessment instruments, including the personality diagnostic questionnaire and the Minnesota borderline personality disorder scale, are available for diagnosis.
According to DSM V, bipolar or depressive disorders often occur concurrently. The presentation of other personality disorders, especially those in cluster B, including antisocial, histrionic, and narcissistic personality disorders, commonly overlap with borderline personality disorder. Additionally, non-suicidal self-injury disorder and substance use disorder are also differentials of borderline personality disorder. Hormonal disorders, especially hyperthyroidism and alcohol withdrawal, exhibit similar features as borderline personality disorder.
The condition has been linked to a strong genetic link. It is approximately five times more common among the first-degree biological relatives of those with the disorder than in the general population. It is also associated with an increased familial risk not only for bipolar and depressive disorders but also for substance use disorders. Additionally, serotonin dysregulation in the brain reduces the sensitivity of the 5HT-1A receptor, which may contribute to borderline personality disorder. Some studies further implicate estrogen in the causation of borderline personality disorder (the University of Illinois at Chicago, 2018). A fundamental explanation for the high prevalence in females compared to males. Culturally, the affected young adults and adolescent population may present with unstable moods accompanied by irritability, anxiety, and intense anger that can be difficult to control, especially when associated with substance use.
A borderline personality disorder is mainly treated using psychotherapy, but medication may be added. However, before treatment, it is essential to test the hormonal blood levels of thyrotropin-releasing hormone and cortisol levels to rule out depression. Moreover, toxicological studies, including drug levels, are important to distinguish borderline disorder from symptoms that may develop in association with persistent substance use.
Evidence-based care effective for patients with borderline personality disorder includes dialectical behavior therapy (DBT), which combines interpersonal and emotion regulation skills with mindfulness practices. Mentalizing-based therapy (MBT) helps patients control their emotional lability by feeling understood and enabling them to learn about the intentions of the people around them (Chapman et al., 2022). Finally, transference-focused psychotherapy (TFP) focuses on internalized images of self and others that organize the patient’s interpersonal experience and sense of self.
Pharmacologically selective serotonin reuptake inhibitors (SSRIs) are preferred over other classes of antidepressants. Fluoxetine 20mg PO qDay may be effective. However, this drug is associated with adverse effects such as insomnia, nausea, headache, nervousness, impotence in men, and decreased libido. Recovery from this disorder seems complicated and varies from patient to patient, requiring long-term follow-up and psychotherapy. Once recovery is attained, the patient can remain stable over some time.
Mental health is a crucial aspect of a person’s overall well-being. The World Health Organization includes mental health as a component in its definition. In that case, borderline personality disorder causes significant impairment and distress and psychiatric co-morbidities. Psychotherapy remains the fundamental treatment approach for borderline personality disorder. However, medications may include antidepressants, antipsychotics, or mood-stabilizing drugs. Hospitalization is also vital to keep patients safe f
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