Diagnostic Case Reports
Karen M. McKenzie
Dr. Lisa Faille
Maladaptive Behavior & Psychopathology Module 2
Borderline Personality Disorder
Major Symptoms of Major Depressive Disorder
According to the DSM-5 “essential features of this disorder is a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity that begins by early adulthood and is present in a variety of contexts. Those with borderline personality disorder make frantic efforts to avoid real or imagined abandonment” (American Psychiatric Association (APA), 2013).
Becky is a 24 year old Caucasian female who was raised as a Mormon up until she was 15 years of age. She has been diagnosed with Borderline Personality disorder. She currently lives with her father in a one bedroom apartment where she makes the dining room her bedroom (McGraw-Hill, 2007). At the time of the interview she was enrolled in school and worked for a huge cooperation, (no other details were disclosed). She remembers at the age of three her father being diagnosed with muscular dystrophy. She stated that she grew up in a dysfunctional home where her parents did not talk to one another (McGraw-Hill, 2007). Yearning for her mother’s attention, she told her mother she was molested by some six grade boys though it never happened and she knew it was wrong (McGraw-Hill, 2007).
Becky has four siblings who are all close in age, Becky being the oldest. Being the oldest child when her mother became frustrated she would take it out on Becky whether mentally or physically (McGraw-Hill, 2007).
Becky stated that in therapy she learned that her mother was the cause of her problems. She stated that there is a history of mental health issues in her mother’s family (McGraw-Hill, 2007). Lack of parental attention and affection and the feeling of emptiness could make her predisposed to this disorder (McGraw-Hill, 2007). Being mentally and physically abused as a child also can make her predisposed to the disorder (McGraw-Hill, 2007). Unstable relationships such as community or culture (Mormon) with family can put an individual at risk for this disorder (National Institute of Mental Health (NIH), n.d.)
During the interview Becky appeared at times to be trying to seek approval of the therapist by using keywords such as “you know” often in her conversation. There were times she seemed to be searching for the right words, seen by the length of her pauses. She had poor eye tack throughout much of the interview and her smile did not appear to be genuine. She discussed her anger issues and the fights with her mother and sister. Hostility is a criterion for this disorder. Even though she appears to be intelligent, she also showed that she could be manipulative and uncaring of others by the lies she would tell to gain attention. Becky talked about relationships and how she can cut them off if she felt they were being dishonest, regardless of their feelings, empathy is not her strong trait and is a criteria for the disorder. She discussed that she had a goal to go to college right after high school which did not happen due lack of self-direction (APA, 2013). Becky’s perception of the human race is total negativity as she feels the human race is stupid, the world sucks, people are horrible, mean and spiteful. She finds it hard to see the good in people (McGraw-Hill, 2007). This is a symptom of specific maladaptive traits in the domain of Negative Affectivity (APA, 2013). Abandonment issues as she describes what would happen if she lost someone in the store. She stated she would panic and flip out. She also does self-mutilation to make herself feel better. She states the cutting can be brought on out of fear such as being called upon in class, which is also a criterion for this disorder (APA, 2013). She admits she has unhealthy coping methods.
What is not a characteristic of this disorder is her attention seeking and approval seeking behavior which is more of a narcissistic personality disorder. Lack of eye contact and placing blaming on her mother for her mental health issues, are inconsistent with the disorder.
Research studies on borderline personality disorder are still in early stages (NIH, n.d..). There has been a general consensus that genic and environmental factors are likely involved with the development of the disorder (NIH, n.d.).
General Medical Conditions
There were no apparent medical issues at the time of the interview that could contribute to this disorder.
Psychosocial and Environmental Problems
Based on statements made during the interview there may be psychosocial and environment issues that may contribute to her mental health issues. She grew up in a dysfunctional home where there was no attention given to the children. She was abused mentally and physically and still would tell her mother she was a good mother. She’s living in the dining room of her father’s one bedroom apartment and lacks her own space.
Base on my observation her overall level of safety when it comes to harming herself or others based on a scale of 1-100 I would rate her 45. Becky has many issues that could trigger a cutting episode, even though she says she has it down to once or twice a week that depends on what is going on at the time. She appears to have attention seeking behaviors, and I do not believe she is being sincere. With her abonnement and trust issues there is still concern that her cutting could return to out of control.
Some religious cultures and environments where you are barely notice until something goes wrong, then you are abused could have an effect on the differential diagnosis. Borderline personality disorder is more common in females (APA, 2013). Mormons theology beliefs emphasis on women’s subordinate status and domestic place could be a factor on differential diagnosis of women trying to leave the community of which they have come to believe, and have learned you are either good or evil (Young, 2007).
Short-Term Treatment Goals
First short-term goal, is to journal daily feelings and the cause of those feeling whether good or bad. Second, to list coping skill that can be used to help with abandonment issues. Third, Practice using the listed coping skill in interpersonal relationships. Fourth short term goal is seek out borderline personality disorder support groups.
Long-Term Treatment Goals
Continue journaling thoughts and feelings and discuss with therapist. Continue to work on abandonment issues, incorporating self-talk into coping strategies, until this is not a real issue. Once comfortable in the support group move to other social activity to the point where crowds are no longer an issue.
Group therapy will help enable her to build trust with others and individual therapy with two different therapists to anticipate client “splitting” one minute idealizing and the next rejecting the therapist (McGraw-Hill, 2007). This enables the client when frustrated with one therapist; she can express her frustration with the other therapist so there is no break in treatment (McGraw-Hill, 2007). Family group to better her relationship, with her mother since she believes her issues stem from her mother.
Cognitive Behavioral Therapy (CBT) to examine thoughts emotions, and behaviors. CBT will help to resolve destructive belief and intrusive thought to help with a better life and to be open minded to different types of situation. DBT therapy is designed to help manage intense emotions and for controlling impulsive behavior (NIH, n.d.).
Karen M. McKenzie
Dr. Lisa Faille
Maladaptive Behavior & Psychopathology Module 2
Major Symptoms of Substance Use Disorder
The DSM-5 states that “the features of a substance use disorder is a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance spite significant substance-related problems” (American Psychiatric Association (APA), 2013).
Bobbie is a 31 year old recovering heroin addict with a 5 year old son named Tyler. Bobbie’s mother is a heroin addict who lives in Portland Oregon. Mom was in and out of her life so much that she felt like she was dead to her. She has one biological younger brother, and a step sister and step brother. She is currently a student studying in the medical office field. She has disclosed that she does have a lot of medical issues that go along with her medical condition and feels she is addicted to methadone. She lived with her father up until she was 16 years of age. At which time she stated he would slap her and knee her in the stomach. She thrived for his attention to the point she attempted suicide, starting drinking and had many boys in her life. Any attention was good attention to her. He never showed affection towards her, which made her believe he did not love her. She had been molested by her step-brother until she turned 15 years old. Bobbie completed half of her 10th grade year of school before running away. At 16 years old she ran away from home and was raped while hitch hiking to Utah. Prior to runaway she felt that she was a bad person because everyone would tell her she was like her mother. She believes all those people hated her mother and was angry with her, so she perceived they were saying she was bad. She was afraid to return to her father so she request to live with her mother in Portland even though her mother struggled with her own addiction. Once there she began prostituting herself, and found herself in an abusive relationship.
When asked how her drug use progressed she stated at 12 years old she began smoking cigarettes and marijuana, at 13 years of age she started drinking alcohol daily, at 15 years of age she was smoking marijuana, cigarettes, drinking alcohol, and by the age of 16 she was snorting cocaine, and using LSD (McGraw-Hill, 2007). She was introduced to heroin by her mother when she was allowed to suck on dirty heroin cotton to stop a toothache (McGraw-Hill, 2007). At twenty years old she was a heroin addict doing 2 ½ grams of heroin a day along with one gram of cocaine a day (McGraw-Hill, 2007). By this time she was in a bi-sexual relationship, prostituting herself daily in order to get more drugs, shooting drugs in her neck and rarely ate (McGraw-Hill, 2007). At 21 years of age she was going to prison for the second time. In 1989 she turned her life around when she found out about her current medical issues (McGraw-Hill, 2007). She has now been clean and sober for 10 years. She worries about her son since both her and his fathers are both recovering addicts (McGraw-Hill, 2007).
Bobbie appears to be clean and properly dressed and very sincere when telling her story. At times she would become emotional but always maintained good eye contact with the interviewer. She seemed to be very comfortable during the interview.
General Medical Conditions
She does have quite a bit of medical issues at the present time that is not contributed to her present disorder, but the disorder is contributed to her current medical issues (McGraw-Hill, 2007). She grew up in an environment where she was abused mentally and physical which could be a contributing factor for her disorder. At this time on a scale of 1-100 I would rate her 90 due to the fact that she has attempted suicide twice to gain attention during her addiction. At this time she drinks responsibly every now and then and smokes marijuana to help control her pain. I do not believe she would harm herself do to her young son.
Journal her thoughts and feelings daily. Second, find and attend a self-help program close to her home. Third find and attend a support group of peer with the same medical condition. Seek help when needed.
Continue with the self-help groups find a sponsor and work the 12-steps with her sponsor. Continue with support group for current medical condition, when comfortable open up to the group. Continue to follow doctor’s order and only take medication as prescribed. Continue to seek help when needed.
Bobbie could benefit from individual and group therapy due to current medical condition. Also since she did state she still has a drink every now and then and smokes marijuana for pain.
Drinking occasionally and smoking marijuana (though used for medical purposes) can be precursor to relapse. A harm-reduction model of treatment could help her to maintain control of her life without a relapse. This model, psychological intervention will help modify the behavior and could possibly help her eliminate alcohol from her life period (McGraw-Hill, 2007).
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition. Arlington, VA, American Psychiatric Association, 2013
McGraw-Hill, (2007) Major Depression. Faces of Abnormal Psychology. Retrieved from http://www.mhhe.com/socscience/psychology/faces/bigvid.swf
Nation Institute of Mental Health (n.d.) Borderline Personality Disorder. Retrieved from http://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml
Young, N. J. (2007). “The ERA is a moral issue”: The mormon church, LDS women, and the defeat of the equal rights amendment. American Quarterly, 59(3), 623-644,1049. Retrieved from http://search.proquest.com/docview/223306643?accountid=34899