A CASE OF Borderline Personality Disorder
By: THEODORE MILLON
et al.
Notes:
(1) Numbers mark aspects of the case most consistent with DSM
criteria as follow, and
do not necessarily indicate that the case
“meets” diagnostic criteria in this respect.
(2) Patient's name has been changed in respect to
confidentiality, and names mentioned are not of a real existent person.
Case of Jenny
Jenny, age 25, was brought for evaluation by her stepmother, Vera. “Sometimes she seems to adore me, and
sometimes she hates my guts,” Vera said, bewildered. “She knows we love her,
but she just goes on and on like this. Sometimes, when it gets real bad, she
accuses us of planning behind her back to hurt her.” (2) Jenny’s efforts
to restrain her emotions are obvious. Initial moments of decorum give way
suddenly as Jenny bursts forth with an erratic stream of anger, accusation, and
feelings of betrayal. (9) The meaning of her words and emotions is
difficult to track. (6)
Jenny is no stranger to psychotherapy. According to her
stepmother, Jenny was hospitalized in her teens and has been in therapy twice before,
each time for about a year. She has an episodic history of substance abuse,
including marijuana, alcohol, amphetamines, “ecstasy,” LSD, and most recently,
cocaine. She has been sexually active since her first intercourse with an older
cousin at age 12 and hates to be without a boyfriend. (4) Jenny’s mother
died of cancer when Jenny was 9. Her father married Vera two years later.
Vera’s two sons and Jenny’s older brother got along well from the start.
Jenny, however, responded to her mother’s death and her father’s subsequent
marriage to Vera with a mixture of withdrawal, anger, and increasingly
outrageous behavior. After a suicide attempt, running away from home, and arrests
for drug possession, she was deemed unmanageable by the family and sent to a
strict boarding school at age 14. She still threatens suicide from time to
time, (5) and seems to have no life goals or real values. (3)
Her anger seems total and indiscriminate. She is angry at the
circumstances that brought her here. (8) She has just been released from the hospital, where she was recovering from minor internal injuries
sustained after jumping out of her boyfriend’s Jeep while on the way to a
concert, something she has done before. (4) She insists she did it
because they were arguing and she was high and just wanted to get away,
describing him as “evil.” She obviously despises Vera, referring to her as the
“wicked witch” several times during the interview.
Her most intense anger, however, is reserved for her father, who “never
gave a damn,” abandoning her and the memory of her mother by marrying Vera. The worst thing is not his abandonment, she says, but
that he doesn’t even know he did it. (1) “The only good he ever did was
teach me not to rely on people, ’cause one minute they’re here and the next
they’re gone,” she continues. She has even gone on a hunger strike and locked
herself in her room and demanded her father and Vera divorce.
Jenny believes that he sent her away because she both looked and behaved
like her mother, and that her father couldn’t handle having a young version of
his dead wife in his new life.
The death of her mother and alienation from her
father have left her feeling “hollow inside,” she states. “Sometimes life is
like moving in slow motion and I seem like an observer, looking at everything
from the outside, numb.” (9) Sometimes during these periods she cuts herself
with a razor blade, “’cause it hurts, but I end up feeling better afterwards. It
shakes me up inside and pulls me back to reality.”
DSM-IV
Criteria
A pervasive pattern of instability of interpersonal relationships,
self-image, and affects, and marked impulsivity beginning by early adulthood
and present in a variety of contexts, as indicated by five (or more) of the
following:(1) frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
(2) a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
(3) identity disturbance: markedly and persistently unstable self-image or sense of self
(4) impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
(5) recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
(6) affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability or anxiety usually lasting a few hours and only rarely more than a few days)
(7) chronic feelings of emptiness
(8) inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
(9) transient, stress-related paranoid ideation or severe dissociative symptoms.
References
(1) Personality Disorders in Modern Life, second edition,
2000, 2004 by John Wiley & Sons, Inc.
(2)Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition. Copyright
1994 American Psychiatric Association.
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