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 Elsa
A
polished and attractive woman of 47, Elsa entered therapy because “I’m just not
feeling up to par, and never have.” Feelings of depression and despair
increased substantially after this, her third, marriage began to dissolve. Not
yet divorced, but living apart from her husband, she reports extreme anger and
feelings of worthlessness at being left helplessly alone. (8) She
states that she cannot deal with the situation, and instead spends her time
shopping, buying what she cannot afford, drinking too much, and looking for
someone to take the place of her husband. (4) “Marital therapy failed,” she states, and “after
I began phoning him four or five times a day, he has changed his number and
moved away. I have no idea where he is.” (1)
Elsa
seems to have two sides to her. In some ways, she is immersed in the
existential angst appropriate to a teenager, still trying to discover “who Elsa
really is.” In other ways, she seems hard, calculating, and embittered. (3) The anger she feels toward her husband seems
inappropriate given that the terms of the divorce are quite generous. Though
admittedly not a particularly good relationship, the marriage nevertheless gave
Elsa “someone to be.”
(8) Sometimes her
husband is described as “the most loving person,” and sometimes as “the
asshole.” (2)
Instability
runs through Elsa’s history. She has lost contact with her oldest brother. Her
mother’s numerous marriages have left her with a combination of half-sisters,
half-brothers, and ex-step0siblings. Family infighting has taken the place of
genuine communication. Certain parts of the extended family are divided into
factions that no longer speak to each other. Elsa states that she always
received the “short end of the stick” when her mother remarried. Because each
marriage required a move, Elsa was unable to make lasting friends as a child, and
her schoolwork suffered. Her mother didn’t care about her grades, and Elsa
found it convenient to adopt this apathetic attitude rather than make a real
effort in her studies.
Elsa
states that although she never really loved any of her husbands, she
“completely lost it” when each marriage failed. (6) Probing further, she discloses that she has
been hospitalized three times, twice following suicide attempts, once for
substance abuse. She received follow-up therapy after each hospitalization, and
is being seen by a different therapist at the current time. (5) Initially,
she thought very highly of her latest therapist, feeling sure that he would
finally get to the root of the problem. More recently, she is disappointed and
angry that he is not more readily accessible to her and is unable to see her
more than twice a week. (2)
Although her visit today seems designed to secure additional nurturance, Elsa
will be referred back to the therapist she is currently seeing.
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.
Read Also
Nonsuicidal Self-Injury (NSSI)Suicidal Behavior Disorder
Suicide
Borderline Personality
HIV and Personality Disorders
Marsha Linehan and Dialectical Behavior Therapy
Domestic Violence and Personality
Rarely Is a Woman Wicked . . .!!??
No comments:
Post a Comment