Borderline Personality Disorder: Case Study
Karen’s Case
Karen was admitted in the intensive care unit of West Raymond medical Center after she knowingly took an overdose of sedatives in addition to alcohol in a suicide attempt following a disagreement with her man.
Consequently, the 32-year old single, unemployed woman lost consciousness which meant that she had to inevitably spend three days in the hospital. While still in the hospital the doctors never wanted to discharge her until when they were convinced that she was under the care of a psychotherapist. Karen’s psychotherapist was, however, reluctant to respond to Karen’s calls concerning her discharge citing that Karen, in a span of two years, had a record of three suicide attempts.
Karen wanted to take away her life because three months her boyfriend, Gary, had damped her. Karen first met Gary, 32-year-old construction worker in a bar where a horrendous love affair between the two blossomed to the extent that Karen started imagining spending the rest of her life with Gary. Karen was so into Gary that she constantly wanted to hear from him. She never noticed that the frequency with which she was meeting Gary was undergoing a temporal but constant decrement. Ultimately, Karen realized the evasive nature of Gary and started to suspect that Gary was gradually leaving her. One day while out with Gary an argument ensued and they ended up breaking up.
Karen had been involved with other men before meeting Gary. For instance, prior to meeting Gary, Karen was dating Eric. According to Karen’s roommate, Karen had barely met Eric for a week before they started dating. Just like their affair with Gary, their affair with Eric was short-lived. Similar stories can be told for her alleged relationships with Ahmad, James and Stefan who came after Eric before she finally met Gary. Worth noting is the fact that immediately after graduating from high school, Karen was married to George who was over protective to Karen and demanded that she only leave the house in his company. Sadly George died in a car accident leaving Karen so much devastated. These occurrences in Karen life made her excessively afraid of being abandoned to the extent that she constantly would want to kill herself whenever anyone abandons her- perhaps the reason why she constantly complained that her roommate was leaving her even after they had spent a whole day together.
The doctors at West Raymond medical Center had to discharge Karen after her psychiatrist refused to continue working with her. She was discharged to local mentor who continued giving her mentorship for sometime before she was recommended by one of the mentors to a Dialectical Behavior Therapist called Dr. Banks. According to Dr. Banks, Karen met the requirements for DSM-IV therapy for Borderline Personality Disorder. This is because one of her greatest fears was abandonment. Again her personal interpersonal relationship was unstable together with an unstable self image. Moreover, she had attempted committing suicide more than three times together with constant infliction of pain to herself. Just like her sense of self, her moods were tremendously unstable with constant feelings of emptiness which she displayed in undeserved anger. To top it off, Karen’s life was profoundly marked with impulsiveness and separation. All this were enough reason to render Karen one of the Dialectical Behavior Therapy patients. Just like other dialectical behavior therapist, Dr. Bank intended to address Karen’s condition in two perspectives; he wanted Karen to participate in behavioral skills training groups which could enable her develop her behavioral skills. The doctor also intended to hold individual psychotherapy sessions with Karen as a way of soothing her as well as offer guidance on the application of the behavioral skills.
Diagnostic and statistical manual of mental disorders (DSM-IV-TR) describes Borderline Personality Disorder as a “pattern of instability in interpersonal relationships, self image, and marked impulsivity” (American Psychiatric Association, 2000). Adolph Stern was the first person to use the term borderline in 1938 to describe patients who with disturbed neurotics (Wirth-Cauchon, 2001); same characteristics that were being exhibited by Karen. Dialectical Behavior Therapy (DBT) was developed by Marsha Linehan in 1993 with the aim of helping people with overwhelming emotional shutdowns (Mckay, Wood & Brantley, 2007). The therapy enjoys international accolade because of its effectiveness in helping people with suicidal instincts; people like Karen. BPD is caused by biological, psychological as well as social factors. Biologically, BPD traits can be inherited from parents and can be carried until early adulthood before it starts showing signs (Paris, 2005). Psychological and social factors on the other hand do not influence this condition directly.
DBT considers reality to be dynamic and holistic and is carried out in stages with the success of these stages being profoundly dependent on an individual theoretical orientation. The theoretical orientations in this light are behavioral science, dialectical philosophy and Zen practice all balanced in balance by dialectical frameworks. The therapy has four fundamental stages all of which having pre-treatment activities and exercises before the beginning of each stage (Freeman & Power, 2007). The first stage is a one year long stage that underscores the pertinence of getting the patients’ behavior under control (Freeman & Power, 2007). Like in Karen’s case, Dr. Bank had to first get Karen to conform to the dictates of the treatment. The doctor urged Karen to stick to therapy and avoid terminating the therapy while still under way by quitting or trying to commit suicide again. Karen was also discouraged from using suicide at a means of solving her life problems The second stage involves dealing with the patient past trauma that according to Freeman & Power (2007) may lead to the patient reverting to stage one behaviors. Dr. Bank by all means tried to help Karen forget the past incidences. Karen was also equipped with the ability to soothe herself in case she remembers her past traumas. Then Karen on being able to forget her past tribulations, the doctor moved with her to the next stage that serves to deal with the long-term effects that Borderline Personality Disorder might face their lives after the therapy is done. Linehan (1993) attests that it is imperative that the therapist addresses the needs of each step before moving to a higher stage. Further, Linehan (1993) asserts that how a session with a borderline personality disorder patient ends is extremely valuable as it determines whether the patient will move to the next stage. Linehan (1993) even goes ahead to give strategies that therapists can use in ending a session. The strategies involve issues like opening discussion with the patient at the beginning of a session, active planning before a session, through to making referrals (Linehan, 1993). As asserted by Freeman & Power (2007), there exist times when a patient might be taken to a fourth stage in which the patient will be under the care of a therapist, a spiritual advisor or a teacher. This stage serves to ameliorate sense of incompleteness as well as enabling the individual find lasting happiness (Miller, Rathus and Linehan, 2006). As highlighted in the last topic of Karen’s case, the therapy the therapy which lasted from over eighteen months was successful. She stopped hurting herself and has since stopped taking alcohol.
There are underlying core elements that are unique to this therapeutic practice. First the therapy should start by articulating its purpose (Miller, Rathus and Linehan, 2006). The entire period of the therapy is regulated by these set objectives. Secondly the therapist must decide on a biosocial theory of the disorder before considering the third element that involves the designing of a developmental framework of the treatment stages with provisions of the pretreatment. sessions (Miller, Rathus and Linehan, 2006). Fourthly, the therapist should clearly highlight the behavior that he or she wants to tackle within each stage (Miller, Rathus and Linehan, 2006). Elements five and six help the therapist formulate some key strategies of the therapy and deciding on a dialectical framework of the therapy respectively (Miller, Rathus and Linehan, 2006). Notably, BPD has no medication that cure except for medication that can only lower some of the effects that come along with it; effects like depression.
Conversely, there are some behaviors by the patients that are known to interfere with effective DBT administration. According to Linehan (1993a) describes these patterns to be falling in three dimensions (as cited in Miller, Rathus and Linehan, 2007). Linehan (1993a) identifies the four patterns as; unrelenting crisis versus inhibited grieving, emotional vulnerability versus self-invalidation and lastly active passivity versus apparent competence (as cited in Miller, Rathus and Linehan, 2006).
Researches indicate that victims of BPD also experience some co-morbid disorders (Clarkin, Marziali and Munroe-Blum, 1992). The researches of Axis 1 Co-morbidity and diagnostic overlap with BPD carried out by various researchers by use of varied assessment tools show how BPD patients stand a risk of suffering from other ailments that are connected to BPD. The findings depicted that BPD patient were more impulsive, self-destructive, angry and showed signs of depression most of the time (Clarkin, Marziali and Munroe-Blum, 1992). In addition, depression is also common with patient with BPD. Quite a sizeable number of the findings concur on the fact that a large number of BPD patients also experienced Major Affective Disorders (MAD) (Clarkin, Marziali and Munroe-Blum, 1992).
References
American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Arlington: American Psychiatric Association.
Clarkin, J. F., Marziali, E & Munroe-Blum, H. (1992). Borderline personality disorder: clinical and empirical perspectives. New York, NY: The Guilford Press.
Freeman, C, and Power, M. J.(Eds). (2007). Handbook of evidence-based psychotherapies: a guide for research and practice. West Sussex: John Wiley and sons
Linehan, M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York, NY: The Guilford Press.
Millerj A. L., Rathus, J. H., Linehan, M. (2007). Dialectical behavior therapy with suicidal adolescents. New York, NY: The Guilford Press.
Paris, J. (2005).Borderline personality disorder. CMA Media Inc., 172 (12). Retrieved from http://www.bpdfamily.com/bpdresources/gunderson.pdf
Wirth-Cauchon, J. (2001). Women and borderline personality disorder: symptoms and stories. Piscataway, NJ: Rutgers University press.
