Overview of the Case
Emmie, a 28-year-old female patient, was recently taken to the hospital with suicidal gestures. The patient has a long history of substance abuse, with her alcohol abuse being traced back to her adolescent years. The patient has also showcased other mental health problems in addition to suicidal gestures and threats, particularly depression. Her history of unstable and abusive relationships has contributed to alcohol abuse and suicidal attempts. The patient has also been involved in various citations and violations over the years.
Mental Status Exam with Target Symptoms
Appearance: The patient was properly groomed with clean clothing and neat fingers and hair.
Behaviour/Attitude: The patient is generally happy during the early stages of her abusive relationship. However, after breakups, the patient showcases suicidal gestures. During the interview, Emma generally depicts emotions of anger and sadness. The patient is overly defence (Noris et al., 2016). When her family attempted to intervene in her current relationship, she went ballistic and attempted to defend her boyfriend. The patient is also overly protective and defensive of her boyfriend. Despite being involved in counseling, she is not cooperative.
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Orientation: Answers questions appropriately except when these questions concern her boyfriend and drinking problems.
Speech and Language: Normal tone. Loud when defending her boyfriend and her alcohol dependence.
Mood: Angry and saddened.
Affect: Congruency with thought content (Noris et al., 2016). Sad, angry, irritable, and hostile.
Thought process: Blocking and incoherent
Thought content: She is angry and sad that nobody but her boyfriend understands her. She thinks her family is out to get her.
Suicidality/Homicidality: Shows suicidal gestures.
Insight: Aware of her condition, but she is reluctant to address it.
Judgment: The patient showcases suicidal gestures and increases her alcohol abuse pattern during a breakup.
Attention Span: Average level of attention and concentration, with a minimal level of distractibility (Noris et al., 2016).
Memory: Good.
Differential Diagnosis
From the diagnostic analysis of the case, Emmie may be suffering from either borderline personality disorder or antisocial personality disorder. This disorder often affects an individual’s behaviour, thoughts, and emotions. However, it is important to note that Emma has a history of highly maladaptive behaviours and abusive relationship. She is impulsive and rarely considers the consequences of her actions. As such, she has a borderline personality disorder and not an antisocial personality disorder.
Just like an antisocial personality disorder, this disorder also affects an individual’s behaviour, thoughts, and emotions. However, a borderline personality disorder is characterized by inappropriate anger, impulsiveness and frequent mood swings. As a result, an individual with this type of personality disorder often pushes away others, even though they may want to have loving and lasting relationships. Emma has a history of highly maladaptive behaviours. She also has a history of abusive relationships. From the differential diagnosis, it is evident that Emma has a borderline personality disorder.
Diagnostic and Treatment Plan
Borderline personality disorder is often diagnosed based on a detailed interview, psychological evaluation, and medical history and exam. Treatment recommendation includes psychiatric session and inpatient treatment. These treatment options will help address Emma’s symptoms as well as her alcohol dependence.
Comparison between Borderline and Antisocial Personality Disorder
A borderline personality disorder is characterized by substantial instability of interpersonal relationships, mood, and impulsive behaviour (Helle et al., 2019). The disorder is characterized by the fluctuation from episodes of confidence to despair, with a strong fear of abandonment, rejection. These patients showcase a strong tendency toward suicidal gestures and self-harm. It is often comorbid with other mental problems, including depression, bipolar disorder, and alcohol and drug dependence ( Fiorentini et al., 2019 ). On the other hand, an antisocial personality disorder is characterized by traits such as impulsivity, low conscientiousness, and high negative emotionality (Helle et al., 2019). Therefore, patients tend to experience unstable interpersonal relationships. They tend to ignore the consequences of their behaviour and their feelings about other individuals. An antisocial personality disorder is, in most cases, comorbid with other disorders, such as depression, anxiety, and alcohol and substance abuse and dependence.
Most patients with borderline personality disorder first show the symptoms in their early adult life. In other instances, these symptoms may not require mental health services until much later. Psychiatric assessment, along with appropriate interventions may improve the symptoms, which makes about 50% of patients diagnosed with the disorder not to seek medical assistance five to ten years into the diagnosis and treatment (Helle et al., 2019). Medical practitioners may recommend the adoption of a short or extended hospital stay depending on the condition of borderline personality disorder. Short-term hospital stays are recommended as the most suitable acute inpatient containment and emergency intervention (Paruk et al., 2016). Inpatient admission to psychiatric wards should be brief and time-limited. Before admitting patients with a borderline personality disorder, specific goals for admission should be developed. If the patient does not meet the goals of admission, she may be discharged, or a new model of treatment be adopted (Chalfin et al., 2017). Therefore, although extended hospital stay may be suitable for people showcasing suicidal gestures, a short-term hospital stay is beneficial to the long-term recovery of individuals with a borderline personality disorder.
References
Chalfin, M., &Kallivayalil, D. (2017). Formulation and treatment of chronic suicidality in patients with developmental trauma. Journal of Contemporary Psychotherapy , 47 (4), 243-250.
Fiorentini, A., Cremaschi, L., & Prunas, C. (2019). Bipolar Disorder and Borderline Personality Disorder. In Clinical Cases in Psychiatry: Integrating Translational Neuroscience Approaches (pp. 73-89). Springer, Cham.
Helle, A. C., Watts, A. L., Trull, T. J., & Sher, K. J. (2019). Alcohol Use Disorder and Antisocial and Borderline Personality Disorders. Alcohol Research: Current Reviews , 40 (1).
Norris, D. R., Clark, M. S., & Shipley, S. (2016). The mental status examination. American family physician , 94 (8), 635-641.
Paruk, L., & van Rensburg, A. B. J. (2016). Inpatient management of borderline personality disorder at Helen Joseph Hospital, Johannesburg. South African Journal of Psychiatry , 22 (1).
