Nancy is a 26-year-old African-American woman who recently got married but planning a divorce because she is not getting along with her 30 years husband. The new married couple has only spent six months in marriage, but they want to divorce because Nancy believes that her husband is cheating. Besides, she believes that her husband does not care enough for her and has been abandoned since they got married. Nancy seems much stressed over her relationship status and spends most of her time indoors. She is ever on mood swings and even threatens to commit suicide if the husband does not do anything about their struggling marriage. Nancy's anger is way too much; she often loses her temper and wants to engage in a physical fight with her husband.
Patent History/Case Study
The patient is a 26 years old woman reported with signs and symptoms of mental health condition. The African American patient has been represented with a non-suicidal self-injury history, significantly cutting her legs and arms. Since her childhood, Nancy has made three suicide attempts, with two involving overdose of the prescribed drug and the most recent one involving an attempt to hang herself using a rope. In her most recent suicide attempt, Nancy shocked her husband, who found her screaming for her life. Besides, Nancy has also reported chronic suicidal ideation indicating that she only regards suicide as the only "way out" to continue her husband's struggles.
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According to her previous medical record, Nancy has been fighting a mental health condition characterized by emotional reactions, mood swings, and unstable relationships, including her current struggling relationship with her husband. Nancy's past medical history indicates that she has been fighting borderline personality disorder since her a teenager, but she has not recovered from the disease. Previously, the disease was being controlled by family members' support, but this did not work out well. Furthermore, Nancy has been married and can no longer access the support she used to get from the family member; Instead, Nancy has become more isolated as she spends most of the time in her house; something facilitates borderline personality disorder. With the impending divorce, Nancy is much stressed, and at times she zones out even when talking with someone. Nancy has also been changing her mode of dressing and hobbies quite often. Even though this behavior has been associated with her constantly changing mood, some of her latest moves and actions at the husband's place has created concern. When Nancy was getting married, she had high expectations from her husband, whom she believed would buy anything she required. But things have changed. Lately, Nancy has been thinking very negatively towards her husband and even panic and regrets marrying him. Nancy also admitted that before her current marriage, she had been engaging in unprotected sex with multiple men, which has since affected her psychological state of mind. At the age of 23, Nancy was diagnosed with mood disorder and anxiety, but did not admit it and even to the extent of assuming the drugs prescribed to her. With her worsening condition, Nancy advanced to take her antidepressant medication as she waits for interpersonal psychotherapy.
Assessment
Nancy complained of an intense fear of abandonment and rejection from the people he is closed to, including her husband; she was having a strained relationship with her husband because she believed the husband never cared enough for her. Nancy was experiencing rapid changes in her self-image and self-identity. In past months, Nancy has been having weird behaviors such as reckless driving, unsafe sex, and even gambling. Nancy's past suicide history was also a matter of concern because she nearly lost her life. At the age of 16, her teenage friends sexually abused Nancy; this is an incident that she found very difficult to forget, even though she has undergone numerous canceling over it. Nancy still remembers the incident like it happened yesterday.
Nancy also presented difficulties in interacting with other people because of her mood swings. Since her divorce proposal, Nancy has been feeling hopeless helpless and is continuously becoming fatigued with increased energy loss. According to Nancy, she had lost weight unexpectedly and was feeling worthless before her husband.
Even though there is no specific diagnostic test for borderline personality disorder (BPD), psychiatric health professionals use screening instruments to assess BPD; it helps the professionals identify particular diagnoses for the patient. According to Sauer-Zavala et al. (2020), different screening tools can diagnose a borderline personality disorder. For this case study, The McLean Screening instrument was used in screening Borderline personality disorder. The device uses a 10-item measure in screening BPD. The standard was developed in the form of a paper and pencil test to detect the possible BDP in the patient. The McLean screening instrument was developed at McLean hospital by Dr. Mary Zanarini. It consisted of ten items based on mental disorders DSM and diagnostic criteria for borderline personality disorder. According to The McLean Screening Instrument, the first eight items of the tool represent the first eight BPD's diagnostic criteria for DSM-IV/5. The last two things are captured on the final DSM-IV/5 criterion ( Keng et al., 2019).
Other instruments that could be used in screening the borderline personality disorder include Scoring of the MSI-BPD, where the tool is used to rate each item as "1" when it is presented and "0" if the thing is absent ( Mirkovic et al., 2020). The articles are then totaled and measured on a scale of 1 to 10. A total score beyond 7 indicates that the patient is meeting borderline personality disorder criteria.
Treatments: IPT
Even though Nancy has been directed to us mood stabilizers and anti-anxiety drugs, she has no improvement, and her condition continues to worsen. Besides, Nancy was not serious with her medication and failed to follow the doctor's prescription strictly. Nancy was scheduled for interpersonal psychotherapy to reduce the symptoms of borderline personality disorder. Past research has indicated that Interpersonal psychotherapy is an effective evidence-based psychotherapeutic for BPD patients. The therapy, which was first proposed by Klerman in 1984, has been a useful diagnosis-based medical model for mental health diseases, especially those involving psychiatric symptoms developing in an interpersonal setting ( Holmes, 2019). The medical model was developed to improve psychiatric symptoms and social functioning and resolve the interpersonal crisis among mentally ill patients. Initially, IPT was used to treat major depression. Later, it was discovered that the model could be used in treating the growing number of mental health diseases, including borderline personality disorder. The model is significant because of its remarkable and frequent interpersonal dimension. Borderline personality disorder has been the main target of interpersonal psychotherapy. IPT for BPD occurs in three phases, as discussed below.
Initial Phase
It is the first phase of interpersonal psychotherapy involving the patient's diagnosis, depending on the type of mental disease. The stage is also known as the formulation phase. In the case of Nancy, a problematic clinical diagnosis was used. Borderline personality disorder is related to individual occupational functioning and impaired social functioning. It has also been associated with suicide and impulsivity risk.
In some cases, a patient with a borderline personality disorder may have a strong mood swing with unexpected fury and anger ( Towle, 2019). The patients are also emotional to an extent they may overwhelm their therapists. Therefore, therapists handling such patients need to take many precautions to ensure that the diagnosis and assessment are efficient and effective. It has also been noted that BPD therapists tend to focus on the treatment of mood disorders to counter borderline personality disorder. Recent studies have suggested cognitive-behavioral therapy adaptation for the treatment of BPD among self-destructive patients.
According to Nancy's assessment outcome, she had a severe borderline personality disorder; Most of the signs and symptoms had been identified in her. Having in mind that Nancy was suffering from severe borderline depression, the first stage of interpersonal psychotherapy involves cross-checking of Nancy's medical history by the therapist. The therapist focused on the symptoms presented in Nancy's case and the interpersonal problems that she was facing. In addition to that, the therapist also considers the relationship that Nancy was having with her husband. The information would help determine the possible cause of borderline personality disorder and how it would be encountered.
Based on the patient's subjective data, some of the possible causes of Nancy's borderline personality disorder is the physical, emotional and sexual abuse that she might have gone through as a child, particularly the sexual assault incident that happened to her when she was only 16 years old. According to the therapist, other possible cause includes exposure to long distress or fear as a child, parental negligence, or being raised in a family with a hereditary mental health condition.
The initial stage of Interpersonal psychotherapy also focuses on Nancy's current state, whether she was having a problem with her husband or not. Based on the assessment, it was clear that Nancy has been having trouble with her husband, and they are even filing a divorce. Even though she is the one who creates the divorce, she has been so much stressed about it and believed that the husband no longer loves her the ways she used to do. Besides, she had a problem coming to terms with her past lifestyle, where she could have unprotected sex with multiple men. The suicide attempt was also raising concern as the therapist believed that it would affect her general state of mind. The therapist urged Nancy to accept and corporate in the interpersonal psychotherapy process to ensure it was effective and successful. Nancy's constant mood swings, anxiety over her past lifestyle, and her husband's relationship were significant challenges. Since Nancy was already seeking a divorce from her husband, the only people who could give her happiness are her family.
After going Nancy's history, the therapist developed a timeline for her current mental health condition. The timeline was used to organize the events associated with the causes of the disorder and how these interpersonal issues can be solved. The timeline was arranged based on the cause of the BPD, and these causes would be encountered. The therapist developed a concept that he believed would change the patient's behavior and the general life view. The two ideas include validation, the ability to accept one's emotions as real, valid, and acceptable. The second concept is dialectics, being open to opinions and ideas that contradict you ( Lein et al., 2017). According to the therapist, the concepts would help Nancy accept herself and control her husband's emotions.
Middle Phase
After the first IPT phase, the client is expected to come to terms with the treatment model to identify whether the therapist would continue with the second phase of the treatment process ( Field et al., 2019). Nancy was positive in step one, thus giving the therapist enough confidence to continue with stage two; the middle stage. In Nancy's case, the intermediate phases focused on how the problems and solutions identified would be implemented. Nancy is expected to regain her senses by validating herself and accepting who she is and what she is made off. Nancy would reconcile with her husband and her past lifestyles. The middle phase also focused on making the patient accepts and appreciate her new position. The mid sessions phase addressed some of the persistent symptoms that Nancy was experiencing after the first and how she encounters the persisting problems. The therapist also admitted and the progress that Nancy was making and encouraged to put more effort into ensuring that she made peace with herself and reconcile with her husband, the therapist' e main target in this phases was to change the mood, Nancy, help her to negotiate with her husband and make forget everything about her past.
Termination phase
It is the last phase of ITP; it reviews the treatment process and the patient's experience throughout the therapy process. The IPT termination phases are announced in advance, and the patients are reminded periodically. The stage allows the therapist to examine the feelings of the patients in regards to be positive and negative aspects integrate these ideas ( Kinney et al., 2020). Through the transition stage, the therapist gave Nancy a sense of independence and confidence in handling her interpersonal matters. They rapped her treatment in this stage by highlighting the achievements and progress that Nancy has made throughout the therapy process. The whole treatment session was also evaluated to find its success. The therapist also identified some useful interpersonal gains that would help the patient overcome her BPD symptoms.
Conclusion
In conclusion, IPT may help treat BPD patients, but the step should be to determine whether the therapy can treat the disorder. If IPT seems not to be effective, it is useful to consider other potential treatment moderators and mediators' outcomes and testing of such treatment. In Nancy's case, IPT would benefit her because it would enable her to understand the factors that triggered her current conditions and how these problems could be solved. Through IPT, the therapist established validation and dialectic concepts that she believed could help treat Nancy BPD conditions. Even though Nancy is not fully recovered, she has improved significantly.
References
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