INTRODUCTION
This case study involves a 31-year old woman, Jodie, who exhibits the classic symptoms of Borderline Personality Disorder (BPD). She suffers from intense bouts of anger and feelings of emptiness which have severely impacted the relationships in her life. While she doesn’t know why she acts the way she does, she has come to the realization that she needs help and is currently seeking treatment. This case study will show the development of Jodie’s self has been severely disrupted by biological and environmental factors. It is my suggestion that deficiencies in her childhood have contributed to the disruption of her development which has resulted in borderline personality disorder. More specifically, it is my opinion that Jodie was neglected or abused as a young child which has resulted in a maladaptive schema.
THE CASE
According to the case study prompt for Psychology 310: Psychology of Personality, Jodie is a 31-year old woman who came to me for help in order to get her anger under control. In her last several relationships with men, she has been guilty of hitting and/or throwing things at them. She states she doesn’t know why she acts like this because she ‘really loved all of them.’ During the course of our conversation, I discover she has been married and divorced three times, and in the last year she has had 4 ‘serious’ relationships. She has attempted suicide twice (pill overdoses) in response to ‘bad breakups’ with various boyfriends and husbands. (Stewart, n.d.)
Jodie is also a compulsive shopper and compulsive eater. She has been known to max out her credit cards on shopping binges, and has a habit of binging and purging food. She states she mostly engages in these kinds of behavior when her relationships are ‘getting bad.’ She says when she is in a relationship, it’s very intense and that her whole world looks brighter yet when the relationship begins to crumble, she goes through periods of intense depression and suicidal thoughts. She states she has resorted, more than once, to falsely telling her husband/boyfriend she was pregnant in order to try to salvage the relationship. She states she has two goals in therapy: to get a handle on her anger issues and to try to resolve her feelings of intense emptiness. (Stewart, n.d.)
ADMINISTRATION OF PSYCHOLOGICAL TESTING
As outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Jodie meets 6 out of the 9 criteria for borderline personality disorder (BPD). BPD is a mental health condition that causes people to have poor self-image, impulsive behavior, and difficulty regulating their emotions. Because BPD has similarities to other conditions (like bipolar disorder), it can be difficult to diagnose. However, based on the symptoms presented in the interview, I would consider using the Revised Diagnostic Interview for Borderlines which measures four major aspects of BPD: Affect, Cognition, Impulse Action Patterns, and Interpersonal Relationships (DIB-R; Zanarini, Gunderson, Frankenburg, & Chauncey, 1989).
According to A Comparison of Interview and Self-Report Methods for the Assessment of Borderline Personality Disorder Criteria, structured interview methods are the “gold standard” for diagnosis of BPD and have been proven to optimally identify BPD criteria (Hopwood et al, 2008). Self-reporting assessments have been developed and are currently used but patients with BPD exhibit a warped sense of who they are which presents a problem in answering the questions accurately. I would also seek a full medical evaluation just to rule out any biological issues especially since she has attempted suicide on more than one occasion.
APPLICATION OF PERSONALITY THEORY
Jodie is experiencing a disruption of self. Her abandonment issues and insecurity are centered around Freud’s oral stage of psychosexual development and Erikson’s trust vs. mistrust stage of psychosocial development. Both theories focus on meeting an infant’s basic needs. When these needs are not met, the child will develop a sense of mistrust and “cull a sense of fear about the inconsistent world, leading to feelings of anxiety, insecurity, and an overall feeling of mistrust toward the world” (study.com, n.d.). By not completing this very important stage, Jodie is unable to trust those around her which affects her relationships and interactions.
Jodie’s desire to binge and purge food is also connected to not completing the oral stage and can possibly be attributed to experiencing trauma in her childhood. Freud stated, “every neurosis in an adult is built upon a neurosis which has occurred in childhood but has not invariably been severe enough to strike the eye and be recognized as such” (Wollheim, 1971, p 158). By talking with Jodie about her childhood, and possibly being able to talk to other family members, I wouldn’t be surprised to learn Jodie was abused which further solidifies a diagnosis of borderline personality disorder.
BIOLOGICAL TRAITS
From a biological standpoint, how much of Jodie’s personality was formed from defective genes and how much is due to her environment? If she was indeed abused in her childhood, did she exhibit any of the symptoms of BPD before the abuse took place or if there was no abuse, were these traits inherited? From severe mood swings and intense anger to a distorted self-image and extreme impulsiveness, Jodie faces myriad issues that keep her from functioning properly in her everyday life.
Several studies have revealed that “impulsive aggression tends to run in families of people diagnosed with BPD which suggests a genetic origin for this behavioral tendency” (Coccaro & Siever, 2005). Neurological studies of brain chemistry have identified abnormalities in people with BPD and have also documented “problematic functioning of their pre-frontal cortex” (Coccaro & Siever, 2005). This suggests that Jodie is not acting on a whim but that the influence of biology on her behavior is to blame. That said, her traits have most likely evolved over time to further meet her biological goals (i.e. survival, nourishment, reproduction, etc.) which has created a mismatch between what her brain is telling her to do and what her body actually needs.
One of the biggest concerns Jodie has is her anger. For people with BPD, mood swings are commonplace. Whereas someone with bipolar disorder may exhibit bouts of mania/depressive episodes for weeks or months, the mood swings of someone with BPD can change during afternoon tea. For Jodie, she may feel that if her partner leaves, she will be alone and not have an opportunity for another relationship. She acts out in an effort to change what is going on. This fight or flight response has manifested itself in violence toward her partner which suggests an underdeveloped cognitive trait. While her intense anger may worsen when she’s under stress, structural and functional changes in her brain are more likely be to blame.
SEXUAL IDENTITY TRAITS
In their review Sexual Behavior in Borderline Personality by Randy A. Sansone, M.D. and Lori A. Sansone, M.D., people who have BPD “are more likely to exhibit greater sexual preoccupation, have earlier sexual exposure, engage in casual sexual relationships, report a greater number of different sexual partners as well as promiscuity.” Jodie stated she has had multiple relationships in the last year. All of which have been ‘very intense’. This is a classic symptom of BPD and indicates she is at higher risk for victimization as well as an increased likelihood of contracting a sexually transmitted disease.
In a study conducted of 71 female patients with BPD, “46% of the women reported having ‘entered into sexual relationships with partners they did not know well, and 28% reported five or more such relationships” (Hull, Clarkin, & Yeomans, 1993). Overall, the psychological themes relating to sexual behavior in borderline personality disorder appear to be characterized by impulsivity and victimization (Sansone, 2011).
PERSONALITY TRAITS
According to Boston University psychologist David Barlow, “BPD reflects an emotional disorder reflecting high levels of the personality trait neuroticism” (2014). In fact, in studies of patients with BPD, they were found to be “less extraverted and conscientious, and more neurotic and emotional than all other groups” (American Journal of Psychiatry, 2005).
Jodie’s core personality traits may have changed over time due to her environment but they are consistent with other people who have BPD. She has a fear of abandonment, impulsive behavior, mood swings, intense bouts of anger, and poor judgement when it comes to sexual behavior. She also exhibits low stability, low conscientiousness, and high neuroticism on the Five-Factor Model of Personality (FFM) which is the most commonly used personality theory in research and the most extensively validated (Säämänen et al, 2016).
METHOD OF TREATMENT
While borderline personality disorder has been historically viewed as difficult to treat, there are options available. In addition, people with BPD usually have other disorders. In a journal published by the Behavioral Research and Therapy Clinics, Department of Psychology at the University of Washington, “major depressive disorder occurs in more than 80% of people with BPD; anxiety disorders occur in about 90%; PTSD in 26%; bulimia in 26%; anorexia nervosa in 21%; and bipolar in 10%” (Harned and Valenstein, 2013).
In Jodie’s case, she has symptoms of depression and an eating disorder. Her impulsivity, which includes her past suicide attempts, is a common feature for bipolar II disorder so this should also be taken into consideration. Based on the information I’ve obtained, I would make the recommendation for Jodie to receive cognitive and behavioral treatment.
TREATMENT PLAN
Dialectical behavior therapy (DBT) is usually the first choice for treating people with BPD. Developed by Dr. Marsha Linehan, DBT is currently the only empirically supported treatment for BPD (May, Richardi, Barth, 2016). DBT is also the most studied treatment for BPD which teaches behavioral skills such as emotional regulation, how to reduce self-destructive behaviors, and interpersonal effectiveness. According to the National Institute of Mental Health (NIMH), DBT “uses concepts of mindfulness and acceptance or being aware of and attentive to the current situation and emotional state” (2017).
Some of Jodie’s symptoms may be easier to treat than others so it is important that she sticks with the program. It would also be helpful to have her family members take part in her treatment plan. By offering emotional support, encouragement and showing their understanding and patience for what Jodie is experiencing, Jodie will be able to rely on them during her recovery. It would also be beneficial for her family members to participate in therapy for their own understanding but note that the therapist or counselor should be different than the one Jodie receives treatment from.
It may also be necessary to begin a drug therapy regimen for depression and bipolar disorder. Because people with BPD have difficulty in maintaining trusting bonds, Jodie’s therapist must use a humanistic approach to ensure she feels comfortable with therapy. NIMH-funded studies have shown that people with BPD who do not receive treatment are more likely to develop additional mental health illnesses as well as have a higher risk of self-harm/suicide (2017). It is in Jodie’s best interest to receive treatment as soon as possible to prevent a tragedy from occurring.
CONCLUSION
Borderline Personality Disorder affects an estimated 1.6% of the population in the United States with nearly 75% of those cases being women (NAMI, 2017). BPD can lead to impulsivity, difficulty with self-regulation, and control over emotional responses. While genetics, biological misfired in the brain, and a person’s environment can all play a part, BPD can be treated successfully with cognitive and behavior therapy.
Jodie has expressed desire to seek treatment which is the first step in overcoming her struggle with BPD. By participating in professional therapy, and possible drug therapy for depression and/or bipolar disorder, she should be able to overcome her BPD symptoms and lead a much more enjoyable life. By learning how to manage her emotions and observe the feelings that lead to her impulsive behavior, she will be able to improve her relationships and have a better self-image.
...(download the rest of the essay above)