A demanding 25Y W begins psychotherapy stating she is both desperate & bored She reports that for the past 5or6 Y she has experienced periodic anxiety & depression & she has made several suicidal gestures She also reports a variety of impulsive & self-defeating behaviors & sexual promiscuity She wonders if she might be a lesbian though most of her sexual experiences have been with men She has abruptly terminated 2 previous attempts at psychotherapy In both cases she was enraged at the therapist because he was unwilling to prescribe anxiolytic medications.Diagnosis is :
a. Dysthymia b. Histrionic personality disorder c. Antisocial personality disorder d. Borderline personality disorder
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ANSWER
The answers is d. (DSM-IV, pp 650–654; Hales,3/e, p 808.) The patient’s history and presenting symptoms are classic for the diagnosis of borderline personality disorder. Patients with borderline personalities present with a history of a pervasive instability of mood, relationships, and self-image beginning by early adulthood. Their behavior is often impulsive and self-damaging; their sexuality is chaotic; sexual orientation may be uncertain; and anger is intense and often acted out. Recurrent suicidal gestures are common. The shifts of mood usually last from a few hours to a few days. Patients often describe chronic feelings of boredom and emptiness.
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