Friday, July 11, 2008

Something Different

A 30 year old female comes to your primary care practice for the first time. As you look at her history, you notice she's shopped around for many different doctors. When you ask her about it, she says she has an intense fear of abandonment and that doctors hate her.

Taking her social history, you notice many short term boyfriends; she admits that her relationships are unstable and intense. "Sometimes I think we'll get married after going out for a month and then the next day I think he's betraying me." She doesn't seem to have a strong sense of identity. She says, "I just don't know who I am. Sometimes, I feel like killing myself. I just feel so empty."

On exam, you find lesions consistent with genital herpes. "Oh yeah, I'm kind of impulsive with sex. And gambling. And drinking," she says. But when you inquire further, you get a sense that this is all the time, not episodic. "You idiot," she says, "What do you think I am? Bipolar? Stupid, all the doctors think that."

Challenge: What personality disorder does this best characterize?

2 comments:

tree said...

Borderline

Craig said...

Something Different

Patients with borderline personality disorder demonstrate instability in self image, mood states, interpersonal relationships, and impulse control. Swings in mood occur throughout the course of a single day rather than weeks or months (bipolar disorder). Patients are prone to viewing others as all good or all bad (splitting). 10-15% die by suicide.

Source: UpToDate.