A 24-year-old woman is brought to the emergency department after threatening to kill herself. She says, "I feel very depressed and can't stop crying. I feel like a piece of garbage that people just throw away." The patient thinks frequently that she would be better off dead and has thought of overdosing on sleeping pills since her boyfriend left her a week ago. The patient has had no significant change in sleep pattern, appetite, concentration, or energy level. She has felt depressed on and off since high school and describes chronic low self-esteem. She is also frequently angry and occasionally experiences a sense of detachment from her body. When a previous relationship ended a year ago, she developed severe depression and thought that people on the street were laughing at her, which lasted for several days. Physical examination is unremarkable except for multiple superficial cuts on her left arm in various stages of healing. Which of the following features is most likely to be associated with this patient's condition?

Question

A 24-year-old woman is brought to the emergency department after threatening to kill herself.  She says, "I feel very depressed and can't stop crying.  I feel like a piece of garbage that people just throw away."  The patient thinks frequently that she would be better off dead and has thought of overdosing on sleeping pills since her boyfriend left her a week ago.  The patient has had no significant change in sleep pattern, appetite, concentration, or energy level.  She has felt depressed on and off since high school and describes chronic low self-esteem.  She is also frequently angry and occasionally experiences a sense of detachment from her body.  When a previous relationship ended a year ago, she developed severe depression and thought that people on the street were laughing at her, which lasted for several days.  Physical examination is unremarkable except for multiple superficial cuts on her left arm in various stages of healing.  Which of the following features is most likely to be associated with this patient's condition?

Quizplus · Accepted Answer

11ec25c8_d7e7_00c2_bc81_0fe8d1ce4cc7_MD0003_00 This patient's pattern of recurrent suicidal behavior, mood instability, unstable relationships, inappropriate anger, impulsivity, abandonment fears, and stress-related paranoia and dissociation are characteristic of borderline personality disorder (BPD). In addition to suicidal threats, gestures, and attempts, these patients often engage in nonsuicidal self-injury (eg, cutting, burning). A history of childhood trauma (eg, physical and sexual abuse, neglect) is common in patients with BPD. Insecure attachment to the primary caregiver may underlie the unstable relationships and fears of abandonment commonly seen in the disorder. Dissociative symptoms (eg, this patient's experience of detachment from her body [depersonalization]) are common in those who have been traumatized. (Choice A) If present, psychotic symptoms in BPD are transient and stress related (eg, this patient's transient paranoia following the end of a relationship). Patients with chronic delusions are more likely to have a primary psychotic disorder. (Choice B) There is no clear association between a family history of schizophrenia and the development of BPD. (Choice C) Patients with BPD typically have an intense, labile, or angry affect. Flat affect is characteristic of schizophrenia. (Choices E and F) Although the mood instability of BPD may resemble the mood swings of bipolar disorder, these patients do not have sustained hypomanic or manic symptoms that would meet the diagnostic threshold for bipolar disorder. (Choice G) The mood disturbance in BPD is characterized by marked mood reactivity (ie, moment-to-moment fluctuations often triggered by psychosocial stressors). Loss of mood reactivity is associated with severe, melancholic depression (ie, mood does not improve with improved circumstances). Educational objective: Borderline personality disorder is characterized by mood instability, recurrent suicidal behavior, unstable relationships, inappropriate anger, impulsivity, and abandonment fears. Stress-related paranoia and dissociation may be mistaken for primary psychosis. A history of childhood trauma is common. References: Childhood adversity and borderline personality disorder: a focus on adolescence. (http://www.ncbi.nlm.nih.gov/pubmed/24270475) Trauma and dissociation: implications for borderline personality disorder. (http://www.ncbi.nlm.nih.gov/pubmed/24442670) Exploring the interaction between childhood maltreatment and temperamental traits on the severity of borderline personality disorder. (http://www.ncbi.nlm.nih.gov/pubmed/24262124)

A 24-Year-Old Woman Is Brought to the Emergency Department After