Borderline Personality Disorder

MODULE 07 CASE STUDY

S.is a 48-year-old divorced woman with one adult daughter and three
grandchildren. She is currently working as an LPN part-time in a nursing
home and also works at a convenience store one or two days per week.
She has had many jobs over the last 22 years, usually changing every one
or two years. S notes that she has been called less often to work in
the convenience store and worries that they don’t like her anymore. She
reports being written up several times for arguing with customers. She
also reports that her supervisor at the nursing home “is a bitch”;
although she really liked her supervisor at first, she says “Now I hate
her; she’s trying to get me fired.” S. reports that she has tried to get
fulltime jobs five times in the last four years, was hired for three,
but only lasted one or two weeks at each one.

S. reports that she is currently not talking to her daughter because
“she is horribly mean to me and she needs to apologize or I won’t talk
to her again”. She is upset that she hasn’t seen her three small
grandchildren in about a year. She sends them presents and cards
frequently that says “I still love you! Grandma”, but hasn’t called them
since she stopped talking to her daughter. She is considering reporting
to the county that her daughter is keeping her grandchildren from her.

S. is very unhappy that she isn’t in a relationship. She was abused
by her ex-husband and has a pattern of meeting and dating men who
eventually abuse her. She states that her last relationship was very
good, however; the man was not abusive and “I loved him very much”. The
relationship ended for reasons that S. doesn’t understand, although she
does report many arguments that ended in “scenes” such as her throwing
chairs, stomping out of the house, making crank phone calls to his
family, and calling the police with false reports. But S. also reports
that she “couldn’t have loved him more and I showed it”. She gives
examples of going to her boyfriend’s place of work with flowers, buying
him expensive presents, surprising him with tickets to Mexico at the
last minute – she was very upset that he wasn’t willing to drop
everything and go with her. S. reports asking him why he didn’t love her
and what she was doing wrong on a regular basis. When the boyfriend
asked to break up, S. reports sitting outside his house for weeks,
crying; she called his mother, called his boss, and called and texted
him until he filed a restraining order. This occurred about 4 months
ago.

S. admitted herself to the mental health unit when she felt suicidal.
She reports that she had stopped her individual psychotherapy 3 months
ago and stopped going to DBT. She also stopped her anti-depressant at
that time, as she felt it wasn’t working, and missed her last two
psychiatrist appointments.

Questions:

Read the case study about Borderline Personality Disorder and answer the following questions in your initial posting:

1. How would you use therapeutic communication and the principles of cognitive-behavioral therapy with the client?

2. Describe your assessment process. What are some likely co-morbid
conditions? List one nursing diagnosis and appropriate nursing
intervention.

3. What interdisciplinary referrals might be appropriate?

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