This case study describes the care provided to a female patient with borderline personality disorder (BPD) who presented to the emergency department (ED). While people with borderline personality disorder use emergency services frequently, clinicians often face difficulties when providing medical and behavioral services to these patients. It may be difficult for nurse practitioners to determine if a patient with BPD who presents to the ED in crisis should be admitted, medicated, observed, or discharged. Self-harm is frequently confused with suicide attempts, which can result in unnecessary hospitalizations. This case study seeks to examine the proper management and difficulties encountered by healthcare providers in managing crises involving individuals with BPD in ED settings. The case study underscores the significance of thorough evaluation, recognition of BPD characteristics, active engagement in treatment, the therapeutic alliance, and the emphasis on interpersonal connections and stressors alongside the utilization of psychopharmacology.
References
[1]
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition, American Psychiatric Association. https://doi.org/10.1176/appi.books.9780890425596
[2]
Hong, V. (2016) Borderline Personality Disorder in the Emergency Department: Good Psychiatric Management. HarvardReviewofPsychiatry, 24, 357-366. https://doi.org/10.1097/hrp.0000000000000112
[3]
Ellison, W.D., Rosenstein, L.K., Morgan, T.A. and Zimmerman, M. (2018) Community and Clinical Epidemiology of Borderline Personality Disorder. PsychiatricClinicsofNorthAmerica, 41, 561-573. https://doi.org/10.1016/j.psc.2018.07.008
[4]
Anderson, G. (2020) Pathoetiology and Pathophysiology of Borderline Personality: Role of Prenatal Factors, Gut Microbiome, Mu-And Kappa-Opioid Receptors in Amygdala-PFC Interactions. ProgressinNeuro-PsychopharmacologyandBiologicalPsychiatry, 98, Article ID: 109782. https://doi.org/10.1016/j.pnpbp.2019.109782
[5]
Doering, S. (2019) Borderline Personality Disorder in Patients with Medical Illness: A Review of Assessment, Prevalence, and Treatment Options. PsychosomaticMedicine, 81, 584-594. https://doi.org/10.1097/psy.0000000000000724
[6]
Shin, H., Lee, H.S., Lee, B.C., Park, G., Uranbileg, K., Park, Y., et al. (2023) The Prevalence and Clinical Characteristics of Borderline Personality Disorder in South Korea Using National Health Insurance Service Customized Database. YonseiMedicalJournal, 64, 566-572. https://doi.org/10.3349/ymj.2023.0071
[7]
Penfold, S., Denis, E.S. and Mazhar, M.N. (2016) The Association between Borderline Personality Disorder, Fibromyalgia and Chronic Fatigue Syndrome: Systematic Review. BJPsychOpen, 2, 275-279. https://doi.org/10.1192/bjpo.bp.115.002808
[8]
Ruocco, A.C., Rodrigo, A.H., McMain, S.F., Page-Gould, E., Ayaz, H. and Links, P.S. (2016) Predicting Treatment Outcomes from Prefrontal Cortex Activation for Self-Harming Patients with Borderline Personality Disorder: A Preliminary Study. FrontiersinHumanNeuroscience, 10, Article 220. https://doi.org/10.3389/fnhum.2016.00220
[9]
Stoffers-Winterling, J.M., Storebø, O.J., Kongerslev, M.T., Faltinsen, E., Todorovac, A., Sedoc Jørgensen, M., et al. (2022) Psychotherapies for Borderline Personality Disorder: A Focused Systematic Review and Meta-analysis. TheBritishJournalofPsychiatry, 221, 538-552. https://doi.org/10.1192/bjp.2021.204
[10]
Zanarini, M.C., Vujanovic, A.A., Parachini, E.A., Boulanger, J.L., Frankenburg, F.R. and Hennen, J. (2003) A Screening Measure for BPD: The Mclean Screening Instrument for Borderline Personality Disorder (MSI-BPD). JournalofPersonalityDisorders, 17, 568-573. https://doi.org/10.1521/pedi.17.6.568.25355
[11]
Saccaro, L.F., Schilliger, Z., Dayer, A., Perroud, N. and Piguet, C. (2021) Inflammation, Anxiety, and Stress in Bipolar Disorder and Borderline Personality Disorder: A Narrative Review. Neuroscience&BiobehavioralReviews, 127, 184-192. https://doi.org/10.1016/j.neubiorev.2021.04.017
[12]
Bøen, E., Hjørnevik, T., Hummelen, B., Elvsåshagen, T., Moberget, T., Holtedahl, J.E., et al. (2019) Patterns of Altered Regional Brain Glucose Metabolism in Borderline Personality Disorder and Bipolar II Disorder. ActaPsychiatricaScandinavica, 139, 256-268. https://doi.org/10.1111/acps.12997
[13]
Bassir Nia, A., Eveleth, M.C., Gabbay, J.M., Hassan, Y.J., Zhang, B. and Perez-Rodriguez, M.M. (2018) Past, Present, and Future of Genetic Research in Borderline Personality Disorder. CurrentOpinioninPsychology, 21, 60-68. https://doi.org/10.1016/j.copsyc.2017.09.002
[14]
de Aquino Ferreira, L.F., Queiroz Pereira, F.H., Neri Benevides, A.M.L. and Aguiar Melo, M.C. (2018) Borderline Personality Disorder and Sexual Abuse: A Systematic Review. PsychiatryResearch, 262, 70-77. https://doi.org/10.1016/j.psychres.2018.01.043
[15]
Zanarini, M.C., Temes, C.M., Magni, L.R., Aguirre, B.A., Hein, K.E. and Goodman, M. (2020) Risk Factors for Borderline Personality Disorder in Adolescents. JournalofPersonalityDisorders, 34, 17-24. https://doi.org/10.1521/pedi_2019_33_425
[16]
Yen, S., Peters, J.R., Nishar, S., Grilo, C.M., Sanislow, C.A., Shea, M.T., et al. (2021) Association of Borderline Personality Disorder Criteria with Suicide Attempts: Findings from the Collaborative Longitudinal Study of Personality Disorders Over 10 Years of Follow-Up. JAMAPsychiatry, 78, 187-194. https://doi.org/10.1001/jamapsychiatry.2020.3598
[17]
Felitti, V.J., Anda, R.F., Nordenberg, D., et al. (2014) Adverse Childhood Experiences Study Questionnaire. APA PsycTests. https://doi.org/10.1037/t26957-000
[18]
Posner, K. (2016) Columbia-Suicide Severity Rating Scale. APA PsycTests. https://doi.org/10.1037/t52667-000
[19]
Wang, F., Zang, C., Goodman, M., et al. (2022) Development of a Screening Algorithm for Borderline Personality Disorder Using Electronic Health Records. https://doi.org/10.21203/rs.3.rs-1350791/v1
[20]
Shaikh, U., Qamar, I., Jafry, F., Hassan, M., Shagufta, S., Odhejo, Y.I., et al. (2017) Patients with Borderline Personality Disorder in Emergency Departments. FrontiersinPsychiatry, 8, Article 136. https://doi.org/10.3389/fpsyt.2017.00136
[21]
Warrender, D., Bain, H., Murray, I. and Kennedy, C. (2020) Perspectives of Crisis Intervention for People Diagnosed with “Borderline Personality Disorder”: An Integrative Review. JournalofPsychiatricandMentalHealthNursing, 28, 208-236. https://doi.org/10.1111/jpm.12637
[22]
Gunderson, J.G. and Links, P.S. (2014) Handbook of Good Psychiatric Management for Borderline Personality Disorder. American Psychiatric Publication. https://doi.org/10.1176/appi.books.9781615378432
[23]
Zanarini, M.C., Frankenburg, F.R., Reich, D.B. and Fitzmaurice, G. (2012) Attainment and Stability of Sustained Symptomatic Remission and Recovery among Patients with Borderline Personality Disorder and Axis II Comparison Subjects: A 16-Year Prospective Follow-Up Study. AmericanJournalofPsychiatry, 169, 476-483. https://doi.org/10.1176/appi.ajp.2011.11101550
[24]
Del Casale, A., Bonanni, L., Bargagna, P., Novelli, F., Fiaschè, F., Paolini, M., et al. (2021) Current Clinical Psychopharmacology in Borderline Personality Disorder. CurrentNeuropharmacology, 19, 1760-1779. https://doi.org/10.2174/1570159x19666210610092958
[25]
Besch, V., Debbané, M., Greiner, C., Magnin, C., De Néris, M., Ambrosetti, J., et al. (2020) Emergency Psychiatric Management of Borderline Personality Disorder: Towards an Articulation of Modalities for Personalised Integrative Care. L’Encéphale, 46, 463-470. https://doi.org/10.1016/j.encep.2020.04.013
[26]
Starcevic, V. and Janca, A. (2018) Pharmacotherapy of Borderline Personality Disorder: Replacing Confusion with Prudent Pragmatism. CurrentOpinioninPsychiatry, 31, 69-73. https://doi.org/10.1097/yco.0000000000000373
[27]
Black, D.W., Zanarini, M.C., Romine, A., Shaw, M., Allen, J. and Schulz, S.C. (2014) Comparison of Low and Moderate Dosages of Extended-Release Quetiapine in Borderline Personality Disorder: A Randomized, Double-Blind, Placebo-Controlled Trial. AmericanJournalofPsychiatry, 171, 1174-1182. https://doi.org/10.1176/appi.ajp.2014.13101348
[28]
Lieslehto, J., Tiihonen, J., Lähteenvuo, M., Mittendorfer-Rutz, E., Tanskanen, A. and Taipale, H. (2023) Comparative Effectiveness of Pharmacotherapies for the Risk of Attempted or Completed Suicide among Persons with Borderline Personality Disorder. JAMA Network Open, 6, e2317130. https://doi.org/10.1001/jamanetworkopen.2023.17130
