Denise Gilmartin Borderline Personality Disorder

Diagnosis:
Denise Gilmartin, a 26 year old female, exhibits behaviors which meet criteria for Borderline Personality Disorder. Denise exhibits unstable intense interpersonal relationships characterized by idealization and devaluation (Criterion 2). She has a history of brief tumultuous relationships and friendships. They start of with quick intense attachments and are described by Denise as “wonderful” and “incredibly special” (idealization); however, these feelings quickly devolve into “contempt” and “loathing” (devaluation). Additionally, Denise displays an unstable sense of self (Criterion 3). Her unsteady employment history is partially explained by dramatic shifts in interests. She switched from marketing to legal work to waitressing. It is also important to note that interpersonal issues underly most of her

occupational troubles.

Denise also displays impulsivity in more than two self-damaging areas (Criterion 4). She has a history of binge drinking, shoplifting, and spending too much money. There is a history of suicide attempts, suicidal gestures, and self-mutilation (Criterion 5). Most recently she presented at the emergency room which self-inflicted cuts which required stitches and a small overdose of Ativan. Denise displays instability and reactivity of mood (Criterion 6). She is often depressed, but is occasionally filled with energy and rage. Denise has expressed chronic feelings of emptiness (Criterion 7) beginning during her teenage years, and stated that it feels like she “doesn’t exist.” Finally Denise has difficulty controlling her intense anger (Criterion 8). One employer fired her for throwing a drink at a customer after becoming so angry. For these reasons, Denise should be diagnosed with Borderline

Personality Disorder.

Treatment Plan:
Denise could benefit from Dialectical Behavior Therapy (DBT). This would require a 12 month commitment to the DBT program. During this time, Denise would attend a DBT skills training group in order to learn problem solving techniques, emotion regulation, and interpersonal skills. DBT groups meet for 2-3 hours weekly. She would be asked to complete two full cycles through the skills training course which contains four modules. The first module is Mindfulness which teaches awareness in the moment and how to be non-judgmental. Next she will learn Emotional Regulation by identifying emotions, knowing the effects of emotions, counteracting negative emotions, and increasing positive emotions. The third module is Distress Tolerance. Here she will learn how to cope with stress and how to self-soothe. The last module deals with Interpersonal Effectiveness. Denise will be taught how to deal with conflict, how to get her needs met, and how to say no. In addition to group skills training, Denise will see an individual DBT therapist. She will be asked to keep diary cards throughout the week, so that she can address any obstacles to her recovery during her individual sessions. These sessions occur weekly for 60-90 minutes each. Also, Denise will have access to phone coaching so that she can call her therapist prior to engaging in self-harm and they can coach her through alternatives. There are four main goals to DBT: 1) keep the patient safe; 2) stay in therapy; 3) better quality of life; 4) address the sense of incompleteness by finding joy, freedom, and spiritual meaning. If Denise is able to complete the program and reach these goals then she is much more likely to be successful.