OUR LADY OF FATIMA UNIVERSITY

COLLEGE OF NURSING

In Partial Fulfilment of Requirements for NCMB 317 RLE

BORDERLINE PERSONALITY DISORDER

A Case study
Submitted by:
Leader:
Policios, Sharmaine Anne
Members:
Biason, Monette
Gandecila, Jerome
Gulinao, John
Mendoza, Agatha
Trinidad, Lliana Marie
Sarmiento ,Rachelle Mae

BSN-3Y2- 3A
Group 3
 Our Lady of Fatima University
College of Nursing

Acknowledgment

The completion of this case study could not be possible without the participation and assistance
of many people whose names might not all be enumerated. We could not express enough thanks
to the following:

Our Creator, for guiding us and enlightening our paths by giving us enough knowledge,
patience, and persistence to do this case study with optimism, perseverance, and confidence.

To all families of the students for their prayers, unwavering love, moral and emotional support.

We would like to extend our gratitude to our clinical instructors for guiding and teaching us
valuable knowledge which became helpful in fulfillment of this case study.

And to the makers of this paper for giving time, skill, effort, and persuasive unity in order for
this case study and manuscript to be fulfilled

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General Objective:
This case study aims to broaden the students’ knowledge regarding Client with
Borderline Personality Disorder, and it is designed to develop and enhance the skills and attitude
in the application of different nursing processes and management of the patient with
Borderline Personality Disorder.

Specific Objectives:
1. To be able to understand the contributing factors and signs and symptoms that influence

the development of Borderline Personality Disorder.

2. To apply the nursing process to the plan of care for clients with Borderline Personality

Disorder.

3. To provide health education to clients, client’s relatives, and even community members.

4. To increase their knowledge and understanding about the mental health problems.

5. To be able to evaluate the personal feelings, attitudes, and responses of clients with

borderline personality disorder.

6. To formulate a comprehensive nursing care plan in the care for the patient with

Borderline Personality Disorder.

7. To learn the nursing implications and prioritize responsibilities to improve patient’s

condition.

8. To provide recommendations to ensure the continuity of the nursing care.

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TABLE OF CONTENTS

I. Introduction........................................................................................................................5

II. Nursing Health History…................................................................................................6

III. Mental Status Examination............................................................................................7

IV. Pathophysiology ….........................................................................................................10

V. Drug Study…....................................................................................................................14

VI. Nursing Care Plan..........................................................................................................15

VII. Recommendation..........................................................................................................18

I. INTRODUCTION

Borderline Personality Disorder defined as an illness marked by ongoing pattern of behaving

moods, self-image, and the environment. It includes perceptions, attitudes, and emotions. The

term "borderline" was first introduced in the United States in 1938. It was a term used by early

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psychiatrists to describe people who were thought to have tendency to regress into

"borderline schizophrenia" in certain situations. 1970s, a deeper understanding of borderline

personality disorder began to emerge. Psychoanalysts like Otto Kernberg defined borderline as a

middle level of personality organization between psychosis and neurosis. People with BPD were

described as having "primitive" psychological defenses such as splitting and projective

identification.

People with borderline personality disorder may experience intense episodes of anger,

depression, and anxiety that can last from a few hours to days, and mostly the person is usually

not aware of his or her personality or attitudes. Biologic and genetic factors may influence the

disorder while other individual develops the way they interact with the environment and other

people. Some personality disorders diagnosed if there is impairment of personal functioning and

personality traits.

Epidemiology of Borderline Personality Disorder

Borderline Personality Disorder has lifetime prevalence of approximately 6 percent. The

disorder is associated with receiving extensive clinical attention and the disorder is more widely

studied than any other personality disorder. Studies in clinical settings found BPD was present in

6.4 percent of urban primary care patients, 9.3 percent of psychiatric outpatients, and

approximately 20 percent of psychiatric patients. Between 8% to 10% of people with this

diagnosis commit suicide, and many suffers permanent damage from self-mutilation injuries

such as; cutting or burning. Up to three-quarters of clients with BPD engage in deliberate self-

harm, sometimes called nonsuicidal self-injury. (Merza, Papp, Molnar, & Szabo, 2017)

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Signs and Symptoms

 Extreme fear of rejection and abandonment, both real and imagined

 Stormy personal relationships swinging from idealization to devaluation

 Unstable self-image

 Inappropriate bouts of intense anger

 Chronic feelings of boredom or emptiness

 Emotional instability, including irritability and anxiety

 Paranoid and dissociative thoughts

 Impulsivity leading to reckless and harmful behavior

Types of Borderline Personality Disorder

1. Discourage Borderline Personality Disorder

- When a person suffers from discouraged borderline, much of how they think, feel, and

behave is driven by the dependent aspects of their personality disorder.

2. Impulsive Borderline Personality Disorder

- According to psychologist, Theodore Millon, this type of BPD is the most charismatic of

all four. The impulsive subtype is said to have much in common with histrionic

personality disorder.

3. Petulant Borderline Personality Disorder

- It fluctuates between outbursts of explosive anger and feelings of being

unworthy or unloved. 

4. Self- destructive Borderline Personality Disorder

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- Intense feelings of self-loathing (self-hatred) Prone to self-harm.

Risk factors of Borderline Personality Disorder

 Family History. People who have a close family member, such as a parent or sibling

with the disorder may be at higher risk of developing borderline personality disorder.

 Brain Factors. Studies show that people with borderline personality disorder can have

structural and functional changes in the brain especially in the areas that control impulses

and emotional regulation. But is it not clear whether these changes are risk factors for the

disorder, or caused by the disorder.

 Environmental, Cultural, and Social Factors. Many people with borderline personality

disorder report experiencing traumatic life events, such as abuse, abandonment, or

adversity during childhood. Others may have been exposed to unstable, invalidating

relationships, and hostile conflicts.

Diagnosis

Early detection is important and reliable screening instrument are required. The Mclean

Screening Instrument for Borderline Personality Disorder (MSI-BPD) is a 10-item self-report

questionnaire that can detect the presence of BPD in a reliable and quick manner. The MSI-BPD

was developed by Dr. Mary Zanarini and her colleagues at McLean Hospital. The test consists

of 10 items that are based on theDiagnostic and Statistical Manual of Mental Disorders criteria

for borderline personality disorder.

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Treatment

Psychotherapywas ordered as part of the treatment plan, such as dialectical behavior therapy

(DBT), Art therapy, and Writing a diary.

Individual Psychotherapy.Method of bringing about change in a person by exploring his or

her feelings, attitudes, thinking, and behavior. It involves a one-to-one relationship between

the therapist and the client. People mostly seek this kind of therapy based on their desire to

understand themselves and their behavior, especially to make personal changes, to improve

interpersonal relationships, or to get relief from emotional pain or unhappiness. Therapist-

client relationship is the key to the success of this type of therapy.

Psychotherapy Group. The goal of psychotherapy group is for members to learn about their

behavior and to make positive changes in their behavior by interacting and communicating

with others as a member of a group. Used to help group members learn about their behavior

with other people and how it relates to core personality traits.

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Dialectical Behavior Therapy. Its main goals are to teach people how to live in the moment,

develop healthy ways to cope with stress, regulate their emotions, and improve their

relationships with others. The process makes three basic assumptions:

- All things are interconnected.

- Change is constant and inevitable.

- Opposites can be integrated to form a closer approximation of the truth.

Art Therapy. Showcase the psychotherapeutic techniques with the creative process to

improve mental health and well-being. It utilizes the process of creating art to improve

mental, physical, and emotional. Activities such as; drawing, painting, coloring, sculpting, or

collage. As the client makes art, they may show and analyze what they’ve made and how it

makes them feel.

Expressive writing. Writing in a diary for a client with Borderline Personality Disorder

helps to express her personal experiences in order to better recognize and understand your

own perceptions, feelings, and responses.  It can keep a traditional paper diary or could

launch a blog that functions as an online journal.

II. PATIENT’S PROFILE

Name: Patient Joy

Age: 26 years old

Sex: Female
Nationality: Filipino
Religion: Roman Catholic
Marital Status: Single
Chief complaints: According to patient: “Hirap akong mag focus. Para akong nawawala sa

sarili. Feeling ko walang nagmamahal sa akin.”

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Admitting T/C Borderline personality disorder

Diagnosis:

History of Past and Present Illness:

Joy is a 26 years old employee, working as secretary in OLFU. She was presented with a

history of non-suicidal self-injury, specifically cutting her arms and legs, since she was a

teenager. She has made two suicide attempts by overdosing on prescribed medications, one

as a teenager and one six months ago; she also reports chronic suicidal ideation, explaining

that it gives her relief to think about suicide as a “way out.” When she is stressed, Joy says

that she often “zones out,” even in the middle of conversations or while at work. She states,

“I don’t know who Joy really is,” and describes a longstanding pattern of changing her

hobbies, style of clothing, and sometimes even her job based on who is in her social group.

At times, she thinks that her partner is “the best thing that’s ever happened to me” and will

impulsively buy him lavish gifts, send caring text messages, and the like; however, at other

times she admits to thinking “I can’t stand him,” and will ignore or lash out at him, including

yelling or throwing things. Immediately after doing so, she reports feeling regret and panic at

the thought of him leaving her. Mary reports that before she began dating her current partner

she sometimes engaged in sexual activity with multiple people per week, often with partners

whom she did not know. According to her mother she was at times observed to be impulsive

throwing things she handled when angry. Sometimes in the mood but sometimes, depressed

and anxious. An hour prior to admission she sliced her wrist with razor thus brought to

FUMC by her mother for further assessment and management. Upon admission she was

observed to be anxious and heavily crying. She was prescribed BusPar (Buspirone) 15mg

stat, Prozac (Fluoxetine) 10mg 1 tablet OD. Psychotherapy was also ordered as part of the

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treatment plan such as dialectical behavior therapy (DBT), art therapy and writing a diary.

MENTAL STATUS EXAMINATION

The patient is a 26-year-old, young Filipino adult,

working as a secretary in OLFU. she has a history of

non-suicidal self-injury, specifically cutting her arms

Appearance and Behavior and legs, since she was a teenager she has made a two

suicide attempts by overdosing on prescribed

medications. Upon the assessment, an hour before the

admission, she sliced her wrist with razor and was

observed to be anxious and heavily crying.

During the initial assessment, she stated “Hirap akong

mag-focus. Para akong nawawala sa sarili. Feeling ko

walang nagmamahal sa akin.” There are also times that

She thinks that her partner is the “best thing that’s ever

happened to me” and impulsively buy lavish gifts,

Thinking sending care text messages. However, sometimes she

also admits thinking that “I can’t stand him” and will

also ignore, yelling and throwing things at times. Her

mother also reported that before she began dating her

current partner, she sometimes engaged in sexual

activity with multiple partner per week.

The patient is quite confused at herself stating that “I

Orientation don’t know who Joy really is”.

She is able to remembers that sometimes chronic

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Memory suicidal ideation, explaining that it gives her relief to

think about suicide as a “way out.”

She also describes a longstanding pattern of changing

Intellectual Function her hobbies, style clothing, and sometimes her job is

based on who is in her social group.

The patient was observed to be impulsive throwing

Cognitive Function things she handled when angry, sometimes in the mood

but sometimes depressed and anxious.

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 DRUG STUDY

MECHANISM OF NURSING
DRUG INDICATIONS CONTRAINDICATION SIDE EFFECTS
ACTION CONSIDERATIONS

Generic name: May inhibit neuronal Management of anxiety - Contraindicated in CNS: Numbness, - Instruct the patient to
buspirone firing and reduce disorders or the short- patients hypersensitive to paresthesia, tremors, take the drug as
serotonin turnover in term relief of the drug and within 14 days dizziness, headache. exactly as prescribed.
Brand name: cortical, amygdaloid, symptoms of anxiety. of MAO inhibitor
BusPar and therapy. CV: Tachycardia, - Do not administer
septohippocampal Rationale: palpitation. concurrently with
Classification: tissue. - Buspirone was alcohol and grapefruit
administered to the GI: Nausea, vomiting, juice.
Therapeutic class: patient for the relief of diarrhea, constipation.
Anxiolytics the symptoms of
anxiety. Urogenital: Urinary - Warn patient to
Pharmacologic class: frequency, avoid hazardous
Azaspirodecanedione activities that require
derivatives Musculoskeletal: alertness and good
Arthralgias. coordination until
Dosage & effects of drugs are
Frequency: Respiratory: known.
15mg stat Hyperventilation,
shortness of breath. - Monitor for
Route of therapeutic
Administration: Skin: Rash, edema, effectiveness.
PO pruritus, flushing, easy
bruising, hair loss, dry - Advice patient to
skin. take consistently; that
is, always with or
Other: Fatigue, always without food.
weakness.
.
 MECHANISM NURSING
DRUG INDICATIONS CONTRAINDICATION SIDE EFFECTS
OF ACTION CONSIDERATIONS

Generic Name: inhibits reuptake Prozac -Contraindicated in CNS: Headache, -Record mood
Fluoxetine of serotonin is a selective serotonin patient hypersensitive to Nervousness, Insomnia, changes. Watch for
allowing it to reuptake inhibitor drug Drowsiness, Anxiety, suicidal tendencies.
Brand Name: persist longer in (SSRI) and a widely Tremor, Light Headedness,
Prozac the synaptic cleft used antidepressant. It -Avoid use in patients Agitation -Take baseline vital
  is considered safe and taking MAO inhibitors or CV: Hot Flushes, signs
Drug effective in treating other serotonergic drugs; Palpitations
Classification: depression, anxiety, may lead to serotonin Skin: Sweating, Rash, Acne, -Administer drug in
Antidepressants and obsessive toxicity Alopecia the morning.
  compulsive disorder GI: Nausea, Vomiting,
Dosage & (OCD) and bipolar. Diarrhea, Anorexia, Dry -Established suicide
Frequency: Mouth precautions for
10mg OD Rationale: It is used severely depressed
for the treatment of patients. Limit
  major depressive quantity of capsules
Route of disorders. Prozac helps dispensed.
Admission: P.O the brain to maintain
enough serotonin. -Monitor appetite and
nutritional intake;
Note for weight loss.
 NURSING CARE PLAN

NURSING BACKGROUND
ASSESSMENT PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS KNOWLEDGE
Subjective Self- BORDERLINE Short term goals INDEPENDENT Short term goals
“Feeling ko Mutilation PERSONALITY Within 8 hours of : After 1 week of
walang related to DISORDER nursing 1. To gain trust and nursing interventio
nagmamahal sa physically intervention and 1.Established to have effective the Patient was abl
akin”vas damaging acts Health teaching rapport and cooperative to:
verbalized by the as evidence the patient will be nurse-patient
patient by Fresh  Demonstrate a
able to: relationship. decrease in
superficial
slashes on  Demonstrate a frequency and
decrease in 2. Feelings are a intensity of sel
Objectives: wrists, history guideline for future
 Fresh of self-injury, frequency and 2.Identified inflicted injury
intervention such as
superficial Emotionally intensity of feelings  participated in
self-inflicted rage at feeling left
slashes on disturbed experienced the therapeutic
injury. out or abandoned.
wrists before and regimen.
 History of  participate in around the act of  Discussed
self - injury the self-mutilation. alternative way
3. Self-mutilation
 Emotionally therapeutic to meet
might also be:
disturbed regimen. 3. Explored with demands of
 Concentration  discuss the client what current
 A way to gain
Difficulties alternative these feelings situation.
control over
 Impulsivity
ways to meet might mean.  signed a “no-
others.
demands of harm” contract
 Mood Cycles
current  A way to feel that identifies
 Risky situation. alive through steps he or she
Behaviors
 will sign a pain. will take when
 Scars of Arms “no-harm” urges return.
and legs  An expression of
contract that
 Suicidal self-hate or guilt.
identifies Long term goals
thoughts steps he or Within 1 month of
she will take 4. Secured a nursing interventio
when urges written or verbal 4. Client is the Patient was abl
return. no-harm contract encouraged to take to:
with the client. responsibility for
Identified healthier behavior.
Long term goals specific steps  be free of self-
Within 1 month Talking to others inflicted injury
such as persons and learning
of nursing to call upon  expressed
intervention alternative coping
when prompted feelings related
skills can reduce
to self-mutilate. to stress and
frequency and
 will be free of tension instead
severity until such
self-inflicted of acting-out
behavior ceases.
injury. 5. Be consistent behaviors..
 express in maintaining  seeked help
5. Consistency can
feelings and enforcing when
establish a sense of
related to the limits, using experiencing
security.
stress and a nonpunitive self-destructive
tension approach. impulses.
instead of  Demonstrate
acting-out 6. Used a matter- 6. A neutral two new copin
behaviors.. of-fact approach approach prevents skills for when
 seek help when self- blaming, which tension mounts
when mutilation increases anxiety, and impulse
experiencing occurs. Avoid giving special returns.
self- criticizing or attention that
destructive giving sympathy. encourages acting
impulses. out.
 Demonstrate 7. After the
two new treatment of the 7. Identify dynamics
coping skills wound, discuss for both client and
for when what happened clinician. Allows the
tension right before, and identification of less
mounts and the thoughts and harmful responses to
impulse feelings that the help relieve intense
returns. client had tensions.
immediately
before self-
mutilating. 8. Plan is
periodically
8. Work out a reviewed and
plan identifying evaluated. Offers a
alternatives to chance to deal with
self-mutilating feelings and
behaviors. struggles that arise.

 Anticipate
certain
situations
that might
lead to
increased
stress (e.g.,
tension or
rage).
 Identify
actions that
might
modify the
intensity of
such
situations.
 Identify two
or three
people whom
 the client can
contact to
discuss and
examine
intense
feelings
(rage,self
hate) when
ther arise.

DEPENDENT

9. Administered 9.
prescribed
medication as  administered
ordered. to the patient
for the relief
 Buspir
of the
one
symptoms of
anxiety.
 Fluox
etine
 It is used for
the treatment
of major
depressive
disorders.
Prozac helps
the brain to
10. Assisted in maintain
enough
Dialectal
serotonin.
Behavioral
Therapy (DBT)
that focuses on 10. Is an evidence-
the role of based psychotherapy
 that began with
cognition, which efforts to treat
refers to Borderline
thoughts and Personality Disorder
beliefs, and (BMC Psychiatry,
behavior, or 2018)
actions.

11. Assisted in 11. Art therapy has

Art Therapy that shown benefits for
alleviates people with
interpersonal borderline
difficulties such personality disorder
as affect and borderline
regulation, an personality disorder
unstable sense of (Drass, J., 2015)
self, self-
injurious
behaviors, and
suicidal ideation.

12. Assisted in 12. A diary have

Writing a Diary been shown to have
that allows a positive impact in
patient to patient with
express their Borderline
feelings and personality disorder
significantly (Salters, K. 2021)
improve healing.
(Ackerman, C.
2020)
 RECOMMENDATION
Table below shows the summary of the recommendation given to the patient as part of her
discharge planning.

MEDICATION
 Instruct the patient to take medications as prescribed
o Buspar(Buspirone) 15mg
o Prozac (Fluoxetine) 10mg1 tab OD
 Educate the patient and the family about the importance to comply exactly in taking the
maintenance medications.

Exercise/Environment
 Instruct the patient to Tactile Exercises and Visual and Auditory Exercises
 Slowly do simple physical activity to improve and do activities of the daily living.
 Advise the patient to avoid doing strenuous activities such as lifting and outdoor activities that are
dangerous and may harm the patient.

Treatment
 Instruct the client/family to do Dialectical behavior therapy (DBT).
o Replacing maladaptive behaviors with healthier coping skills,such as mindfulness,
interpersonal effectiveness, emotion regulation, and distress tolerance.
 Instruct the client/family to do art therapy and writing a diary.
 Explain the importance of taking the prescribed medications by the physician.

Health teaching
 Healthy habits, such as getting enough sleep, eating healthy foods, getting regular exercise.
 Avoiding alcohol and drugs. These habits can help reduce stress and anxiety.
 Instruct the patient and family in monitoring the neurologic status and occurrence of any
complications.
 Instruct the patient about proper hygiene, self-care and wound caring
 Explain to the family the techniques in assisting the patient.

Outpatient
 Remind the patient about the follow-up check- up.
 Advise the patient about the medication, frequency, time and its importance of taking it.
 Learning to manage your emotions, thoughts and behaviors takes time.

Diet
 Instruct the patient about the importance of adherence to diet.
 For the body and mind to be as healthy as possible, your diet needs to be healthy and balanced.
Foods that need to be included in your diet are:
o Whole grains and cereals
o Lean proteins such as lean meats, seafood, nuts and legumes
o Fruits and vegetables
o Low-fat dairy products
o Unsaturated fats such as olive oil
o Avoid eating fatty, salty foods and caffeinated drinks
Spiritual
 Encourage the family or friends to provide emotional/ psychological support.
 Encourage the patient to verbalize fears, concerns and complains
 Show support the patient with spiritual coping measures within their own spiritual traditions.

I - Introduction
Policios, Sharmaine Anne

II – Psychopathology
Biason, Monette

III - NCP
Mendoza, Agatha
Trinidad, Lliana Marie

IV - Drug Study
Sarmiento ,Rachelle Mae

VI - Discharge Planning
Gulinao, John