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Clinical Crossroads
February 27, 2002

A 44-Year-Old Woman With Borderline Personality Disorder

Author Affiliations

Author Affiliation: Dr Oldham is Director, New York State Psychiatric Institute, New York, NY.

JAMA. 2002;287(8):1029-1037. doi:10.1001/jama.287.8.1029

DR BURNS: Ms J is a 44-year-old woman with a history of borderline personality disorder. She lives alone and currently works full-time as a residential counselor in the mental health field. She purchases Medicaid-type insurance through Common Health in Massachusetts. She initially came to see Dr M in July 2000 because she was unhappy with her previous primary care physician.

Ms J has an extensive psychiatric and comorbid medical history. She first had contact with a mental health care professional at the age of 22 after moving away from home and starting her first job. The transition precipitated extreme anxiety, and Ms J lost her sense of self-direction. She became extremely dependent on others and feared abandonment. When other changes and personal losses occurred, Ms J reacted with intense emotional instability, marked by depression and intermittent anger. She has had numerous, prolonged hospitalizations for depression, suicidal ideation, and suicidal behavior with multiple drug overdoses and self-injury. These factors led to the diagnosis of borderline personality disorder. Additionally, Ms J has many medical problems that have necessitated additional hospitalizations, surgery, and orthopedic interventions. Some physicians have questioned whether these medical problems had a psychological component to them.

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