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.
Oldham JM. A 44-Year-Old Woman With Borderline Personality Disorder. JAMA. 2002;287(8):1029–1037. doi:10.1001/jama.287.8.1029