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Acute stress response
6%
3/54
Antisocial personality disorder
0%
0/54
Borderline personality disorder
94%
51/54
Normal grief response
Post-traumatic stress disorder
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This patient who presents with splitting and self-injurious behavior is presenting with a behavior pattern suggestive of borderline personality disorder.Borderline personality disorder presents with pervasive behavior patterns of impulsivity, mood instability, and an unstable sense of self. These patients fear abandonment, have unstable relationships, and often participate in self-harm and suicidal behaviors. Splitting is the most common defense mechanism used and occurs when patients make claims of things to be all good or all bad (such as stating the physician is the best doctor in the world followed shortly by calling them incompetent). Dialectical behavior therapy is the treatment of choice along with other medications (mood stabilizers), which can include lithium or antidepressants.Paris reviews the evidence regarding self-injurious behavior in patients with borderline personality disorder. He discusses how many patients with this disorder will die by suicide. They recommend specifically designed psychotherapies.Incorrect Answers:Answer 1: Acute stress response could explain some abnormal behavior in a patient; however, this patient's splitting and self-harm behavior make borderline personality disorder a more likely diagnosis. Treatment is supportive for normal acute stress response.Answer 2: Antisocial personality disorder presents with lifelong criminal behavior with a disregard for the rights of others. These patients are often criminals and have extensive records. Patients may require incarceration as this disorder is extremely hard to treat.Answer 4: Normal grief response could explain some anger and crying in a situation such as this; however, the presence of splitting and self-harm behavior make borderline personality disorder a more likely diagnosis. Treatment for normal grief response is supportive.Answer 5: Post-traumatic stress disorder presents with flashbacks related to an acutely stressful event rather than splitting and self-harm behaviors. Treatment is with cognitive behavioral therapy and with selective serotonin reuptake inhibitors.Bullet Summary:Borderline personality disorder presents with splitting, self-harm, impulsivity, and mood instability.
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