A 25-year-old woman was brought to the casualty after taking an overdose of diazepam following a broken relationship. History revealed that she had many such relationships in the past and also has cut marks over her wrists. What is the most likely diagnosis?
Narcissistic personality disorder.
Histrionic personality disorder.
Borderline personality disorder.
Severe depressive episode.
The Correct Answer is C
Borderline personality disorder is marked by pervasive instability in relationships, affect, and self-image, often accompanied by impulsivity and recurrent self-harming behaviors. Individuals may experience intense emotional reactions to perceived abandonment, leading to suicidal gestures or overdoses. They often have a history of unstable interpersonal relationships and may engage in self-mutilation as a maladaptive coping strategy. These behaviors are not necessarily driven by a desire to die but rather to regulate overwhelming emotions or elicit care. The condition is more prevalent in young women and requires structured, empathetic, and consistent therapeutic approaches.
Rationale for correct answer
C. The combination of impulsive overdose, wrist cutting, and unstable romantic relationships strongly supports borderline personality disorder. These behaviors reflect emotional dysregulation and fear of abandonment, hallmark features of the disorder.
Rationale for incorrect answers
A. Narcissistic personality disorder involves grandiosity and need for admiration, but does not typically present with self-harm or impulsive suicidal behavior following relationship loss.
B. Histrionic personality disorder features attention-seeking and dramatic emotional expression, but lacks the recurrent self-injurious behavior and emotional instability seen in borderline personality disorder.
D. A severe depressive episode may include suicidal ideation, but the pattern of repetition and impulsivity, along with unstable relationships and self-mutilation, points more specifically to a personality disorder rather than a mood episode.
Take Home Points
- Borderline personality disorder often presents with impulsive self-harm and emotional instability triggered by interpersonal stress.
- It must be differentiated from mood disorders and other personality disorders that lack recurrent self-injurious behavior.
- Management includes dialectical behavior therapy, mood stabilizers, and structured therapeutic boundaries.
- Accurate diagnosis is essential to guide appropriate treatment and avoid mislabeling behaviors as purely depressive or manipulative.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Borderline personality disorder is characterized by pervasive instability in interpersonal relationships, self-image, and affect, often accompanied by impulsivity. Clients may engage in self-harming behaviors, such as superficial cutting, as a maladaptive way to regulate intense emotions or to express distress. These acts are not always suicidal but may serve to relieve internal tension or elicit care. Splitting—viewing others as all good or all bad—is a defense mechanism reflecting fear of abandonment and difficulty with emotional regulation. Disruption in group settings and manipulation of staff are common behavioral manifestations.
Rationale for correct answer
A. The client’s superficial wrist cutting indicates a pattern of self-mutilation, which is a hallmark behavior in borderline personality disorder. This behavior is often used to express emotional pain or gain attention, and it poses an immediate safety risk, making it the priority diagnosis.
Rationale for incorrect answers
B. While coping deficits are present in borderline personality disorder, they are not the most urgent concern when active self-harm is evident. Safety takes precedence over emotional processing or therapeutic insight.
C. Although abandonment fears and splitting behaviors are common in borderline personality disorder, they are not life-threatening. These dynamics contribute to interpersonal instability but do not supersede the risk of physical harm.
D. The wrist cutting described is non-lethal and superficial, which does not meet the threshold for prioritizing suicide risk. There is no mention of suicidal ideation or a lethal plan, making self-mutilation the more immediate concern.
Take Home Points
- Borderline personality disorder often involves self-mutilation as a coping mechanism for emotional dysregulation.
- Splitting is a defense mechanism rooted in fear of abandonment and contributes to staff manipulation.
- Suicide risk must be differentiated from non-lethal self-harm behaviors in borderline clients.
- Priority nursing diagnoses focus on immediate safety threats before addressing coping or interpersonal issues.
Correct Answer is B
Explanation
Borderline personality disorder is characterized by pervasive instability in interpersonal relationships, self-image, and affect, along with marked impulsivity. Individuals often experience intense fear of abandonment, rapidly shifting emotions, and chronic feelings of emptiness. They may idealize caregivers or providers, then quickly devalue them when they perceive rejection. Self-injurious behaviors, such as cutting or burning, are common coping mechanisms to manage emotional pain or dissociation. These patients often form intense attachments to specific caregivers, leading to boundary-testing and emotional volatility.
Rationale for correct answer
B. Emotional dysregulation and self-harm are hallmark features of borderline personality disorder. Josie’s idealization of the nurse, intense reaction to perceived abandonment, and use of self-injury to “stop the numbness” are classic signs. Her unstable relationships, identity disturbance, and affective instability further support this diagnosis.
Rationale for incorrect answers
A. The focus of obsessive-compulsive personality disorder is on control, orderliness, and perfectionism, not emotional instability or self-harm. These individuals are rigid and preoccupied with rules, not prone to impulsive or self-destructive behavior.
C. Antisocial personality disorder is marked by disregard for others’ rights, deceit, and lack of remorse. Josie’s emotional vulnerability, fear of abandonment, and self-harm are inconsistent with the manipulative, unemotional traits of antisocial behavior.
D. Schizotypal personality disorder involves eccentric behavior, cognitive distortions, and social anxiety. While these individuals may be socially isolated, they do not typically exhibit the intense emotional reactivity or self-injury seen in borderline personality disorder.
Take Home Points
- Borderline personality disorder presents with emotional instability, fear of abandonment, and recurrent self-harm.
- Self-injury in BPD is often a maladaptive coping mechanism to relieve emotional numbness or distress.
- BPD must be differentiated from antisocial personality disorder, which lacks emotional depth and remorse.
- Obsessive-compulsive and schizotypal personality disorders do not typically involve impulsivity or self-injurious behavior.
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