Case study of borderline personality disorder

The movie, “Girl Interrupted” is based on a true story, which involved an 18-year-old Caucasian as the main character, named Susanna Kaysen. She was from Princeton, New Jersey, and the daughter of parents of high stature.

Susanna attempted suicide which led her to the admission of Claymoore Hospital in Massachusetts. She was referred by her psychiatrist, even though she claimed chasing a bottle of aspirin with a bottle of vodka was not an attempt to kill herself, but a remedy to cure a headache. With the force of her parents, Susanna voluntarily checked herself into the mental institution. Upon arrival, she was examined and many possible diagnoses were made due to her depression, suicidal, promiscuous, unstable and lack of interest for future goals and plans. Among the possible diagnoses were “psychoneurotic depressive reaction” and “personality pattern disturbance, mixed type.” “Undifferentiated schizophrenia.” was also ruled out in order for a proper diagnoses to be made. After being clinically assessed, Susanna was diagnosed with “borderline personality disorder” (Geller, 2000).

Personality disorders are a form of psychological disorders in which greatly affects an individual’s life. They can be further described as “inflexible and maladaptive patterns of behavior” (Comer, 2008). The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV-TR), describes Borderline Personality Disorder (BPD) as “a pervasive pattern of instability of interpersonal relationships, self-image, and affects , and marked impulsivity beginning by early adulthood” (American Psychiatric Association, 2000). Individuals with borderline personality disorder makes suicidal attempts or self-mutilation which may be a response to rejections or disappointments in interpersonal relationships. Additional characteristics of borderline personality disorder may include frequent mood changes, recurrent suicidal or self-mutilating behavior or both, chronic feelings of emptiness, and difficulty controlling inappropriate anger (Dziegielewski, 2002).

Some of the symptoms expressed by Susanna are similar to that of Mood Disorders. For example, Susanna portrayed intense, impulsive anger when she verbally attacked her nurse Valerie. Due to her verbal abuse, Valerie called her an unstable self-concept and a fragile identity and seeks support and attention from others. She was very attached to her friends, and very dependent on a specific one Lisa, a “sexualized sociopath”. Lisa’s position within the institution was not consistent despite her being there for eight years. However, when Lisa, did not return to the clinic after a doctor’s visit, Susanna went into a depression , she did not know how to function without her friend being there. This showed her lack of ‘self-being’ and her reliability to others.

Depersonalization was also displayed when she randomly thought that there were no bones in her hand, while sitting on a chair at the hospital. This was not a simple thought, but she was convinced of this, and took drastic measures to prove her thought, for she did not take anyone’s opinion into consideration. This was done by biting down on her hand until it bled in an attempt to get all the way down to the bone. She felt the need to have to prove to everyone that she was right.

Another symptom in which Susanna possessed is promiscuity. According to the DSM-IV-TR, one of the criteria is “impulsivity in at least two potentially self-damaging areas” which usually included sex. Susanna knew how to use this to her benefit and it was demonstrated when she had sexual intercourse with her boyfriend one morning, attempted to seduce a security guard later on in that same day, had an affair with her old English professor and even engaged in sexual relations with her friend Lisa. Although these acts were performed, she denies any thought of being promiscuous. “She claims that she is a descent person, and it was plain coincidence that she was caught with two guys in one day, and that it would never happen again (Konrad, 1999).

Even though in the movie Susanna was diagnosed with Borderline Personality Disorder, there were inconsistencies in her symptoms and little to no evidentiary support to, which lead to further misdiagnoses. Borderline Personality Disorder is not easily treated, and usually takes a long process. “Treatment prognosis is typically considered guarded because of these patients’ long-standing problems and extreme instability” (Butcher, Mineka, Hooley, 2007). In the movie, however, Susanna’s recovery was not as long as the usual process when compared to patients treated with BPD. Her symptoms, can be argued to be similar to that of everyday individuals, in that at some point in an individual’s life they undergo some form of stress, which may be similar to that of Susanna’s symptoms such as vagueness of purpose or long term goals, constant need for attention from friends and lovers and instability. These symptoms does not necessarily mean that an individual is mentally unstable.

Patients with Borderline Personality Disorder exhibit a unique trait, in that they believe that their outrageous actions are not mistakes, refuse to accept that they are and intend to keep doing them. Their reliability on others, their seeking for constant attention and not caring about anyone but themselves makes them very self involved. These patients usually solely rely on self-importance and is extremely preoccupied with one’s self. At times in the movie, it didn’t seem like Susanna had this specific disorder. A specific example was when she escaped the mental institution with Lisa, and then checked herself back in , at times she was also sympathetic to her friend Daisy and even blamed herself for her death, for she believed she could have prevented it in some way. “Borderlines are extreme liars and deceitful. They enjoy creating a dramatic environment while pretending to be friends and confidants of each victim” (Cornell &Petricelli, 1999).

When Susanna was diagnosed with Borderline Personality Disorder she assumed it was genetic, and she inherited it from her mother. From a biological view, genetics do play an important role in the development of this disorder. An individual’s personality traits which are prominent in BPD can be partially heritable (Butcher, et al., 2007). These patients also have a lower levels of serotonin activity in the brain, this leads to aggressive behavior toward others. After many researches carried out, it can be determined that close relatives of those with BPD are five times more likely to develop this disorder (Comer, 2008). Psychodynamic theorists tend to believe that abandonment and abuse in adolescents can also be a causal factor. This abuse can result in low self-esteem and always seeking attention (Comer, 2008). These could be reasons to Susanna’s disorder. She was raised in a strict household where her parents were quite fortunate. She did not have a close relationship with them, they were ignorant and unaware of their daughters needs. Susanna’s dream was becoming writer, but at times she was discouraged from this and eventually gave up, due to her parents disapproval. They claimed that was not a proper profession resulting in a distorted self-image.

Even though Susanna is at a hospital, to seek medical attention, many factors still influence her disorder. One major factor is her friends, specifically Lisa. This is so because Lisa’s personality is very extreme and she exuberates sex and charisma. She disregards all authority, by engaging in pranks and verbal abuse. Her demanding personality sometimes comes across as a threat to the other girls and they are forced to obey especially Susanna. This does not aid in her recovery, but instead adds to her insanity. Susanna is easily manipulated by Lisa to stop taking her medication and resist the influences of therapy. She also encouraged Susanna to run away from the institution leading to an increase in her prognosis.

Some other characters in the film are affected by Susanna’s behavior. She writes about them all in journal which was a therapeutic technique recommended to allow her to express her thoughts rather than keeping them to herself. This affected the others because she would write detailed and cruel descriptions of them all. This affected the friendships between Susanna and the other girls at the ward because Lisa finds the journal and decides to share the information with the other girls.

Studies have shown, that gender differences exist when diagnosing an individual with a personality disorder. This was expressed in the film when Susanna had a 15-minute interview with a male psychiatrist. These gender issues that are portrayed shapes Susanna’s behavior and concept of the world as a whole because it makes her evaluate and compare herself to the other female patients. She considered herself to be ‘normal’ after comparison and labeled the other girls as insane. However, after living with these women, she started to understand their unique personalities rather than judging them.

Susanna’s first step to recovery was when she signed herself into Claymoore Hospital and was willing to accept her disorder. Her writing skills, also aided in her recovery process. In this way she was able to express her feelings. Taking her medication and attending therapy was also important.

Psychotherapy, leads to improvement in the individual’s personality. This may not be easily achieved since these patients express fluctuating interpersonal attitudes (Comer, 2008). “The goal of this treatment is to strengthen the weak egos of the individuals and focus on the defense mechanism of splitting” (Butcher, et al., 2007). Another form of therapy is dialectal behavioral therapy, this is a combination of cognitive and behavioral therapy to help improve the patient’s interpersonal skills and emotion regulation (Comer, 2007). The Biological approach through medication can also be considered a form of treatment, however, it is relatively associated with suicidal behavior. In the film medication was the only form of treatment Susanna originally received. Her therapeutic treatments were not specified.

After two years of treatment, Susanna recovered and was released from the hospital. She was able to achieve her goal in pursuing a career as a writer. She gained an identity and was able to control her emotions.

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