Case Study Analysis: Psychopathology and Treatment of Vee’s Mental Health

### Case Study: Vee

#### 1. Presenting Problems
Vee is a 26-year-old African-American woman who exhibits several significant mental health concerns. The primary presenting problems include:

– **Non-Suicidal Self-Injury (NSSI):** Vee has a history of cutting her arms and legs since adolescence.
– **Suicidal Behavior:** She has attempted suicide twice via overdose, once as a teenager and once six months ago. She also experiences chronic suicidal ideation.
– **Dissociation:** Vee reports frequent “zoning out” episodes, even during conversations or at work.
– **Identity Disturbance:** She expresses uncertainty about her identity, frequently changing her interests, appearance, and jobs to align with her social groups.
– **Interpersonal Relationship Instability:** Vee exhibits patterns of idealization and devaluation in her relationship with her partner, with impulsive behaviors such as buying lavish gifts or lashing out.
– **Impulsivity in Sexual Behavior:** She has a history of engaging in frequent, casual sexual encounters with multiple partners.

#### 2. Primary and Differential Diagnosis
Based on the DSM-5 and ICD-10 criteria, Vee’s symptoms align most closely with Borderline Personality Disorder (BPD).

– **Primary Diagnosis:**
– **DSM-5:** Borderline Personality Disorder (301.83)
– **ICD-10:** Emotionally Unstable Personality Disorder, Borderline Type (F60.31)

**Differential Diagnoses:**
– **Major Depressive Disorder (MDD):**
– **DSM-5:** Major Depressive Disorder, Recurrent Episode (296.30)
– **ICD-10:** Major Depressive Disorder, Recurrent (F33.1)
– **Bipolar II Disorder:**
– **DSM-5:** Bipolar II Disorder (296.89)
– **ICD-10:** Bipolar Affective Disorder, Current Episode Depressed (F31.3)
– **Post-Traumatic Stress Disorder (PTSD):**
– **DSM-5:** Post-Traumatic Stress Disorder (309.81)
– **ICD-10:** Post-Traumatic Stress Disorder (F43.1)

#### 3. Cluster of the Primary Diagnosis
Borderline Personality Disorder belongs to **Cluster B** of personality disorders in the DSM-5. This cluster is characterized by dramatic, emotional, and erratic behavior, and includes other disorders such as Antisocial Personality Disorder, Histrionic Personality Disorder, and Narcissistic Personality Disorder.

#### 4. Treatment Plan
A comprehensive treatment plan for Vee should address both immediate safety concerns and long-term therapeutic goals. The plan should be evidence-based and patient-centered, incorporating a combination of psychotherapy, pharmacotherapy, and supportive interventions.

**Immediate Safety Measures:**
– **Risk Assessment and Safety Planning:** Given Vee’s history of suicide attempts and chronic suicidal ideation, a thorough risk assessment is crucial. A safety plan should be developed, including emergency contact information, warning signs, and coping strategies for crises.
– **Hospitalization:** In cases of imminent risk of harm, short-term hospitalization may be necessary to ensure safety and stabilization.

**Psychotherapy:**
– **Dialectical Behavior Therapy (DBT):** DBT is considered the gold standard for treating BPD. It focuses on skills training in mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness.
– **Cognitive Behavioral Therapy (CBT):** CBT can help address maladaptive thought patterns and behaviors, particularly in managing symptoms of depression and anxiety.
– **Trauma-Focused Therapies:** If Vee has a history of trauma, therapies like Eye Movement Desensitization and Reprocessing (EMDR) or Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) may be beneficial.

**Pharmacotherapy:**
– **Selective Serotonin Reuptake Inhibitors (SSRIs):** Medications like sertraline or fluoxetine may be prescribed to manage comorbid depression and anxiety.
– **Mood Stabilizers:** Medications such as lamotrigine or valproate can help with mood swings and emotional instability.
– **Antipsychotics:** Low-dose atypical antipsychotics (e.g., aripiprazole) may be considered for severe impulsivity or mood dysregulation.

**Supportive Interventions:**
– **Psychoeducation:** Educating Vee and her support system about BPD and its management is essential.
– **Support Groups:** Participation in support groups for individuals with BPD can provide additional emotional support and coping strategies.
– **Social and Vocational Support:** Assistance with building stable social relationships and vocational training can help Vee develop a consistent sense of self and purpose.

**Follow-Up and Monitoring:**
Regular follow-up appointments to monitor progress, medication adherence, and symptom management are critical. Adjustments to the treatment plan should be made based on Vee’s evolving needs and responses to therapy.

### References

– American Psychiatric Association. (2013). *Diagnostic and Statistical Manual of Mental Disorders* (5th ed.). American Psychiatric Publishing.
– World Health Organization. (2019). *International Statistical Classification of Diseases and Related Health Problems* (10th Revision).

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