Case Study Report: Katy's Borderline Personality Disorder (NURS20026)

This report presents a detailed analysis of a case study involving Katy, a 23-year-old woman diagnosed with Borderline Personality Disorder (BPD). The report begins with an introduction to Katy's background and the circumstances leading to her diagnosis, including her move to Australia and subsequent emotional distress. It then delves into the diagnostic criteria for BPD, highlighting Katy's symptoms and how they align with the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) guidelines. The report examines Katy's legal status under the Mental Health Act 2007 (NSW), discussing her rights to treatment and potential admission to a public hospital. It further explores the risks associated with managing BPD patients and outlines both pharmacological and non-pharmacological treatment approaches, including psychotherapy, medication, and lifestyle interventions. The rationale for a multi-disciplinary team is discussed, along with the criteria for discharging a patient from the hospital. The report concludes with a focus on the nurse's role in providing comprehensive care to patients like Katy, adhering to the standards set by the Nursing and Midwifery Board (NMBA).

Running Head: Healthcare 0
BORDERLINE PERSONALITY DISORDER
[Document subtitle]

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Contents
Introduction......................................................................................................................................2
Diagnosing symptoms of Borderline personality disorder..............................................................2
Katy’s legal status under Mental Health act 2007(NSW)...............................................................3
Risks associated with managing BPD patients................................................................................3
Pharmacological and Non-pharmacological ways of treating BPD patients...................................3
Rationale of multi-disciplinary team members................................................................................4
Evidences to discharge patients.......................................................................................................4
Nurse’s role in providing care.........................................................................................................5
Conclusion.......................................................................................................................................5

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Introduction
Katy is a 23-year-old girl who has studied nursing in UK. After studies completion, she
came back to Australia to work as an AIN in a large hospital. The prime reason for her returning
to Australia was her adoptive mother’s death. She got to know after her adoptive mother’s death
that her biological and adoptive mother were sisters, as her real mother also lives in Sydney. She
came to Australia to stay close to her. On her birthday, she met her biological mother. After
meeting with her, Katy’s mood darkens and she find hard to motivate herself to do mundane
tasks of the day. Her mood exacerbated to such an extent that dark thoughts in her pushed her to
suicidal risks. The case study is about the 23-year old Katy who suffers from Borderline
personality disorder. The following report discusses about the Borderline Personality disorder, its
symptoms, cure, and the legal status of Katy under the Mental Act 2007(2007)
Diagnosing symptoms of Borderline personality disorder
Katy who suffers from Borderline personality disorder has strange mood swings. Her
mind is always occupied with vague thoughts. She finds herself mentally cluttered that hampers
her self-image. She explains that there are days when she feels herself like a vacuum while on
other days, she experiences the storm of colorful thoughts. She says that it is difficult to describe
her emotional condition in lucid words. There are voices, which play inside her head all the time,
and it becomes difficult to for her to differentiate the real voices of the people with those playing
inside of her head. She blames the voices for lack of her social connections with real humans.
The all-different reality being played in her head make her feel that she does not belong to this
world. She is as a bubble trapped in an invisible reality (Brush, 2017). These symptoms make it
difficult to do her mundane tasks well. It also affects her behavior with people thus resulting in
unstable relationships. The affected relationships are the cause of her chronic emptiness. These
recurrent queer thoughts are pushing her to the suicidal edge ( Becker, 2019).
American psychiatric association has released the manual guide in past, the name of the
handbook is The Diagnostic and Statistical Manual of Mental Disorders. The manual guide
consists of various criteria to classify a situation as a mental disorder. It contains symptoms and
descriptions about various mental disorders. It is termed as a medium for a doctor to convey to

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the patient that he suffers from the disorder. the Guidelines of Borderline personality Disorder in
the Diagnostic and statistical Manual of Mental Disorders are (Lubit,, 2018).
Confused Self-image, Emotions and highly-unstable social relations
A patient trapped between the real and imagination world
Excessive substance abuse, sex, and unhealthy eating because of highly impulsive behavior
(Bertsch, et al., 2019)
Prolonged feelings of chronic emptiness
Increased Temptations to self-harm and suicide (Joel, 2019)
These are the queer personality traits reflected above for a person to be considered the patient of
Borderline Personality disorder. Katy is showing symptoms like the symptoms reflected in the
guidelines. She is also suffering from confused self-image, chronic feelings of emptiness,
feelings of being trapped between the real and imagination world and the increased suicidal
temptations. Her symptoms match with the symptoms reflected in the guideline which shows she
is the patient of Borderline Personality Disorder (NHS, 2019).
Katy’s legal status under Mental Health act 2007(NSW)
Mental health Act 2007 (NSW) was established with the motive of providing treatment
and care to the persons suffering from the mental illness. It follows a well-maintained framework
that specifies the appropriate circumstances where the person suffering from the severe mental
disorders could be admitted to Public hospitals. It also specifies the conditions of compulsory
treatment requirements. It regulates the conditions for providing Electroconvulsive therapy
(Mhcc, 2019).
The act applies to the Katy who is suffering from Borderline Personality Disorder. The
act grants her the right to get admitted in the public hospital for treatment. The act grants the
legal status to get treatment either voluntarily and non-voluntarily and to receive the treatment in
the community. Under the act, Katy comes among the mentally ill patients as she is getting
increased level of dark thoughts. She is not considered mentally disordered as her behavior is not
highly abnormal and the Borderline personality disorder is a temporary condition that a person

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faces in a lifetime. Katy can admit herself voluntary as she is aware of her mental conditions
(Pugh, Aziz, Herring, & Savulescu, 2019).
Risks associated with managing BPD patients
Individuals suffering from borderline disorders have extreme mood swings. Their
impulsive behavior and sudden anger outburst could pose a problem for the hospital staff to
handle them. The mental disorder has already hampered their self-image so anybody including
the nurse trying to medicate them could led to the patient misleading the signal. The patient
suffering from this condition feels the sense of being unloved by people. Any individual
encountering the patient might result in act of negativity from the patient. Doctors and nurses
might find it difficult to tame the emotions of an individual. It would be tough for them to
prepare the patient for a new treatment. The sporadic uncontrollable anger outburst could cause
high level of noise in the ward thus affecting other patients suffering from the mental disorders.
Managing patients with the disorder is not an easy task. It involves patience on the part of
hospital staff. To manage these anger outbursts, the crises team could be set up in the hospital so
that it can be managed in time with ease. Patients affected with such disorders dislike meeting
with people, sometimes the excess number of visitors are the cause of their distress. The
management staff of the hospital should limit the number of outside visitors and the nurses in
their room at one time (Bertsch, et al., 2019).
Pharmacological and Non-pharmacological ways of treating BPD patients
The mental disorder can be cured with various pharmacological and non-pharmacological
ways. Some of the pharmacological ways of treating the disorder are treating patients with
antidepressants, anticonvulsants and mood stabilizers and Antipsychotic medications.
Depression is one of the outcomes of Borderline Personality Disorder (Mayoclinic, 2019). It
becomes important to treat it. Serotonin reuptake inhibitor has been one of the ways of treating
depression. As according to the study, the serotonin reuptake inhibitor increases the level of
serotonin in brain thus easing depression (Lapierre, 2014). The other kind of medicine used are
Amitriptyline, the medicines is helpful in reliving the mood of the patients. It improves the
energy levels of an individual. There is a high level of variation in mood of those suffering from
BPD. The anticonvulsants and mood stabilizers could be used to stabilize the mood of the
patients. In a study placebo are used to treat the patients with highly impulsive behavior.

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Medicines available to stabilize the mood of patients are Valproate semisodium, Lamotrigine and
topiramate. These medicines have reduced the aggression in individuals. The other kind of
medication is Antipsychotic medications, which is responsible for controlling the aggression,
anxiety, and impulsivity in a patient (Health Direct, 2019).
There are other non-pharmacological ways to treat the symptoms are psychotherapy
which means curing the patient through talks. The talks help in relieving the emotional burden
the patient is facing. It helps in the development of the patient’s self-esteem. There are different
types of Psychotherapy, which include Dialectical behavior therapy, schema-focused therapy,
metallization-based therapy, and good psychiatric management ( Tan & Averbeck, 2018).
Dialectical behavior therapy is a group therapy that helps in teaching the patients the skills to
cope up with their emotional outbursts, impulsivity, and anger. The other therapies such as
Schema focused therapy helps in the identification of unmet needs of the patients, which plagued
them with the disorder (Zanarini,, 2013).
These therapies are helpful in bringing an individual from the depression to a place of
peace. Other kind of non –pharmacological ways of treating the symptoms are doing regular
exercise and meditation. Exercise and meditation help in the stretching of the mental muscles
thus reliving an individual suffering from borderline personality Disorder (Salters, 2019).
Rationale of multi-disciplinary team members
Katy suffers from most of the typical borderline personality symptoms. The admission of
Katy in the hospital is important for her effective treatment of the disorder. According to the
psychologists, the admission of the Katy is important as she is getting the flood of dark thoughts
which might exacerbate are emotional condition if not treated properly. It was reported in the
case study that she is also getting suicidal thoughts. According to the doctors, a person getting
suicidal thoughts needs immediate care because only a highly depressed individual can think of
taking such a step. After her birthday party, she started experiencing some dark thoughts. There
are chances that these negative thoughts might lead to emotional outburst in future. The negative
thoughts could also result in self-harm. According to the emotional crises’ manager, it becomes
essential for the person who is unable to control the influx of dark thoughts to be admitted in the
hospital so that further self-harm and danger to others could be avoided. The productivity of
Katy is also getting affected because of her inability to do the mundane tasks. The productivity

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manager says that such individuals are increasing the burden on the nation so it becomes
important to provide them with the best treatment by admitting them in the hospital.
Evidences to discharge patients
After the treatment is provided to the individual, it becomes important to determine the
factors that convey the individual’s ability to survive without the Hospital’s support. The factors,
which will help in determining the discharge of Katy from the hospital are that she is able to
control her mind which would be visible in her actions. As she would be calm in doing the
routine tasks, she would stutter less while speaking and she would be able to sleep without much
problem. She would be less fearful in meeting with people (Thompson, et al., 2019). The
frequency of anxiety attacks will be less. The individual would be calmer from the first time he
was admitted. After the treatment gets over, in a counselling with the doctor the katy can claim
with confidence that she can now sense the clarity of thoughts. The reduction of the dosage of
medicines is also a good sign of discharging a patient from the hospital (Tyrer, 2019).
Nurse’s role in providing care
The Patients like Katy should be provided various services under the board of Nursing.
The Services include Preventive care, laboratory services, medical supplies, and emergency
services. The preventive care for the Katy may include regular checkups and healthy dietary
plans to prevent the Borderline Personality disorder to happen again. She could get immediate
access to emergency services in case she experiences any kind of anxiety attacks (DC health,
2019). The right kind of prescription could be delivered at her home according to her medical
condition.
The Nurse role according to the standards set in the Nursing Midwifrey board (NMBA)
should be rendered to the patients (nursingmidwiferyboard., 2019). The standard 6 of NMBA
which states to provide appropriate, responsive, and safe quality nursing practices to patients
could be applied by nurses to provide high quality of services to the mentally ill patient Katy and
the standard 7 states for the nurse to evaluate the progress of their nursing practice. The standard
7 can be applied by evaluating the progress in the mental treatment of Katy, to evaluate whether
she has come out of the depression or not and the interventions that could be applied to increase
the progress of the treatment.

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Conclusion
A person showing symptoms where he loses the connection with reality and is unable to
control the dark thoughts should communicate the symptoms to the nearby doctors. it is the
responsibility of the fellow person associated with the patient to get them admitted to the hospital
before the mental situation of the person worsens. In the case, Katy’s friend Res helped her and
took her to the General Practice nurse who then suggested her admission to the hospital. Under
the Mental Act2007(NSW), the patient will be provided with right treatment of Borderline
personality disorder with the help of the effective pharmacological and non-pharmacological
ways available in the medical field.
.

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