Board Review: Neuro/Psych
A 42 year old female presents to the ED with lower abdominal cramping. She tells you that she went to her primary yesterday and “they did absolutely nothing for me”. She focuses most of the encounter with negative comments about her visit yesterday. She is pleasant towards you and tells you that you’re the best doctor she has ever met. At the end of the encounter, she asks you for oxycodone for her pain because it is the only thing that will help. On informing her that you will prescribe her other modalities for pain control, the patient immediately begins yelling and threatening you. What personality disorder does this patient most likely have?
This patient is “splitting” which is a common thing for patients with Borderline personality to do, showing high regard for some providers and disdain for others. Other features of Borderline personality disorder include a pattern of unstable relationships, episodes of anger/acting out, recurrent threats of self-harm, and impulsivity.
Aviram RB, Brodsky BS, Stanley B. Borderline personality disorder, stigma, and treatment implications. Harv Rev Psychiatry 2006; 14:249.