Diagnosing Annie Wilkes : Borderline Personality Disorder

For this applied paper I chose to read the novel Girl, Interrupted by Susanna Kaysen. In her biography she writes about her time at McLean Hospital, a residential psychiatric facility in Massachusetts. She tells about the experiences she had there, the people that she met, and most importantly her diagnosis; Borderline Personality Disorder. Through reading her novel I was able to see what caused her diagnosis, the symptoms that she portrayed, and the treatment she received to have the status of recovered.

Personality disorders are the maladaptive way of thinking and behaving that can interfere with the individuals’ personal relationships and their integration to society. An individual who suffers from a personality disorder would typically behave and think outside of the societies’ norms. Although, there are ten personality disorders, in this essay we will be analyzing and focusing on the borderline personality disorder and its portrayal in the popular film, Silver Linings Playbook.

Borderline personality disorder is defined in its most simplest sense as being a mental health disorder that generates significant emotional instability. [1] In sufferers it generates a wide range of symptoms typically characterised into three groups; Problems regulating emotions and thoughts; impulsive behaviour without thinking of the consequences of actions; and lastly unstable relationships. Evaluating the most effective treatment(s) for BPD remains a target for mental health services as the disorder is associated with self harm and suicide attempts, with suicide attempts recorded in 69-80% of patients. [2]

A personality disorder is characterized by a distinct pattern of behavior that does not meet normal standards of behavior within one’s culture. This pattern is ingrained as the norm to the person affected, and the characteristics of the affected person deviate markedly from societal standards (Hebblethwaite, 2009). The two main features that help to identify a personality disorder are chronic interpersonal difficulties and persons with one’s identity or sense of self (Livesly, 2001). Within this set of mental health disorders lie several other subsets, including one of the most prominent personality disorders - Borderline Personality Disorder (BPD). BPD is a severe, long-lasting disorder that has an incidence of occurrence approximately equal to that of bipolar disorder and schizophrenia combined (Grant, Chou, Goldstein et al., 2008). BPD also puts those affected at risk for damage in many areas of their life if not properly diagnosed and treated, including personal relationships, school, work, and self-imagine. Furthermore, this disorder has a high co-morbidity with other disorders such as depression, substance abuse, eating disorders, and social phobia, among many more (Hebblethwaite, 2009). Misdiagnosis of borderline personality disorder can have serious clinical implications. This paper looks to identify the risk factors associated with BPD, the affects on various aspects of the person’s life, treatments, and give recommendations as to how to properly identify and

Borderline personality disorder can include many aspects: instability in mood regulation, impulse control, difficulties in interpersonal relationships and self-image. (Lieb et al, 2004) Jaynelle has experienced all of these at some time in her life. She grew up stealing from Safeway to be able to eat, uprooting her family to move with multiple boyfriends, and she overreacts when she thinks she is being slighted by social services. She is quick to anger and lashes out when provoked.

4) Gunderson, J. G. (2011). Borderline personality disorder. The New England Journal of Medicine, 364(21), 2037-2042. Retrieved from https://ez.salem.edu/login?url=https://search.proquest.com/docview/869106178?accountid=13657

Abstract: This paper will discuss the causes and psychological impact of borderline personality disorder. It will also talk about how to treat those impacted by borderline personality disorder.

Borderline personality disorder in this film is accurately represented with it's symptoms of mood change, impulsivity, unstable self-image, and conflicting interpersonal relationships. Susanna Kaysen, an 18 year old whom begins the film trying to overdose on pills while drinking vodka, is admitted to a mental institution by her parents because of the behaviors she is expressing. A symptom the character is expressing in the film is impulsivity. According to the text, "Studies suggest that around 75 percent of people with borderline personality disorder attempt suicide at least once in their lives" (Comer, 2016). The action that Susanna took represents a suicide attempt, therefore it accurately depicts a strong picture of the disorder.

“Personality disorders have been documented in approximately 9 percent of the general U.S. population” (Angstman, Rasmussen, 2011). Emotional dysregulation disorder or its common name borderline personality disorder is a very serious and chronic disorder. The Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) describes borderline personality disorder as “a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity that begins by early adulthood and is present in a variety of contexts” (Gardner, 2006). Within the last 20 years, psychologists and other mental health professionals have made tremendous strides in research on what exactly borderline personality disorder, some of its triggers and possible effective treatment options. Borderline personality disorder is defined as a disorder that generates severe emotional instability which can be a springboard that can lead to other stress induced mental and behavioral problems.

Lisa received treatment to help her with depression and borderline personality disorder (BPD), as she has been diagnosed with these disorders. However, it is important to understand the factors that have led to these diagnoses. It would be quite simplistic and stigmatising to reduce Lisa to those disorders. In fact, it may be interesting to try to understand Lisa’s problems by looking through her past and present on a biological level and on a psychodynamic level.

Though several personality disorders are highly complex and a challenge to treat, there are effective treatments available (“Treating Borderline” 1). The various treatments are broken down by method, the first of which being cognitive behavioral therapy, which attempts to alter the conscious thoughts and behavioral patterns of patients (Daniel); (“Treating Borderline” 2). Cognitive behavior therapy itself is broken down into two therapies, dialectical behavioral therapy and schema-focused therapy (“Treating Borderline” 2). Dialectical behavioral therapy, developed by Dr. Linehan, is centered on the basis that personality disorders are formed when hypersensitive patients are in situations which lack the emotional support they require, therefore leading to their “inability to regulate emotions” (“Treating Borderline” 2). Thus, the treatment serves to help the patient gain control over their emotion and behavior (“Treating Borderline” 2). The treatment itself consists of group and individual sessions and typically lasts approximately one year (“Treating Borderline” 2). During the group sessions, patients learn to become more aware of their behaviors and emotions through sessions pertaining to “problem solving, mindfulness meditation, and breath training“(“Treating Borderline” 2). In personal sessions, referred to as psychotherapy, the psychiatrist explains to the patient how the lessons from the group therapy sessions are applicable

The objective of this study is to describe the assessment and care of a client with borderline personality disorder. This work will additionally demonstrate the complexity of the problems and needs of this client and how this impacts on their illness and service providers. Additionally this work will describe the client's particular mental health problems, discuss possible causative factors and describe how the person was assessed and what interventions were used to help them. Evaluate the effectiveness of these assessments and interventions with reference to published literature, policy and legislation.

Annie feels like others are out to get her, and believes that is her against the world. According to the article with medical references titled “Paranoid-Personality Disorder” it states that “people with PPD are always on guard, believing that others are constantly trying to demean, harm or threaten them.” Similarly Annie displays behavior to avoid other people and she goes out of her way demonstrate that she is a stable and proper woman. In different instances Paul becomes aware that most of Annie’s efforts to clean and to take care of her farm are to “keep up appearances.”

This paper will be based on a character in the movie” Girl, Interrupted” who was suffering from one of the PD’s in cluster B, Borderline Personality Disorder (BPD) and with this disorder; and with is disorder, they are often dramatic, emotional and very erratic. According to DSM-5, the prevalence for the general population for BPD is 5.9%, it is more diagnosed in women about 75% than men, it was associated with considerable mental and physical disability especially among the female populations and it may decrease in the older population. . BPD symptoms can be severe, debilitating, and isolating, and individuals with the disorder are shamed into hiding. . Interpersonal relationships, employment, and other functionings can be negatively impacted.

Borderline Personality Disorder (BPD) is characterized by fluctuation of self-image, lack of stable interpersonal relationships and pronounced and unpredictable impulsivity. The Diagnostic and Statistical Manual of Mental Disorders 5 (2013) also lists fear of abandonment, suicidal or self-harming behaviors, intense or inappropriate anger that is difficult to control as well as paranoid ideation or dissociative symptoms. Morcos and Morcos (2016) wrote that patients with BPD are often misdiagnosed with other trauma related disorders, such as PTSD, depression or bipolar disorder. According to Beatson, et al. (2016) there are additional issues in diagnosing older patients, as the criteria indicates that symptoms would have been seen early in the patient’s life, not later. Beatson, et al. (2016) also noted that there is a considerable lack of studies and literature concerning BPD in older patients, making the diagnostic process more difficult. In this case study we will be working with an older patient, one that was well into midlife before Borderline Personality Disorder was included in the DSM, to see if she fits the criteria for BPD and what treatment options might be available.