A 24-year-old woman has a history of intense unstable relationships, frantic efforts to avoid abandonment, recurrent self-cutting, a persistent empty feeling, and brief dissociative episodes when stressed. According to DSM-5, her presentation MOST closely fits which personality disorder cluster and specific diagnosis?
- A Cluster A; Paranoid Personality Disorder
- B Cluster C; Dependent Personality Disorder
- C Cluster B; Histrionic Personality Disorder
- D Cluster B; Borderline Personality Disorder ✓
Explanation
Borderline Personality Disorder (BPD, DSM-5 Cluster B) requires at least 5 of 9 criteria: frantic efforts to avoid abandonment, unstable intense relationships (idealization/devaluation), identity disturbance, impulsivity, recurrent self-harm/suicidal behavior, affective instability, chronic emptiness, inappropriate intense anger, and transient stress-related paranoia/dissociation. This patient has at least 5: abandonment fears, unstable relationships, self-harm, empty feeling, and dissociation. Cluster B is the 'dramatic, emotional, erratic' cluster. Dialectical Behavior Therapy (DBT) is the first-line psychotherapy for BPD.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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Written and medically reviewed by the StethoPrep medical team.