Borderline Personality Disorder Case Study: Healing the Fragmented Self
Patient Information:
Age: 26
Gender: Female
Background: Graphic designer in Thane. No family contact. Short-term romantic relationships predominated, and multiple short-term jobs dominated her work life.
History or Cause:
Sahej Meghani (name changed for confidentiality) is a 26-year-old freelance graphic designer who sought therapy after breaking up with her boyfriend, Simon, which accelerated her emotional crisis. Feeling empty, equating her self-worth with how others perceived her, having dysfunctional swings in emotion, and ever-present ideation about self-harm began an unravelling of her existence that she wanted to halt.
Upon revealing a pattern of impulsivity in therapy — binge drinking or extended periods of no sleep, compulsive spending, and chaotic and unpredictable emotional responses to strangers, friends and any romantic partners — the therapist began to worry for Sahej Meghani's safety. When Sahej Meghani was in a relationship in which she could commit but often felt that her partner was abandoning her, she would often operate in extremes. A delayed text message from a friend or partner could provoke a nearly uncontrollable spiral that took her from despair, through rage, until she eventually landed wherever any of these emotions allowed her to be stable.
Sahej Meghani's history pointed to early emotional instability. No emotional stability can be expected from a childhood with emotional turmoil. Sahej Meghani grew up in a toxic home that included emotional neglect, emotional abandonment and even verbal abuse intermittently. Her father was out of the picture, and any emotional support from her mother was impossible because she was symptomatic of untreated depression. Sahej Meghani was often left to babysit for her younger sister, a scenario where, as a child, she felt her expectations of being a good parent to her dysfunctional family. She was burdened with adult responsibilities at a time when she was not emotionally equipped to accept the tasks and duties of an adult.
Sahej Meghani’s emotional landscape was all or nothing. People were either "good or evil", and relationships were the same; they started with intense closeness, followed by explosive conflict, and rapidly ended in an intense rupture. After a suicide attempt at age 22, she went into the hospital for a couple of weeks for psychiatric care, but she'd never been engaged in ongoing therapy – until now.
Diagnosis:
Sahej Meghani was clinically evaluated by a clinical psychologist over three sessions using formal clinical interviews, behavioural observations, and self-report inventories.
Assessment Tools Used:
- Structural Clinical Interview for DSM-5 Personality Disorders (SCID-5-PD)
- Borderline Evaluation of Severity over Time (BEST)
- Beck Depression Inventory-II (BDI-II)
- Difficulties in Emotion Regulation Scale (DERS)
Results:
- SCID-5-PD: Met at least 6 out of 9 DSM-5 criteria for Borderline Personality Disorder
- BEST: Average score indicated moderate to severe BPD
- BDI-II: Moderate depression
- DERS: High across all subscale levels – particularly impulse control and emotional clarity.
Final Diagnosis:
- Borderline Personality Disorder (DSM-5)
- Comorbid Conditions:
- Moderate Major Depressive Disorder (MDD)
- Subclinical features of PTSD (related to early trauma, not meeting full criteria)
Treatment:
Approach:
Sahej Meghani participated in an intensive outpatient programme for personality disorders. The primary treatment for Sahej Meghani was Dialectical Behaviour Therapy (DBT), a proven evidence-based treatment for borderline personality disorder (BPD), which was designed primarily to treat emotional dysregulation, self-harm, and instability in interpersonal relationships. Sahej Meghani's team included a psychiatrist, a group therapy facilitator, and a DBT skills coach.
Program:
1. Dialectical Behaviour Therapy (DBT) Core Structure:
- Individual Therapy (Weekly): A focus on behavioural chain analysis by tracking Sahej Meghani's emotional dysregulation episodes, identifying triggers to the incidents, and reinforcing adaptive coping strategies.
- Skills Training Group (Weekly, 2 hours): A focus on DBT skills and modules:
1. Mindfulness
2. Distress Tolerance
3. Emotion Regulation
3. Interpersonal Effectiveness
- Phone Coaching (As Needed): Therapist in Mumbai available for immediate coaching during crisis moments
2. Psychiatric Medication Management:
- Starter medication of fluoxetine (Prozac) 20mg was prescribed to address Sahej Meghani's depressive symptoms and emotional lability
- Tapered use of nocturnal low-dose quetiapine (Seroquel 25mg) for rest and to lessen racing thoughts
- Medications were checked every two weeks for side effects and titration of medication
3. Trauma-Informed Approach:
- Although the diagnosis was not primarily trauma-related, sessions incorporated trauma-sensitive mindfulness and a validating therapeutic alliance
- The therapist used non-pathologising language in efforts to strengthen Sahej Meghani's experience as adaptive routing rather than dysfunction.
4. Crisis Planning and Safety Contracts:
- Sahej Meghani signed a non-suicide pact and developed a crisis response plan with emergency contacts, grounding exercises, and a list of coping strategies.
- “Maintained a 'Distress Toolbox' (a collection of items to use during urges-- ice cubes, materials, DBT flashcards)
5. Creative Expression Therapy (Optional):
- Weekly art therapy group to process feelings non-verbally.
- Sahej Meghani started making visual journals that became valuable therapeutic tools in a short period.
Therapy:
DBT in Practice:
- Mindfulness: Sahej Meghani learnt how to observe her states of emotions without making quick evaluations. Her therapist would often say, "You are not your emotions-- you are the observer of your emotions."
- Distress tolerance: Used "TIPP" skills (Temperature, Intense exercise, Paced breathing, Paired muscle relaxation) to cope during emotional crises.
- Emotion Regulation: Started to label her emotions in a more accurate way-- "I feel abandoned" vs "I feel bad." She also started to practise the opposite action when she had urges.
- Interpersonal Effectiveness: She practised skills using scripts like “DEAR MAN” (Describe, Express, Assert, Reinforce, Mindful, Appear Confident, Negotiate) to move through emotionally charged conversations.
Art Therapy:
- Sahej Meghani created a symbolic depiction of her "inner child" as a vulnerable, yet fierce character; this was a significant breakthrough.
- Sahej Meghani also created metaphorical collages to externalise negative beliefs about her self-worth, competence, and control.
Medication Review:
- Sahej Meghani reported less frequent depressive episodes, less frequent.
- By week 6, Sahej Meghani's episodes were described as "waves, not tsunamis".
Improvements/Recovery Timeline:
Week 1-2:
- Started with tracking moods and safety planning.
- Saw some initial resistance to group (DBT) work ("I hate being with other people who have problems"). However, she did practise some basic mindfulness (naming sensations, basic breathing).
Week 3-4:
- Used distress tolerance skills during a phone call that had the potential to trigger anguish.
- Sleeping better, on quetiapine
- Used ice and breathing to manage the first urge to hurt.
Week 5-6:
- Attending all DBT sessions and completing homework without issues.
- Worked on an "emotion map" in therapy to recognise patterns.
- Less interpersonal blow-up – able to pause and send a thoughtful text instead of impulsively confronting.
Week 7-8:
- Reconnection over coffee with estranged sibling, huge accomplishment.
- Reported the first week with no urges to self-harm.
- Recognised sharing DBT strategies with a peer in the group.
Month 3:
- Worked on a vision board with her future self on it (therapy, stability, pet adoption).
- Reduced her medications to a maintenance dose and said at the last consult, we could reduce even further.
- Had engaging/meaningful creative work again and freelanced for a mental health NGO!
Month 4-6:
- Weekly episodes of crisis dropped from three to zero.
- Created a supportive friend circle through the DBT group.
- Maintained healthy romantic boundaries with her new partner—honesty, communication, self-regulation and active participation in the relationship.
- Created a recovery journal to capture the trajectory of her DBT progress and emotional development."
Our Success:
Impact on Sahej Meghani’s Life:
Although Sahej Meghani’s transformation was neither immediate nor linear, it was revolutionary. Through DBT, Sahej Meghani learnt that she didn't have to let her emotions dictate her life. She learnt to ride the waves of her emotions rather than feel like she was drowning in them.
Today, Sahej Meghani has not only significantly lessened her urges to self-harm, but she has also developed a stable sense of identity. She has maintained steady work and some friendships, and although she no longer sabotages relationships, she still sometimes feels fear. While she sometimes still has moments of dysregulation, she is now able to go responsive, not reactive.
She explained, "I used to believe I was broken. Now I believe I am healing – and that is so much stronger than just being perfect."
Family and Community:
Sahej Meghani’s healing became contagious. Her reconnection with her sibling renewed a primordial family connection. Her friends saw a dramatic shift in her emotional presence – less emotional volatility, more emotional vulnerability.
Sahej Meghani now publicly advocates for mental health awareness, specifically in the community of creatives. Sahej Meghani has even begun to mentor younger BPD patients in a local support group, sharing both her educational experience of DBT and emotional presence.
The Final Thought:
This case study of borderline personality disorder (BPD) highlights the pain and confusion often carried by individuals diagnosed with BPD, and the possibility for healing if you have the right tools and support.
BPD is not a character defect. It is a disorder of emotion regulation, and regardless of the challenges we face as human beings, it deserves empathy, not stigma. Sahej Meghani's narrative demonstrates how Dialectical Behaviour Therapy can foster transformation from chaos to clarity, pain to purpose, and fragmentation to integration.
Healing from BPD is not related to diminishing the intensity—it's about learning to wield it. And as for Sahej Meghani? She is now able to paint with all the colours of her emotions—and it is a masterpiece.
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