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No. 1 (2025)

CASE REPORTS

Clinical Case: Depressive Disorder and Undiagnosed Comorbid Borderline Personality Disorder

https://doi.org/10.48612/psyph/2n75-f9fa-ur2h

Published 2025-03-30

  • T.I. Prusova
    • ,
  • A.V. Vasileva
    • ,
  • T.A. Karavaeva

T.I. Prusova
V.M. Bekhterev National Research Medical Center for Psychiatry and Neurology of the Ministry of Heath of the Russian Federation

A.V. Vasileva
V.M. Bekhterev National Research Medical Center for Psychiatry and Neurology of the Ministry of Heath of the Russian Federation; Saint Petersburg State University

T.A. Karavaeva
V.M. Bekhterev National Research Medical Center for Psychiatry and Neurology of the Ministry of Heath of the Russian Federation; Saint Petersburg State Pediatric Medical University; National Medical Research Center of Oncology Named after N.N. Petrov; I.I. Mechnikov North-Western Medical State University

Abstract

The problem of diagnosis and treatment of patients with comorbid mental disorders has remained relevant for many years. Routine practice challenges medical professionals, even psychotherapists, who tend to limit their consultations to a symptomatic assessment of patients’ condition. This approach may be appropriate for the identification of affective disorders, but leads to an underestimation of the coexisting personality pathology as symptoms of a personality disorder are rarely presented among patients’ complaints. Moreover, borderline personality disorder (BPD) may be a common diagnosis worldwide, but lack of close alternatives from the traditional Russian psychiatric school contributes to the complexity of BPD recognition in our country. Data indicate a high comorbidity of anxiety and depressive disorders with BPD, and depressive episodes in this group of patients may occur without any typical trigger situations for personality disorder decompensation. The development of appropriate psychotherapeutic tactics becomes the crucial step in the BPD management because of the absence of etiological and pathogenetic pharmacological treatment for this disorder. In this clinical case, a 24-year-old female patient, who had previously undergone combined psychotherapeutic and pharmacological treatment for the depressive episode, sought help again in the situation of emotional distress after 2 months of remission. BPD symptoms were detected for the first time only during second admission and subsequently her condition was re-evaluated. She was then admitted to a psychiatric facility, where she received olanzapine at a dosage of 10 mg per day and started dialectical behavioral therapy (DBT) skills training. She continued to attend training after discharge, and individual DBT therapy was added to the treatment plan. After six months of follow-up, the patient’s condition significantly improved. This clinical case demonstrates the importance of defining psychotherapeutic targets, particularly those appropriate to the patient’s psychopathology.

Keywords

clinical case, depressive episode, anxiety, borderline personality disorder, comorbidity, psychotherapy

PDF (Русский)

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