Management Challenges Encountered in a Borderline Personality Disorder with Multiple Somatic Diagnosis: A Case Report
DOI:
https://doi.org/10.5195/ijms.2025.4086Keywords:
personality disorder, Liver Transplantation, Suicide Attempt, Comorbidity, antidepressantAbstract
Background: Borderline personality disorder (BPD) is a complex psychiatric condition characterized by pervasive instability in affect regulation, impulse control, interpersonal relationships, and self-image. Patients often present with comorbidities such as mood disorders, substance use, or somatic illnesses, which complicate diagnosis and treatment.
The Case: We present the case of a 26-year-old female with a history of major depression, known with borderline personality disorder, and multiple prior suicide attempts. The aim of this case report is to underline the therapeutic challenges in managing severe psychiatric illness in the context of complex somatic comorbidities. Psychiatric evaluation of the patient revealed depressive symptomatology with anhedonia, suicidal ideation, fatigability and social withdrawal. Somatically, the patient had a recent diagnosis of Child-Pugh A liver cirrhosis, ulcerative colitis, and primary sclerosing cholangitis, requiring careful therapeutic adjustments. The extent of hepatic damage suggested the potential need for future liver transplantation. Pharmacological management included antidepressants, antipsychotics, and benzodiazepines.
Conclusion: This case underscores the ethical and clinical challenges of considering liver transplantation in a patient with a personality disorder. Although prior suicide attempts complicate prognostic assessment, the patient remained adherent to both pharmacological treatment and medical rehabilitation, underscoring that psychiatric illness alone should not preclude access to life-saving interventions, which must be considered through individualized, multidisciplinary evaluation.
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Copyright (c) 2025 Alexandra Zirbo, Maria Palfi, Cristina Maria Simian, Bianca Crecan-Suciu
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