Introduction
A year ago, Derek, a twenty-year-old man, is accused of murdering his best friend, Yvonne, who was a woman aged 21 years. He was afterwards certified into a state forensic hospital for evaluation and treatment while his trial is pending. Derek had a history of mental wellness concerns, especially borderline personality disorder, which might have contributed to the murder. Dialectical behavior therapy (DBT) is the best intervention for borderline personality disorder (BPD), which focuses on helping people to regulate their emotions, develop healthier coping skills, and improve their relationships.
Summary of Case Study and Restatement of Diagnosis
The accused has a history of aggression, impulsivity, and poor coping skills. Derek started using drugs and having sex at age thirteen, and his relationship with his parents was tense and strenuous. He was suspended from school often and spent time living with the murder victim, Yvonne. Derek has been in and out of trouble with the law and has a history of mental health issues. His lawyer plans to argue that Derek was in a dissociative state during the murder due to drug abuse.
Six weeks after starting to experience ‘rushes’ of feeling strange, tense, and agitated, he killed Yvonne. The night before the murder, he stayed at a house of one of his friends and drank vodka and did acid. He woke up the following day in a state of panic, with suicidal thoughts and the need to take Yvonne’s car and leave. He remembers picking up a knife and stabbing her in an extreme emotional rage. In the morning, he went to work where he confessed of feeling unwell before returning to Yvonne’s apartment and taking her car. As he drove out of the city, the car developed issues, and he seemed very disordered that he was unable to identify himself when the police stopped him to enquire if he needed assistance. He was detained at that instance and has been unable to clarify the drive behind his actions adequately. He has expressed remorse for what he had done.
According to the DSM-5, people with BPD have a history of impulsivity, poor impulse control, and unstable interactions with others that persist into adulthood. For diagnosis with BPD, a person may engage in risky and imprudent actions in an effort to maintain attachments or get acceptance from others (Sharp & Wall, 2021). These patients may also have trouble regulating their emotions, which can lead to suicidal thoughts, actions, and even attempts.
Self-harm is another dysfunctional coping strategy utilized by many individuals with BPD. The diagnostic criteria that should be met for BPD is: impairments in interpersonal functioning, for instance, empathy and intimacy and self functioning such as identity and self-direction. Derek meets the diagnostic criteria for BPD since in his mental illness, impulsivity, volatility in relationships, and difficulties in regulating emotions are observed. Derek’s impulsivity is observed in his history of stealing, vandalizing property, and lying. He also struggled to maintain close relationships with others, with his frequent temper tantrums and can be very aggressive.
People with BPD often have a history of trauma and may display signs of other mental disorders, such as depression, anxiety, or eating disorders. At thirteen years, Derek had a history of trauma when his grandfather died, this was overwhelming, and it messed him. Later, he began drug use and was suspended from school for infrequent attendance. Additionally, he has a girlfriend who broke up with him and was pretty upset by this. These experiences can be traumatic and lead to mental disorders such as depression, anxiety, or eating disorders. On the other hand, his substance use disorder may be related to his personality disorder. While the vast majority of people who have personality disorders do not break the law, a small minority of them exhibit behavior that is antisocial, socially incorrect, or unlawful (Catalano, 2020). People with BPD often have difficulty controlling their emotions and may turn to drugs or alcohol to self-medicate.
Reviewing the Crime
Based on the information provided from the case study, it seems that Derek was in a dissociative state at the time of the murder due to drug use – vodka and acid. His dissociative state possibly barred his control of actions, and he did not understand what he was doing. As crucial as it is to raise awareness of the issue of BPD, it is important to gain a deeper understanding of the disorder to better prevent its negative effects (Fowler et al., 2018). Derek’s impulsivity and poor coping skills led him to use drugs, which developed into a substance use disorder that led to the murder. Another could be linked to his issues that are associated to mental health history, including his BPD, which made him more likely to act out extremely and violently when feeling stressed or upset. Finally, his mental disorder may have made it difficult for him to understand his actions’ consequences and appreciate the severity of what he had done.
Recommendations for Treatment
The most preferred treatment for BPD due to its effectiveness is psychotherapy, DBT to be specific. DBT is a cognitive-behavioral therapy that focuses on helping people regulate their emotions, develop healthier management skills, and improve their relationships (Storebø et al., 2020). It is more effective than other types of psychotherapy in treating borderline personality disorder. In addition to DBT, medication may also help treat symptoms of borderline personality disorder, such as impulsivity, anxiety, and depression.
Other therapies that may help treat BPD include psychodynamic therapy, mentalization-based therapy, transference-focused psychotherapy, and electroconvulsive therapy (ECT). These therapies focus on helping people to understand and work through their emotions, develop healthier coping skills, and improve their relationships (Storebø et al., 2020). ECT is a type of treatment that uses electrical pulses to stimulate the brain; it can be helpful by reducing symptoms such as impulsivity and aggression. In other cases, hospitalization may be necessary for people with BPD who are a danger to themselves or others, as in this case.
Since Derek had his BPD associated with a substance-related disorder, it had to be treated as well. Substance-related and addictive disorders can be treated with various methods, including individual and group therapy and 12-step programs (Storebø et al., 2020). Individual and group therapy can help people with substance-related and addictive disorders to identify and change the behaviors that led to their addiction. 12-step programs, such as Alcoholics Anonymous within the community, can provide support and accountability as Derek recovers from addiction.
Conclusion
Derek killed Yvonne while in a dissociative state due to drug abuse. His impulsivity, poor coping skills, and history of mental health issues made him more likely to act out extremely and violently when feeling stressed or upset. Derek had a BPD as the primary illness and a substance abuse disorder that developed from the borderline disorder. Treatment for BPD can be done using effective psychotherapy, specifically DBT. In addition to DBT, medication may also help treat symptoms of borderline personality disorder. Other therapies that may help treat personality disorder include psychodynamic therapy, mentalization-based therapy, transference-focused psychotherapy, and ECT. Since Derek had a substance-related disorder, it had to be treated. Substance-related and addictive disorders can be treated with various methods, including individual and group therapy and 12-step programs.
References
Catalano, G. (2019). Community practitioners supporting young men with borderline intellectual functioning in the criminal justice system: Capability for voice and agency. Research and Practice in Intellectual and Developmental Disabilities, 7(1), 39-48. Web.
Fowler, J. C., Madan, A., Allen, J. G., Patriquin, M., Sharp, C., Oldham, J. M., & Frueh, B. C. (2018). Clinical utility of the DSM-5 alternative model for borderline personality disorder: Differential diagnostic accuracy of the BFI, SCID-II-PQ, and PID-5. Comprehensive Psychiatry, 80, 97-103. Web.
Sharp, C., & Wall, K. (2021). DSM-5 level of personality functioning: Refocusing personality disorder on what it means to be human. Annual Review of Clinical Psychology, 17, 313-337. Web.
Storebø, O. J., Stoffers-Winterling, J. M., Völlm, B. A., Kongerslev, M. T., Mattivi, J. T., Jørgensen, M. S., Faltinsen, E., Todorovac, A., Sales, C. P., Callesen, H. E., Lieb, K., & Simonsen, E. (2020). Psychological therapies for people with borderline personality disorder. Cochrane Database of Systematic Reviews, 5. Web.