DIFFICULTIES IN DIFFERENTIAL DIAGNOSIS OF BPD (CLINICAL CASE)

Introduction. Borderline personality disorder (BPD) is characterized by instability of interpersonal relationships, self-esteem, and emotions, as well as impulsivity in a wide range of situations that cause significant impairment in functioning and/or subjective distress [1].

BPD is found in 2.7–5.9% of the population, but according to American studies, 30% of the population have symptoms of BPD [2].

Objective: to determine what disorders BPD is most often confused with, to present an illustrative clinical case.

Materials and methods of the study. An analysis of literary sources for the period 2014–2024 was conducted based on the following databases: Russian Science Citation Index (RSCI), PubMed. A clinical case is presented. An analysis of the medical records of patient M. was conducted.

Results of the study. According to a study assessing the ability of psychiatrists to recognize BPD, 83.8% of doctors made an incorrect diagnosis. The largest number of incorrect answers was associated with the erroneous diagnosis of affective (29.7%), hysterical (27%) and antisocial (13.5%) personality disorders. In 5.5% of cases, an organic personality disorder was erroneously diagnosed, in 8.1% - an unspecified one. The doctors' attention was focused on periods of "rise" or "fall" while ignoring the patients' lifestyle, impulsivity and mood reactivity [3].

The diagnosis of BPD is associated with a wide range of symptoms that coincide with other diagnostic categories. In addition, the diagnosis of BPD is associated with extensive comorbidity, which leads to problems in differential diagnosis. Symptoms similar to the psychopathology of BPD may hide various phenomena related to other mental disorders [1].

Differential diagnosis of BPD is most often carried out with the following mental disorders: with hysterical, schizotypal and dependent personality disorders; with depressive and bipolar disorder; with schizophrenia spectrum disorders; with PTSD [2].

To confirm this, we would like to consider a clinical case:

Patient M., 17 years old.

Life history: Born in Stavropol, lives in Novoalexandrovsk. The family is complete, since the age of 3 she remembers episodes of domestic violence from her father towards her mother (beatings). She herself has not been subjected to domestic violence. She is afraid of her father, and when she sees him, her whole body starts shaking.

Since the 1st grade, she has had problems in her group, and was bullied because of her appearance (being overweight). She was doing well at school. Since the 5th grade, the situation has worsened: her classmates beat her, threw various objects at her, insulted her, and because of this, she started skipping school. She never had any friends at school. She began to avoid people around the age of 13.

Currently, she is studying at Moscow State Pedagogical University. She has good relationships with her group. She enjoys drawing and customizing things. She works as a director of an art group.

Medical history: The patient associates the development of the disease with traumatic events in her life (domestic violence, bullying at school). She considers herself ill since the age of 13, when she first developed social phobia and hallucinations: auditory (imperative) and visual. She heard voices that insulted her and called for self-harm. Saw images of people. During attacks, the hallucination notes a change in the state of consciousness, inflicted harm on herself unconsciously.

Periodically, panic attacks occur, notes memory deterioration.

Contacted a psychiatrist at her place of residence at the age of 13-14. Did not tell the doctor about the hallucinations. The diagnosis was: Recurrent depressive disorder. Was treated on an outpatient basis.

At the age of 14-15, the first suicide attempt: cut a vein with a blade. The reason was the lack of desire to live due to many problems. After that, she underwent long-term psychotherapy, without effect. She also received religious "treatment" - the expulsion of the Djinn.

She began to often inflict bodily harm on herself intentionally in order to splash out accumulated feelings. She did not feel physical pain, she felt spiritual relief.

The second suicide attempt after the end of psychotherapy - threw herself under a car.

At the age of 15, there was an episode of anorexia lasting about a month and a half. Over the past year, eating behavior has normalized.

In June 2023, due to deterioration of her condition, she was sent to the SKKSPB No. 1, hospitalized in the acute department with a diagnosis of: Schizotypal disorder. Discharged the next day.

After that, she underwent long-term psychotherapy, without effect.

Hospitalized in the 4th department of the SKKSPB No. 1 in July 2023. Treatment for about a month, with a positive effect.

Six months ago, a third suicide attempt: drug overdose.

After another deterioration of her condition, she was hospitalized on February 29 in the 4th department of the SKKSPB No. 1. Diagnosis: BPD. At the time of examination on March 13, she has no complaints. She notes an improvement in her condition: disappearance of anxiety and aggression, improved memory, normalization of sleep. She does not want to be discharged, she has made friends with other patients.

Mental status: The patient is well oriented in place and time, willingly makes contact. The girl is very bright, impressive, well-groomed. Neatly dressed, with a neat hairdo and make-up. She happily talks about her life and illness. She is in a good mood. She knows exactly who is to blame for her problems. She projects her personal qualities onto others: injustice and aggression. She notes memory impairment. She interacts well and actively with other patients, and has made friends among them. She is not informed about her diagnosis. She is critical of her condition. After discharge, she plans to immerse herself in work.

Conclusion. 1. In this example, we can observe the dynamics of changes in the patient's diagnosis. The diagnosis of "Recurrent depressive disorder" was made on the basis of long-term recurring episodes of depressed mood without manic episodes, decreased academic performance at school, apathy, anhedonia, self-deprecating thoughts, social isolation, as well as the patient's deliberate concealment of hallucinations.

2. The diagnosis of "Schizotypal disorder" was made on the basis of existing hallucinations, increased anxiety, depressive episodes, lack of friends. As well as ignoring such factors as self-harm, frequent suicide attempts, chronic feelings of emptiness, and outbursts of anger.

3. It took almost 4 years to make the diagnosis of "Borderline personality disorder", since differential diagnostics of the disease is extremely difficult. Its symptoms are similar to many other diseases. Therefore, when diagnosing, it is necessary to evaluate the picture of the disease comprehensively. Otherwise, the treatment of incorrect diagnoses will be ineffective and will only worsen the situation.