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Borderline Personality Disorder: Case Study

LukeNotes, Summer 2021

Sr. Rita was angry and frustrated after being asked to step down from a third committee in two years. She was informed that she was being removed from the welcoming committee because she was not very friendly or hospitable and might deter potential members from joining the community. Sr. Rita huffed off in disbelief and worked to control her rising anger. She marched to mother superior’s office prepared to plead her case.

How did Sr. Rita get here? Why has she been removed from yet another committee?

Sr. Rita struggles with fear of rejection and abandonment and insecurity about not being good enough. She has a history of impulsivity, aggression, and self-injurious behavior. At age sixteen, after an intense argument with her best friend, Sr. Rita attempted suicide by ingesting a bottle of pills. She briefly engaged in therapy but did not believe there was anything she needed to work on.

Sr. Rita has been in religious life for 22 years. As a child, she did not consider pursuing a religious vocation. In college Sr. Rita joined a Catholic youth group, volunteered at the local monastery, and sought guidance from a family friend in a religious community. Immediately following college, she joined a community in the Midwest and started her religious journey. Sr. Rita is happy with her decision and shows her love for religious life by getting involved, planning activities for the community and neighborhood, and suggesting ways to improve community living.

Initially, Sr. Rita embraced the quiet time for prayer and found the structure and routine helpful. More recently, however, she balks at not being able to coordinate her own schedule and does not always participate in community activities. She does not enjoy sharing a kitchen or car with other sisters and often fails to adhere to established rules. Some community members are afraid of Sr. Rita and shared their concerns with the superior. Sr. Rita seems unaware of her impact on the other sisters and becomes irate when concerns are expressed about her behavior. She was encouraged to utilize additional support and reluctantly agreed to meet with a Saint Luke Institute therapist.

Sr. Rita felt scared, yet relieved, when she received the diagnosis of borderline personality disorder. The diagnosis helped explain years of chaotic behavior. Although therapy was challenging, every day Sr. Rita gained new insight and skills. Most notably, through her work at Saint Luke Institute, Sr. Rita finally opened up about her traumatic upbringing. Sr. Rita lost her father in a car accident when she was eight years old. Her mother battled depression and stopped taking care of Sr. Rita and her siblings. One day Sr. Rita’s mother dropped her siblings and she off at church and never came back to pick them up. Sr. Rita still remembers the feeling and the moment when she realized her mother was not coming back to get them.

Sr. Rita’s traumatic and unstable childhood shaped the way she navigated the world. She was sensitive to any hint of abandonment due to feeling discarded by both of her parents. She existed in a state of hypervigilance as a means of self-protection and shut down her feelings to avoid reliving the terrible experiences from growing up in the foster care system.

With the support of trauma therapy, group counseling, and psychoeducation workshops, Sr. Rita slowly recognized how much pain she carried around and masked all those years. She replaced unhealthy coping skills with mindfulness and distress tolerance skills and identified triggers to create a process for difficult moments. Sr. Rita still struggles with managing expectations and receiving feedback, but continues to work with her therapist to better understand her behavior. Sr. Rita also creates more balance in her life by exercising, setting boundaries, and building time in her schedule for self-care.

As Sr. Rita continues the therapy work and practices therapeutic tools, her style of relating to others will improve, she will respond instead of reacting, and she will have greater control over her thoughts and feelings. Every day Sr. Rita reminds herself that healing is a process and a lifelong journey.

For confidentiality, reasons, names, identifying data, and other details of treatment have been altered.