Question

A 25 year old female was brought to the casualty after she allegedly attempted suicide, with her wrists slashed. She has a past history of difficulty in maintaining interpersonal relationships and also recurrent mood fluctuation episodes. What is the most likely diagnosis?

• A. Depression
• B. Borderline personality disorder
• C. Histrionic personality
• D. Schizophrenia

Hint:

Long standing unstable relationships plus mood swings plus impulsive self harm such as wrist slashing point to borderline personality disorder, not a single depressive episode.

Answer 1

The Correct Option is B

Step 1: Understanding the Question:
A 25 year old woman has slashed her wrists in a suicide attempt, and her history shows long standing trouble keeping relationships stable along with repeated swings in mood. We need the diagnosis that best fits this long term pattern plus the self harm act.

Step 2: Key Concept:
Borderline personality disorder is a long standing pattern, present since early adulthood, of unstable relationships, an unstable self image, marked impulsivity, recurrent self harm or suicidal behavior such as wrist slashing, and sharp mood swings that can shift within hours to days. It is a personality disorder, meaning it is a fixed way of relating to the world, not a single mood episode.

Step 3: Detailed Explanation:
The wrist slashing is a classic self harm act seen often in borderline personality disorder, used at times to cope with intense emotional pain.
Her past history of difficulty keeping relationships stable is a core marker of borderline personality disorder, where relationships often swing between idealising a person and devaluing them.
The recurrent mood fluctuation episodes fit the affective instability of this disorder, where mood can shift quickly in reaction to stress, rather than staying low for weeks as in a depressive episode.
Depression is a mood episode with sustained low mood, loss of interest, and low energy over at least two weeks; it does not by itself explain a long standing pattern of unstable relationships going back further than the current crisis, so it is a less complete fit than a personality disorder.
Histrionic personality centers on excessive emotionality and attention seeking behavior, often through dramatic or seductive presentation, but it does not carry the same weight of recurrent self harm and identity instability that borderline personality disorder does, so it fits less well here.
Schizophrenia needs psychotic features such as hallucinations, delusions, or disorganised thinking, none of which are mentioned in this history.

Step 4: Final Answer:
A pattern of unstable relationships, recurrent mood swings, and impulsive self harm such as wrist slashing points to borderline personality disorder.