To Catch a Borderline

Yesterday I felt terrible, depressed. Today I don’t even know what I feel.

There was a young patient at the hospital today. A girl. 18 years old. Pregnant and depressed. She was brought to the hospital against her will. The resident (senior doctor-in-training) I worked with today interviewed her and to me she seemed pretty normal, nothing stood out other than her depression. After the interview, the resident took me and the other medical student aside and asked us what our impression of the girl was. The other medical student said, without losing a beat: “Borderline.”

I was surprised. So I asked her why she thought that. She said because of the drama surrounding the patient and the pattern of unstable/abusive romantic relationships she’s had. I had only gotten a small whiff of BPD from the girl, but I wasn’t about to go and diagnose her.

I’m still surprised. I guess I’m just a bit skeptic because I’m not about to go around and diagnose everyone I see with a personality disorder. Also, it made me think that what is “normal” to me, is most definitely not “normal” to other people. The resident and the medical student mentioned that there was a lot of drama surrounding the life of this girl, while I just thought it was all normal. Was it because I’m borderline? Or because I’m just blind and couldn’t see the obvious?

Also, many residents have mentioned that patients with personality disorders tend to drain them, and that when you feel that way interviewing a patient you should suspect a personality disorder is to blame. It has all made me think about whether I drain M. I most certainly hope not, but what if I do? What if M has to prepare herself mentally every time she sees me? What if I drain her? It scares me to think that she would think that way of me, because to me that would mean abandonment.

All of this has really left me thinking; about my career, about my future patients…I thought it would take a borderline to know a borderline.

So…how do you catch a Borderline?

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