114

May 12th 1992

 * 1:24 am**

I feel unloved. I feel empty. I feel worthless. I look at myself in the mirror and yell out, “Why do you even exist!” My own reflection disgusts me. Living in this world is a pure torture. It is as if I have been robbed of my identity and soul. I am left, trapped in my own body that is completely useless. I feel //abandoned//. I feel rejected. I feel angry. All this overwhelms me. I can not control myself because I am a stranger to me. I am nothing! so why bother living! The world is just too scary. I feel vulnerable to my surroundings. I have to calm myself down. I get out of bed and grab **a pair of scissors....**


 * 2:13 am**

I feel relaxed. I feel tranquil. There are drops of blood on the floor. Hurting myself is the only way that I can compose myself. I see no other alternative.


 * 3:45 am**

I can not sleep. I am so anxious.

**4:02 am**

My phone beeps and I reach out my feeble arms to grab the cell. My best friend friend, Amy texted me saying that I can’t come over to her house. I scream. I yell. I throw any object that is in my view. She has rejected me. I am a powerless ant, not even worth looking at. My face becomes red from the fury that I feel inside. I hate her. I hate her. I hate her. Get out of my life. I hate her. I hate her. I hate her. I hate her. I hate her. I hate her. I hate her. I hate her. I hate her. I hate her. I hate her. I hate her. I hate her. I hate her. I feel as if I have just shattered into pieces... I am now tiny fragments left on the floor for someone to step on. I am always the victim.


 * 5:43 am**

I am powerless. I am alone. I need drugs.


 * 6:00 am**

I feel empty.... and this feeling of insecurity is the deadly poison in my life.

**Bibliography (APA Format):**

Gershon, J. (2007, May). The Hidden Diagnosis: "Though It Is Considered to Be Two to Three Times More Common Than Bipolar Disorder or Schizophrenia, [Borderline Personality Disorder] Is Far Less Understood and Grossly under Recognized.". //USA Today (Society for the Advancement of Education)//, //135//, 72+. Retrieved January 7, 2010, from Questia database: http://www.questiaschool.com/PM.qst?a=o&d=5021356360

Bower, B. (2007, June 16). Borderline Aid: Psychotherapy Soothes Personality Ailment. //Science News//, //171//, 374. Retrieved January 7, 2010, from Questia database: http://www.questiaschool.com/PM.qst?a=o&d=5028572187

[Untitled photograph of a white mask]. Retrieved January 8, 2010, from: http://ecx.images-amazon.com/images/I/21UjPRDwYWL._SL500_AA280_.jpg

[Untitled photograph of scissors]. Retrieved January 8,2010, from: http://www.boston.com/ae/theater_arts/exhibitionist/scissors.png

[Untitled photograph of a rose]. Retrieved January 8,2010, from: http://artfiles.art.com/images/-/Allyson-Ricketts/Dead-Black-Rose-Poster-B12056241.jpeg

=Symptoms: =  - very very low self esteem/self image - feelings of uselessness, is insecure. - feels abandoned, rejected (is dependent on others) - SELF HARM - dramatic mood swings (related to self harm) - possible insomnia (is writing this at 1:30am~6am) - feelings of anxiety (prevent sleep) - misinterpretation of others' motives. assuming that other people do not like them. - violent outbursts depending on mood. ANGRY. - feels victimized by the rejection of others. - is very sensitive to rejection, takes it as a confirmation of her perceived 'low self-worth' - dependence on others, self harm, or drugs. =Diagnosis: = This person seems to have Borderline Personality Disorder. This disorder is characterized by mood instability and poor self image (patient goes from being subdued and depressed to causing self harm to being violent and enraged. Patient also claims to feel empty, unloved, and rejected- evidence of poor self esteem/low sense of self worth). People with this disorder are said to suffer from constant mood swings and bouts of anger (both of which the patient suffers from). Another characteristic of this disorder is that the patient is quick to anger when his/her expectations are not met- the level of anger directed at the friend 'Amy' is not a normal reaction to rejection. The most dangerous part of this disorder is that the person will commonly take their anger out on themselves. The patient in question used scissors to cause self-harm, and it seems will soon turn to drugs to lessen feelings of rejection and anxiety. 

=Treatment:= My suggested treatment for this patient would be to begin psychotherapy (professional counseling) immediately. I think that it is crucial to begin by preventing any more suicidal/self destructive behavior- before moving on to deal with the more complicated issues associated with the patient's lack of self esteem or feelings of being powerless and victimized.

I would initially suggest 'dialectical behavior therapy'- a form of counseling for people who are unable to moderate their emotions (such as those with BPD). This type of therapy focuses on preventing/reducing destructive behavior (cutting, alcoholism, drug addiction, other methods of self mutilation, etc..) by teaching healthier ways to cope with feelings of anger/frustration/helplessness/victimization/etc.. It is useful in regards to teaching a patient how to prevent themselves from being overwhelmed by negative emotions, interacting with other people without a feeling of inferiority, and tolerating negative emotions without turning to self-harm. 

Other forms of treatment that may prevent the patient from feeling additional stress or anxiety include: getting enough sleep and setting up a regular sleep schedule. eating a balanced diet. getting regular exercise- staying active instead of wallowing in negative emotions. avoiding alcohol or other medicines (legal or otherwise) as they may interfere with treatment and cause lapses in behavior. Building/repairing relationships with family and friends, in order to build a strong support system. Avoiding making major life decisions while irritated or angry.

sources: 1. http://www.webmd.com/hw-popup/dialectical-behavior-therapy 2. http://www.webmd.com/mental-health/tc/borderline-personality-disorder-treatment-overview

=PART IV = = =  The diagnosis and the treatment, which the person suggested are correct and effective. She was able to clearly identify the person's problems and also provided specific kind of treatment such as "Dialectical Behavior Therapy", which is targeted to help clients control their emotions to avoid putting oneself in danger. I agree that the most important issue that the person (who wrote the diary) needs to solve is being able to express their feelings in a healthy and positive way such as exercise (which the person above suggested). If I were to add on to the treatment section, I would also recommend antidepressant drugs or mood stabilizers if the counseling does not seem to work. Another form of psychotherapy that may work is **Transference-focused psychotherapy (TFP).** TFP focuses on the relationship between the patient and the therapist. This helping the therapist understand the emotions and difficulties the patients face in a social relationship. Developing a healthy bond with others is also very important in an individual's life.

Sources: Mayo Foundation for Medical Education and Research. (2009). Borderline Personality Disorder: Treatments and Drugs. Retrieved January 13, 2010, http://www.mayoclinic.com/health/borderline-personality-disorder/DS00442/DSECTION=treatments-and-drugs

