October 1, 2019
Psychiatrists are often wary to assign a diagnosis of borderline personality disorder to a patient due to the stigma that will often follow them for the rest of their lives and influence the medical treatment they receive, said Dr. Marisa Giggie. She led the latest installment in the College of Community Health Sciences Grand Rounds lecture series.
Giggle, a psychiatrist in the Betty Shirley Clinic at University Medical Center, which is operated by the College, presented a case on a 12-year-old female patient at the Brewer Porch Children’s Center, which is operated by the College of Arts and Sciences.
Brewer Porch is a live-in treatment center and school in Tuscaloosa for special needs children. Giggie, also an associate professor of psychiatry and behavioral medicine at CCHS, frequently works with the children there to develop long-term treatment plans for their mental illnesses.
“Maddy” was brought to Brewer Porch for a 16-month stay after her mother admitted her to the hospital 20 times over the course of nine years for suicide attempts. Maddy had no physical illness except a body mass index that was classified as Class 1 obese. Giggie’s treatment plan included group therapy, behavior modifications, individual therapy and a reduction of the number of prescription antipsychotics that were contributing to Maddy’s unhealthy weight.
“What was truly unique in Maddy’s case is there was no evidence of past trauma,” said Giggie. “Often in cases of BPD there is some severe trauma that has led to the detachment of self.”
Prior to the final diagnosis of borderline personality disorder, Maddy showed signs of ADHD, opposition deficit disorder, generalized anxiety disorder and mood disorder not otherwise specified. Giggie said she wanted to avoid labeling Maddy as BPD until all other options had been exhausted.
Maddy showed little signs of improvement and continued to have obsessive tendencies, severe insomnia and was exhibiting inappropriate sexual behavior.
After her diagnosis with BPD, Maddy was discharged to a specialized facility in Atlanta. Giggie reiterated the need to follow the best treatment plan for the patient, including recognizing when another facility should be contacted.
The CCHS Grand Rounds series, which provides Continuing Medical Education for physicians and other health professionals, is designed to help medical professionals and learners look at past cases and learn from the investigative process. In this case, Giggie expanded the gathered medical professionals’ expertise on BPD and how to treat patients who have been diagnosed with the serious mental illness.
