Borderline Personality Disorder, A Psychological Illness OR Hyperandrogenic Disorder A Wider Insight into The Etiopathology, A Case Report
Introduction
Borderline personality disorder (BPD) is a chronic debilitating mental illness characterized by unstable interpersonal relationships, emotion dysregulation, marked impulsivity, recurrent non-suicidal self-injury (NSSI) and chronic suicidal behaviour. Psychotherapy is the cornerstone for BPD treatment. Nevertheless, approximately half of the BPD patients do not respond to psychotherapy.
Methods
This report describes a 29-year-old female patient diagnosed with posttraumatic stress disorder (PTSD) and chronic BPD with comorbid depression. Although PTSD was partially treated with psychotherapy, BPD core features remained active. Given the chronicity and severity of her illness, the patient had been reassessed to explore the presence of other potentially treatable etiologic factors. Reassessment included a clinical interview, blood tests, vital signs, anthropometric characteristics, and screening and monitoring tools to assess and quantify the severity of borderline core features and the presence of comorbidities. Due to the presence of masculine hair distribution, hirsutism was assessed by Ferriman-Gallwey Scale. The patient has been treated with a combination of spironolactone and metformin. The effect and side effects of treatment were monitored during a 10-week follow-up period.
Results: Reassessment revealed active BPD core features with significant impulsiveness, moderate degree of anxiety and depression, and moderate to severe hirsutism on a background of hyperandrogenism. Four weeks post-treatment the patient achieved complete remission in all BPD core features including suicidal thoughts and self-harm behaviour. Besides, partial improvement in hirsutism was reported by the patient.
Conclusion: This case report demonstrates a state of hyperandrogenism as an underlying aetiologic factor for BPD core features in a young adult female. Treatment of hormonal dysregulation was associated with complete remission in all BPD core features and BPD comorbidities, anxiety and depression. This case report suggests the need for a wider holistic approach in the management of mental health disorders than that commonly adopted in current practice
Key words: Borderline personality disorder, Hyperandrogenism, Antiandrogens Treatment
