| Course | NUR-7642 Advanced Assessment, Differential Diagnosis, and Management of Psychiatric Disorders Adult Population, Part B |
|---|---|
| Module | Module 2 |
| Paper type | Case analysis: borderline personality disorder |
| Length | About 1,090 words, 6 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | M.S. in Nursing, Psychiatric Mental Health Nurse Practitioner |
| Updated | October 2026 |
Free sample paper for NUR 7642 Module 2
Five Medicines and No Diagnosis: Recognizing Borderline Personality Disorder and Choosing a Therapy for a 24-Year-Old Server
Student Name
M.S. in Nursing, Psychiatric Mental Health Nurse Practitioner, Thomas Edison State University
NUR-7642: Advanced Assessment, Differential Diagnosis, and Management of Psychiatric Disorders: Adult Population, Part B
Mentor Name
Month Day, Year
Five Medicines and No Diagnosis: Recognizing Borderline Personality Disorder and Choosing a Therapy for a 24-Year-Old Server
A History in Crises
Brianna, an invented patient, is 24 and waits tables at a boardwalk restaurant in Asbury Park. She was referred after a hospital stay for an overdose of her own pills the night her boyfriend left. She has cut her forearms since age fifteen, usually after a fight or a feeling of being abandoned, and says the cutting "turns the noise off." Her moods shift within hours. She describes a constant emptiness, intense friendships that end in bitter breaks and a fear of being left that leads her to text partners dozens of times a night. She has quit or lost six jobs in four years.
Over those years, emergency and urgent care clinicians have prescribed quetiapine, sertraline, lamotrigine, clonazepam and trazodone, each after a crisis, and she takes some of them some days. She was told once she might have bipolar disorder, but she has never had a week of elevated mood with little need for sleep. She drinks heavily on weekends. Her childhood included a father who drank and left when she was nine.
Her work history shows the pattern from another side. She is good at her job, quick and funny with customers, and managers like her at first. Then a criticism or a schedule change feels like rejection, she walks out mid-shift or stops answering calls, and the job ends. She has no savings and shares an apartment with a friend who has asked her to move out by summer. These pressures will shape what treatment she can attend and when.
The Diagnosis
Brianna meets the criteria for borderline personality disorder: frantic efforts to avoid abandonment, unstable intense relationships, an unstable sense of self, impulsive spending and drinking, recurrent self-harm and suicidal behavior, mood reactivity lasting hours, chronic emptiness, intense anger and brief stress-related dissociation. Her mood shifts last hours and follow events, unlike the sustained episodes of bipolar disorder. The paper explains the diagnosis to her plainly, as a condition with known treatments and a hopeful course, and she says it is the first time her history has made sense.
Safety
Her self-harm and the recent overdose are assessed directly. She has no current plan, cuts about once a week and drinks before most episodes. A safety plan is written with her, naming her warning signs, such as a partner not answering, and what she will do instead. Only a week's supply of any medicine is dispensed at a time for now, and the clonazepam and old pills at home are returned to the pharmacy with her agreement.
Choosing a Therapy
Linehan et al. (2006) randomized 101 women whose borderline personality disorder came with recent suicide attempts or self-injury to twelve months of DBT or twelve months with experienced community therapists nominated as experts, with a further year of follow-up. Over two years, DBT patients attempted suicide roughly half as often as women treated by the experts, needed fewer hospital stays for suicidal thinking, had less medically serious self-harm and were less likely to drop out of treatment. The comparison was demanding, since the community therapists were experienced experts.
McMain et al. (2009) next set twelve months of DBT against general psychiatric management, a structured approach combining case management, psychodynamically informed therapy and medicine management based on practice guidelines, in 180 patients who had harmed themselves at least twice in five years. Self-harm fell sharply in both arms, as did emergency visits, hospital days, borderline symptoms, depression and anger, and no outcome differed between them.
For Brianna, a dialectical behavior therapy program in Monmouth County has an opening. It includes weekly individual therapy, a weekly skills group, phone coaching between sessions and a therapist consultation team. The weekly group works through four DBT skill modules; the one on asking for what she needs and saying no without losing the relationship is the part aimed at her late-night texting and sudden breakups. If the program had a long wait, general psychiatric management would be started at once, since the trial showed it to work as well.
Phone coaching is explained carefully, because it can be misunderstood. It is for help using a skill in the moment, such as before she cuts or sends a stream of texts, not for long conversations. Brianna agrees to a commitment that is part of the program: she will stay in treatment for the year, attend the group even when she does not feel like it and work toward ending self-harm. The therapist's commitment to her is stated as plainly.
| Option | Evidence | Fit for Brianna |
|---|---|---|
| Dialectical behavior therapy | Halved suicide attempts against expert care | Chosen; local program with a group |
| General psychiatric management | Matched DBT in 180 patients | Backup if DBT waitlist is long |
| Medicines alone | Not a primary treatment | Simplify, do not add |
Simplifying the Medicines
No medicine treats borderline personality disorder itself, and practice guidance favors psychotherapy. Brianna's five drugs are reviewed one by one. Clonazepam, which can worsen impulsivity and is dangerous with alcohol, is tapered. Trazodone and quetiapine, both taken for sleep after crises, are tapered over a month with a sleep plan. Lamotrigine, started for a bipolar label that does not fit, is stopped. Sertraline is continued for now because she had some benefit for low mood, and it will be reviewed in three months. She is told that fewer pills mean fewer side effects and less risk in an overdose.
A Hopeful Course
Zanarini et al. (2010) followed 290 inpatients with borderline personality disorder every two years for ten years. Ninety-three percent reached a remission of symptoms lasting at least two years, and 86 percent a remission lasting four years, with recurrences uncommon once remission was sustained. Full recovery, meaning remission plus good work and social functioning, was harder: half reached it, and a third of those later lost it. Brianna is told both parts: most people's symptoms ease substantially, and building steady work and relationships is the longer task, which therapy and vocational support will address.
Conclusion
Brianna has borderline personality disorder, previously mistaken for bipolar disorder and treated with a growing list of crisis prescriptions. Her self-harm risk is managed with a safety plan and limited supplies. Dialectical behavior therapy, supported by a trial against expert therapists, is started, with general psychiatric management ready as an equally supported alternative. Four of her five medicines are tapered or stopped, and a ten-year study gives her a realistic and hopeful view of what lies ahead.
References
Linehan, M. M., Comtois, K. A., Murray, A. M., Brown, M. Z., Gallop, R. J., Heard, H. L., Korslund, K. E., Tutek, D. A., Reynolds, S. K., & Lindenboim, N. (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry, 63(7), 757-766. https://doi.org/10.1001/archpsyc.63.7.757
McMain, S. F., Links, P. S., Gnam, W. H., Guimond, T., Cardish, R. J., Korman, L., & Streiner, D. L. (2009). A randomized trial of dialectical behavior therapy versus general psychiatric management for borderline personality disorder. American Journal of Psychiatry, 166(12), 1365-1374. https://doi.org/10.1176/appi.ajp.2009.09010039
Zanarini, M. C., Frankenburg, F. R., Reich, D. B., & Fitzmaurice, G. (2010). Time to attainment of recovery from borderline personality disorder and stability of recovery: A 10-year prospective follow-up study. American Journal of Psychiatry, 167(6), 663-667. https://doi.org/10.1176/appi.ajp.2009.09081130
NUR 7642 Module 2 instructions, in plain terms
Personality disorders and self-harm fall within the adult psychotherapeutic work that TESU's NUR-7642 course description highlights, and with the syllabus not posted publicly, this module was planned as a borderline personality disorder case. Expect an analysis that confirms the diagnosis criterion by criterion, separates it from bipolar disorder and other conditions, assesses self-harm and suicide risk with a written safety plan, picks a structured therapy on the strength of trials and spells out its components, reviews and simplifies medicines rather than adding more and shares the long-term course honestly. Some sections assign antisocial or avoidant personality disorder, or a patient seen only in a crisis setting. Look for whether the assignment names a therapy, a family section or a discussion of how the diagnosis is shared with the patient, and keep stigma out of the language throughout.
Inside the NUR 7642 Module 2 example
Brianna's history of cutting, her overdose after a breakup and her five crisis prescriptions open the paper. Each criterion she meets is named, and the past bipolar label is reasoned away. A safety plan with limited supplies follows. The dialectical behavior therapy trial against expert therapists and the trial against general psychiatric management are both reported, and a three-row table weighs the options. The local program and its four parts are described, with general psychiatric management ready if needed. Her medicines are reviewed one by one, with four tapered or stopped. The ten-year study of remission and recovery is shared with her in plain terms before the conclusion. Margin notes explain the bipolar differential and why a second therapy is offered.
NUR 7642 Module 2 rubric: what earns full marks
Borderline personality disorder cases are graded on a diagnosis confirmed criterion by criterion and separated from mood disorders, a direct self-harm and suicide assessment with a written safety plan, a structured psychotherapy chosen from trial evidence and described in its parts, a medicine review that simplifies rather than adds, and an honest account of the course. Mentors credit language free of stigma and a diagnosis explained to the patient as treatable. Offering an equally supported therapy when access is limited is often rewarded. Limiting supplies and returning unused pills shows practical safety. Linehan's, McMain's and Zanarini's figures must be quoted exactly, and APA headings should run from Brianna's history through safety and treatment to her ten-year outlook.
Common NUR 7642 Module 2 mistakes, and how to avoid them
Students often add another medicine for each symptom; review the list and explain which drugs can stop. Another gap is calling quick mood shifts bipolar disorder; compare the length and triggers of the shifts. Do not write "refer to DBT" without describing its parts, and have a backup if the program has a waitlist. Ask plainly about cutting and overdose, and let the safety plan sound like her. Avoid stigmatizing language such as "manipulative" or "attention seeking." Share the long-term course honestly, including what is harder to achieve. Brianna's case shows the method; for your own borderline personality paper, a first version written to your brief costs nothing.
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NUR 7642 Module 2 questions, answered
Where can I find a free NUR 7642 Module 2 sample paper?
Brianna's borderline personality disorder case, from five crisis prescriptions to dialectical behavior therapy, is printed in full above.
Does dialectical behavior therapy work for borderline personality disorder?
Linehan's 101-woman trial found half as many suicide attempts with DBT as with expert community therapy, plus fewer admissions and less dropout.
Is DBT better than general psychiatric management?
A trial of 180 patients found both improved self-harm and symptoms substantially, with no differences between them.
Do people recover from borderline personality disorder?
In a ten-year study, 93 percent reached a remission lasting two years, though only half achieved full recovery with good work and social functioning.
Is there a medicine for borderline personality disorder?
No medicine treats the disorder itself; psychotherapy is the main treatment, and medicines are used sparingly for specific symptoms.