Case Study
Patient Demographic: Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Agency Type of Counseling: Outpatient Presenting Problem: Recent Hospital Discharge Diagnosis: Borderline Personality Disorder (BPD) 301.83 (F60.3)
Mental Status Exam: Mental Status Exam: The client is wearing a low-cut blouse and short shorts. Her affect and mood are labile, and her speech is pressured. She is fidgety at times and sits with her arms crossed. The client states that she has had three previous suicide attempts and has been cutting since her late twenties. Her last suicide attempt was an overdose, which resulted in her recent hospitalization. She stated that this was the result of her last boyfriend “ghosting” her. The client denies audiovisual hallucinations but states that she often feels that others are conspiring against her. She says that she continues to have suicidal thoughts but denies having a current plan. Fam
Presenting Problem: You are a mental health counselor in an outpatient setting. Your client is a 30-year-old white female who was released from the hospital 48 hours ago. The client presents today for a postdischarge follow-up appointment. The hospital clinician diagnosed the client with borderline personality disorder(BPD) and substance use disorder. The client has a history of suicidality, impulsivity, and relational instability. She explains that she has a “quick temper,” which occurs when she is feeling rejected. She explains that she has a long history of being treated poorly by others, including her last boyfriend, former employers, and family members. During these times, the client admits to substance misuse and self-mutilation (i.e., cutting). She states that there are times when she drinks to black out and that she is more inclined to do so when her feelings become intolerable. The client has had multiple hospital admissions and has been in the care of several counselors. She questions your credentials and your ability to “work with someone like (her).”
Other Contexts:   You are a mental health counselor in an outpatient setting. Your client is a 30-year-old white female who was released from the hospital 48 hours ago. The client presents today for a postdischarge follow-up appointment. The hospital clinician diagnosed the client with borderline personality disorder(BPD) and substance use disorder. The client has a history of suicidality, impulsivity, and relational instability. She explains that she has a “quick temper,” which occurs when she is feeling rejected. She explains that she has a long history of being treated poorly by others, including her last boyfriend, former employers, and family members. During these times, the client admits to substance misuse and self-mutilation (i\. e., cutting). She states that there are times when she drinks to black out and that she is more inclined to do so when her feelings become intolerable. The client has had multiple hospital admissions and has been in the care of several counselors. She questions your credentials and your ability to “work with someone like (her).” ily and Work History: The client attended 3 years of college and reports dropping out due to “depression, anxiety, and anger issues.” She has worked off and on as a server at several restaurants and says she usually quits after coworkers or employers “reject or betray her.” The client’s mother was a teenager when the client was born. Her mother is diagnosed with bipolar disorder, which first appeared after childbirth. She reports moving back and forth between caretakers when she was younger. Her maternal grandmother eventually became her legal guardian and died when the client was in her early twenties. The client reports that she constantly fears abandonment and has “never been successful in a relationship.” She has limited contact with her mother, and the identity of her father is unknown

Question: Which one of the following is more indicative of suicidal self-injury than nonsuicidal self-injury (NSSI)?
(A): A desire to cause harm, to feel better, or to end distressing feelings permanently
(B): A persistent urge to cause harm that is often difficult to resist
(C): Difficulty coping with negative emotions and poor self-worth immediately before the injurious act
(D): The constant need to regulate persistent emotional pain and self-critical thoughts

Correct Answer: A desire to cause harm, to feel better, or to end distressing feelings permanently
Explanation: The desire to cause harm, feel better, or end distressing feelings permanently is more indicative of suicidal self-injury than NSSI. Suicidality differs from NSSI in that there is a desire to permanently end feelings. In contrast, with NSSI, there is a chronic or persistent urge to cause harm to oneself to regulate or detach from distressing emotions. The DSM-5-TR discusses NSSI not as a mental disorder, but as a symptom or consequence that may be confronted when supporting individuals with mental disorders. With NSSI, there is no suicidal intent. Instead, there is the expectation that the self-inflicted damage relieves a negative feeling or cognitive state. NSSI may also include intentional injury associated with feeling distressed, anxious, sad, or tense. Feelings immediately before the act may also be coupled with self-criticism. Finally, NSSI is associated with the persistent urge to cause harm that is often difficult to resist. Therefore, the correct answer is (C)
Competency: intake, assessment, and diagnosis