Mary has difficulty maintaining relationships because she goes back and forth from being a best friend to hating people in her life quite often. Her romantic relationships are always characterized by incredible loving passion alternating with episodes of horrible fighting, and sometimes she becomes violent. At times Mary becomes so upset that she cuts herself and reports that this makes her feel better emotionally. Mary suffers from _____ personality disorder.

Question

Mary has difficulty maintaining relationships because she goes back and forth from being a best friend to hating people in her life quite often. Her romantic relationships are always characterized by incredible loving passion alternating with episodes of horrible fighting, and sometimes she becomes violent. At times Mary becomes so upset that she cuts herself and reports that this makes her feel better emotionally. Mary suffers from  _____ personality disorder.

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BlackTom AI · Accepted Answer

Question restatement: Mary experiences extreme shifts in her relationships (from best friend to hating people), volatile romantic interactions with intense love and raging fights, occasional violence, and self-harm that she believes improves her emotional state. The task is to evaluate which personality disorder best fits this pattern.

Option 1: 'dependent' — This diagnosis involves an excessive need to be cared for, fear of separation, and submissive or clinging behavior. While dependence can affect relationships, it does not typically include the dramatic oscillations between idealization and devaluation, nor self-harm and overt violence as core features. The hallmark feature here is instability and fear of abandonment rather than a persistent pattern of needing others to survive emotionally.

Option 2: 'narcissistic' — Narcissistic personality disorder centers on grandiosity, a constant need for admiration, lack of empathy, and often entitlement. It does not primarily describe the intense, volatile swings in relationships or self-harm behaviors that are seen in this stem, which are more characteristic of affective instability and fear of abandonment.

Option 3: 'borderline' — This pattern is most consistent with the description. Key features include rapid mood shifts, unstable and intense interpersonal relationships with alternating idealization and devaluation (the 'best friend' to 'hating people' pattern), identity disturbance, impulsivity, possible self-mutilation or self-harm, and episodes that can involve anger or aggression. The combination of emotional instability, self-harm, and tumultuous relationships strongly supports a borderline personality organization rather than other PDs.

Option 4: 'histrionic' — Histrionic personality disorder involves pervasive attention-seeking, excessive emotionality, and a need to be the center of attention. While relationships may be shallow or dramatic, the core issues here (self-harm, extreme fear of abandonment, and violent shifts in closeness) align more closely with borderline features than with histrionic traits.

Summary of distinctions: The presence of dramatic interpersonal instability with rapid shifts between idealization and devaluation, coupled with self-harm and intense emotional responses, is pathognomonic for borderline personality features in contrast to the more consistent dependence, grandiosity, or attention-seeking patterns seen in the other options. This pattern helps differentiate borderline from dependent, narcissistic, and histrionic presentations. The question’s emphasis on alternating passion and fighting, along with self-harm, strengthens the alignment with borderline pathology.

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