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Terry is 19-year-old African American college freshman. She presented on emergency at her college's counseling center, reporting that she had recently been feeling extremely depressed due to dating an emotionally abusive boyfriend for the past 6 months. She was extremely tearful and reported that she had been crying frequently for the past week and was sleeping very little. In addition, she reported a history of self-mutilation (cutting her wrists) that had recently begun reoccurring, and acknowledged regular, frequent thoughts of suicide with a plan (to overdose on pills) and intent to harm herself. She was admitted to the behavioral health unit of the local hospital for stabilization, and upon discharge received follow-up treatment through her college's counseling center.

Terry described herself as a generally hard-working and dedicated student, graduating from high school with a 3.7 GPA while also working part-time and being involved in different student organizations. However, she noted that her grades had dropped considerably since coming to college. She reported having a difficult time balancing her school work with other obligations such as work, but also stated that some of her professors are "assholes" who expected too much of students. However, she acknowledged that she had not spoken to any of her professors regarding her struggles, stating that she gets anxious and has a hard time talking to people she doesn't know well.

Terry was the youngest of 2 children (her brother was 26) from divorced parents. She reported that she and her mother left her father approximately 3 years ago after he become physically abusive toward her; she reported that her father also had a history of alcoholism, depression, and long-standing physical and emotional abuse toward her mother. She has had no contact with him since that time. She also reported a generally conflictual relationship with her mother, whom she described as overprotective, highly anxious, and emotionally unstable. She noted that her older brother was estranged from their father and had minimal contact with their mother.

Terry reported a chronic, intense fear of being alone, and often worried that her friends would abandon her. This fear frequently lead her to sacrifice her own needs to make her friends happy and keep them from leaving her. She also viewed her friendships as largely being unsatisfying, describing a frequent pattern of highs and lows in her relationships with friends. For example, she noted that, although she tends to sacrifice her own needs, this leads her to become resentful toward her friends; as a result, she will at times explode into anger outbursts and later end up regretting things she said to them.

She also described her relationship with her boyfriend as generally unsatisfying. She reported that he was often verbally abusive (e.g., frequently belittling her in front of others) toward her, which several of her friends had expressed concerns about. Despite this, she continued to remain with him, although she could not explain why. Terry also reported that prior to dating her boyfriend, she frequently had one-night stands with boys in high school in the hopes that they would be interested in dating her, although she rarely dated any of them for more than a few weeks. Consequently, Terry stated that she often felt depressed and empty.

Upon release from the hospital, she came to her first appointment in great spirits, reporting that everything had dramatically improved within a week's time. During her treatment, she would often present with a positive mood and report that she was not experiencing any difficulties; however, she would also frequently attend her appointments in great distress, often blaming others (e.g., her mother, brother) for her problems and endorsing thoughts of suicide, resulting in several other hospitalizations. In addition, she reported occasionally hearing sounds and music that others did not hear, as well as frequent headaches, tension, and worry. She also tended to idolize her therapist, often expressing worry about her ability to function without him. However, she also tended to become easily upset with her therapist and would frequently skip appointments when angry.

Questions:

1. Which personality disorder does Terry show the most evidence of and why?
2. Identify relevant biological, psychological, and sociocultural factors that have contributed to Terry's disorder.
3. Describe what would be the most effective treatment(s) for Terry's condition.