Integrative multi-framework assessment of borderline personality disorder in a late-adolescent male: a case report
DOI:
https://doi.org/10.67440/ahj.vi.3185Keywords:
Adolescent; Borderline personality disorder; Mentalization; Projective techniques; Case reports; Gender identity.Abstract
Objective: To present an integrative, gender-sensitive assessment model for borderline personality disorder in a late-adolescent male, combining categorical diagnosis, psychodynamic defense analysis, mentalization theory, and projective narrative data.
Case description: A 23-year-old man with a clinically confirmed diagnosis of borderline personality disorder, established through the International Personality Disorder Examination, was assessed using a single-case, mixed-methods design. Responses to the Sacks Sentence Completion Test were thematically coded with NVivo 12, with substantial interrater reliability (kappa = 0.85). The dominant themes were parental rejection (28%), identity confusion (22%), interpersonal mistrust (20%), emotional numbing (18%), and resentment toward authority figures (12%). These narratives were cross-mapped with diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision and the International Classification of Diseases, 11th Revision, as well as with primitive defenses—including splitting, projection, dissociation, and denial and mentalization difficulties, including psychic equivalence, epistemic mistrust, teleological thinking, and reduced reflective functioning.
Comments: The findings illustrate how externalizing presentations in late-adolescent males may obscure borderline personality disorder and contribute to misdiagnosis, particularly as antisocial personality disorder. Integrating projective narratives with diagnostic, psychodynamic, and mentalization-based frameworks can deepen clinical formulation, contextualize symptoms within the patient’s subjective experience, and guide interventions such as mentalization-based therapy, dialectical behavior therapy, and transference-focused psychotherapy. The model offers a replicable approach to gender-sensitive personality assessment during the transition to adulthood.
