Persistence of impulsivity in an adolescent with Borderline Personality Disorder

Adolescence is a period of transition and changes where borderline personality traits can influence the manifestations of a depressive illness. Adolescents may present dysphoric features and extreme sensitivity to rejection, which can sometimes culminate in self-harm. The thoughtless and explosive behaviors are a group of impulsive acts whose purpose is to choose immediate and short responses as well as to select the most likely options regardless they are less rewarding, which represents a high risk for suicide. The pathogenesis of Borderline Personality Disorder (BPD) involves interactions between genetic, biological and environmental factors, resulting in fluctuations in mood, impulsivity, and cognitive dysfunctions. This is the case of an adolescent with major depressive disorder and BPD after numerous unsuccessful therapeutic regimens, including Selective Serotonin Reuptake Inhibitors (SSRIs), antipsychotics, and mood stabilizers, achieves improvement after medication with amitriptyline, a tricyclic antidepressant. There is no specific drug for treatment. The multidimensional nature of the factors involved makes drug management complex. Psychotherapeutic treatment is essential to modulate some target symptoms.