Melissa Herbert is a 27-year-old Caucasian woman who has been diagnosed with borderline personality disorder. She experienced physical and sexual abuse as a child and has a history of suicidal ideation, attempts, and gestures. Melissa struggles with feelings of abandonment and emptiness that negatively impact her relationships. Her symptoms meet the criteria for borderline personality disorder. Dialectical behavior therapy combined with medication management from a psychiatrist is recommended as it could help Melissa develop emotional regulation skills and stability in interpersonal relationships.

1. Running head: CASE STUDY: MELISSA HERBERT 1
CASE STUDY: MELISSA HERBERT 8
Case Study: Melissa Herbert
Karina Bard
Capella University
HMSV5002
Dr. Betsy McDougall
ABSTRACT
This case study is about a 27- year-old Caucasian female who
suffers from Borderline Personality Disorder. Melissa has been
going through trauma since the age of 5 and continued over the
years. Now as an adult Melissa past continue to affect her
tremendously. Family and friends believes Melissa condition is

2. getting out of hand and they’re ready to get intensive help but
Melissa is not open to it at the time. Due to Melissa condition
there may be some ethical dilemmas that may occur throughout
this process.
Keywords: DBT therapy, Borderline personality disorder,
Substance abuse, physical abuse, sexual abuse.
Background History
Melissa Herbert is a 27-year-old, Caucasian female. Over
the last 18 months, Melissa has been seeing a psychiatrist due to
her suicidal ideation. Melissa has been hospitalized at least 4
times for treatment of suicidal ideation, one suicidal attempt.
Melissa also had numerous of suicidal gestures such as drinking
bleach, anti-freeze and self-inflicting cuts. One of Melissa’s
hospitalization lasted for a duration of 4 months. Melissa’s
family thinks she is too dangerous to seek long-term care out of
the hospital, but Melissa disagrees with the family.
As a child, Melissa was raised by both parents and was the
only child. Both of Melissa’s parents had a history of substance
abuse and depression. At age 5, Melissa’s father sexually
abused her. Not only was Melissa being sexually abuse by her
father, both of Melissa’s parents physically abused her
throughout her childhood. The abuse continued until Melissa
was 15 years old. During the beginning of age 14, Melissa begin

3. abusing alcohol and binging and food restriction. While in
college, Melissa attended a Drug and Alcohol treatment
program where she met a guy who she later married. Despite her
problems, Melissa was able to finish college and complete 2
years of law school. While in her second year of law school,
one of Melissa’s acquaintances committed suicide. This
traumatic event caused Melissa to fall into depression and
decide she wanted to kill herself. Within weeks, Melissa
dropped out of law school and officially became actively
suicidal and hopeless.
Melissa’s suicidal behavior patterns became precipitating.
Melissa’s encounters began with feelings criticized, threaten or
unloved by her husband and family. Depending on how angry
she was at the time, Melissa’s feelings were followed by urges
of self-mutilate or suicidal ideation. Other times, Melissa
expressed emptiness and hopelessness desiring to end her
emotional pain, during this state Melissa was erratic and
unstable. Melissa would also be verbally aggressive towards her
friends and then will do things to try to win them back because
she was afraid they would abandon her. When friends and
family would distance themselves from Melissa because of
aggressiveness, she would make suicidal commits by either to
keep them from leaving her or attempt to beat them in ending
the relationship. Nevertheless, Melissa could not accept her
strengths and weaknesses or identify her place in the world.
Melissa expected her needs to be met but was too unstable to
verbalize them effectively.
Problems and Needs
Melissa has been diagnosis with F60.3 Borderline Personality
disorder. Based on the behavior being displayed, Melissa is
demonstrating the criteria for Borderline Personality Disorder.
Melissa has showed signs of her frantic effort to avoid
abandonment from her parents and fear of abandonment from
her friends (Criterion 1), demonstrate patterns of unstable and
intense relationships such as verbally berating her friends and
then doing something kind to win them back in fear of the

4. leaving her (Criterion 2). Melissa also showed a lack in
identifying her place in the world or accepting her strengths or
weakness as acceptable (Criterion 3) (DSM-5, 2013).
In addition, Melissa performed impulsive behaviors such as
binging, food restriction and abusing alcohol (Criterion 4),
recurrent suicidal behaviors, gestures, threats and self-
mutilating behaviors such as burning her leg and injecting it
with dirt (Criterion 5), Instability due to a marked reactivity of
mood such as her acquaintance committing suicide (Criterion 6)
and chronic feelings of emptiness (Criterion 7). Nevertheless,
Melissa had difficulty controlling her anger such as having
thoughts of “I’ll show you” when feeling threatened or
criticized by her husband or close persons (Criterion 8) (DSM-
5, 2013).
A therapeutic approach for Borderline Personality Disorder is
Dialectical Behavior Therapy (DBT). According to Bedics,
Korslund, Sayrs, & McFarr (2013), Dialectical Behavior
Therapy is a comprehensive and principle-based cognitive–
behavioral intervention initially developed for the treatment of
suicidal behavior and has expanded to treatment of borderline
personality disorder. Dialectical Behavior Therapy consists of
multiple modalities of intervention including individual therapy,
skills training, telephone consultation, team consultation, and
the structuring of ancillary treatments. Majority of a Dialectical
Behavior Therapy sessions is spent in the application of
standard behavioral principles such as a clear problem
assessment and solution generation. During Dialectical
Behavior Therapy, therapists drag out new behavior and seek to
optimize generalization to all relevant contexts in clients’ lives.
During this therapy sessions therapists act with speed and flow
and combine a reciprocal interpersonal style with acceptance,
change, confrontation and irreverence (Bedics, et al., 2013)
Community Problem Analysis
Due to this case being so severe, I recommend Melissa to a
licensed mental health professional or a psychiatrist for
assistance with this case study. A mental health professional

5. such as a psychiatrist will be more experienced in this situation
and have the specific treatment and medication if necessary. In
addition, Melissa can also seek help at the National Institution
for Mental Health (NIMH) which is the lead agency for research
on mental health. The National Institution for Mental Health
mission is to transform the understanding and treatment of
mental illnesses through basic and clinical research, paving the
way for prevention, recovery, and cure (NIMH, 2017). Speaking
to a professional may help Melissa understand and may get her
to look at her mental health diagnosis from a different
perspective. A human service professional knows the roots of
his or her profession and can work in a consultative and mature
manner (Neukrug, 2015).
Ethical Considerations
In this case study there may be several ethical challenges we
may face as a Human Service Professional. As stated in Chapter
3, “Human service professionals hold a commitment to lifelong
learning and continually advance their knowledge and skills to
serve clients more effectively” (Neukrug, 2015). The ethical
challenges we may face as a Human Service Professional are;
informing clients of the purpose of the helping relationship,
keeping information confidential, respecting client self-
determination, breaking confidentiality if the client is
threatening harm to self, and also sharing confidential client
information with your supervisor. These ethical challenges are
many that we may face every day while interacting with clients
and interacting with Melissa is no different.
As Human Service Professionals, confidentiality is major
when it comes to client’s rights and responsibilities. Some of
our clients does not want to disclose their personal information
when it comes to their medical condition or mental health
diagnosis and they have that right, but sometimes at some point,
that need to be broke especially interacting with a client who
may have suicidal ideation. When a client is threatening to him
their self or others, you may have to step in and disclose that

6. information to a family member and your supervisor in order to
take the next step. Even though you want to respect your clients
wishes, sometimes you have to do what’s best for the client in
order to keep them safe and out of harm’s way.
Summary
Melissa Herbert an is a 27-year-old, middle-class
Caucasian woman who experiencing symptoms and signs of
Borderline Personality Disorder. Melissa has recently been
hospitalized and is currently experiencing suicidal ideation,
suicidal attempts, and suicidal gestures. In addition, Melissa has
demonstrated feelings of abandonment, emptiness, and
hopelessness that is affecting her relationship with family and
friends. Nevertheless, Melissa is struggling with remaining
interpersonally stable and identifying her place in the world. I
think Dialectical Behavior Therapy would be effective for
Melissa’s diagnosis along with appropriate prescribed
medication from a psychiatrist. These approaches will have a
significant impact and demonstrate a positive outcome on
Melissa’s mental, emotional and social skills.
References
American Psychiatric Association. (2013). Diagnostic and

7. statistical manual of mental
disorders (5th ed.). Arlington, VA: American Psychiatric
Publishing.
Bedics, J. D., Korslund, K. E., Sayrs, J. H., & McFarr, L. M.
(2013). The observation of essential
clinical strategies during an individual session of dialectical
behavior therapy.
Psychotherapy. 50(3). 454-457.
National Institution of Mental Health (NIMH). Retrieved (April
15 2017) from
https://www.nimh.nih.gov/index.shtml
Neukrug, E. (2017). Theory, practice, and trends in human
services: An introduction(6th ed.). New york: Cengage learning
Verheul, R., Van Den Bosch, L. M., Koeter, M. W., De Ridder,
M. A., Stijnen, T., & Van Den
Brink, W. (2003). Dialectical behavior therapy for women with
borderline personality disorder: 12-month, randomized clinical
trial in the Netherlands. British Journal of Psychiatry. 183, 135-
140.