16 Copyright © SLACK Incorporated case challenge A 34-Year-Old Woman with Intentional Ingestion of a Foreign Object Qammar Jabbar, MBBS; Iqra Ansari, MBBS; Kim-Lan Czelusta, MD; Aliza Sharoon; and Ali Shah A 34-year-old woman pre- sented to the emergency department (ED) for the seventh time in 2 months after swal- lowing an eight-pack of triple A batteries. Five of her six prior ED visits were due to ingestion of a va- riety of batteries, whereas an over- dose of acetominophen (eight 350- mg tablets) was the chief complaint of her ED visit immediately prior to her current ED presentation. Immediately after ingesting the batteries the patient texted her hus- band, who then called emergency services. After arriving at the ED by ambulance, the patient expressed concern that her new husband of 6 months no longer loved her due to her escalating weight, which was now more than 400 pounds. The patient also shared feelings of missing her mother, with whom she had lived prior to her current (sec- ond) husband. The patient reported having mixed emotions about her recent marriage, including excite- ment leading up to the wedding combined with stress about leav- ing her mother’s home. Over time, the patient began to experience her new husband as dull and boring. When asked about prior relation- ships, the patient reported she had been married once before to a kind man whom she missed, similar to the feelings she had about missing her mother. The patient noted a pattern of difficulty staying in relationships for long periods and expressed in- termittent feelings of emptiness. She described multiple, brief stints of employment due to constantly changing career goals, which was a source of tension in her current and prior relationships. After an over- night stay in the ED, the patient reported feeling significantly better and was discharged home. Borderline Personality Disorder DIAGNOSIS The patient’s instability in long- term relationships, recurrent at- tempts at suicide, irritability, fear of abandonment, and feeling of emptiness all provided clues to the diagnosis of borderline personality disorder. DISCUSSION Patients with borderline per- sonality disorder (BPD) often have chronic suicidality that may not be improved with hospitalization. In fact, hospitalization after repeated suicide attempts can have negative effects in BPD patients. 1 Dialectal behavior therapy and pharmaco- therapy with selective serotonin reuptake inhibitors 2 are common treatment recommendations. Patients with BPD often present with a history of unstable interper- sonal relationships combined with affective and behavioral impulsivity that result in impairment. Affective instability with BPD often mim- ics mood swings seen with bipolar disorder. Because many clinicians are reluctant to make a personality Qammar Jabbar, MBBS, is a Gradu- ate, Jinnah Sindh Medical Univer- sity. Iqra Ansari, MBBS, is a Graduate, Jinnah Sindh Medical University. Kim- Lan Czelusta, MD, is an Assistant Profes- sor, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine. Aliza Sharoon is an Under- graduate Student, C.T. Bauer College of Business, University of Houston. Ali Shah is an Undergraduate Student, College of Natural Science, University of Houston. Address correspondence to Qammar Jabbar, MBBS, 780 Pifer Road, Houston, TX 77024; email: qamar.jbr@hotmail. com. Disclosure: The authors have no rel- evant financial relationships to disclose. doi:10.3928/00485713-20171130-01