Borderline Personality Disorder

P.H. is an 18-year-old female with bipolar disorder (diagnosed age 12) and ODD, currently on aripiprazole 15 mg BID with inadequate symptom control per her mother. Prior trials of SSRIs worsened symptoms; quetiapine was also used historically. A recent DFS case involving violence toward her mother was dismissed. Mother declined records release.

Current presentation includes significant acting-out behavior (lying, stealing, impulsivity, violent temper, oppositional conduct) alongside mood symptoms (tearfulness, sadness, worry, poor concentration) and a rapidly progressive manic-like episode with agitation, increased energy, psychomotor agitation, flight of ideas, racing thoughts, decreased sleep, and pressured speech.