The current case study highlights the treatment of “Thelma,” a 48-year-old woman of African American and Hispanic descent who was diagnosed with borderline personality disorder (BPD), major depressive disorder, post-traumatic stress disorder, and bulimia. An attachment theory approach was used to elicit core structure change in Thelma's BPD symptoms after traditional modern cognitive approaches proved ineffective. It was hypothesized that treating her Axis II disorder would actually serve to reduce her Axis I symptoms. The attachment approach entailed a shift toward second-order change processes, a shift away from problem-solving approaches, a focus on the quality and intensity of the relationship, and a more relaxed approach to boundary setting in the context of treatment. The approach did appear to reduce many Axis I symptoms including self-mutilation, suicidal ideation, and binging and purging behaviors and appeared to improve her interpersonal functioning.
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