Medical Challenge Case

Case: Cut to the Quick

S: Sara is a 16 year-old, right-handed, female patient who presents with lacerations to her wrist. She has just received seven stitches for a cut she indicated she received from the edge of a garbage can while taking out the trash. 

O: The cut was about 1.5 inches long and traced a short course along the underside of her right forearm. Another well healed scar was nearby and was about twice as long ending just before the palm crease. When the patient turned her hand over to hide the scar, it revealed her fingernails, green with polish, bitten down to the quick. When asked who her psychiatrist was, she indicated it was Dr. Pong. He had recently died by committing suicide on an overdose of pain killers after checking into a hotel room. Examination of the patient's left forearm revealed a maze of scars that crisscrossed every way. Short thick scars and great long gashes lined with suture marks ran the entire length of her forearm. When asked if she inflicted the cut on herself, the patient looked away, embarrassed and proud. When asked why, she replied "I dunno." She didn't indicate any problems at home but her shoulders began to shake. When asked about her boyfriend, she looked away, tearful and bored. She then stated that "Dr. Pong left me." 

A: What is your diagnosis of this patient?

P: What is your recommended plan of treatment?