Clinical Research Case Report

Abstract

Keywords: Borderline Personality Disorder, Polycystic Ovarian Syndrome, Tourette syndrome

Background: Polycystic Ovarian Syndrome (PCOS) is a complex disorder characterized by infertility, hirsutism, obesity, metabolic syndrome and various menstrual disturbances due to elevated androgen levels. Borderline Personality Disorder patients are also known to have highercomorbid obesity, metabolic syndrome and disturbed androgen metabolism. To our knowledge, only one case control study has found association between Polycystic Ovarian Syndrome and Borderline Personality Disorder. So, there is intense need to report such association to have better understanding of etiopathogenesis of Borderline Personality Disorder. We report a case of Borderline Personality Disorder with a comorbid diagnosis of Polycystic Ovarian Syndrome and Tourette syndrome.

Methods: A 30 year old married female with history of menstrual irregularity at onset of puberty and subsequently diagnosed as PCOS at age 12. Later, she developed simple motor tics at 19 years of age and progressed to multiple motor tics and vocal tic by age of 24 years. She developed a pervasive pattern of instability of interpersonal relationships, self-image distortion, affect dysregulation and marked impulsivity by 22 years of age. She had recurrent gestures, threats, self-mutilating behavior, difficulty in controlling anger and transient anxiety spells. The patient was on regular OCP for PCOD. She was maintained on low dose of Aripiprazole and Fluoxetine for Tics and Anxiety spells. She was evaluated by MCMI3 and found to have higher scores for Borderline Personality Disorder. She responded well to regular behavior therapy. Her socio-occupational functioning markedly improved with the treatment in subsequent follow up.

Results: Elevated androgens in women with polycystic ovaries might have an impact on psychopathology leading to Borderline Personality Disorder. Relevant literature pertaining to association between Borderline Personality Disorder and Polycystic Ovarian Syndrome are reviewed and discussed in the report.

Conclusion: The present case report supports the clinical evidence of association between Borderline Personality Disorder and Polycystic Ovarian Syndrome.