Mental Health — Personality disorders

A 24-year-old woman presents to the emergency department after cutting her left forearm with a razor following an argument with her partner. This is her third emergency visit in 6 months; she had one impulsive acetaminophen overdose 2 years ago. She describes a long history of intense, unstable relationships, fear of being abandoned, chronic feelings of emptiness, impulsive spending, and childhood physical and sexual abuse. She says she is not trying to die but "cannot handle the feeling" and asks for clonazepam, which she says "calms her down". She has no hallucinations, delusions, or episodes of elevated mood, denies current suicidal intent or plan, and demonstrates capacity. She took sertraline for 3 months last year without benefit and takes no current medications; she has no known allergies. On examination, there are multiple superficial linear lacerations on the left forearm, with no tendon or neurovascular involvement and no active bleeding; old healed scars are present bilaterally.