A 21 year old woman is referred for psychiatric evaluation, following treatment of a self-inflicted cut injury to her left forearm.

She has engaged in deliberate self harm thrice over the last 2 years, each time after the break-up of a romantic relationship.

Her mother says that she has been "difficult to handle" since early adolescence, with little respect for rules. She also has difficulty in keeping friends, and her love affairs have always been short lived and full of conflicts.

Furthermore, she recklessly spends money while shopping, and is often prone to outbursts of anger which end up destroying property.

On questioning, she complains of "feeling empty", and confesses to be nervous about staying alone.

She was diagnosed with moderate major depressive disorder 3 years ago, but defaulted on treatment soon afterwards.

She only drinks socially, does not smoke, and denies drug abuse.