Recurrent postpartum chest pain unmasking undiagnosed borderline personality disorder: a diagnostic case report
Abstract
Recurrent Emergency Department (ED) visits for non-cardiac chest pain are common among postpartum women. When cardiac workups are repeatedly normal, psychiatric etiologies, particularly trauma-related personality disorders, should be considered. Borderline Personality Disorder (BPD) may present with panic-like somatic symptoms during periods of interpersonal stress but is often underrecognized in acute care settings. We report the case of a 29-year-old postpartum woman who presented to the ED five times over two months with episodic chest pain, palpitations, and a fear of dying. Cardiac and medical evaluations were consistently unremarkable. Each episode followed emotionally distressing interactions with her estranged spouse. The clinical pattern did not meet DSM-5 criteria for primary panic disorder. A structured psychiatric evaluation, corroborated by collateral history, resulted in a diagnosis of BPD based on five core DSM-5 criteria: abandonment fears, affective instability, identity disturbance, impulsivity, and unstable relationships. A sixth criterion, past self-injury, was present but excluded from the diagnostic threshold due to its isolated nature. Treatment included restarting sertraline, continuing propranolol for somatic symptoms, and referral for Dialectical Behaviour Therapy (DBT). The patient reported improved emotional regulation and no further ED visits at one-month followup. While longer-term outcomes remain unknown, her early response was promising. This…
How strong is the evidence?
Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
Read the paper
Related studies
- The neurocircuitry of addiction: an overview
- Gender Differences in Human Brain: A Review
- Stratified medicine for mental disorders
- The neurobiology of drug addiction: cross-species insights into the dysfunction and recovery of the prefrontal cortex
- Annual Research Review: DNA methylation as a mediator in the association between risk exposure and child and adolescent psychopathology
- Schizophrenia: The new etiological synthesis
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.