Application of a Brief, Personality‐Based Intervention for Borderline Personality Disorder for a Patient With Intersecting Identities: A BPD Compass Case Study

Borderline personality disorder (BPD) is a heterogeneous condition characterized by emotion dysregulation, interpersonal dysfunction, impulsivity, identity disturbance, and elevated rates of co‐occurrence with other mental health conditions. Criterion B of the Alternative Model of Personality Disorders (AMPD) conceptualizes BPD symptoms as manifestations of dimensional personality traits, particularly negative affectivity, antagonism, and disinhibition. BPD Compass (Cognitive‐behavioral Modules for Personality Symptoms) is an 18‐session modular cognitive‐behavioral intervention designed to target these higher‐order personality dimensions and their underlying maintenance mechanisms. This article presents a detailed case study illustrating the application of BPD Compass with a 25‐year‐old bisexual Appalachian woman diagnosed with BPD, persistent depressive disorder, binge eating disorder, and subclinical social anxiety disorder. Treatment integrated values clarification, cognitive flexibility, behavioral skills, and mindfulness strategies tailored to the patient's cultural and identity‐related experiences. Throughout treatment, interventions were personalized to address the impact of Appalachian cultural norms, minority stress related to sexual identity, emotional avoidance, interpersonal mistrust, and impulsive coping behaviors. By posttreatment, the patient demonstrated substantial reductions in BPD symptom severity, with Zanarini Rating Scale scores decreasing from 23 to 6. She no longer met criteria for binge eating disorder or clinically significant social anxiety symptoms and reported meaningful improvements in emotion regulation, interpersonal functioning, and impulse control.