A woman has a history of self-mutilation and multiple suicide attempts. What is her most likely diagnosis?

The scenario described aligns closely with Borderline Personality Disorder (BPD). This disorder is characterized by a pervasive pattern of instability in interpersonal relationships, self-image, and affects, as well as marked impulsivity. Individuals with BPD often exhibit self-harming behaviors, such as self-mutilation, as a way to cope with emotional pain or distress. The presence of multiple suicide attempts indicates significant emotional dysregulation and feelings of emptiness or intense fear of abandonment, which are also common in people with this diagnosis.

In contrast, the other disorders mentioned have distinct features that do not typically include self-harm as a prominent symptom. Histrionic personality disorder is characterized by excessive emotionality and attention-seeking behaviors but does not specifically involve self-mutilation. Narcissistic personality disorder focuses on a pervasive pattern of grandiosity, need for admiration, and lack of empathy, which wouldn’t lead to self-harming behaviors as commonly as seen in BPD. Antisocial personality disorder involves a disregard for the rights of others and often includes manipulative or deceitful behavior, but self-harm is not a common feature. Thus, the characteristics of self-mutilation and frequent suicide attempts strongly suggest a diagnosis of Borderline Personality Disorder.