Impact of Munchausen Syndrome by Proxy on the Development of Borderline Personality Disorder: A Care Plan Based on Standardized Languages

Abstract

Borderline personality disorder (BPD) is a complex clinical entity characterized by affective dysregulation, impulsivity, and instability in interpersonal relationships, with an estimated global prevalence of around 5.9%. Scientific evidence identifies childhood trauma as a determinant factor in its etiopathogenesis, highlighting factitious disorder imposed on another (FDIA)—formerly known as Munchausen syndrome by proxy—as a severe form of child abuse. Prolonged exposure to emotional invalidation and iatrogenic trauma interferes with the development of a stable identity and promotes the emotional dysregulation patterns characteristic of BPD. The objective of this article is to describe a nursing care plan for a female patient diagnosed with BPD and a documented childhood history of FDIA, using a structured assessment based on Virginia Henderson's model and a care plan based on NANDA (North American Nursing Diagnosis Association) nursing diagnoses, NOC (Nursing Outcomes Classification), and NIC (Nursing Interventions Classification) taxonomies. We present the case of a 20-year-old woman admitted to a medium-stay unit following a persistent crisis marked by behavioral instability, recurrent self-harm, severe anxiety, insomnia, and relational difficulties. The nursing intervention focused on emotional validation, therapeutic containment without overprotection, and the progressive promotion of autonomy. After six months of hospitalization, the patient showed a favorable outcome, with the cessation of self-harming behaviors, improved sleep, and strengthened social skills. This case highlights the importance of specialized, structured, trauma-informed nursing care in the comprehensive management of BPD associated with complex maltreatment.