Isabella is a 23 year old veterinary assistant. She reports that her mother has recently become pregnant, which upset her and led her to drink heavily. Her drinking led to a series of "one-night-stands". Isabella says she's been "feeling panicky" and is having experiences in which she felt removed from her body and in a trance. Recently, in response to hearing a voice in her head telling her to jump off a bridge, she asked her supervisor for help. At that time the supervisor noticed scars on Isabella that appeared to be from a recent wrist slashing, so she quickly referred Isabella for hospitalization and evaluation.

During her intake interview, Isabella was cooperative and coherent, but also quite frightened. She did not feel hospitalization was needed, but welcomed the prospect of relief from her anxiety and sense of depersonalization. She acknowledged that she had feelings of loneliness and inadequacy and brief periods of anxiety and depressed mood since adolescence. Recently she had been having fantasies that she was stabbing herself or a little baby with a knife, and felt she was "just an empty shell that is transparent to everyone"

Isabella's parents divorced when she was three and she lived with her mother, who had a serious drinking problem. Isabella had frequent night terror episodes as a child, and often ended up sleeping with her mother. When she was eight, her maternal grandmother passed away, and she recalls trying to hide her grief about the

loss from her mother. When she was nine years old, her mother was diagnosed with schizophrenia. She spent most of the next two years living with various relatives, including a period with her father, whom she had not seen since the divorce.

Isabella's school record was consistently good, and she dated regularly. She reports having an active but rarely pleasurable sex life. Her relationships with men have typically ended abruptly after she becomes angry with them when they disappoint her. She then concludes "they were no good to begin with." She has had several roommates, but has difficulty maintaining a stable living situation because of her jealousy about sharing her roommates with friends and her manipulative efforts to keep them from socializing with other people.

What is the diagnosis and treatment?