Fundamentals of Psychiatry by Mohr Wanda K. Tasman Allan & Allan Tasman

Author:Mohr, Wanda K., Tasman, Allan & Allan Tasman
Language: eng
Format: epub
Publisher: John Wiley & Sons, Ltd.
Published: 2010-11-29T16:00:00+00:00

Clinical Vignette 2

Ms L, a 21-year-old college sophomore, unexpectedly returned home in the middle of the first semester proclaiming that she could no longer suffer the anxiety and depression she felt at college. Neither she nor her parents felt they had a clear understanding of what was making her feel so distraught. She was doing fine in her classes and was actively involved in a number of college organizations. Her mother called her academic advisor at college for advice, and Ms L was referred to a clinician for consultation and treatment.

Ms L indicated at the initial session that she had been intensely ambivalent about attending college and had in fact delayed enrollment for two years in the hope that she could convince her parents that she would not have to leave home. She indicated that she felt overwhelmingly frightened and tearful away from home. She had been calling her parents three to five times each week, seeking their advice and reassurance but also simply to maintain regular contact. Her level of anxiety decreased substantially when she returned home but quickly emerged at the thought of leaving home again.

Ms L's parents were concerned that she was returning home to be close to a boy that she had once dated. She, however, denied this motivation, indicating that she had long abandoned any hope of a future in that particular relationship. She was a popular young woman, generally considered to be quite amicable, modest, friendly, warm, attractive, bright, and engaging. However, she acknowledged that she often felt very insecure in her relationships, requiring reassurances from her girlfriends and boyfriends that she was not a burden to them, as she in fact grew increasingly burdensome in part from her need for their reassurance. She indicated that she had often fallen in love but had repeatedly felt crushed and devastated when the object of her love failed to become as attached. She said that one boyfriend broke up with her explicitly because he experienced her as being too “needy” and “clinging.” She admitted that this was “not far from the truth” but had pleaded to him that she would no longer be so needy if only he would not leave her.

Ms L described her relationship with parents, particularly her mother, as being very close, supportive, and dependable. Her childhood history, however, included many examples of failures to develop an independent self-confidence. For example, she felt unable to attend a summer camp attended by her best friends because of fears of separation from her parents. She did attend the following summer but taxed the patience of the camp counselors with her demands for attention and support. Her parents verbally encouraged her to develop greater independence and self-confidence but they also would repeatedly give in to her requests for protection and support. Her mother in fact often appeared to be somewhat reluctant to be separate from her.

Ms L was seen in twice-weekly individual psychotherapy. Pharmacotherapy was provided for her anxious and depressive symptoms but was discontinued after 2 months after to complaints of side-effects.

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