Mary, a 26-year-old unemployed woman was referred for admission to a hospital by her therapist because of intense suicidal preoccupation and urges to mutilate herself with a razor. 

Mary, a 26-year-old unemployed woman was referred for admission to a hospital by her therapist because of intense suicidal preoccupation and urges to mutilate herself with a razor.  Mary was relatively well until her junior year in high school, when she became preoccupied with religion and philosophy, avoided friends, and was filled with doubt about who she was.  Academically she did well, but later, during college, her performance declined.  In college she began to use a variety of drugs, abandoned the religion of her family, and seemed to be searching for a charismatic religious figure with whom to identify.  At times, massive anxiety swept over her and she found it would suddenly vanish if she cut her forearm with a razor blade.

Three years ago she began psychotherapy, and initially rapidly idealized her therapist as being incredibly intuitive and empathic.  Later she became hostile and demanding of him, requiring more and more sessions, sometimes two in one day.  Her life centered on her therapist, by this time to the exclusion of everyone else.  Although her hostility toward her therapist was obvious, she could neither see it nor control it.  Her difficulties with her therapist culminated in many episodes of her forearm cutting and suicidal threats, which led to the referral for admission.

Use the DSM Library to diagnose case study. Answer questions:

1. Identify the disorder.

2. List symptoms which led to this disorder (using what is listed on DSM)

3. Include any differential diagnoses (what it may not be) and why.

4. Include any specific details (culture, age, gender, etc.) that may have played a role in making the diagnosis.

5. Develop a treatment plan that may facilitate help for the individual.

 

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