A CASE OF Self-Defeating (Masochistic) Personality
By: THEODORE MILLON
et al.
Notes:
(1) Numbers mark aspects of the case most consistent with DSM
criteria as follow, and
do not necessarily indicate that the
case “meets” diagnostic criteria in this respect.
(2) Patient's name has been changed in respect to
confidentiality, and names mentioned are not of a real existent person.
Case of Theresa
Theresa
entered the therapist’s office with downcast eyes, slumped shoulders, and a blotchy face, as if she
had been crying recently. She had come
at her husband’s suggestion. While arranging the appointment, he mentioned that
she might be depressed, but followed up with a curious statement: “She torments herself . . .
she’s been this way for as long as I’ve known
her . . . she seems to live for it. (1) I
hope you can help her, but even if you do, she’ll
probably find a way to turn it around.” (2) “Don’t let her enjoy herself too much,” he added
sarcastically, “or you might make her suicidal.”
(5)
Theresa
looks younger than her 21 years. Her expression and posture are that of a young
child about to be punished for doing something wrong. Although she could be
quite attractive, this is overshadowed
by her self-effacing mannerisms and takes some time to notice. She begins by apologizing in advance, “I shouldn’t
be taking up your time when you could be helping other people.” She notes further, “Nothing can be done for me, I was meant to
suffer.”
Theresa
is the older of two girls raised by their mother. Her father abandoned the family before they were old
enough to remember him. Her mother was loving,
but so busy working two jobs that the girls saw
her only a few minutes each day. Nevertheless, the family was stable until, as an adolescent, Theresa developed recurrent
infections that required repeated hospitalizations. Because her mother was the sole source of income, the family was usually broke
trying to pay the bills. Now, her mother has no
money saved for retirement, and neither child
has a college fund. Theresa accepts full responsibility and feels unbearably
guilty. “My mom basically worked her life away
trying to keep me healthy,” she says through the tears.
Though
she has worked very hard, things somehow never work out for Theresa. She goes to school, works a
full-time job, and takes care of the house, but
sees herself as incompetent regardless of the effort
put forth. “Everything I touch falls apart.” she says. Her performance at work
is excellent, but she “forgets” to ask for a lighter load during midterms and has to call in sick, angering her
coworkers. (8) Then, her hard-fought grades sag because she
allows herself to be scheduled for overtime
during finals week. (6) Sometimes, she
takes classes that are too hard without the
necessary prerequisites and has to give up and
withdraw, forfeiting her effort completely. (1)
When her husband volunteers to find her a tutor
and do the housework, she refuses, saying she
doesn’t want to burden him with responsibilities that are rightfully hers. (2) Yet, despite her work, she always finds time to send birthday and holiday cards and even
volunteers at church, but complains that no one
follows up on her offers of friendship because
she is always depressed. (8)
If
something does go right, Theresa refuses to celebrate, or else celebrates, but refuses to have a good
time, and works extra hard for the next few weeks. (5)
“Christmas and birthdays are the worst,” her
husband states. “It’s terrible watching her try to get out from under the burden of all the gifts, most of which she returns.
One time I got pissed off, and all I could think
of was telling her she won the lottery.”
DSM-III-R Criteria
A. A pervasive pattern of self-defeating behavior, beginning by early adulthood and present in a variety of contexts. The person may often avoid or undermine pleasurable experiences, be drawn to situations or relationships in which he or she will suffer, and prevent others from helping him or her, as indicated by at least five of the following:(1) chooses people and situations that lead to disappointment, failure, or mistreatment even when better options are clearly available
(2) rejects or renders ineffective the attempts of others to help him or her
(3) following positive personal events (e.g., new achievement), responds with depression, guilt, or a behavior that produces pain (e.g., an accident)
(4) incites angry or rejecting responses from others and then feels hurt, defeated, or humiliated (e.g., makes fun of spouse in public, provoking an angry retort, then feels devastated)
(5) rejects opportunities for pleasure, or is reluctant to acknowledge enjoying himself or herself (despite having adequate social skills and the capacity for pleasure)
(6) fails to accomplish tasks crucial to his or her personal objectives despite demonstrated ability to do so, e.g., helps fellow students write papers, but is unable to write his or her own
(7) is uninterested in or rejects people who consistently treat him or her well, e.g., is unattracted to caring sexual partners
(8) engages in excessive self-sacrifice that is unsolicited by the intended recipients of the sacrifice
B. The behaviors in A do not occur exclusively in response to, or in anticipation of, being physically, sexually, or psychologically abused.
C. The behaviors in A do not occur only when the person is depressed.
References
(1) Personality Disorders in Modern Life, second edition,
2000, 2004 by John Wiley & Sons, Inc.
(2)Diagnostic and Statistical Manual of Mental Disorders, Third
Edition Revised.
Copyright 1987 American Psychiatric Association.
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