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 Sheila
Sheila called the university counseling center just after
midnight. She spoke softly into the answering machine and seemed
to be fighting back tears.
“Uh, I feel really shitty and I’m mad at everyone I know and I need to talk
with someone who cares or I’m going to kill myself right now and I’m not kidding either!”
Although she left her phone number at her dorm
room, attempts to reach her by the on-call therapist were unsuccessful. According to
her roommate, Sheila was out “making the rounds.” After a second call the
next morning, she agreed
to come in for evaluation. (6)
Sheila arrived 30 minutes late, chewing bubble gum and
dressed scantily
in a shocking black outfit. When her male interviewer paused immediately upon
seeing her, she stated simply, “It symbolizes the way I’m feeling right now. Do
you like it?” A turban covered her hair, and dark stones adorned her fingers,
ears, and neck. The whole getup seemed chosen for its obvious shock
value. (4) An assessment of suicidal
potential was the first objective, but Sheila denied that she was really
serious. “If I was serious,” she quipped dramatically, “I wouldn’t be here, now would I?”
(6) “It’s a good way of getting attention . . . I
don’t like to be ignored . . . always works on the parents. (1)
You’d be surprised what
you can get if you try hard enough.” At that moment, she blew a big bubble, and
then suddenly sucked the air out of it, all without losing eye contact with the
interviewer.
(2)
Sheila reports problems in many areas of life. First, she is
doing poorly
in school and fears she may be thrown out if her grades do not improve. She is already on
academic probation. When asked about her attendance, she admits that she rarely makes
it to classes, because most of
them are in the morning, and her social activities get started after midnight. However, “a lot
of the guys in class
have volunteered to take notes for me.” Second, Sheila and her roommates have had
problems getting along since the beginning of the semester. They object to her
“borrowing” their things, her late nights, and her frequent male visitors, who
often stay overnight
in various states of intoxication. Finally, her boyfriend, whom she regards as extremely
and unreasonably jealous, wants to break up, objecting to her flirtatious behavior, even
though she swears
she has been completely faithful to him over the month they have been together. Sheila
states that she is overwhelmed that “the closest person in the world to me would turn on me all
of a sudden like
that.” And that, she notes, is what prompted her call to the counseling center.
(8)
Although Sheila speaks of her great distress and depression,
her demeanor
belies her words. She is animated and demonstrative, perhaps even slightly
manic. (6) She flits from topic to topic and from emotion to emotion with only
minimal insight and no real transition in between. (5) No follow-up appointment could be made,
because Sheila
is “too busy.” She denies continued feelings of suicidality.
When asked if she wants
to continue next week, she remarks teasingly “I’ll get back to you,” blowing
another bubble and then pressing the gum under her seat on the way out.
(3)
DSM-IV Criteria
A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:(1) is uncomfortable in situations in which he or she is not the center of attention
(2) interaction with others is often characterized by inappropriate sexually seductive or provocative behavior
(3) displays rapidly shifting and shallow expression of emotions
(4) consistently uses physical appearance to draw attention to self
(5) has a style of speech that is excessively impressionistic and lacking in detail
(6) shows self-dramatization, theatricality, and exaggerated expression of emotion
(7) is suggestible, i.e., easily influenced by others or circumstances
(8) considers relationships to be more intimate than they actually are
References
(1) Personality Disorders in Modern Life, second edition,
2000, 2004 by John Wiley & Sons, Inc.
(2)Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition. Copyright
1994 American Psychiatric Association.
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