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I am studying abnormal psychology and have been given this case file and am required to come up with at least three possible diagnosis, then choose the most suitable one.
My initial thoughts on first read were:
Schizoaffective disorder with possible co-diagnosis of OCD and GAD
Bipolar Disorder with co-diagnosis of OCD (i want to rule this out though because she doesn't seem to have any major depressive episodes, she seems more on the manic side)
Borderline personality disorder with possible co-diagnosis of OCD and GAD
Here is the case, I would sincerely appreciate any input you can offer.
Holly is a 28-year-old single European-American woman who is currently a junior in college. Holly has two sisters who are six and seven years older. She remembers trying very hard to please others and was often upset, feeling like "nothing seemed to be good enough" at school or at home. Holly describes her childhood as isolated and neglected, but she was also physically and sexually abused. She still has nightmares about these abusive experiences.
Holly complains of problems in her ability to focus and concentrate. Her thoughts tend to race and it can be difficult to organize and express her ideas. She has problems maintaining close relationships. She says that people get mad at her because they think she is not listening to them. She says that is because her mind wanders or she notices a bird sitting in the window or she thinks she knows what someone is going to say and gets caught up in what she is going to say back. People also tell her that she talks too fast and that they can't understand what she is saying. She says they also get frustrated because she can never "just get to the point" and has trouble sticking to the main point of her story. Either that or she tends to say the first thing that comes into her mind, which embarrasses her friends. People also get mad at her because they say that she interrupts them. Holly also says that it annoys other people when she constantly has something in her hands or nervously jiggles the table or taps her fingers.
Holly reports that her mind frequently wanders or "goes blank" up to several minutes at a time during conversations or when she is reading. The lapses during conversations happen even when she likes the person and is interested in what they have to say. "In long conversations, after a while, my ears just hear noise... the same sort of feeling like my brain is not working properly using the information when I am trying to read."
In conversations, Holly appears to have difficulty organizing her thoughts in words and keeping her ideas in the right order. She reports that she often "loses words" during conversations. She reports that she has detailed picture in her head, but can't access it and then has difficulty "getting out the details." "It seems like one little part will get out, and it's often not the most representative of what I mean or where I am coming from. I know what I mean I just can't seem to get it across to others. I often feel misunderstood."
Holly often has piles of things lying around. Holly constantly lost things and had problems with follow through (e.g. in high school she often stayed up late in order to complete her assignments but failed to turn them in). She says that she still will "bounce around from project to project, doing a little here and a little there without actually getting a project finished." She says she finds it impossible to prioritize, sort through information and locate main ideas or steps. For example, she recently was stumped by the directions provided for applying wax to her car and had to ask for help.
Another time she found herself focusing on an inconsequential task while cleaning house (i.e. sorting through screws) because she had no idea how to finish the 10-15 projects she had begun and abandoned that day. Holly says she is constantly running late, frequently forgets things (e.g. appointments, class assignments, and dates) and loses essential materials (e.g. identification, keys, purse, and books). She has given up on balancing her checkbook and has poor credit due to missed payments.
Holly reports that in school she did not pay attention to subjects she hated, like history and science, where memorization of facts was required. She felt bombarded with stimuli in general and concluded that learning "trivia" was not essential to her life. Currently Holly does not pay attention to current events or watch the news for the same reason. Holly procrastinates and has a hard time getting herself going on a project. She usually is up late writing papers or cramming for tests.
She states that her life has always been chaotic. She says that she is impulsive and restless and frequently becomes bored with activities. She finds that she has so many interests and that causes her to take on too many things during a semester. This results in a crisis midway into the term.
Her friends complain that she cannot sit still long enough to watch a video with them. Holly used to drive too fast, believing that nothing would happen to her. She has had seven traffic tickets and two car accidents. Since graduating from high school, Holly has moved about 30 times and has attended six different colleges. Holly is often distracted by "the silliest things" and often doesn't realize what she has done. For example, she recently asked her roommate why she had left the water running in the shower. Her roommate hadn't even gone into the bathroomHolly had started the water to let it get hot and then forgot about it.
This lack of attention has caused Holly to be concerned with safety issues. As she looks back on her life, Holly realizes that she has put herself in dangerous situations due to her impulsivity and lack of awareness (e.g. riding the subway alone at night). She says that she has difficulty anticipating extreme situations and has problems setting boundaries. She can't figure out what her immediate needs are and tends to lack a connection between her wants, desires, and needs. Holly also is concerned that she doesn't know how to distinguish safe from unsafe people. Holly feels ashamed of the times in which she has been "sexually impulsive."
Holly reports substantial anxiety and obsessiveness. She has extreme difficulty making decisions. Realizing that her impulsive behavior has put her in danger in the past, Holly now mistrusts her judgment and worries about her ability to cope with life. She has difficulty distinguishing between important and unimportant matters and frequently feels overwhelmed. To try and compensate, she tries to take in as much information as she can, which is like a barrage of pieces of information that are not clearly organized. Holly obsessively plays out a range of "what if " scenarios in her mind, but she has no idea how she would cope. Often she feels like she is "losing her mind." She has a lot of anxiety and describes herself as very "nervous." She frequently feels guilty and ashamed of herself.
Holly says that she tends to be very moody. While she can be happy and energetic, she also struggles with constant anxiety and pressure to perform. She "obsesses about everything" and cannot let things go or make decisions. Sometimes she is very hyper and other days she feels like a failure and doesn't want to go to class or take care of her responsibilities. She feels a lot of shame about her difficulties managing her life. It seems like the more she tries the worse it is. Holly says that she has problems with relationships because she tends to annoy others. She says that she has such a wide range of interests and experiences of herself that others don't know what to do with her. People see her in one context (e.g. very serious) and don't know what to make of her when she is at the opposite extreme.
Holly says that she has difficulty sleeping. She wakes up often during the night or she will wake up very early and not be able to get back to sleep. Holly states that she often has difficulty quieting her mind and worries about events of the day. Sometimes she is so caught up in a project that she doesn't notice the time and doesn't sleep much for a few days.
Holly experimented with cocaine and LSD drugs in high school and as an adolescent. Currently she drinks alcohol a few times a week and occasionally smokes marijuana in order to calm her anxiety and restlessness. Holly has 2-3 "big gulp" size caffeinated sodas per day to help her focus.
On her therapist's recommendation, Holly recently took a psychological test called the MMPI-2. Results indicate that she appears to be experiencing anxiety, tension, and concentration difficulties. She can be suspicious of others, worries excessively, and often obsesses and ruminates about what is happening to her and around her. Holly may be tend to be impatient and easily annoyed. She appears to lack confidence in herself and is prone to give up easily because she underestimates her own ability. Holly is likely socially extroverted, outgoing, energetic, and impulsive. External restrictions on her activities may possibly result in agitation and dissatisfaction.
My initial thoughts on first read were:
Schizoaffective disorder with possible co-diagnosis of OCD and GAD
Bipolar Disorder with co-diagnosis of OCD (i want to rule this out though because she doesn't seem to have any major depressive episodes, she seems more on the manic side)
Borderline personality disorder with possible co-diagnosis of OCD and GAD
Here is the case, I would sincerely appreciate any input you can offer.
Holly is a 28-year-old single European-American woman who is currently a junior in college. Holly has two sisters who are six and seven years older. She remembers trying very hard to please others and was often upset, feeling like "nothing seemed to be good enough" at school or at home. Holly describes her childhood as isolated and neglected, but she was also physically and sexually abused. She still has nightmares about these abusive experiences.
Holly complains of problems in her ability to focus and concentrate. Her thoughts tend to race and it can be difficult to organize and express her ideas. She has problems maintaining close relationships. She says that people get mad at her because they think she is not listening to them. She says that is because her mind wanders or she notices a bird sitting in the window or she thinks she knows what someone is going to say and gets caught up in what she is going to say back. People also tell her that she talks too fast and that they can't understand what she is saying. She says they also get frustrated because she can never "just get to the point" and has trouble sticking to the main point of her story. Either that or she tends to say the first thing that comes into her mind, which embarrasses her friends. People also get mad at her because they say that she interrupts them. Holly also says that it annoys other people when she constantly has something in her hands or nervously jiggles the table or taps her fingers.
Holly reports that her mind frequently wanders or "goes blank" up to several minutes at a time during conversations or when she is reading. The lapses during conversations happen even when she likes the person and is interested in what they have to say. "In long conversations, after a while, my ears just hear noise... the same sort of feeling like my brain is not working properly using the information when I am trying to read."
In conversations, Holly appears to have difficulty organizing her thoughts in words and keeping her ideas in the right order. She reports that she often "loses words" during conversations. She reports that she has detailed picture in her head, but can't access it and then has difficulty "getting out the details." "It seems like one little part will get out, and it's often not the most representative of what I mean or where I am coming from. I know what I mean I just can't seem to get it across to others. I often feel misunderstood."
Holly often has piles of things lying around. Holly constantly lost things and had problems with follow through (e.g. in high school she often stayed up late in order to complete her assignments but failed to turn them in). She says that she still will "bounce around from project to project, doing a little here and a little there without actually getting a project finished." She says she finds it impossible to prioritize, sort through information and locate main ideas or steps. For example, she recently was stumped by the directions provided for applying wax to her car and had to ask for help.
Another time she found herself focusing on an inconsequential task while cleaning house (i.e. sorting through screws) because she had no idea how to finish the 10-15 projects she had begun and abandoned that day. Holly says she is constantly running late, frequently forgets things (e.g. appointments, class assignments, and dates) and loses essential materials (e.g. identification, keys, purse, and books). She has given up on balancing her checkbook and has poor credit due to missed payments.
Holly reports that in school she did not pay attention to subjects she hated, like history and science, where memorization of facts was required. She felt bombarded with stimuli in general and concluded that learning "trivia" was not essential to her life. Currently Holly does not pay attention to current events or watch the news for the same reason. Holly procrastinates and has a hard time getting herself going on a project. She usually is up late writing papers or cramming for tests.
She states that her life has always been chaotic. She says that she is impulsive and restless and frequently becomes bored with activities. She finds that she has so many interests and that causes her to take on too many things during a semester. This results in a crisis midway into the term.
Her friends complain that she cannot sit still long enough to watch a video with them. Holly used to drive too fast, believing that nothing would happen to her. She has had seven traffic tickets and two car accidents. Since graduating from high school, Holly has moved about 30 times and has attended six different colleges. Holly is often distracted by "the silliest things" and often doesn't realize what she has done. For example, she recently asked her roommate why she had left the water running in the shower. Her roommate hadn't even gone into the bathroomHolly had started the water to let it get hot and then forgot about it.
This lack of attention has caused Holly to be concerned with safety issues. As she looks back on her life, Holly realizes that she has put herself in dangerous situations due to her impulsivity and lack of awareness (e.g. riding the subway alone at night). She says that she has difficulty anticipating extreme situations and has problems setting boundaries. She can't figure out what her immediate needs are and tends to lack a connection between her wants, desires, and needs. Holly also is concerned that she doesn't know how to distinguish safe from unsafe people. Holly feels ashamed of the times in which she has been "sexually impulsive."
Holly reports substantial anxiety and obsessiveness. She has extreme difficulty making decisions. Realizing that her impulsive behavior has put her in danger in the past, Holly now mistrusts her judgment and worries about her ability to cope with life. She has difficulty distinguishing between important and unimportant matters and frequently feels overwhelmed. To try and compensate, she tries to take in as much information as she can, which is like a barrage of pieces of information that are not clearly organized. Holly obsessively plays out a range of "what if " scenarios in her mind, but she has no idea how she would cope. Often she feels like she is "losing her mind." She has a lot of anxiety and describes herself as very "nervous." She frequently feels guilty and ashamed of herself.
Holly says that she tends to be very moody. While she can be happy and energetic, she also struggles with constant anxiety and pressure to perform. She "obsesses about everything" and cannot let things go or make decisions. Sometimes she is very hyper and other days she feels like a failure and doesn't want to go to class or take care of her responsibilities. She feels a lot of shame about her difficulties managing her life. It seems like the more she tries the worse it is. Holly says that she has problems with relationships because she tends to annoy others. She says that she has such a wide range of interests and experiences of herself that others don't know what to do with her. People see her in one context (e.g. very serious) and don't know what to make of her when she is at the opposite extreme.
Holly says that she has difficulty sleeping. She wakes up often during the night or she will wake up very early and not be able to get back to sleep. Holly states that she often has difficulty quieting her mind and worries about events of the day. Sometimes she is so caught up in a project that she doesn't notice the time and doesn't sleep much for a few days.
Holly experimented with cocaine and LSD drugs in high school and as an adolescent. Currently she drinks alcohol a few times a week and occasionally smokes marijuana in order to calm her anxiety and restlessness. Holly has 2-3 "big gulp" size caffeinated sodas per day to help her focus.
On her therapist's recommendation, Holly recently took a psychological test called the MMPI-2. Results indicate that she appears to be experiencing anxiety, tension, and concentration difficulties. She can be suspicious of others, worries excessively, and often obsesses and ruminates about what is happening to her and around her. Holly may be tend to be impatient and easily annoyed. She appears to lack confidence in herself and is prone to give up easily because she underestimates her own ability. Holly is likely socially extroverted, outgoing, energetic, and impulsive. External restrictions on her activities may possibly result in agitation and dissatisfaction.
