Question

Marilyn is a 23-year-old M.B.A. student at the business school of a large Midwestern university. For years she has been frustrated and dissatisfied with her life. She has always done well academically, but lately she has had little interest in doing her schoolwork and little confidence that she can do it well. She describes herself as a person with "big plans," who ultimately won't "cut it." She also fears that she will never be satisfied with life, even if she does succeed. She frequently feels irritable, despondent, and helpless. Marilyn said, "It's as if my entire life has been laid out for me. I don't feel like I have any choice about what I do. Worst of all, I think that it may all be a total waste." Lately her persistent negative cognitions have interfered with her ability to work on her thesis and to fulfill her duties as a teaching assistant. She is easily distracted from her work and usually puts it off until weeks after it is due. She says that sometimes she hesitates because she fears that her adviser will reject the work as substandard (although this has never actually happened), and sometimes she puts it off because she "doesn't really care about it anymore." Marilyn describes herself not only as having problems with academic work but also as having trouble establishing relationships with men. She describes a long-standing habit of picking up men (either at bars or at parties on campus) and quickly pressuring them to have sex with her. Within a week she then 'dumps" them without an explanation, understandably engendering a good deal of hostility. Marilyn describes a recent example. Several weeks ago she met a man in one of her classes and asked him to come over for dinner. They slept together that night, despite his initial hesitancy. Marilyn described their sex as "boring and routine." Two days later they saw a movie. When his reactions to the movie differed from hers, she decided to stop seeing him because he was uninteresting and a relationship with him would be "a pointless waste." Marilyn began drinking heavily during the past year. She usually drinks socially at campus bars and parties, especially when she is trying to pick up someone. She has found that her drinking often makes her pass out after sex or after "cruising" the local bars. She complains that her drinking is also interfering with her academic work by making her tired and easily distractible. Marilyn complained about her problems to a fellow student, who recommended a psychodynamically oriented therapist he knew. At first Marilyn was put off by this suggestion, but she eventually came to the conclusion that it might be a good idea. After an initial interview, the therapist decided that Marilyn should be seen for individual therapy three times a week. Marilyn agreed. PERSONAL HISTORY Marilyn is the oldest of four children. Her father is a dermatologist. Her mother has a bachelor's degree in advertising, but she did not pursue a career after graduation. Both grandfathers died young, leaving both parents to grow up in single-parent homes. Marilyn's overall impression of her parents is that they were generally attentive and supportive, although paradoxically they seemed somewhat neglectful of her true needs. For example, when Marilyn had difficulty learning to read, her parents' response was to push her to try harder. They became frustrated at her slow progress. It was not until after several months that her need for corrective eyeglasses was finally noticed. After medical school, Marilyn's father did his residency in Chicago, where both parents' families were located. However, he had always wanted to live in a rural area, so after his residency the family moved to a small town in Colorado. Marilyn, who had become a vociferous reader after she got her glasses, felt very unpopular in this small town, mostly because education and intelligence were not highly valued. After high school she applied to her father's alma mater but was rejected, partly, she believes, because of her substandard education. She grudgingly settled for the state university, which she felt was far below her intellectual capabilities. Marilyn described her first two years of college as unremarkable. She spent her junior year of college in Europe, where she initiated her pattern of sleeping with men and then quickly breaking up with them. This pattern has persisted for the past three and a half years. When her therapist asked her how she felt about her relationships, Marilyn stated that she felt compelled to sleep with a man for him to really accept her. After a only a week or so, however, she would begin to feel bored and would look for someone new. Upon her graduation Marilyn applied to several M.B.A. programs. She was bitterly disappointed when her first two choices turned her down, and she began worrying about whether she would ever be successful. In particular, she complained about having to miss out on the best schools and the most interesting cities, saying, "In my entire life I could never get anywhere that really mattered." What are the abnormal behaviors worth noting and what diagnosis would be given. What is her diagnosis? Is it a personality disorder?

Answer 1

Some abnormal behavior patterns worth nothing in Marilyn’s case are following:

• Frustration and fear of dissatisfaction with life
• Lack of interest in schoolwork
• Lack of confidence in her abilities
• Feeling irritated and helpless frequently
• Persistent hopelessness and negative thought patterns
• Getting easily distracted and procrastination
• Difficulty establishing stable relationships
• Finding respite in physical satisfaction or sexual activity
• Putting her needs before the needs of others (like men she dates) or taking advantage of others
• Drinking habit to gain attention
• Feeling upset on rejection and on not receiving according to her worth

Diagnosis (Personality disorder or not)

Marilyn is displaying serious issues managing her academic and other work, as well as her relationships. She is also unable to handle her everyday stresses in a healthy way. She has developed unhealthy thought patterns that she can notice in her work problems and relationship issues. From her personal history, it reflects that she felt neglected by her parents and felt lack of attention in most occurrences in her life. As her needs were not fulfilled, she later fulfilled her desires by dominating over men and having sex with them even without their willingness. She visits bars and parties and drinks to gain the attention that she did not get as a child.

Further, frequent rejections or failure at critical times in her academic life made her feel hopeless, incompetent and non-confident about her intellectual ability to make achievements. When she procrastinates, she feels boredom and frustration that add to her negative thought patterns. From all this and Marilyn’s abnormal behavior patterns listed above, it reflects that she is showing symptoms of a personality disorder, which depending on a deeper psychoanalysis, can be diagnosed as either the borderline personality disorder (BPD) or narcissistic personality disorder.

A personality disorder refers to such behavior that involves unhealthy thought patterns displaying over a long period of time. These behavioral or thought patterns are quite inflexible too. Thus, the person faces problems with personal and work life. Even if the person is fed up of his/her behavior, he/she is reluctant to go for help, which he/she ultimately chooses to receive. As personality disorders may vary per the symptoms, it is critical to make the final diagnosis based on a detailed analysis of the person’s personality and behavioral patterns.