Tuesday, September 11, 2012

February 12, 1982: diagnosis and dynamic considerations

Psychiatric diagnosis:

Access 1 - Conduct disorder a typical  with depression
Access 2 - Borderline personality traits
Access 3 - None
Access 4 - Severe
Access 5 - Fair

Dynamic considerations:

This young girl shows many classic signs of the abused child and the neglected child.  Her superego is quite severe and her world is split into good and bad.  She also has suffered multiple traumas which include abandonment, physical abuse, and sexual overstimulation (by history).  She describes her feeling at home as being one of constant tension and not knowing whether she is being good or bad.  She does not have enough internal reality testing in her superego to internally know whether she is good or bad.  She seems to be in constant fear that her anger will overwhelm her and cause her to be abused.  I would suspect that she feels the reason she was abandoned early by her mother is she was bad.  It seems that her early dependency needs were not met at least by her father and probably also not by her mother.  She probably is in great conflict when she gets in close proximity to something she wants.  Since as an infant when she had basic needs she was simply locked in a room and cried herself to sleep.  I would suggest that she has a tremendous amount of unconscious and preconscious rage which is directed mostly at herself during this interview and probably episodically at the environment.

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