Anglia Ruskin University

Psychopathology

Case Study 3

Word Count: 1450 excluding references

This essay is based on the case study of Kate. Kate is a young female who is
recently single following an unexpected traumatic break-up with her partner. Kate
had a dysfunctional childhood, due to her parents being substance dependant and
divorcing at an early age. Kate’s Mother has bipolar and her Father died of a heart
attack. Based on the information provided, it can be hypothesised that her
psychopathological diagnosis is border line personality disorder, comorbid with
anxiety and depression.

The case study will formulate an understanding of Kate’s underlying

psychopathological disorders following the theoretical models of psychodynamic and
cognitive approaches. The Psychodynamic approach was founded by Sigmund
Freud. Freud has been a huge influence in psychology and is his work is still used
today (Glassman & Hadad, 2013). The Psychodynamic approach findings were
largely based on Freud’s subjective case studies, and provide minimal empirical
evidence and much of the work is queried today for its falsifiability. The contrasting
model is the Cognitive Approach. Cognitive psychology was introduced in the 1960s
by Aaron T. Beck. The underlying principles are based on providing a cohesive
narrative of the patient’s internal world. Evidence and findings are obtained by
objective measures, including questionnaires and formulating models (Beck & Beck,
1995).

The Psychodynamic foundations centre on the notions that a dysfunctional

relationship with parents in early childhood are a determinant for the development of
psychopathologies in adulthood. This can be taken into consideration when reflecting
on the patient’s childhood. It can be assumed that Kate’s parents were distant and
displayed an inconsistent parenting style. When a parent suffers with addictions,
they unable to provide consist attention to children. Kate states: “It was basically a
case of who was most able to look after me at the time”. Showing evidence of an
insecure attachment style.

Self-criticism and dependency are proposed personality dimensions the confer a

vulnerability to developing depression. Research from (Luyten, Sabbe, Blatt, &
Meganck, 2007) investigated diagnostic specificity of these traits, and their
relationship with severity of depression, gender differences and specific symptoms.
They found, self-criticism was strongly related with higher severity of depression,
with medium effect sizes of dependency and larger for self-criticism. “omen showed
higher levels of dependency than men in the depressed group, and dependence and
self-criticism may be effect of depression and not a cause.

Object relations theory (Lubbe, 2010) identifies depression as a pattern of insecure

attachment, set by the foundations established in childhood and progresses into
adult life. A study from (Herbert, McCormak, & Callahan, 2010) investigated the
relationship between attachment of both friends and parents and made comparisons
with symptoms of depression. The results supported perceptions that childhood
attachments and adult peer attachments, are predictive of current depressive
symptoms. Object relation theories speculate depression can arise from fearing the
loss of an important and loved object, adopted in early life, and extends to being
repeated in adult relationships (Kaslow & Magnavita, 2002).

In the understanding of personality disorders, defence mechanisms are a central

aspect to understanding the pathology and development of the ego. Patients
diagnosed with borderline personality disorder use a variety of defence mechanisms,
such as repression. In respect to this case, the patient may have repressed
memories of childhood trauma or of the death of her father.

(Cooper, Perry, & Arnow , 1988) provide empirical evidence on studying defence
mechanisms, evaluating the effect of Rorschach defence scales. They concluded
that the scales can predict aspects of psychological functioning, regarding
interpersonal relationships and tendencies towards self-destructive behaviour, but
are not able to accurately detect specific defines mechanisms. Further research from
(Davidson & MacGregor, 1998) established that individuals with experienced early
traumatic relationships and repressed memories are a factor of greater risk to mental
health disorders.

The psychodynamic theory focuses on internal conflict and explains that

experiencing thoughts of low self-worth and harbouring feelings of guilt, blame and
anger, are a product of ongoing unconscious conflict in the mind. This can manifest
in an individual as symptoms of anxiety. A study from (Shevrin, 2012) focusing on
patients with anxiety disorders aimed to measure unconscious conflicts contributed
towards symptoms of anxiety. Underlying conflicts were inferred by the researcher
and their symptoms measured on a scale. They concluded that those with
unconscious conflict scored greater, than those without, but further research should
be considered as a direct measurement of unconscious conflict is not possible.

In contrast to the psychodynamic approach, the cognitive model considers personal

beliefs and not behaviour, and argues that psychopathology results from patterns of
negative thinking. Behaviour, emotional and occasionally physical symptoms can
occur from abnormal cognitions (Beck & Beck, 1995).
(Beck A. T., 1967) argues that personality disorders assign individuals to behave in
dysfunctional ways because of negative internal beliefs. Core beliefs are
assumptions held about the world, other people are ourselves. When the individual’s
belief system is distorted are biased, this causes situations to be misinterpreted.
Dysfunctional behaviour can result in provoking reactions from the outside world
which are consistent with the internal beliefs, and strengthening the initial incorrect
belief.
(Beck A. T., 1967) theory of depression argues that people who negatively appraise
events are prone to depression. The underlying mechanisms contributing to
depression are: a cognitive triad of automatic negative thinking, including thoughts
about the self, the world and the future. In respect to the current case, Kate
experiences thoughts of “not being able to move forward” and feels “she has nothing
to offer”. Examples of these negative thinking patterns arise naturally and
automatically.
Negative schemas are personal expectations and can be beliefs that are negative
and pessimistic in nature. (Beck A. T., 1967) argues these schemas are acquired in
early life following from a traumatic event. Traumatic events are defined as death or
a loved one, dysfunctional parenting or relationships and bullying or exclusion from
friendship groups.

Depressive schemas are dormant, but will be triggered following a stressful life
event, influencing how the experience is interpreted and the development of
dissatisfaction from the event. Evidence from (Brown & Harris, 1986) conducted a
longitudinal study on females, measuring personal support, levels of self-esteem,
psychological disorders and personal life events. They found that those who were
diagnosed with depression had experienced traumatic life events in the last six
months. They concluded that those who had personal support were less likely to
experience depression, and those without pose a greater risk of relapse. And
suggested poor intimacy and care from a parent in childhood is closely related to a
poor self-image in adulthood. External validation from others is a source of self-
regard and those exposed to poor care in childhood are more likely to underestimate
their own worth.

(Seeds & Dozois, 2010) Studied the interaction of negative self-schemas and
negative life events of those diagnosed with depression. There report found that
those with cognitive vulnerabilities, such as negative schemas, contributes to the
onset of depression (Ingram, Miranda, & Sagal, 1998). However, those without
cognitive vulnerabilities experience stressful events with appropriate levels of
negative mood and thoughts, and does not necessarily result in onset of depression.

(Seligman & Maier, 1976) Provide a cognitive model of depression called learned
helplessness. Seligman’s theory argues depression can occur when someone learns
their attempts to remove themselves from a negative situation makes no difference
to the negativity of the situation. Consequently, they can become passive and remain
stuck in the negative situation, and no longer are motivated to escape. This theory
relates to this case and explains a small number of symptoms to an extent, but it fails
to consider causal cognitions.

(Golib & Colby, 1987) Studied people who have previously suffered with depression
and those who have not, they found that those who had been depressed showed no
differences when viewing their situation with attitudes of learned helplessness.
Suggesting helplessness could be a symptom of depression and not a cause.

In conclusion, it is important to consider the relationship between both approaches,

and how they explain psychopathologies. One theory does not fit everyone and
comes down to the individual experiences. The psychodynamic theory was argued
by Freud as a universal model of development for all, focusing on past events. It has
evolved and been modified over time, there is evidently observable evidence for his
theories, but they remain unable to be falsified. In comparison to the cognitive model,
it is passive and assuming. Whereas, the cognitive model considers the interaction
between maladaptive thinking and core belief systems and how they interact with
depression and anxieties. It is based on a construction of models and lays out
foundations, with an objective means of measurement, focusing on aspects of the
present, taking a holistic approach.
References

Beck, A. T. (1967). Depression: Causes and treatment. . Philadelphia: University of

Pennsylvania Press.
Beck, J. S., & Beck, A. T. (1995). Cognitive Therapy: Basics and Beyond.
Brown, G. W., & Harris, T. (1986). Stressor, vulnerability and depression: a question
of replication. Psychological Medicine, 16(4), 739-744.
Cooper, S. H., Perry, J. C., & Arnow , D. (1988). An emperical approach ti the study
of defense mechanisms: Reliability and preliminary validy of the Rorschach
defense scales. Journal of Personality Assessment, 55(6), 187-203.
Davidson, K., & MacGregor, M. W. (1998). A Critical Appraisal of Self-Report
Defense Mechanism Measures. Journal of Personality, 66(6), 965-992.
doi:10.1111/1467-6494.00039
Glassman, W. E., & Hadad, M. (2013). Approaches to Psychology: Theoretical
Foundations. In Approaches to Psychology: Theoretical Foundations.
Golib, I. H., & Colby, C. A. (1987). Treatment of depression: An interpersonal
systems approach. Pergamon Press.
Herbert, G. L., McCormak, V., & Callahan, J. L. (2010). AN INVESTIGATION OF
THE OBJECT. Psychoanalytic Psychology, 219-234.
Ingram, R. E., Miranda, J., & Sagal, Z. V. (1998). In Cognitive vulnerability to
depression. New York: Guildford Press.
Kaslow, F., & Magnavita, J. (2002). Comprehensive handbook of psychotherapy.
New York: Wiley.
Lubbe, T. (2010). Object Relations in Depression A Return To Theory. Hoboken:
Taylor & Francis.
Luyten, P., Sabbe, B., Blatt, S., & Meganck, S. (2007). Dependency and self-
criticism: Relationship with major depressive disorder, severity of depression,
and clinical presentation. Depression and Anxiety, 24, 586-596.
Seeds, P. M., & Dozois, D. J. (2010). Prospective evaluation of a cognitive
vulnerability-stress model for depression: the interaction of schema self-
structures and negative life events. Journal of Clinical Psychology, 66(12),
1307–1323. doi:10.1002/jclp.20723
Seligman, M., & Maier, S. (1976). Learned Helplessness: Theory and Evidence.
Journal ol Experimental Psychology, 105(1), 3-46.
Shevrin, H. (2012). University of Michigan Health. Retrieved from
http://www.uofmhealth.org/news/unconscious-anxiety
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PSYCHOPATHOLOGY 2

In psychology, there are key principles and concepts of different models that help a

psychologist understand a patient’s issue. In the case study, Sophie is a 66-year-old woman who

has been referred by her GP to the community mental health team following a physical check-up

in which she described feeling “useless” and “lonely.” Her closest confidant, the husband, died

some years earlier and she has been feeling the worst feelings possible. In the following

discussion, the author analyzes the case study based on psychodynamic and social approaches in

understanding the problem in the case study.

Brandwein (2011) reports that the approach combines all the theories in psychology,

especially the idea that human’s actions are affected by the unconscious from different aspects of

the patient’s life. The theory, developed from Sigmund Freud’s ideas postulate that a person’s

feelings and behavior are influenced by a variety of factors. The basic assumptions of the

approach are, first, that human behavior is affected by the unconscious (Greenson, 2016).

Secondly, the approach argues that a person’s behavior and feelings are rooted in childhood

experiences, and that all actions are determined by the unconscious. As the following discussion

shows, psychodynamic approach can be used to understand the issues bedeviling the client.

The first concept of the approach is that human behavior is determined by the

unconscious. Wilson (2004) asserts that the unconscious part of the mind consists of mental

processes which the conscious mind cannot access. Freud (1916) had earlier theorized that the

mind is the primary source of human behavior and that the most important part is the

unconscious part that a person cannot see. Bornstein (2015) says that psychodynamic perspective

emphasizes unconscious psychological processes. The idea behind psychodynamic is that the

issues individuals have and not resolved are usually pushed into the subconscious and

subsequently affects a person’s behavior.

PSYCHOPATHOLOGY 3

Freud (1916) postulated that the conscious and the unconscious part of a human mind

usually come into conflict producing a phenomenon called depression. In majority of the cases, a

person stores the undesired experiences they are not prepared to deal with in the unconscious

mind, and they usually exploded bringing forth psychological issues. In Sophie’s cases, she had a

rough life that caused her current psychological situation. Sophie is a caretaker; she used to take

care of her parents, siblings, and later her husband. In all these situations, it was not ideal

because the majority of the people she had to take care of were unwell and emotionally draining.

Hence, according to psychodynamic approach, she repressed these feelings, pushing them into

the unconscious mind. Her current problems are a manifestation of the issues in her life she has

repressed into the unconscious mind.

Bateman, Brown, and Pedder (2010) noted that early childhood experiences play role in

future psychological underpinnings of the concerned person. According to the approach,

traumatic childhood events have a significant influence on how adult live their lives and their

psychological situations. Traumatic events that occur in childhood are usually pushed into the

subconscious (as discussed above), but later causes problems because they have never been

resolved. Sophie had a rough childhood. She had to take care of her sick mother while at the

same time ensuring the family was cared for because her father was a drunk who did not look

after the family’s interests. These early childhood experiences of taking care of sick people could

be the reason she is feeling “useless” and “lonely” because she has no one to take care of.

Robinson and Gordon (2011) argues that psychodynamic approach is further based on the

assumption that nothing in the mental sphere of a person happens by chance. From Freudian

thoughts, psychodynamic theory is strongly determinist because it assumes that a person’s

behavior is affected by unconscious issues which the individual has not control over (Freud,
PSYCHOPATHOLOGY 4

1916). The subconscious thoughts and feelings can affect the conscious mind by revealing those

issues that are deeply rooted in the mind to the extent that the conscious mind articulates them. In

the case of Sophia, her rough childhood, later taking care of her sick husband and the

abandonment that followed after his death are the reason she is feeling lonely and useless.

The social approach in understanding psychological issues argues that an individual

cannot be understood without examining her social context (Feldman and Lynch, 1988). In the

social context, Sophie’s psychological issues can be explained by studying social connection she

has with her parents, friends, institutions, and wider society (Tew, 2011). When she was a child,

Sophie was entrusted with taking care of her sick mother. Being a second born, she was also

obligated to take care of her siblings because her mother was sick and the father was an

accomplished drunk. She had to work variety of jobs to ensure the people around her were well

taken of, while later in life she had to take care of her sick husband. These are the social context

that Sophie grew up and currently lives in.

A study carried out by Reicher, Spears, and Haslam (2010) demonstrated how people

identify themselves socially and how the same identification affects their thinking. In the case of

Sophie, she identified herself as a caretaker to the extent that when she did not have someone to

look after, she felt “lonely” and “useless.” At a young age, she had to take care of her mother and

was also entrusted with ensuring that the family was intact. Further, at the age of 15, she had to

drop out school to look for work because she needed to take care of her family. Later, as an

adult, she had to take care of her sick husband and his death left her with no one to take care of.
PSYCHOPATHOLOGY 5

The experiences in relation to other people had a tremendous effect on Sophie’s life

leading to the feeling she has at the age of 60 years. Throughout her life, Sophie was forced by

circumstance to take care of family members to the extent that she felt she was a “warrior”

fighting for a healthy course. At the age of 66, with no one to take care of, she felt “useless” and

“lonely” because she was used to taking care of people in need. Therefore, she was unable to be

at peace psychologically because she did not have someone to look after. The social approach

explains her situation because she was used to be the caretaker of people around her, and in the

current situation where she has no one to take care of, she feels “lonely” and “useless” and not

the “warrior” she is used to being.

As postulated by Smith, Mackie and Claypool (2014), the social context in which a

person finds herself in is influential on her subsequent behaviors and thoughts. Sophie had

always considered herself a “warrior” who is able to take care of others, and right now she feels

“useless” because she has no one to take care of. Further, she is afraid of seeking help, whether

from her family members or a mental institution because she is afraid such a decision will make

her appear weak and vulnerable. Therefore, taking care of weak and vulnerable family members

had a tremendous impact on how Sophie behaved later in life and the reason for her current

psychological problems.

The two approaches in analyzing Sophie’s case have some similarities and differences.

Regarding similarities, Glassman, Glassman, and Hadad (2008) report that the two approaches

contend that early childhood experience have a significant impact on the psychology of an adult.

According to Freud (1916), early childhood experiences are important in analyzing a patient’s

psychological issues. On the other hand, Glassman, Glassman, and Hadad (2008) say that a

child’s familial connections have a significant impact on the concerned person’s adult life. Thus,
PSYCHOPATHOLOGY 6

both approaches believe that the relationship Sophie had with her family member could explain

the current psychological crisis she is experiencing.

However, the two approaches diverge on one pertinent issue regarding the causes of

psychological problems Sophie is facing. According to Freud (1916), the unconscious is

responsible for some of the repressed feelings Sophie has, which is manifested by her current

psychological conundrum. On the other hand, the social approach argues that what is happening

to Sophie is based on the quality of the social context she grew up in (Brooks, 2012). Therefore,

according to psychodynamic approach, repressed unconscious feelings can be used to explain

what is happening to Sophie, while the social approach postulates that it is the societal context

that best explains her predicament.

In a nutshell, the two approaches can be used to explain the cause of Sophie’s problems.

First, psychodynamic approach shows that taking care of her family engraved in Sophie’s

subconscious a care take attitude, which later affected her when she did not have anyone to take

care of. Secondly, the social approach shows that Sophie’s social life was filled with issues

which later affected her psychological state. Thus, the two approaches are helpful in determining

the issues bedeviling Sophie.

PSYCHOPATHOLOGY 7

Brandwein, D. (2011). Psychodynamic Approaches. In Encyclopedia of Child Behavior and

Development (pp. 1174-1176). Springer US.

Bornstein, R. (2015). The Psychodynamic Perspective.

Feldman, J. M., & Lynch, J. G. (1988). Self-generated validity and other effects of measurement

on belief, attitude, intention, and behavior. Journal of applied Psychology, 73(3), 421.

Bateman, A., Brown, D., & Pedder, J. (2010). Introduction to psychotherapy: An outline of

psychodynamic principles and practice. Routledge.

Robinson, M. D., & Gordon, K. H. (2011). Personality dynamics: Insights from the personality

social cognitive literature. Journal of Personality Assessment, 93(2), 161-176.

Tew, J. (2005). Social perspectives in mental health: Developing social models to understand

and work with mental distress. Jessica Kingsley Publishers.

Reicher, S., Spears, R., & Haslam, S. A. (2010). The social identity approach in social

psychology. Sage identities handbook, 45-62.

Smith, E. R., Mackie, D. M., & Claypool, H. M. (2014). Social psychology. Psychology Press.

Glassman, W., Glassman, W. E., & Hadad, M. (2008). Approaches to psychology. McGraw-Hill

International.

Freud, S. (1916). The future of psychoanalytic therapy. The Psychoanalytic Review (1913-

1957), 3, 215.

Brooks, D. (2012). The social animal: The hidden sources of love, character, and achievement.

Random House Incorporated.

Greenson, R. R. (2016). The Technique and Practice of Psychoanalysis: A Memorial Volume to

Ralph R. Greenson. Karnac Books.

Wilson, T. D. (2004). Strangers to ourselves. Harvard University Press.

PSYCHOPATHOLOGY 8
 Psychopathology Coursework 2017-18

Case Study 1

Sophie is a 66-year-old woman who has been referred by her GP to the community mental
health team following a physical check-up in which she described feeling “useless” and
“lonely”. The GP was also concerned that Sophie had not been eating well or looking after
herself properly and suspected she might be suffering from depression.

Sophie lives on her own in a small village. Her husband John died three years ago (he had
dementia and vascular problems). For the last year of his life, John was very unwell and had
significant memory impairment and became very dependent on his wife, Sophie. Sophie
dedicated herself to looking after him; a role which could be quite physically and emotionally
exhausting. Because of her caring commitments, she had to give up other activities including
voluntary work and a book group.

Sophie was the second oldest of four children. Her sister Clare (the youngest one) is still alive
but her two sisters have both passed away. Her mother died young and was often unwell
during Sophie’s childhood. Sophie recalls her mother as “kind but never really happy”, and
explains that she often had to look after her mother and siblings whilst growing up. Her father
was a heavy drinker and she describes him as “very harsh”.

Sophie left school aged 15 and then worked on the land to raise money for the family. She
later went on to attend evening classes where she studied geography, English and IT. She
worked in various jobs throughout her career, most recently as a receptionist in a dental
surgery. Sophie met John at college and they married aged 22. She describes him as a
“wonderful man” but one who “always worked too hard”. They were both looking forward to
retirement together but “everything changed” after John became unwell. They had two
children, a son and a daughter, both of whom now have families of their own. Sophie retired
from her job aged 65. She enjoyed her work, and had been with the same firm for 26 years.

Sophie describes herself as a “worrier”. She says she has never felt very confident in herself,
and often worries that other people see her as “foolish”. Just recently, she has been worried
about being referred to mental health services and people finding out and thinking she’s
“losing it”.

Since her husband’s death, Sophie has found it hard to re-engage with activities she formerly
enjoyed, saying she simply “doesn’t have the will”. Sophie says she can’t seem to concentrate
on books any more, and remarks “I never have anything clever to say anyway”. She has also
been experiencing frequent headaches and worries about her memory. She found it tough
turning 60, she says, as “it seems so old”.

Sophie largely confines herself to the house and spends most of the time on her own. She sees
her family only occasionally as they live a long way away. Sophie says she wishes she was
closer to her children and grandchildren but she tends to wait for them to make contact as she
is “sure she annoys them” and “doesn’t like to burden them” with her problems. Her sister
Claire says that Sophie is someone who “always puts others first” and has been encouraging
her to think about her own needs at this time.
Case Study 2

David is a thirty-five-year-old veteran of the British army, who returned from a tour of duty
in Iraq five years ago and now lives with his wife Ruth and their two children. Whilst he was
in Iraq, an improvised explosive devise blew up several metres from the vehicle he was
driving. David suffered severe burns to his face and neck as well as significant spinal injuries.
He has undergone extensive medical treatment and now walks with the aid of crutches. David
lost two of his close friends in the incident.

Since his return from Iraq, David has found it difficult to readjust to civilian life. He
describes feeling like he “can’t be the man he was before”. He finds images of Iraq popping
into his mind seemingly out of the blue. Particularly terrifying is the feeling of helplessness
that often comes with these memories, which he connects with being trapped inside his
vehicle and unable to help himself or his fellow soldiers. David rarely talks about what
happened, often dismissing the topic with comments like “you’ve just got to put it behind
you”. He says: “a lot of it I can’t remember very clearly”. He acknowledges, however, feeling
“wracked with guilt” about the fact that his friends didn’t survive, frequently asking himself
whether there were things he could have done to prevent it.

David is an only child and grew up in Manchester. His parents were young when they had
him and he describes his childhood as “kind of chaotic: there was always someone staying or
some party to go to”. His parents divorced when he was 11 which, he says, was “really
sudden and unexpected”. Not long after then, he went through a period when he became
“pretty anxious and obsessive - worrying all the time about locking doors and stuff.” David
ended up dropping out of college (“I was never one for sitting at a desk all day”). After
working for a while as a car mechanic, he joined the army aged 23. He says, “I guess I liked
the routine. It felt like a second home”.

Ruth is worried that David has become more emotionally withdrawn, and struggles to be
affectionate with her and their children. He finds it difficult to talk about what happened in
Iraq and Ruth feels he is “pushing away the good things as well as the bad”. She describes
him as “tetchy” and says he will sometimes “fly off the handle” at little things. She struggles
with what she describes as his “military behaviour” – wanting things to be “just so”, getting
stressed and annoyed if things don’t go according to plan.

David spends most of his time at home, doing what he can around the house and “trying to
figure out what to do with my life”. He finds it difficult to relax and is often tense and on
edge. He describes feeling “like his body is still in Iraq” – on the lookout for the enemy – and
says: “it’s just as well to be alert; you never know what anyone is capable of”. David is
diligent with his physiotherapy and keen to get back into work. He can no longer drive on
account of his injuries, and avoids public transport because being in a vehicle “brings it all
back”. In fact, he generally avoids crowded places altogether, explaining “I can’t tell how my
body’s going to react – it’s easier just to stay at home”. A few times now he has found
himself overwhelmed with panicky feelings whilst out. He says, “it’s like something is
broken in my body, I have no control over it. I can’t stand that.”
Case Study 3

Kate is a 29-year-old woman who has has been referred for an urgent psychiatric assessment
following a tumultuous few weeks which have left her feeling extremely low to the point
where she has been experiencing suicidal thoughts.

The trigger for Kate’s recent distress was the breakup of her relationship with her partner
Paula. Kate and Paula had been together for three years. Kate says that the difficulties had
been brewing for some time but “she never thought it would really happen” because “we’ve
been through so much together and understand each other so well”. The breakup came about
as a result of frequent explosive arguments, often centred around a recurring dynamic
whereby Paula experienced Kate as “possessive” and “hot-headed”, and Kate experienced
Paula as “rejecting” and “cold”.

Kate was born as the younger of two children. Her parents had a volatile relationship which
was at times violent. They separated when she was 12 and Kate grew up living “between her
parents”. She reflects: “it was basically a case of who was most able to look after me at the
time”. Her mother had bipolar disorder and a history of drug use, and spent periods of time in
hospital. She is now well and lives nearby, although Kate describes their relationship as
“tortured”. Her father worked as an actor and was often away on tour. He had a history of
alcohol use and died from a heart attack when Kate was just 23.

Kate did well at school and enjoyed acting and dance. She went on to drama school but had a
tough time making friends and ended up feeling quite isolated. She describes constantly
comparing herself to others and feeling she had “nothing to offer”. She tried hard to play “the
glamorous actress”, she said, but underneath it all was this “constant feeling of inadequacy”.
Kate describes how she would often form strong attachments to others but inevitably “there
would be some disappointment at some point”. She would often then find herself feeling very
hurt and angry. She says, “I’d usually end up blaming and hating myself”. It was at this time
that she began to start bingeing and making herself sick. She describes how food became “her
only comfort” but at the same time left her feeling “disgusted” with herself.

A couple of years after her father died, Kate went through a really tough period when she
experienced periods of very low mood and disordered eating. She was diagnosed with
depression and then later borderline personality disorder, and received therapy and
psychiatric medication from a community mental health team. The therapy was helpful, she
says, but “it was meeting Paula that really restored my faith in myself”. Kate feels that
without Paula she “has nothing – that she is nothing”. She feels deeply depressed and cannot
see how she can move forward. She describes living in “a state of nervous exhaustion” –
hardly sleeping or eating. Her mother has moved in to live with her as she is very worried
about her daughter.