CASE PRESENTATION

SREE AISWARYA V – 2037558

Case History
Identifying Information/Intake
• Name: Mr. A
• Age: 24
• Sex: Male
• Education: B.E Civil engineering
• Occupation: Civil engineer
• Socioeconomic status: middle class
• Informant: self
• Reliability of information
- consistency is present
• Adequacy of information – sufficient
Presenting problem (with duration)
• Porn Addiction x 7 years
• Difficulty in social situations x 7 years
• Self-doubt and shyness x 3 years
• Lack of motivation and low energy throughout the day x 4 months
• Withdrawal symptoms like mood swings and lack of sleep x 4 months
• Salient concerns – The client experiences difficulty at work place, feels unproductive
and often procrastinates. He also faces difficulty in communicating. Unable to focus
on any work he does. Very poor group skills.
• Verbatim – ” Since I got addicted to watching porn and masturbating, I feel very
drained and less productive. It is affecting my sleep, I cannot concentrate on my
goals and I do not feel confident in any of my decisions. My friends always describe
me as SAD and SILENT. Now, porn addiction has become my companion whenever I
feel lonely”
• Onset: Gradual (few months- few years)
• Precipitating factors – Constant feeling of loneliness especially during lockdown,
Boredom and sad of being lonely. Being alone is the main trigger for excessive
internet usage and porn addiction. Continuous lack of productivity at work place and
the feeling of regret. Also, he becomes very sad and frustrated when his father
drinks and verbally and physically abuses his mother (increased in the past few
months)
• Course of the illness: Continuous
• Psychiatric/physical illness: Nil
• Associated disturbances: Change in sleeping patterns, feeling very weak and lack of
energy throughout the day, lack of productivity and motivation at workplace. The
 degree of the disturbances is such that he constantly regrets for engaging in his
addictive behaviour. There are no organic concerns.

History of present illness

• His friends introduced him to porn sites, videos and nude pictures of stresses at the
age of 15 and it started impacting his studies around 11th and 12th grade. Peer
pressure.
• Masturbation was not present until the end of school years
• There was some gap until he started watching porn movies again in his friend’s
house. On an impulse, the clients said “ I got indulged in the act of masturbation”
• This behaviour got stronger day by day. It started impacting almost all parts of his life
(work, family, friends)
• The client started to develop low self-esteem because porn addiction has become a
hindrance in the way to achieve his goals (becoming a scientist)
• At the age of 20, he approached a girl in an intention to propose her. He got rejected
and it was very painful for the client. This rejection triggered his loneliness and
sadness and reinforced the porn addiction.
• He started to develop shyness in social situations and a lot of difficulty in
communication. Started to feel uncomfortable in social situations.
• The client started to develop a pattern – Being alone, sad or bored – increased his
urge to watch porn videos. Since he is mostly alone, he engages a lot in this activity
• The clients said, “It feels like a part of my day and at the same time I regret doing it”
• The client started feeling very weak both physically and mentally, not being able to
concentrate on his work and other goals like getting a government job and entrance
exams.
• He also started to have withdrawal symptoms in the past 4-5 months like mood
swings and lack of sleep if he does not masturbate or watch porn videos.
• He started feeling that he is living a different life in secret which others around him
do not know about
• HOW OFTEN? – All days in a week (during work from home) and at present since he
has started to go for work it has become inconsistent. He comes to his place in the
weekends just to get some private space away from his PG.

Family history
Description of individual family members
Name - AL
Age - 55
Education - ITI
Occupation – Contractor
Relationship – father
Alcoholic (severe x 6 months)
Name – SA
Age – 52
Education – English literature
House wife
Relationship – mother

Name – AA
Age – 19
Education – pursuing civil engineering
Relationship – Younger brother

FAMILY GENOGRAM
Socio-economic condition
Middle-class

Leadership pattern
• Power structure – gender specific (patriarchy)
• Decision making – Autocratic (only father makes all decisions)

Role functions
• Instrumental role – father/husband
• Expressive role – mother/wife
• Role conflict – Mr. A constantly experiences difficulty in fulfilling role obligations
• Role performance – Mr. A’s brother is seen as someone who performs his roles well
and gets more encouragement compared to Mr. A
• Role expectation – Mr. A constantly feels the pressure because he is unable to fulfil
his family’s and societal expectations

Communication within the family

• Both direct/indirect and verbal/non-verbal communication is present
• Unequal participation is present
• Clarity of communication is mostly absent
• Noise level – Mr. A’s voice is too low and his father’s voice is contrasting
• Respect, regard, listening skills, self-disclosure are totally not present
Affective communication
• Welfare feelings like joy, love are very low
• Emergency feelings like fear and anger are dominating

Cohesion/Bonding
• Enmeshed family (connectedness is not healthy)
• Emotional bonding – there is emotional separateness and limited closeness
• Parent child relationship – clear generational boundaries are present and closeness
is very limited
• Rituals, celebrations, events – Mr. A, participates only for societal pressure and
other family members also gives more importance to societal norms.

Adaptive patterns
• Conflict resolution – absent
• Problem solving ability – very low, use of avoidance is high
• Coping strategies – father(alcohol), Mr. A (porn addiction), Mother (religious),
Brother (studies)
• Flexibility – Rigid
Personal history
• Birth and developmental history:
Developmental milestones were normal. No complications in child birth

• Educational history:
School years were between (3-17 years). Mr. A went to a private school till 10 th grade and
experienced bullying by rich kids in school. After 10th grade he was changed to a state school
because of his low grades and experienced peer pressure to watch porn and that is where
the negative behavior began and he notes this shift in school as a significant event in his life.
He has faced a lot of criticisms and discouragements from his teachers for scoring less marks
and which made him more silent. His attitude towards his peers were negative most of the
time and he has not had any close trustful relationships in school and college.

• Occupational history
He started his work as a civil engineer at the age of 22. The client does not feel very
satisfied at the work place because he does not feel productive and also he experiences
difficulty in getting along with colleagues. He has a lot of ambitions and goals but is unable
to achieve any.

• Marital history/ Relationship history

None
• Sexual history
Masturbatory practices started at the age of 17. Using masturbation as a coping strategy for
boredom, to overcome feelings of loneliness and sadness and stress.
No Use and Abuse of substances

Premorbid personality

• Attitude to others in social, family and sexual relationships

The client feels that he does not have any trust-worthy friends and emotional support. He
has always been following an avoidant attachment style with his friends and family. He is
always confused about his decisions and has a belief that he always chooses the wrong one.
He does not participate freely in social circles. He describes himself as having difficulty
expressing emotions and understanding others emotions. He has difficulty in role taking in
family context because his voice is never given importance and he actively does not take any
initiatives in other aspects of his life.
• Attitude to self
He is totally dissatisfied with the way he is among friends, among family members and
dissatisfied with his work. He feels he is the sole reason for all his failures in life and feels
hopeless to try. He is dissatisfied about his health and the way he looks (low self-esteem)
 • Moral and religious attitudes and standards
No specific compulsive religious attitudes or standards
• Mood
Most of the time in a day he worries, feels anxious and sad. He feels that he cannot express
his anger especially inside the family. He chooses others unhealthy ways to express or cope
with that anger.
• Leisure activities and interests
His circle of friends is very small and most of the times empty. He feels that he does not
have any trust-worthy friends. He spends most of the time alone. His interest include
improving general knowledge by reading from online websites and spends most of his free
time watching porn.
• Fantasy life
There are no notable dreams or fantasies. His greatest wish is to travel around the world.

• Reactions pattern to stress

Excessive use of defence mechanisms when experiencing disappointments, anger and stress
- Avoidance, watching porn, shying away.

• Habits
Normal and healthy eating habits are present. Sleep patterns are not appropriate and is
often disturbed by watching porn.

Mental Status Examination

General behaviour – He generally weak and dull. He is fully conscious and in touch with the
surrounding. He is calm during the session but sometimes looks restless. He is slow but
attentive. He is cooperative and it was not difficult to build a rapport with him. He does not
maintain adequate eye contact while he is explaining something. Absence or any repetitive
mannerisms and catatonic behaviours.
• Psychomotor behaviour – normal
• Speech
– Spontaneous – spontaneity is present and answers all the questions
– Amount – appropriate amount/ sometimes repeats the same concept
– Tone/tempo – very low toned
– Relevant, coherent – yes
Thought
• Stream – flight of ideas are present, no retardation in thinking
• Possession – watching porn and excessive internet usage are the only obsessive-
compulsive behaviour present and it is impulsive especially when he is around any
triggers related to it.
 • Content – absence of delusions. Depressive ideation, ideas of worthlessness, guilt,
hopelessness are present.
• Mood:
Subjective/ Objective
• Quality – mostly feels sad and anxious and occasional happiness
• Intensity – Sadness, anxiety and loneliness are experienced in more depth
• Range – Negative affective responses are higher (disappointment etc..)
• Reactivity – environmental factors like family situations or work place affects his
mood but he does not react or express it where required.
• lability – Absence of rapid or extreme changes in emotions

Perception
Absence of any illusions or hallucinations. All senses are normal.

Cognitive function
 Attention and concentration – Attentive and adequate concentration is present
during the sessions
 Orientation – Absence of disorientation
 Memory – recall of information is clear and detailed
 General information -
 Intelligence -
Judgement
 Personal – He is aware that his addictive behaviour is harmful to him
 Social – Appropriate behaviour in social situations are present
 Insight – presence of full insight about his addictive behaviour. Awareness about the
physical, intellectual and emotional nature of the addiction is present.