Case history

Demographic Details
Name: S
Age: 26
Sex: Female
Education: Post-graduation in Content Writing
Occupation: Student
Marital Status: Unmarried
Socio-economic Status: Upper-middle class

Chief Complaint
“I think I’m anxious, depressed, and I have problems with eating.” “My parents are too toxic for
me and they trigger my anxiety, I want to cut them off.”

History of present Illness

Since the client was 5-year-old, she was verbally and emotionally abuse by her paternal
grandparents and father. She was treated as an outsider by her paternal grandparents and
pressurized her mother for giving birth to a girl child. Growing up as a child, her father
physically abused her while throwing tantrums, for academic performance, assignment and
homework completion, etc. The client grew up watching abuse between mother and father,
additionally used to get yelled at and hit by her father when she would defend her mother.
The client was micromanaged by her mother with every household chore such as folding the
laundry in certain way, arranging the books in a certain way, etc. The client’s mother used to call
her friends home in absence of the client to warn them to cut ties with her, as it could affect her
studies. This resulted in the client having conflicts in friendships.
The client was forced to take up science in her 11th and 12th and engineering in the later years due
to parental pressure although her interest was humanities. Due to extreme pressure and stress, the
client went through a period of depressed mood, decreased sleep and appetite, not being able to
get out of bed, etc.
The client is currently pursuing Content Writing abroad, and is being financially funded by her
parents. Yet, her parents periodically call her and force her to get married, throw tantrums for
changing her stream of studies, is against her current relationship as he is not an Indian. Due to
the above-mentioned events. The client has been feeling anxious to pick calls from parents or to
even reply to their messages. The client stated to go out of breath, feel shaky, unsteady, and feels
like losing control while picking her parents’ call. She is preoccupied with thoughts about
consequences of picking her parents’ call. The client stated to have stooped her hobbies and has
disturbances in sleeping. The client also stated to go through series of binge eating during stress.

Past history
No past history of psychiatric illness

Medical History
Nil

Family history
The client’s parents had non-consanguineous marriage. The client has one younger male sibling,
4 years younger to her. She considers her brother to be her only support system in the family, and
they have a harmonious relationship. The client’s mother works at a bank. The client states to
have emotionally abusive relationship with her mother. Her mother seems to take side of her
father even when she is aware that the client is being affected by it. Her mother throws tantrums,
micro-manages, and taunts the client often.
The clients father works at HAL. Due to him growing up in a patriarchal family, he has rigid
mind set and forces the client to fit into the rigid structure. He is emotionally, verbally and
physically abusive towards the client since her childhood. Currently she has cut off her father
and is not in talking terms.
The clients’ parents have a conflicted marital life. The father was emotionally, verbally and
physically abusive towards her mother.

Personal history
Birth and childhood: Normal delivery, full term baby, no birth complications, and milestones
were met appropriately.
Behavior during Childhood: Normal, no tics or mannerisms, no thumb sucking behavior or any
such behaviour in the childhood
Conduct disturbances: The client threw temper tantrums often and was labelled as “devil child”
Relationship with sibling and peers: The client liked making friends and was generally
surrounded by people, up until her mother started getting involved in her friendships.
Physical illness during childhood: No major physical illness present during childhood, but the
client often fell sick.
Schooling: The client maintained excellent scholastic and academic performance, was involved
in various co-curricular and extracurricular activities such as art, debate, elocution. The client
was an athlete and took part in swimming competitions. The client maintained good relationships
with teachers who supported her extracurricular activities, but often got into argument with
teachers who focused on traditional way of education.
Sexual History: The client attained menarche at 13 years. Her menstrual cycle is regular but has
severe abdominal cramps. The client identifies as pansexual and is sexually active.
Substance abuse history: Nil.

Premorbid Personality
Social relationship- Maintains harmonious relationships with friends and partner, frequent fights
with parents and relatives, is outgoing, extroverted.
Hobbies- Art and painting, singing, swimming, running
Mood- Sad, and anxious
Attitudes towards others- Social, kind, empathetic, compassionate, caring and understanding.
Intellectual activities- Debate, elocution, creative writing, poetry, column writing
 Mental Status Examination

General appearance
Appearance: well groomed, clean, well dressed, nails trimmed, hair combed properly
Eye to Eye contact: Maintained
Rapport: Well-established
Tics and Mannerisms: Not present
Behaviour towards examiner: Talkative, cooperative
Anxiety signs: Present (Running short of breath, restless thoughts, feels shaky, unsteady, fear of
losing control)

Psychomotor activity
Normal

Speech
Spontaneous, moderate tone, moderate tempo, normal reaction time, relevant and coherent

Thought
No formal thought disorder found, no flight of ideas, no thought block, no circumstantiality,
perseveration, no obsessions and possessions, no delusions, overvalued ideas

Emotions
Mood: Sad and Anxious
Affect: normal range and appropriate to the context

Perception
No hallucinations, delusions, depersonalization, derealization, etc present.
Cognitive functions
Orientation: Time, Place and Person orientated
Attention and Concentration:
 Days and months forward and backward: answered correctly
 Digit span test: forward- 5/5, backward- 5/5
Memory:
 Immediate memory: Good
 Recent memory: Good
 Remote memory: Good

Intelligence
 General fund of information- Good
 Comprehension- Good
 Arithmetic- Good
 Abstraction- Good

Judgment:
 Personal judgment- Good
 Social judgment- Good
 Test judgment- Good

Insight
Complete Insight – level 6