Case

Monica, 29 years old. Noticed anxiety and low mood

Signs

- Drink 70 units of alcohol

- Smoke 2 gr of cannabis
- Take 10 gr of Diazepam per week
- is currently drinking a bottle of wine daily (AVB 13.5%), mostly during the nights to
help her fall asleep and maintain sleep during the night. 10 units of alcohol per day
- smoking cannabis daily, at night and at work 2 or 3 times per week to calm anxiety
- hates eating by herself
- sentimientos de culpabilidad (se siente responsable del abuso sexual y de su dinámica
familiar). Guilty for his death. Guilty for feeling sad and weak
- She does not perceive her drinking behavior, her smoking behavior and the fact that
she self-medicates as problematic

Symptoms

- Restlessness, Sweating, Palpitations, Problems sleeping

- Sadness, lack of motivation, increased appetite. Low mood in the past six months
- Restless and on-edge (inuieta y nerviosa)
- increase heart rate, sweating, difficulty concentrating and a general tension that she
finds draining (she has been feeling fatigued). (una tensión general que le agota)
- has been experiencing difficulties sleeping throughout the night without the aid of
alcohol, cannabis or Diazepam
- she lacks motivation for things she used to enjoy (anhedonia)
- has been eating much more than what she used to (this lead her to gain a bit over 10
kilos and affects her self-perception and self-esteem).
- started taking Diazepam (5mg) one or two nights per week when she finds it
particularly difficult to sleep
- when she does she takes a few puffs of cannabis in the bathroom and goes back to
work
- not sure of what triggers the anxiety but considers that it is more likely to happen
when something makes her realize she is not accomplishing anything and time is
running out or when something makes her remember her experience of sexual abuse
and how her family reacted. Is random, anything can make her remember and dampen
her mood
- refers to have always “struggled with depression and anxiety”
- general idea that “something terrible will happen”.
- drinking with more frequency (drinking at last a cup of wine per day) and smoking
cannabis occasionally (Monica only felt the need to smoke more once she felt her
anxiety symptoms increasing).
- Monica is currently at risk of respiratory depression by combining alcohol with
cannabis and Diazepam.
- reported experiencing suicide thoughts again. But not attempts of

Facts:
 - She experience this symptoms since a family member who sexually abused her died 8
months ago. Increasing anxiety
- If she has been drinking with Chiara, she can finish the leftover in the bottle on her
own, but would not open a bottle of wine is she were the only one to drink from it. The
same applies to Cannabis. When Chiara has an early day and refuses to smoke, Monica
does not smoke either (these are the days in which she relies on Diazepam to help her
sleeping).
- It is usual for her to experience anxiety at nighttime when she is “alone with her
thoughts”. She gets very restless and thinks “I will never be worthy”, “my entire life
will be like this”, “this is my prime and I will die alone”, “nobody will love me like this”
and remembers her past experience of abuse.
- She tends to feel worst during the weekends, experiencing more episodes of anxiety
and a general lower mood because she has “more time to think” and is more likely to
encounter content in a movie, series or book that she finds triggering for her anxiety
- She attributes the onset of both sets of symptoms to a sexual abuse experience when
she was 9 years old. She started experiencing irritability and anxiety symptoms
whenever she was near the perpetrator of he was talked about. felt rejected and
belittled by her mother and experienced ongoing depressive symptoms (they changed
in intensity over the years and have intensified during the past months, but refers that
deep down the sadness, shame, disappointment and negative self-view were always
there).
- Start drinking and smoking cannbis at 13 years old. She started drinking wine on a daily
basis when she finished college and moved in with her best friend
- Dice que no necesita alcohol ni canabis pero sí lo hace

Antecedents

- When she was 10, she being brought to a psychiatrist because change on her behavior
- Scare of her mom if she told her teacher the truth. Her mother think she “overactive
imagination” and “tendencies to lie”
- She started drinking wine on a daily basis when she finished college and moved in with
her best friend. The medication made her feel less anxious. She felt no one believed
her included the therapist. She thought she was not worthy enough to be believed
(BAJA AUTOESTIMA)

Family history

- Monica considers her mother to have a histrionic personality disorder because of how
selfish, superficial and self-centered she is, but she has no way of corroborating this
- In the extended family from his father’s side, there is history of depression
(grandmother and aunt)
- her mother’s extended family an aunt has been diagnosed with bipolar disorder and
an uncle was in inpatient treatment for cocaine and heroin addiction.

Chilhood

- Bad relationship with mother, adequate with father

- Sexual abuse when she was 9 year old by her mother’s cousin and best friend. the
groped her and groomed her into allowing herself to be touched and touching him, he
started pressuring her to perform oral sex on him. Her mother reacted in an aggressive
way and blamed her for imagining and inventing things that “could destroy one of my
 most beloved cousins”. Monica was punished for a month, and she learnt that it was
better not to disclose the truth to anybody else to avoid further punishment
- She also became more introverted and quiet and felt terribly ashamed, guilty and
uncomfortable with her body (she felt she was “dirty and tainted”). She became very
uncomfortable when people touched her (particularly males), showing clear signs of
anxiety when teachers or family members touched her. She tried to avoid him,
maintaining ocupate at school and spend time in her best friend’s house
- Monica experienced suicidal thoughts thinking she was never going to escape him and
even though he never touched her again, he was always there “taunting her”.
- Inseguridad con su cuerpo, no le gustaba usar ropa ajustada y se sentía incomoda que
los hombres la vieran
- avoided dating and even though she experienced attraction towards boys, physical
intimacy was something that made her very nervous
- Eight months ago the person who sexually abused her died. She has noticed that since
this happened a lot of the shameful memories are coming back and she is struggling to
deal with the anxiety this causes and the effects on her modo

Sexual life

- Monica has never had a romantic relationship and states that she finds it difficult to
think that she will be able to trust someone enough to explore sex with (“I don’t see
myself being so vulnerable or exposed with anybody” “I don’t know how other people
do it”).
- She labels herself as asexual (“it is not sex what I crave, but the emotional connection,
I really wouldn’t mind if I never have sex”).

Self perception

- perceives herself physically as a generally plain and unattractive woman

- currently feeling unpleased with her body image due to the ten kilos she has gained
during the past year