SYLVIA PLATH

A DIFFERENTIAL DIAGNOSIS
Elainna Simpson
 SYLVIA PLATH
Þ A confessional poet and author:
posthumous Pulitzer Prize
ÞFather died when she was 8, mother and
her had a difficult relationship.
ÞFrequent self harm and suicide ideation –
after internship
ÞWas formally diagnosed with depression
when she was 20 after a suicide attempt.
ÞTreated at psychiatric hospital -ECT
ÞMarried to Ted Hughes ended in
separation due to infidelity by him
ÞSuicide at the age of 30
8/27/1932 - 2/11/1963
“fated to become insane” after a “rather brief and
traumatic experience of badly-given shock treatment”
“pretty soon the only doubt in my mind was the
precise time and method of committing suicide”
-letter to a friend
“I am terrified by this dark thing that sleeps in me.” 
“Dying is an art.
Like everything else,
I do it exceptionally well.
I do it so it feels like hell.
I do it so it feels real.
I guess you could say I have a call.”
-Poems
 SYMPTOMS
ÞSelf harm & Suicidal Ideation/Attempts “Is there no way out of the mind?”
ÞInsomnia
ÞIssues with keeping friends/boyfriends “I desire the things that will destroy me in the end.”

Þ2 opposing personalities: Bright and successful or isolation and

emptiness “I don’t care about anyone, and the feeling is quite
obviously mutual.”
ÞEmotional Instability
ÞOutbursts of anger
“If I didn't think, I'd be much happier; if I didn't have any
ÞRacing thoughts sex organs, I wouldn't waver on the brink of nervous
emotion and tears all the time. ”
ÞTimes of productivity in writing and times of decreased productivity.
ÞDepressed mood
“Think. You can. You must, moreover, not continually run
ÞInability to manage life/cope away while asleep- forget details- ignore problems- shut
walls up between you and the world and all the gay
ÞIntense emotions bright girls-: please think –snap out of this.”
MAJOR DEPRESSIVE “Can you understand? Someone, somewhere, can
you understand me a little, love me a little? For all

DISORDER
my despair, for all my ideals, for all that — I love
life. But it is hard, and I have so much — so very
much to learn.”

A. 5 or more, during 2 weeks 9.Recurrent thoughts of death or suicidal ideation

1. Depressed Mood
• “have a lot to do but I am sick and sad”
• “is anyone really happy?” cannot fathom happiness
2. Loss of interest or pleasure
3. Significant weight loss or weight gain
• lost 20 lbs, was gaunt, could eat when given something.
4. Insomnia or hypersomnia nearly every day
• “I wonder why I don't go to bed and go to sleep. But then it would
be tomorrow, so I decide that no matter how tired, no matter
how incoherent I am, I can skip on hour more of sleep and live.”
5. Psychomotor agitation or retardation nearly every
day
6. Fatigue or loss of energy every day
7. Feelings of worthlessness or excessive or
inappropriate guilt nearly every day
8. Diminished ability to think or concentrate or
indecisiveness, nearly every day.
• Racing thoughts: “Loss of perspective humor. Colossal desire to escape, retreat
not talk to anybody. Thesis panic- lack of other people to be with fear, big and
ugly and sniveling.”
•“I want to kill myself, to escape from responsibility, to crawl back
abjectly into the womb. I do not know who I am, where I am
going,- and I am the one who has to decide all these hideous
questions. I long to escape from freedom- I am weak, tired, in revolt…”
B. Significant distress or impairment in social, occupational, or
other areas of functioning
• In her journal she speaks on struggling to maintain a
social, academic, and personal life without going into
manic depression.
C. Not due to substance abuse or medical condition
• No apparent effects of medical condition or substance
D. There has never been a manic or hypomanic episode
• No. Bipolar not added to DSM until 1980
BIPOLAR II  “It is as if my life were magically run by two
electric currents: joyous positive and despairing

DISORDER
negative—whichever is running at the moment
dominates my life, floods it.”

A. At least 1 hypomanic episode & 1 depressive episode. Not Depressive Episode:

severe enough for hospitalization. 1. 5 or more from last slide
Hypomania Episode:
1. Abnormal or persistent irritable mood, increased goal- B. There has never been a manic episode
directed activity or energy lasting 4 days, present every day.
C. Occurrence of hypomanic episodes
2. 3 or more not better explained by schizophrenia
a. Inflated self esteem
• “Kiss me, and you will see how important I am.” D. The symptoms of depression or
b. Decreased need for sleep unpredictability of mood changes
c. More talkative than usual or pressure to keep talking causes clinical significant distress of
d. Flight of ideas or subjective experiences that thoughts are racing impairment to social, occupational, or
e. Distractibility other areas of functioning.
f. Increase in goal-directed activity or psychomotor agitation • “I have the choice of being constantly active
• Would write more at one time and happy or introspectively passive and sad.
g. Excessive involvement in activities with high potential for painful Or I can go mad by ricocheting in between.”
consequences
• Skiing dangerously, driving her car off the road, etc.
BORDERLINE
PERSONALITY DISORDER
A. Pervasive pattern of instability of interpersonal
relationships, self-image, and affects marked with
impulsivity. Onset early adulthood. 5 of the following:
1. Frantic efforts to avoid real or imagined abandonment
• Felt loss of emotional comfort of a dad, ended relationships with
boyfriends for no apparent reason.
2. A pattern of unstable & intense interpersonal
relationships, alternating to extremes of idealization and
devaluation.
• She was noted for emulating her husband often and being all
consumed by him. “ted is my salvation, how could anyone else
stand me?”
3. Identity disturbance: persistently unstable self-image or
sense of self
• At some points she is very confident and others she is very self-
conscious about her body, her looks, and her abilities
4. Impulsivity in at least 2 or more areas of potential self-
damage
• She skied dangerously and would drive off of the road
“If you expect nothing from
somebody you are never
disappointed.”
5. Recurrent suicidal behavior, gestures, or threats or
self-mutilating behavior
• Frequent self-harm and suicidality
6. Affective instability due to a marked reactivity of mood
• “I have the choice of being constantly active and happy
or introspectively passive and sad. Or I can go mad by
ricocheting in between.”
• She talks about crying and being emotional a lot
7. Chronic feelings of emptiness
 “Outcast on a cold star, unable to feel anything but an awful
helpless numbness. I look down into the warm earthy world.
Into a nest of lovers’ beds, baby cribs, meal tables, all the
solid commerce of life in this earth, and feel apart, enclosed
in a wall of glass.”
8. Inappropriate intense anger or difficulty controlling
anger
• She was known to have angry outburst
9. Transient stress-related paranoid ideation or severe
dissociative symptoms.
 MOST LIKELY:
Bipolar II with the addition of borderline personality
disorder.
Mostly bipolar II: Not extreme enough to always inhibit
her functioning only after a large stressor (sexual assault,
separation from Ted). She has clear mania and depressive
episodes.
Partly personality: Sylvia seems to have grown up with a
mother who encouraged her personality traits and a
situation where borderline personality symptoms make
sense.
TREATMENT
Bipolar II Borderline Personality
Þ Medication to stabilize mood ÞPsychotherapy: reduce impulsivity,
work to improve relationships
ÞPsychotherapy: talk through the
issues and allow a relationship that ÞDBT: group and one-on-one,
teaches you how to control your relationship with therapist, practicing
feelings: self-harm and suicidality, skills, rework assumptions, control
issues with parents, depressive distress: interpersonal issues, anger,
moods, racing thoughts abandonment, self-image, self-harm
ÞCBT: identify and change unhealthy
behavior: Self-harm and suicidality
ÞECT: worked for her when done
correctly