Client’s name: Susanna Kaysen

Psychiatric diagnosis: Borderline Personality Disorder

Name of movie: Girl, Interrupted

1. What is the chief complaint?

She is initially institutionalized for taking a bottle of aspirin with a bottle of vodka. She says

that she is not trying to kill herself, but to relieve headache. While in the institution, the staffs find out

the severe bruises on her hands and she says that she has no bones in her hand. This could be a

sign that she has some perception that is far from reality or that she just deviate the real and makes

false statements. This suggests that she may have some delusional disorder. She tries to commit

suicide and substance abuse in her history along with self-mutilation (which is cutting of her own

wrist). Her attempt to end her life may suggest some life circumstances that she cannot get through

with so it can be traced that there are some problems arising from her.

The doctor has his first impressions about Susanna’s condition:

a. She is currently having depression particularly psychoneurotic depression reaction. She

reacts to certain conflicting circumstances in her life in ways that relatively deviate from

normal. Although she does so, she still is able to retain her capacity to think normally and

able to exercise normal judgment. It is actually not a form of insanity, as portrayed in the

film, her patterns of thinking, behavior and emotional responses depart from the normal. She

attempts to kill herself for she is depressed about her life and the happenings in her

environment. Upon interview by Melvin, she states that she is not in the ball of joy

b. She is highly intelligent and denial of her actions

 When the doctor asks about the reason of Susanna for attempting to kill herself, she states

that she had a headache and just took in the aspirin. She denies that she attempted

committing suicide; all she wanted is just to stop the pain.

c. Personality Pattern Disturbance

She says that she is puzzled about the things happening around her. She is promiscuous,

having sex on two different men at the same day and with another person. She has sexual

activities whenever she wants to. Sometimes she is happy and later becomes sad. There is

no consistent pattern of personality existing on her. She also becomes sleepless but there is

no major fear.

2. What questions would you raise during history taking?

The questions to be asked to the client must be categorized in an organize way to clearly

emphasize the area in which there can be problems with regards to the chief complaint. Here is a

sample history taking in personality disorder:

Demographic Profile

1. What is your name?

2. What is your relation to the patient?

3. Where do you live?

4. What is your permanent address?

5. What is the name of the patient?

6. What is his permanent address?

7. What is his date of birth?

8. What is his age

9. What is his eduacational attainment? & 12, Graduation, PG/Technical/professional

10. What is his occupation

11. When is he last employed?

12. How much is his monthly salary?

13. Is he dependent?

14. What is his nationality

15. What is his religion?

16. Is he married or single? widow? Separated?

17. How many children does he have?

18. What is the living arrangement? ( Nuclear family/ joint family/ alone/  any other etc.)

19. What is the reason for consultation?

20. Who is the source of referral?

21. Does he have a any previous consultation: from medicine OPD, surgery OPD or any other

physician or any psychiatric clinic or hospital?

Questions if patient abuses drugs

1. What is your age?

2. What is your employment status: following points come under it like, never employed, self

employed, presently unemployed, full time employed, part time

employed, student, housewife or girl, any other.

3. What is your marital status? All of above points you can add whether he was seperated due

to drug abuse

4. Are you currently using drugs frequently including herion (smack, brown sugar), opium

(opium, doda), other opiods like (morphin, proxyvon, parvon forte, parvon plus, parvon,

parvon-n, spasmoproxyvon, fortwin etc), cannabinoids (ganja, charas), (sedatives like valium,

nitravel, tablet no-10), cocaine,amphetamines?

5. Are you taking in hallucinogens (LSD, PCP), tobacco, or any other?

6. Have you ever used any injecting drug use? If yes, what is the route of administration?

7. Are you sharing injection or syringe? What was the name of injectable compound?

8. Have you ever had these sumptoms like, Genital Ulcer Growth, urethral discharge, vaginal

discharge, burning micturition, itching around genitals rectal pain or discharge?

9. Have you ever had jaundice?

10. Have you ever had sex with sex workers?

11. Have you ever had HIV screening what was result positive or negative?

12. Have you had concurrent psychiatric illness?

13. Have you had concurrent medical illness?

14. Have you had previous treatment for drug abuse, if any?
 15. Have you ever been hospitalized for treatment of drug abuse?

General Psychiatric Symptoms and Relevant Facts

1. Have you ever been physically abused?

2. Have you ever been sexually abused?

3. Have you experienced other severe trauma in the past?

4. Have you experienced missing blocks of time, even when not using alcohol or drugs?

5. Have you recently lost interest in things you normally enjoy?

6. Have you been feeling guilty without any real reason?

7. Have you recently been crying more than usual?

8. Have you recently have difficulty in concentrating?

9. Have you recently have problems with your memory?

10. Does anxiety make it hard for you to do simple things most people do without a second thought?

11. Do you feel “stressed out” most of the time?

12. Do you feel anxious just talking to other people?

13. Do you have “panic attacks”?

14. Have you ever heard voices that other people don’t hear?

15. Have you ever felt you had “special powers” that other people don’t have?

16. Do you ever find you have boundless energy, so much that you don’t need to sleep for days?
17. Are you often in such a good mood that people think there is something wrong with you?

18. Do you often feel compelled to do things repeatedly, such as counting or checking, even when

you know there is no real reason to do so?

19. Are you disturbed by repetitive thoughts that you find offensive or bothersome?

20. Do you get “caught up” in certain patterns of thought or behavior that take up a lot of time, and

interfere with your life?

21. Do you frequently “binge” on food, that is, eat to the point of discomfort?

22. Have you ever purged (made yourself throw up) after binging?

23. Do you hide food in your home so that you can secretly eat?

24. Have you used laxatives to get rid of food after binging?

25. Do you exercise excessively (over 1 hour a day) to lose weight? (does not apply to bodybuilders)

Family Psychiatric History

1. Does anyone in your family (related to you by blood) have psychiatric problems? If yes, who are they?

2. Does anyone in the family ever manifest symptoms that you are currently experiencing?

Social History

1. Where were you born and raised?

2. Who were the “parent” figures in your home?

3. Is there anything else I should know about your situation growing up?
                                                          History of Present Illness

1. What is the onset, duration, progress of each complaints?

2. What are the precipitating factors?

3. Do you have late night insomnia, early morning insomnia, midnight disturbance, or normal?

4. Do you have appetite normal or increased or decreased?

5. Does he or she takes care or hygiene?

6. Does he or she wearing according to season?

7. What are the effects on work increase or decreased or no effect?

8. What are the effects on social activities, no effect or increased or decreased?

                     

Suicidal and Parasuicidal Symptoms

1. Have you ever had any problem to do with your mental state of well being?

2. Have you ever seen anyone because of problems with your inner emotional health or sate of

mind?

3. Have you ever suffered from:

 ongoing or severe nervousness

 depression
  extreme prolonged excitement/elation

 an altered sense of reality,

 seeing/hearing things that others couldn't,

 alcohol or drug abuse,

 deliberate self harm, suicide or hospitalisation for any psychiatric illness?

4. Have you ever thought that life was not worth living?

5. Have you felt so bad that you considered ending it all?

6. Have you thought of killing yourself?

7. Have you made any plans of doing this?

3. What is the reason for asking any possible answer?

Psychiatric diagnosis often depends upon the history of the patient including personal psychiatric

history, family psychiatric history, social history, present illness history and social history. Although

there are many sign in critically analyzing patient behavior, tracing the causes of the behavior lie on

the patient or significant other’s report about the patient.

It is important to seek answers to help the client recover from the disease. It will also help the

primary caregiver in planning of care and intervention for the patient’s current condition. The patient

may tell about his childhood times, personal life and other significant information. In explaining why

the behavior occurs, taking a glimpse or history about the patient’s early time will answer the

necessary questions.

Likewise in the movie, the Doctor asks questions about the client’s plan in life. Although there are

some instances that the client does not answer the question directly, the doctor still considers the

information relevant for the patient’s record. There may be some interruptions such as disorientation

and daydreaming of the patient, still there is a communication between the two, making it not so

difficult to plan care.

4. What observation do you have about the client’s behavior?

There are certain behaviors that Susanna possesses in the movie, making her role support the

disorder. She often exhibits spontaneous damaging behavior mainly sexual. This sexual activities are

dangerous because she do sex with a married man, with two people on the same day and with

another individual. She uses denial when asked about promiscuity. She says that a person that is

sexually promiscuous sleep with five or more men.

Another behavior is being risk-taker. She breaks out of the hospital together with a psychiatric

patient, stealing medical files and not taking medications. Spontaneous dangerous behavior is one of

the major signs of borderline personality disorder.

5. Suzanna often exhibits spontaneous damaging behavior that is mainly sexual. Dangerous
sexual activity includes sex with a married man, sex with two people the same day, and with
another individual. Other spontaneous
6. In your opinion, is the diagnosis discussed above accurate?

7. What DSM-IV-TR criteria support this diagnosis?

 Rapid changes in mood, intense unstable interpersonal relationships,  marked impulsively,

instability in affect, and instability in self image.

As indicated by at least five of the following:

1. Going to about any lengths to avoid real or imagined abandonment.

2. Intense unstable interpersonal relationships characterized by changing  between idealization and

devaluation the relationship.

3. Lack of ones own identity. A Marked instability of self image or the sense of self.

4. Impulsively in two or more areas that are self damaging. These may included

abuse, sex, spending, eating, driving reckless, or etc.

5. Recurrent gestures, self mutilation, suicidal behavior, or threats.

6. Instability in affect.

7. Marked feelings of emptiness.

8. Frequent displays of anger due to a difficulty in control.

9. Dissociative or paranoid.
8. Does the client have any other psychiatric disorder? If so list and include supporting DSM-IV-TR?

9. What treatment plan would you outline?

10. With what expected outcomes?