The purpose of this paper is to illustrate a lady with regression and disassociation with multiple psychiatric symptoms. This case highlights the limitations of descriptive psychopathology and the usefulness of psychodynamic psychopathology in explaining and managing the mental phenomena.
Case report: the patient R is a 29-year-old lady. She has been known to the mental health institution since 14 years old. Over the next 15 years, she was admitted 27 times. She had been diagnosed with schizophrenia, bipolar disorder, depression, mental retardation, autism spectrum disorder and dissociative identity disorder. She has been subjected to long-standing abuse by her mother.
Discussion: labyrinthine diagnosis – placing a diagnosis on R proves to be challenging. When R presents with psychosis like and depressive symptoms, she is labelled as having a primary psychotic disorder and mood disorder, respectively. When R regresses to the P or the non-verbal individual persona, she is deemed to have mental retardation and autism spectrum disorder. Furthermore, R’s intelligence quotient was tested to be 65 at 14 years old. However, the intelligence quotient test was not consistent with her level of functioning during her non regressed state and therefore not considered reliable. Explosive and emotional outbursts and a positive family history of bipolar disorder rendered her to be diagnosed with the same. The multiple personas seem classical of dissociative personality disorder. However, the personas seem to exist on a continuum and are not independent of each other. Upon regression, R seems to be fixated at the oral stage. R also reported amnesia of events especially her emotional outbursts, while she was displaying her third persona. Dissociation could have rendered her unable to remember these events.
While the use of descriptive psychopathology is pragmatic and has the obvious advantage of being free from the burden of seeking explanation of the psychopathological phenomenon in a theoretical construct such as the psychodynamic framework, not all patients can be awarded a meaningful diagnosis using such an approach. This case report exemplifies that psychiatric presentation in some patients refuses to be neatly subjected to a useful psychiatric diagnosis using descriptive psychopathology as the diagnostic tool resulting in a confusing array of diagnoses, with each diagnosis representing an isolated facet of the psychological world of the patient while ignoring the rest. Explanatory models of psychopathology such as psychodynamic psychopathology still remain relevant in such cases for both understanding and explanation of the mental phenomena, and devising appropriate intervention strategies.
Conflict of interest: none to declare.
Tay, J., Lijo, A., Wen, B., Zachariah, S. and Lal, M. (2019), "Regression and labyrinthine diagnosis – a case report", Mental Health and Social Inclusion, Vol. ahead-of-print No. ahead-of-print. https://doi.org/10.1108/MHSI-07-2019-0018Download as .RIS
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