CASE HISTORY 1

DEMOGRAPHICS:

Name : L.A
Age : 17
Gender : Female
Education
qualification : High school
Marital status : nil
Occupation : nil

CHIEF COMPLAINT:
• psychosomatic symptoms ( headaches, dizziness, fainting episodes, sadness,
insomnia and lack of appetite), diagnosis of depression-anixety
• engaging in attention seeking behavior
• using sexually provocative behaviors to control others or gain attention
• displaying excessive , shallow emotions

DURATION:
• age of onset - at the age of 16
• course of illness - unstable emotions, desired to be noticed , seductive and
provocative behavior .

HISTORY OF ILLNESS:
L. A., age 17, as a high school student in the city’s technical profile high school where
she studied a mechanic curriculum. She had a rather low grade report and attendance
problems. L. A. would often get observed, both at school, as well as in an informal
and familial environment, through her explosive and provocative behaviour in her
interactions with others. At school, she would manifest contexts where she sought to
be provoked by either her classmates or her teachers, only to realize afterwards that
the drama she had created was meant to attract attention or to delight and impress her
audience. The student was very active on social networks, with large groups of friends
and predominantly posting selfies. Whenever she had the opportunity, she would
manifest herself in a loud and colourful manner: involved in school festivals (often in
the leading part), parties, educational projects, the school’s choir and theatre club, etc.

PAST HISTORY
L. A shared her rape experience , undergone approximately one year before (that also
happened to be her first sexual experience). L. A. claims she spent “maybe half of
life” in and out of hospitals, having been a sick child. the client relates an episode
from her early childhood that marked her, when the mother locked-her up one evening
in the nearby cemetery as a punishment for failing to learn a poem for the school fair
and the the mother frequently telling her “I shouldn’t have had you”.

NEGATIVE SYMPTOMS
• history of suicidal behaviors
• no history of social isolation

PAST PSYCHIATRIC HISTORY BIOLOGICAL HISTORY

nil no
parental consanguinity

FAMILY HISTORY

no history of
family mental illness

17 YEARS
L. A. comes from a shattered family (parents divorced when she was about 5 years old
on account of frequent conflicts described by the mother, aggressed by the alcohol
drinking father) - growing up at the countryside, L. A. and her older sisters were left
with their father, since their mother left the country to work abroad after the divorce
(and then got remarried and had another child); the contact between mother – daughter
and the extend family is unstable and often conflictual. one of the reasons being the
mother would accuse her of flirting with her step-father (L. A. denies the truth of this
accusation, is extremely irritated by her mother’s opinion, that she accuses once more
of being an “unnatural mother” that always ends up by pushing her aside and
abandoning her).

PERSONAL HISTORY
• Physical illness during childhood - been a sick child
• history of substance use – drugs

PREMORBID HISTORY
❖ interpersonal relations – average
❖ hobbies and interest – not mentioned
❖ attitude and work responsibility – poor
❖ habits
• eating pattern- abnormal
• sleeping pattern- abnormal

HISTRIONIC PERSONALITY DISORDER

According to DSM-V 301.0(F60), A diagnosis of a histrionic personality disorder
requires a pervasive and ubiquitous pattern of consistent attention seeking behaviors
and emotional dysregulation as outlined by specific manifestation. People must show
atleast 5 of the following :
➢ Discomfort when they are not the center of attention
➢ Interaction with others that is inappropriately sexually seductive or provocative
➢ Rapidly shifting and shallow expression of emotions
➢ Consistent use of physical appearance to call attention to themselves
➢ Speech that is extremely impressionistic and vague
➢ Self-dramatization, theatricality, and extravagant expression of emotion
➢ Suggestibility (easily influenced by others or situations)
➢ Interpretation of relationships as more intimate than they are

TREATMENT`

• INTEGRATIVE THERAPY
Integrative therapy is an approach to treatment that involves selecting the
techniques from different therapeutic techniques best suited to a client’s particular
problem.
 CASE STUDY -2

DEMOGRAPHICS

Name : Mr. X
Age : 20
Gender : male
Educational
qualification : medical student
Occupational : nil
Martial status : bachelor

CHIEF COMPLAINT
• headache
• loss of awareness
• occasionally fainting
• memory loss
• anxious
• fall from standing position

DURATION
• age of onset – 20
• course of illness – memory loss ( amnesia) of certain time period and violent
behavior.

HISTORY OF ILLNESS
Mr. X is a 20 year old unmarried medical student of second year from a medical
college of northern part of Bangladesh. He was brought to that hospital as he felt from
standing without loss of consciousness and any focal neurological deficit. The patient
had light headache and he used to talk irrelevantly, as if he was a different person.
However, the person later denied experiencing any such events except headache. At
the psychiatry department, he was found to adopt at least three different identities
though he denied having any such events except light headache followed by transient
loss of memory for an episode. However, his friends who witnessed him told that at
that time of illness he claimed himself as the Principal of that medical college (where
the person studied). He commanded others as if; he was the principal during that
episode. At other times, he took either the identity of his Anatomy teacher or of a
trauma victim patient with one leg. Besides, he also took a different identity which
seemed to be the person himself while he was in higher secondary level. The patient
when having original personality was unaware of what he told or how he behaved.

PAST HISTORY
He read primary in the school where his mother used to work and higher secondary
from the school where his father used to work. Mother was very strict and he was
often physically punished by the mother. His friends were not allowed to his place
before he completed higher secondary level. The patient’s mother had harsh parenting
style. Frequent physical abuse for silly reasons was the rule. Neither had she allowed
his friends (patient’s) to come to his home nor did she let the patient go outside in the
evening. Recent life stressors might play the strong role in causation of the disease.
Mr. X was not comfortable with his anatomy batch teacher. He was teased in front of
all, by the lady teacher in her class frequently. He was compelled to sit behind the
girls as a form of punishment. As a result he developed low self esteem. His class
mates used to tease him due to his local (sylhetty) accent.

NEGATIVE SYMPTOMS
• no history of suicidal behavior
• no history of social isolation

PAST PSYCHIATRIC
HISTORY BIOLOGICAL HISTORY

no past psychiatric history no parental

consanguinity
FAMILY HISTORY

No history of family
mental illness

20 YEARS

PERSONAL HISTORY

• birth – uneventful
• early development - unevenful
• no history of substance use
• no history of
• anti-social act

PREMORBID PERSONALITY
• hobbies and interest – not mentioned
• attitude towards others – friendly
• habits
➢ eating pattern – normal
➢ sleeping pattern – disturbed

DISSOCIATIVE IDENTITY DISORDER (DID)

In DSM -5 301.50(F60.4) dissociative identity disorder is described as a disruption of

identity characterized by two or more distinct personality states or an experience of
possession. Diagnosis of DID and major dissociative disorders:
➢ Dissociative amnesia : the main symptom is memory loss that’s
more severe than normal forgetfulness
 ➢ Dissociative identity disorder : this disorder is characterized by
“switching “ to alternate identities.

TREATMENT

➢ relaxation technique
➢ talk therapy
MEDICATION
• clonazepam