Reference no: EM133668689

Personality Disorders Case Study

A 23-year-old woman comes to see the general practitioner with her mother. She has been married for four years. Her mother has brought her because she was in two minds about whether to come. She is worried that it may make the problem worse. The GP realizes quickly that he is going to need more than 10 minutes and has one other patient left. He sees this other patient first in another consultation suite and returns in order to give more time for the discussion. The woman is in tears when he returns and describes that she loves her husband but that he is very possessive of her, and has never been happy for her to go anywhere without him. He works on a computer during the day at a large insurance firm. Despite having trained at college in Child Care she is not currently working, mainly because her husband made it clear when they married that he wanted to be the main breadwinner and did not wish for her to work. He likes to stay in and watch television, and will usually drink a few cans of lager 3 or 4 nights a week. He does not usually drink to excess.

She stopped her hobbies such as Salsa lessons and going out with friends when they started seeing each other, about three months before they got married. He used to accuse her of flirting if he ever saw her laughing or smiling with any other man and she began to restrict who she spoke to as a means of avoiding this. She explains that about 6 months ago her best friend, who he never really liked, began encouraging her to go out with a group of four old school friends that meet at a Line Dancing group and go for a drink and meal afterwards. Her husband was not keen, but let her go. When she returned he was very suspicious and asked her numerous questions about what she had been doing and whether she spoke to any other men. She considered not going any more, but with the support of her best friend and mother, decided that she was doing no harm and that he may get used to the idea. She went on four more occasions. On each occasion when she returned he insisted on examining her underwear and was aggressive and abusive calling her offensive names. After the most recent occasion he threw the contents of all her drawers around the bedroom and forced her onto the bed shouting in her face. She says she has never thought of involving the police.

She does not know what to do, because she feels that if she never goes out she will feel trapped, but she cannot cope with his levels of suspicion and hostility. She thinks he needs help but does not know what to do next. The woman's mother says that she has always been a quiet girl and endorses her daughter's assertion that she has never been nor would she ever be unfaithful. The mother says that her son-in-law can be sociable and charming, but has always been controlling of her daughter. He has superficial friends but no-one visits the house and he does not visit anyone else so far as they are aware. He will sometimes have a drink with a work colleague on the way home, but never invites his wife and has not brought this friend home.

• What are the possible causes and diagnoses?
• What treatment(s) will you choose for this patient?
• If you choose a pharmacological intervention, write out the prescription for your choice.
• What teaching information is important for this client? Think about common and serious side effects.
• What are your follow-up plans?