Читать книгу Dynamic Consultations with Psychiatrists - Jason Maratos - Страница 28

Ms. B has had a stormy relationship with her boyfriend ever since they started courting when they were Form 3 classmates (7 to 8 years previously). Over the years, they broke up many times and, in between, Ms. B also had many short‐lived relationships. Ms. B would throw temper tantrums and employ self‐harming behaviors when she expected to be abandoned by her boyfriend. In January 2018, they reunited. The couple agreed that they would not lie to each other, and there would be no personal privacy in the relationship. Her boyfriend promised that he would not do anything harmful to her. Ms. B also treated her boyfriend better as a kind of compensation.

However, later, Ms. B searched her boyfriend's smartphone and found that he had sent WhatsApp messages to two female colleagues with flirtatious content. Ms. B was so angry that her boyfriend was not totally loyal to her. Upon confrontation, instead of explaining the meaning of the suspect WhatsApp messages, her boyfriend would linger on her past maladaptive coping and unstable emotions. He labeled her mentally ill. She was dissatisfied with her boyfriend's response, implying that she was the only one who should bear the responsibility for their disharmony. She slashed her wrist to get the painful feeling and to remind herself that she did not treat her boyfriend well at the beginning. She had poor sleep when she ruminated about her boyfriend's WhatsApp messages. In the previous month, Ms. B had two episodes of drug overdosing and one episode of climbing at the edge of a high slope. She had left a suicidal note to her family. Yet, Ms. B denied a pervasive depressive mood. She still enjoyed part‐time work as basketball match referee assistant. Her self‐care and hygiene were satisfactory.

On the day of admission, Ms. B reported that she and her boyfriend had been arguing from morning to night. She had discovered in WhatsApp a message in which her boyfriend had asked his friends' opinion whether he should send a bunch of flowers to his former girlfriend. She calmed down a little after an afternoon nap. The couple later went out and met their shared friends. Ms. B consumed two bottles of apple cider and became emotional again. She scolded their friends as she felt that they were colluding with her boyfriend for his unfaithfulness. She cried loudly and threw an empty glass bottle on the floor. She impulsively banged her head on a lamppost and hit the gate of a street shop. She also attempted to rush into the traffic but was stopped by her boyfriend. Later, her father and maternal aunt were called for help. She hid in a restaurant's toilet and expressed negative ideas to relatives: “You will regret this…. you can never find me; this will be the last time that you saw me.” Ms. B was subdued by father and was eventually sent to casualty.

There was satisfactory self‐care and hygiene, and she was cooperative and respectful to the staff. Her mood was stable; she was not overly depressed and presented with congruent affect. Her speech was coherent and relevant, and she freely shared her feelings. She was not psychotic, suicidal, or aggressive. She had mixed feelings toward her boyfriend with grievance and guilt. She showed no psychomotor retardation.

Ms. B was physically fit. There were many old slash marks over the volar aspect of both wrists. There was a tattoo (with the boyfriend's name) on her right thumb.