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Case 21 - The woman who has always been out of control

Published online by Cambridge University Press:  19 October 2021

Stephen M. Stahl
Affiliation:
University of California, San Diego
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Summary

Patient Intake

• 30-year-old woman diagnosed with long-standing schizoaffective disorder, bipolar type, polysubstance abuse in remission in a controlled environment and with premorbid childhood onset PTSD, borderline intellectual functions, and antisocial personality disorder with borderline features

• Has carried the diagnosis of PTSD related to childhood sexual and physical abuse by her father

• Juvenile and adult criminal activity and poor school performance, with cognitive testing showing cognitive and memory abilities in the borderline range

• Difficulty managing anger since age 13, longstanding impulsiveness since age 13 with psychotic illness since age 16 associated with irritable and depressed moods, auditory hallucinations (some in her father's voice) command hallucinations to harm herself, ideas of reference and persecutory ideation

• Numerous psychiatric hospitalizations, self mutilatory behavior including cutting and swallowing behaviors (e.g., keys, other objects)

• Convicted of arson and while imprisoned assaulted a prison guard but found not to be criminally responsible by reason of insanity and transferred to a forensic facility

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Publisher: Cambridge University Press
Print publication year: 2011

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