- Create an outline in which you address the following items:
- Define the major DSM IV-TR categories of anxiety, somatoform, and dissociative disorders.
- Examine the various classifications of anxiety, somatoform, and dissociative disorders.
- Submit separately.
- Select one of the case studies from Ch. 3, 4, or 5 located in Case Studies in Abnormal Behavior (otherwise, paper will not be accepted/graded).
Prepare a 700- to 1,050-word analysis of your selected case in which you address the following items:
- Provide a brief overview of your selected case.
- Analyze the biological, emotional, cognitive, and behavioral components of the disorder from your selected case.
- Submit separately.
Format your paper consistent with APA guidelines.
Case Study:
Anna (actually Bertha Pappenheim), an unmarried 21-year-old woman from a prominent Jewish family in Vienna, first consulted with Breuer at the end of November 1880 with the initial complaint of a persistent cough. Breuer used hypnosis to elicit memories to reconstruct the events that led up to referral. This included Anna’s reaction to childhood and, more recently, to her distress around caring for her father while his health gradually failed. In July 1880, he developed a pleuritic abscess, probably caused by tuberculosis—the possible cause of Anna’s symptoms as well.
As is often the case with seriously disordered individuals, any success and/or acceptance of the initial complaint allows elaboration into numerous allied symptoms—in Anna’s case, vision and hearing problems, neck weakness, headaches, and anesthesia of her right arm and leg. She then became mute for two weeks, and soon thereafter revealed two distinct personalities that apparently switched back and forth without warning. Anna’s first, or usual, personality was a bit melancholy, in part because, as is common with MPDs, she experienced gaps in consciousness, mood swings, and even possible hallucinations. As is also often the case with MPDs, the second personality has a more antisocial quality, what Anna termed “naughty.” It was also often abusive toward others, and occasionally generated odd, rebellious behaviors, such as tearing buttons off of bedclothes. After Anna’s father’s death on April 5, 1881, she (1) stopped recognizing anyone except Breuer, (2) would communicate only in English (her second language), and (3) would eat only if fed by Breuer. As is evident, this first Freudian was hardly orthodox in his therapeutic technique. Each and every day, Anna would become somnolent in the afternoon (probably autohypnotically), and after sunset, Breuer would formally hypnotize her or she would do the autohypnosis, and would then recount her hallucinations/dreams of that day and then awaken “calm and cheerful.” Yet, Anna’s condition worsened, and she became suicidal. On June 7, 1881, she was moved to a house outside Vienna, where she could be monitored more closely. Breuer now visited her most days, occasionally resorting to pleading to get her to talk. She would sometimes talk only after thoroughly feeling Breuer’s hand to make sure it was him, asserting she could not recognize him visually. Though her symptoms had at first worsened, they now calmed somewhat—Anna attributed this to the “talking cure” of reliving her memories under hypnosis—and Anna moved back to Vienna. However, Anna’s personalities again changed more dramatically, and Breuer could now elicit a personality shift by showing her oranges (the only food she would eat during the first part of her illness). It was in this period that after avoiding water for six weeks, Anna, while hypnotized, recalled her disgust when she saw a dog drink from a water glass. When she awoke from the hypnosis, her hydrophobia disappeared. Breuer now had the insight to recognize this as catharsis, a basic principle of psychoanalytic technique, and systematically used it on her many other symptoms. Most disappeared, and in the process Breuer discovered they had all started the summer her father fell ill. Breuer and Freud later theorized that Anna’s feelings about this had been “strangulated” (later termed “repressed”), only to come out later in her various symptoms, and then relieved by “insight” as well as “working through” by analyzing dreams and talking into “abreaction,” and eventual catharsis, bringing
a cure. Though many of these symptoms cleared, Anna’s alter personality appeared again in the spring of 1881, something Breuer called a “disagreeable event.” Breuer last saw her in June 1882 and stated that she now enjoyed “complete health.” But, possibly reflecting his Victorian ethics, or his pride, or his reported panic, or all three, he neglected to note that in their last session, Anna had told him she was pregnant with his baby. After calming her down by inducing a hypnotic trance, Breuer arranged for his own immediate departure to Venice with his wife for a second honeymoon. Anna was not pregnant. Freud later used his belief that Breuer had misunderstood Anna’s sexual attraction to Breuer to develop his concepts of transference and countertransference. She “was institutionalized for a year following her therapy with Beuer” (Larson et al., 2007). Documents were later obtained from Anna’s file at the Bellevue Sanatorium in Kreutizlingen, where she had been hospitalized in July 1882 for morphine addiction, indicating periodic inability to speak German (her first language), absences of consciousness, and feelings of “time missing.” Anna also showed two separate personality states at least five years after termination.
Consistent with the concept that abuse is often (though not always) found in the histories of those who later manifest MPD, there were indications that Anna had been sexually abused, and that she was certainly emotionally abused by her mother. As an adult, she showed a consistent preoccupation with as well as active efforts in her social work career against Jewish men who abused women. Some believe that Anna was also generally emotionally abused, in that her needs to be independent were stifled by her father, by the family’s Orthodox Jewish practices, by her mother and brother who eventually excluded her even
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