Personality Disorders

The Case of Cathy

Cathy is a 32-year-old, divorced, heterosexual African American female. She came to her first initial intake session with complaints of depression with passive suicidal thoughts, anxiousness, and trouble sleeping. She presented as casually groomed, coherent, and goal directed. Cathy’s primary concern was that she has been having episodes 3–5 times a week during which she reported she cannot breathe, her heart feels like it will explode, and she feels like the “walls close in.” She stated that this has been going on for about a year, but lately it has been getting worse. She self-referred after being prompted by her sister to contact a social worker. The following is a summary of the initial appointment and assessment for Cathy.

Cathy is the oldest of four children (two brothers and one sister), all of whom are married and live in the same community. Cathy works in a doctor’s office and lives in a one-bedroom apartment where she often “isolates.” She is the primary caretaker of her mother, who was involved in a car accident 20 years ago and was left a quadriplegic. Cathy goes to her home daily to help with her personal hygiene.

Cathy has an arrest history and was incarcerated for 3 years for drug-related charges. She was charged with possession and intent to distribute. Cathy stated that at that time she was addicted to heroin and using daily. When she completed her prison sentence, she was paroled and mandated to attend a 1-year outpatient drug treatment program, which she successfully completed. Cathy reported that she started using cocaine 2 years ago, stating that it helps her do her fast-paced job better and it keeps her energy up so she can help her mother early in the morning and late at night. She said no one in her family or at her job knows that she has been doing drugs. She drinks alcohol daily (two to three drinks). Cathy also takes numerous medications prescribed to her by her primary care doctor, including an antidepressant and pain medication.

As we discussed her presenting concerns, multiple issues came up. Cathy shared her feelings about being her mother’s primary caretaker, stating, “I love my mom, but everyone expects me to care for her. It feels so unfair, but it’s because I am not married and don’t have any children.” She said her father does not help with the care of her mother and that all he does is “hang out.” She reported feeling increasingly frustrated with this added responsibility and resentful that her father and siblings have relegated this job to her. She was dysphoric as she shared this content and described some shame at being “stuck.” She described her father as a “manipulative loser.”

She also stated that she recently allowed one of her brother’s friends to move in with her as a favor because he was homeless and had nowhere to go. She said she believed he was a sweet person who just has had a hard time in life, and she wanted to help him. She had been supporting him financially over the last month, and she was concerned because it appears that he has not made any effort to get a job. She feared she made a mistake allowing him into her home and worried she will not be able to get him to leave.

Cathy said that she and this new roommate had sex one time when he first moved in. She said they both got very intoxicated, and she is not sure exactly what happened, but she blacked out and found him in her bed, undressed. She then told him she had herpes, and he responded that it had been a “mistake” and that he did not want to have sex with her again because he was afraid of getting infected. Cathy became angry with him at this. Cathy explained that her ex-husband’s cheating had resulted in this lifelong disease, and she expressed anger and resentment toward him. She said even though the herpes is controlled with medication, she feels embarrassed and fears she will never have another healthy relationship. She said she feels used, slighted, and humiliated by the man now living in her home.

Cathy then shared that when she was 12 years old her father began molesting her. She stated that she tried to forget what happened to her, but this recent incident with her new roommate brought it up again. Cathy complained of recent nightmares related to the abuse and exaggerated startle reactions to other people’s movements.

Adapted from: Plummer, S.-B., Makris, S., & Brocksen, S. (2013). Social work case

studies: Concentration year. Baltimore, MD: Laureate Publishing.