Chapter 13. Case “A” (3)

Developmental history)
A’s father is working for the local government and her mother was a house wife. A has a brother three years younger than she. Her mother is emotionally labile and very domineering, whereas her father is a quiet man who usually follows the decisions of his wife (i.e., A’s mother). A was a very obedient child who did not require much care (at least as her parents thought). There was no overt episodes of abuse in A’s childhood. Her parents were more preoccupied with her wayward younger brother who needed much attention and disciplining. In A’s mind, however, she felt lonely and abandoned by her parents who were “so much busy caring for” her younger brother. (It was found later that she used to conjure up an imaginary friend when she felt especially lonely in her childhood.)
In her elementary and junior-high school periods, A was a very good student who excelled academically in the classes. Her parents got use to assuming that she is always a model student. A was meeting her parents’ expectation without much difficulty until she entered a prestigious high school, where she found it much harder to remain a all A student any more. A began having episodes of “syncope” as a cry for help, but her parents never took it seriously. A’s school record started to decline which scared A, as she felt that she was no longer lovable as she is no longer a model student. Her academic failure also surprised her parents who suddenly became very watchful and controlling about her school performance. They mainly blamed A for her “laziness” and “playing sick”, which deeply disappointed A. She felt it pointless to stay a hard worker and remain a good child, and stopped communicating with her parents any more. A then chose to enter a college away from her home town, so she can live legitimately away from her parents. Her parents were very reluctant to pay for her apartment, and she needed to work for a local fast-food restaurant to pay for a part of her rent.
Initial case formulation)
A had an adjustment disorder due to her interpersonal stress in the welfare office, and showed a feature of borderline personality organization characterized by her low self-esteem and self-injurious tendency. Although no obvious past history of trauma was indicated, serious emotional stress in her childhood could have been present, partly suggested by her dissociative pathology, and also by her parent’s extreme anger and hatred toward A was unusual. Dissociative problem which later became a problem was not quite obvious in the initial assessment.