Psychological Assessment of Nina Sayer, The Black Swan Lisa Pinkerton PSY-215-Q3847 Southern New Hampshire University

CASE STUDY

Name: Nina Sayer Date of Evaluation: 02/01/2015
Date of Birth: 01/01/1992
Age: 23 years, 1 month

PURPOSE FOR EVALUATION: Nina Sayer is a 23 year old, single, white female. She is the lead ballerina in a prestigious New York Ballet Company. She has been under an intense amount of stress due to the pressures of her job and her demands from her ballet director. She suffers from hallucinations and paranoid delusions. She describes her delusions and hallucinations as bizarre and sometimes violent. She has trouble recognizing what is real and what are her delusions and hallucinations. After struggling to get the role as the white swan in Swan lake, she is extremely paranoid and afraid that someone is trying to take her lead role in the ballet. She focuses this paranoia on a particular ballerina named Lily. She is extremely thin and shows signs of an eating disorder. She uses purging as a way to control her weight. Nina also has scars on her shoulders from self- mutilation. She seems very shy, reserved and almost childlike, but has moments of being very dark and reckless. This dichotomy in her personality causes her great distress. She feels she is under extreme pressure to be perfect for her mother and others. This obsession with perfection and her feeling of losing control is a major factor in her psychotic breakdown.

BACKGROUND INFORMATION:
Educational:
The educational level of Nina Sayer is unknown.
Social/ Emotional: Nina has no friends and has difficulty making friends because of her extreme shyness and work schedule. Any free time she has is spent with her mother.
Family History:
Nina lives with her mother. Her father is unknown. Her mother, Erica, is an ex- ballerina that lives vicariously through Nina. Her mother blames Nina for ending her ballet career, which causes Nina to carry a lot guilt and pressure to be perfect because she does not want to disappoint her. She says her mother is controlling, smothering, and treats her like a child. Nina says her mother is obsessed with her which makes her uncomfortable. She mentioned her mother would sometime slip into her room at night to watch her sleep. Nina's mother believes that Nina is not acting like herself and is beginning to crumble under the pressure of the job.

Medical History and Psychological History:
Nina does not have any history of psychological or medical issues prior to this incident

PSYCHOLOGICAL ASSESSMENT

The movie Black Swan is a psychological thriller about a woman's descent into madness. It revolves around the character Nina Sayer, a very complex woman, who is a shy, fragile, soft spoken young ballerina that suffers from low self- esteem and is obsessed with perfection. Her desire to be flawless, at all cost, would eventually cause her death. She lives with a controlling mother, Erica, who is an ex- ballerina that gave up her career to give birth to Nina. Erica uses this sacrifice as a way to manipulate and guilt Nina into control. Nina's desire to please her mother and appease her guilt lead to her obsessive pressure to be perfect. When she is offered the lead role in Tsychaikovsky's Swan Lake, she was told she would have to embraced her dark side, the black swan, and let go of the illusion of perfection. She struggles to maintain the sense of control while discovering the dark side within her. This causes great internal conflict for Nina. It is the inability to accept her internal dichotomy that drives her into fatal psychosis.
Nina's behavior would fit into a few different disorders. She begins the movie exhibiting symptoms of having an obsessive compulsive personality disorder and anorexia nervosa. Her desire to be perfect could be linked to both of these disorders. In an article discussing multidimensional perfectionism and personality disorders, researchers say that there is a connection between perfectionism and the diagnosis of certain disorders such as anorexia nervosa and obsessive compulsive disorder (Ayearst, L et.al., 2012). Nina also has low self- esteem, which is exacerbated by her rigid perfectionism. She, as with all perfectionists, has a tendency to have unrealistic standards, is highly critical of oneself, and believes it is either success or failure, having no middle ground. By having these high standards, the perfectionist, often suffers from negative consequences such as low self- esteem, guilt, shame, and feelings of failure (Hamachek, D 1978).
Nina believes one way to maintain her illusion of perfection is to maintain control and this manifests in an obsessive compulsive personality disorder. This disorder is described as a preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness and efficiency (Psych Central, 2014). People with OCPD also have an excessive devotion to work which can interfere with their social and family life (Van Noppen Phd., B. 2010). Because of Nina's desire to be perfect, she practiced excessively and made little time for anything else. Nina's low self-esteem and the controlling pressure from her mother could be a contributing factor in her OCPD. Her rigid perfectionism was a way to prove her self -worth and appease the guilt imposed by her mother. Another symptom of obsessive compulsive personality disorder is feeling upset or unbalance when the order is disrupted. This symptom is represented in Nina's inability to accept her ballet director's request to find the perfection in the imperfection. This is the beginning of her unraveling. Nina's job as a ballerina and the pressure to maintain a dancer's body played a factor in her eating disorder. She used restricted eating and purging to control her weight. The DSM-V criteria for anorexia nervosa is a distorted body image, restricted intake of food, and fear of becoming fat. This is evident when Nina was afraid to eat the cake her mother had bought to celebrate and by the minimal amount of food she ate throughout the day.
Nina's perfectionism and low self-esteem could be another factor in her eating disorder. Researchers at Trinity Laban Conservatoire of Music and Dance study how perfectionism, self-esteem and eating disorders correlate among dancers. They found that perfectionists dancers with low self- esteem suffered greater anxiety and were at risk of developing an eating disorder. (Nordin-Bates, S,. et al, 2011). They also suggested that perfectionism and eating disorder were exacerbated during periods of stress (Nordin-Bates, S,. et al, 2011).
Although she showed signs of other disorders, schizophrenia, a brain disorder in which causes a person to lose touch with reality, would be her final diagnosis. For a person to be diagnosed with schizophrenia, they must meet the specific criteria. According to the DSM-V, They must have two (or more) of the follow symptoms must be present for a period of a one month . At least one of these should include, delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, or negative symptoms. Nina experienced persecution delusions. She believed that another ballerina was trying to steal her part. She also had bizarre and sometimes violent hallucinations. In criterion B, social/occupational dysfunction, the symptoms would have to interfere with one or more major function such as work or relationships. Because of Nina's psychosis, she was having difficulty concentrating on her work. She was breaking down and beginning to spiral out of control. She would also meet criteria C, disturbance persist for at least six months. Because of the elimination of subtypes and implementing a dimensional rating scale of an individual symptom in the DSM-V, Nina sayer would be diagnosed as having schizophrenia at a level 4, especially regarding her hallucinations and delusions.

Diagnostic Impressions- DSM-V 301.4 Obsessive Compulsive Personality Disorder 307.1 Anorexia Nervosa 295.90 Schizopherina Level 4

Treatment recommendations:
1. Psychiatric hospital for observation and therapy.
Because of Nina's complete psychotic breakdown, she would not be able recognize she was in need of help. She would need others to take control. Nina would need emergency involuntary hospitalization, or commitment. This would be done in an effort to protect Nina and possibly others from harm. By committing Nina to a psychiatric hospital, doctors would be able to monitor the Nina's condition, medication, and progress.

2. Antipsychotic and anti- anxiety medication. A neuroleptic , such as thorazine, would benefit Nina because this type of medication helps reduce the symptoms of hallucinations and delusions (Whitbourne, S. 2000). She would also need an anti- anxiety medication to relieve some of the anxiety associated with her recovery.
3. Cognitive behavioral therapy Cognitive behavioral therapy Nina find strategies to cope with her disorders. It would teach her how to recognize and reframe her dysfunctional thinking.

References

Ayearst, L., Flett, G., & Hewitt, P. (2012). Where is multidimensional perfectionism in DSM-5? A question posed to the DSM-5 personality and personality disorders work group.Personality Disorders: Theory, Research, and Treatment, 3,4, 458-469. Halgin, R., & Whitbourne, S. (2000). Schizophrenia Spectrum and Other Psychotic Disorders. In Abnormal psychology: Clinical perspectives on psychological disorders (7th ed.). Boston: McGraw-Hill.

HamacheCk, D. E. (1978). Psychodynamics of normal and neurotic perfectionism. Psychology, 15, 27-33.

Nordin-Bates, Sanna M. , Walker, Imogen J. and Redding, Emma(2011) 'Correlates of isordered Eating Attitudes Among Male and Female Young Talented Dancers: Findings From the UK Centres for Advanced Training', Eating Disorders, 19: 3, 211 — 233

Psych Central. (2014). Obsessive-Compulsive Personality Disorder Symptoms. Psych Central. Retrieved on February 25, 015, from http://psychcentral.com/disorders/obsessive- compulsive-personality-disorder-symptoms

Tandon, R., et al., Definition and description of schizophrenia in the DSM-5,Schizophr. Res (2013) http://dx.doi.org/10.1016/j.schres.201305/028
Van Noppen,Ph.D., (2010). International OCD Foundation. Retrieved form http:// www.ocfoundation.org/ uplaodedfiles/maincontent/find- help/ocpd%20fact% 20%sheet.pdf