Regression and labyrinthine diagnosis – a case report
| Date | 01 November 2019 |
| DOI | https://doi.org/10.1108/MHSI-07-2019-0018 |
| Published date | 01 November 2019 |
| Pages | 185-188 |
| Author | Jing Ling Tay,Alias Lijo,Bixue Wen,Susan Zachariah,Manu Lal |
| Subject Matter | Health & social care,Mental health,Social inclusion |
Regression and labyrinthine
diagnosis –a case report
Jing Ling Tay, Alias Lijo, Bixue Wen, Susan Zachariah and Manu Lal
Abstract
Purpose –The purpose of this paper is to illustrate a lady with regression and disassociation with multiple
psychiatric symptoms. This case highlights the limitations of descriptive psychopathology and the usefulness
of psychodynamic psychopathology in explaining and managing the mental phenomena.
Design/methodology/approach –Case report: the patient R is a 29-year-old lady. Sh e has been known
to the mental health insti tution since 14 years old. Ov er the next 15 years, she was ad mitted 27 times.
She had been diagnosed with schizophrenia, bipolar disorder, depression, mental retardation, autism
spectrum disorder and d issociative identity d isorder. She has been su bjected to long-stand ing abuse
by her mother.
Findings –Discussion: labyrinthine diagnosis –placing a diagnosis on R proves to be challenging. When R
presents with psychosis like and depressive symptoms, she is labelled as having a primary psychotic
disorder and mood disorder, respectively. When R regresses to the P or the non-verbal individual persona,
she is deemed to have mental retardation and autism spectrum disorder. Furthermore, R’s intelligence
quotient was tested to be 65 at 14 years old. However, the intelligence quotient test was not consistent with
her level of functioning during her non regressed state and therefore not considered reliable. Explosive and
emotional outbursts and a positive family history of bipolar disorder rendered her to be diagnosed with the
same. The multiple personas seem classical of dissociative personality disorder. However, the personas
seem to exist on a continuum and are not independent of each other. Upon regression, R seems to be fixated
at the oral stage. R also reported amnesia of events especially her emotional outbursts, while she was
displaying her third persona. Dissociation could have rendered her unable to remember these events.
Originality/value –While the use of descriptive psychopathology is pragmatic and has the obvious
advantage of being free from the burden of seeking explanation of the psychopathological phenomenon in a
theoretical construct such as the psychodynamic framework, not all patients can be awarded a meaningful
diagnosis using such an approach. This case report exemplifies that psychiatric presentation in some
patients refuses to be neatly subjected to a useful psychiatric diagnosis using descriptive psychopathology
as the diagnostic tool resulting in a confusing array of diagnoses, with each diagnosis representing an
isolated facet of the psychological world of the patient while ignoring the rest. Explanatory models of
psychopathology such as psychodynamic psychopathology still remain relevant in such cases for both
understanding and explanation of the mental phenomena, and devising appropriate intervention strategies.
Keywords Regression, Dissociation, Defence mechanism, Dissociative identity disorder
Paper type Case study
Introduction
Regression is an unconscious defence mechanism (Freud, 1989). It can be precipitated by
anger, fear and insecurity. It helps individuals feel safe by allowing them to return to an earlier
phase in their development. It has been described in patients with cancer (Straker, 1998) and
case report (Tarazi, 1990).
Dissociation is a psychological defence mechanism, which usually results from trauma.
Dissociation allows an individual to detach from reality and stay in a different world where the
situation, thoughts and feelings are more bearable (Bromberg, 2003).
In this case report, we present a lady with a myriad of diagnosis that can be explained with
regression and dissociation. This history comes from R, her brother and several professionals. Conflictof interest: none to declare.
Jing Ling Tay, Alias Lijo,
Bixue Wen, Susan Zachariah
and Manu Lal are all based at
Institute of Mental Health,
Singapore.
DOI 10.1108/MHSI-07-2019-0018 VOL. 23 NO. 4 2019, pp. 185-188, © Emerald Publishing Limited, ISSN 2042-8308
j
MENTALHEALTH AND SOCIAL INCLUSION
j
PAG E 18 5
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