Descriptive Psychopathology: The Signs and Symptoms of ...

144 Section 3: Examination domainsdepression at age 8, a second at age 11, and then many episodes of depressionand mania afterward. Her depressions were characterized by profound anergiawith social isolation, despondency, and apprehension. In later episodes, hallucinatedvoices encouraged her to kill herself. Her manias were characterizedby irritability and grandiosity.In her late teens she drank alcohol heavily, but after age 20 she rarely drank.She denied all illicit drug use. Her father was an alcoholic. Two of her threebrothers were alcoholic. Her mother had manic-depression, as did severalmembers of her father’s family. The patient had no significant general medicalproblem, and never had a head injury. Her development was normal, but herperiods were never regular, and she had been taking five-day courses ofprogesterone every three months for many years to induce them. She showedno other signs of an endocrinopathy or developmental problem.Since her teens, the patient suffered from migraine, ranging from one toseven monthly. Her headaches often began with scotoma, but at other timeswith a panoply of sensory experiences. Her headaches began over the righttemple and then generalized. Associated nausea and photophobia often incapacitatedher for a day or more. Her mother also had migraine.Beginning in her late teens, the patient began to experience multipleepisodes of hallucinosis usually lasting a few minutes. When looking in themirror in the morning, and occasionally at other times, she sometimes clearlysaw that she had a different person’s face. Sometimes she experienced greatanxiety before seeing the image, but not always. At other times she saw“ghosts”, vague shadowy ominous figures walking to and fro in front ofher. She also saw “bugs” that sometimes looked “real” and at other times like“sci-fi creatures”. The bugs sometimes covered her body. She could feel as wellas see them. These experiences were often preceded by headache differentfrom the migraine, sudden anxiety, a feeling as if intoxicated, or intense totalbody skin discomfort leading her to remove her clothes. Sometimes she fell tothe floor for no apparent reason, but only recalled losing consciousness twice.At other times she lost periods of time, usually for several minutes, but shebelieved one or two lasted for “weeks”. Many of her longer memory lapsesoccurred during an exacerbation of her mood disorder.Because of her erratic moods her job history was poor. When describingher changing moods, some of her sensory experiences and time losses to anemployment counselor, she was advised that she had multiple personalitydisorder. When she saw this phrase in a note by her psychiatrist she concludedthe diagnosis was confirmed. Based on the different faces she saw in the mirrorand the frequency of time losses, she estimated that she had 140 differentpersonalities and gave names to those faces in the mirror that recurred.