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Running Head: PSYCHOLOGICAL EVALUATION

Psychological Evaluation Jennifer Keil University of Missouri-Kansas City April 4, 2017

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Running Head: PSYCHOLOGICAL EVALUATION

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PSYCHOLOGICAL EVALUATION Date of Evaluation: March 1, 2017 Name: Ariel DOB: September 6, 1992

AGE: 25

Race/Ethnicity: Danish Marital Status: Single Occupation: Princess of Atlantica Source and Reason for Referral: Ariel’s father, King Triton, referred his daughter Ariel to identify stealing and hoarding issues and for her disruptive behavior. Ariel has had no psychiatric history before this. There is no known history of mental illness within her family. Assessment Instrument & Evaluative Procedures: Intake interview, mental status exam, intelligence test, personality test, obsessive-compulsive disorder test.

Presenting Concern Ariel lives under the sea with her father, six sisters, and confidant but has, on occasion, become human and lived with her romantic lover above the ocean in a castle by the shore (Musker, 2006). She reveals she spends her time stealing objects from the wrecked ships lost at sea. She keeps all her findings, organized, in her secret cavern and feels emotionally attached to all of them. She reports she seems to disappoint her father on many occasions by not fulfilling her father’s wishes and commands in helping to provide a positive family image in their community. She feels her father is overprotective over her because he doesn’t act that way with her sisters.

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She expresses severe discontent for her mermaid tail. She reported she spends a vast amount of time desiring legs instead of a tail as she observes humans above the surface. She shared she wants to go to extreme measures for the complete removal of her “defective” mermaid tail. She feels these feelings have been with her most of her life but just started to get more intense when she became human for three days. The client’s father reported that the client has engaged in disruptive behavior since a very young age, after discovering the loss of her mother and after discovering human existence and their life above water. Ariel’s father reported deceit; that she lies about not contacting humans. She constantly goes to the ocean’s surface and talks to Scuttle, approaches ships, and interacts with Prince Eric though she denies it to her father. Ariel stated she has engaged in such behavior because “life under the sea is not where she is meant to be, she wants to be where the people are because it makes her happy” and refuses to believe that “such horrible people can create such wonderful things (human objects)” (Musker, 2006). Background Information Ariel has been an independent and determined young mermaid. She spends her days singing, daydreaming, and adventurous. She is the youngest and seventh daughter of King Triton and Queen Athena. Ariel lost her mother at a very young age. Her mother was crushed by a pirate ship, leaving her to grow up without the presence of a mother-figure. Athena’s death (Ariel’s mother) triggered her whole family to be incredibly bitter, apathetic, disobedient, and resentful, especially for Ariel’s father, King Triton. Her father became more bitter towards her because she resembled more of his deceased wife. Ariel has always been interested in other activities, like stealing, that her older sisters do not participate in, thus becoming impossible for her to relate to her older sisters.

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Ariel’s disruptive behavior includes her always putting herself and her friends, Flounder and Sebastian, in compromising situations to excessively gather human possessions (Musker, 2006). Ariel would become distressful when her human possessions were disarranged and not in a certain order. Ariel has been forbidden to go to the surface of the ocean by her father, who claims that humans are barbarians, dangerous, and will hurt her. Ariel constantly argues with her father because she feels that life under the ocean is not where she is meant to be, she states, “flipping your fins, you don’t get too far” (Musker, 2006). She believes there are too many rules, restrictions, and misunderstandings between humans and mermaids. Ariel claimed to have goals, dreams, and lifestyle choices that she cannot pursue because of her father claiming them to be dangerous. Ariel reported that her frustration with her lifestyle has led her to make the choice to leave the sea at any cost. When she became human for a short time, she went to the ocean’s surface, formed a relationship and fell in love with Prince Eric, who asked her to marry her. He is currently waiting for her father’s approval and for Ariel’s permanent physiological change of being a human. Behavioral Observations Ariel displayed disobedience and opposition to authority figures but her behavior includes the more serious forms of behavior characteristic of conduct disorder. Ariel also displayed behavioral symptoms in response to her father’s extensive and strict set of rules with significant impairment but this was not considered a stressor since it’s a parental technique. Ariel presented herself well groomed, oriented in all spheres, with speech, affect, concentration, and thought process unaffected.

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She presented three examples, one of Individuation (Jung), separating herself from collective unconscious (the ideas and beliefs shared by all mermaids) to find her own identity through differentiation (Journal Psyche, 2015) Schema, has her own ideas about the uses for human items because she has never been shown that are used. And objection theory, reduction to appearance, thinks she can only be happy if she changes her appearance (Schneider). Assessment Results Personality Test: 97% Histrionic Personality Disorder Obsessive-compulsive disorder test: 60% Ariel is traumatized by the death of her mother and was forced to grow up in a broken home, under the sea in a castle with six sisters and no mother. Ariel has problems related to her social environment. She feels she doesn’t fit in because of her mismatched fin and seashell top colors. Her father, King Triton’s xenophobia leads to the development of teenage rebellion in Ariel, this rebellion then grows into a fixation. She doesn’t do her duties as a princess while not listening to her father. Constant observations of surface creatures cause Ariel to resent her own predicament. Adventurous, outgoing, rebellious, and is extremely curious about humans, Ariel’s goal in life is to be out of the waters and be part of the human’s world. She clearly has identified a purpose in life and has found meaning. Her impulsive stealing of objects she finds in the ocean, helps her just to feel relief. Ariel will do whatever she can to obtain her materialistic desires. Ariel keeps all the things she finds from the human world in a secret cavern, even if they have no value because they make her happy. After seeing human objects and going to the surface to see human life, she is positive that “a world that makes such wonderful things cannot be bad” (Musker, 2006). She acknowledges that she is a fortunate individual with many treasures and

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acknowledges that anyone in her position would feel like they have everything they could ever wish for. These objects serve as an instant gratification when she discovers them and she is motivated by her desire for more. She has gone against her father’s wishes and rules accepting the consequences of her choices which have included the destruction of her secret cavern, her father’s anger, and being assigned a confidant to follow her around. She has avoided anxiety and guilt that is normal of an individual when lying to her father, leaving home, and living in a strange new world. She has not acted in a conscientious manner or resisted her daimonic urges which result in destructive behavior of sneaking out and moving away from her home, changing her psychological appearance, and gambling her voice and soul to her estranged aunt Ursula. Ariel assumed responsibility for her personal choices of going to the ocean’s surface, living with humans, and leaving her family. Ariel has failed to acknowledge the coexistence of life and imminent death by changing her physiological appearance to be human, which can result in death if her spell would have been reversed. Ariel has made all her choices and decisions based on her love and need to be with Prince Eric. She denied any symptoms of suicidal ideation, hunger, sleep, or eating influences. Diagnostic Impression – DSM V Diagnosis 312.89 (F91.9) Severe Conduct Disorder Unspecified onset 312.32 (F63.2) Kleptomania 313.81 (F91.3) Oppositional Defiant Disorder 300.3 (F42) Obsessive-Compulsive Disorder with poor insight Hoarding Disorder with absent insight/delusional beliefs (disposophobia) 300.7 (F45.22) Body Dysmorphic Disorder with absent insight/delusional beliefs 301.50 (F60.4) Histrionic Personality Disorder

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Summary Ariel lives in an environment with only mermaids around her. There were certain expectations to be upheld and everyone did what they had been nurtured to do. Perhaps her psycho sexual development was not fully successful in Ariel’s life. Maybe one of her early stages was disrupted by the absence of her mother and were not fully filled by her father, or her family. That stressful event could have triggered within Ariel simply trying to cope with her issues. Ariel portrayed aggressiveness by explaining how she threatens and intimidates her close friends, Flounder, into being her alibi and her father’s confidant, Sebastian, into not disclosing her whereabouts. Ariel’s hoarding of human objects, has filled her secret cavern, indicating excessive accumulation. Each object has a certain place in the cavern, which portrays her OCD. She keeps all the things she finds even if they have no value. Ariel becomes unaware of her habits and fails to prioritize properly. She cancels on her father to instead search for lost objects, which leads to family dysfunction and hostility. These objects serve as instant gratification and a source of comfort, when she discovers them and she is motivated by her desire to want more. Ariel’s central psychiatric problem is her hoarding disorder. Ariel will do whatever she can to obtain her materialistic desires. One of Ariel’s major conflicts will be her physiological nature of being a mermaid. She is used to swimming instead of walking, and living in the ocean where it is always cool and dark. The new physiological attributes of being human may bring Ariel adjustment issued in her environment, making her unable to accommodate to human life. Her new bodily functions as a human may pose a new problem instead of being a mermaid and having fins. Being that turning human is an irreversible step in her life, if Ariel cannot adjust to her new life, she cannot just

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simply jump back in the ocean and go live with her family. This might provoke neurotic anxiety and guilt, which may result in pathology. If things do not work out between Ariel and Prince Eric, to the point that they separate, Ariel may have trouble finding a new place to live, new people to have interpersonal relationships with, and carry about in general since she has no idea of how the human world works. Ariel compares her life as a mermaid to lives of humans. Her obsession with joining the human world impairs her normal function, disrupts her routine, and strains her relationship with her family. She was agitated and irritable about the rules imposed by her father, which get in the way of her purpose in life, to become human. Ariel trades her voice for the man she desires. As Freud stated, “All human behavior is motivated by sexuality.” This urge for her to want to change her appearance has caused significant distress and social withdraw.

Recommendations Ar i e lc a ng a i nc on t r olofh e rh oa r d i n gdi s o r de rb ypa r t i c i pa t i n gi nps y c hot he r a p y , i nd i vi dua lc oun s e l i n g ,i nc l ud i ng , c or r e c t i n ghe rf a l s ebe l i e fa bouthe r“ de f e c t i v et a i l ”Ar i e lha sa n a t t a c hme ntt opo s s e s s i onswhi c hi swh a tma k e si td i ffic ul tf orh e rt odi s c a r dob j e c t s , t ha t o t h e r wi s eha v enov a l ue .Thi swou l da s s i s tAr i e li nf oc us i n gonc ha n gi n ghe rt hi nki n ga nd be ha vi ora ndi nr e a l i z i n gt ha ts hene e dst os or tt h r o ug hhe rc l ut t e ra ndd e t e r mi newha tt ok e e p a ndwha tc a nbet h r o wna wa y . Shec a ns t a r tma ki n gpor t i onsofhe rs e c r e tc a v e r nus a bl ea g a i n, f o r e xa mpl e ,g e t t i n gr i doft hr e et os i xt hi n g sada y ,whi l eno ti nt r odu c i n ga n yne wi t e mss hes t e a l s . Th e r ea r et woESTt r e a t me nt sa v a i l a bl ef orAr i e l ’ sbod yd y s pho r i cdi s or de ra ndhe r ho a r d i n gdi s or d e r . Se r o t on i nr e upt a k ei nhi bi t or s( SSRI ’ s )a ndc o gni t i v ebe ha v i or a lt he r a p y ( Ma dd ux, 20 12) . CBTwi t hAr i e lwoul dbe gi nwi t ha s s e s s me nta ndps y c hoe duc a t i ondu r i n g

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whi c hIe xpl a i na ndi ndi vi du a l i z et heCBTmode lofBDDa ndaf or mofCBTf orh e rho a r di n g . Thi swi l li nc l udet e c hn i q ue s , s uc ha s , c o gn i t i v er e s t r i c t i n g , e xp os ur ea ndr i t ua lpr e v e nt i on, a nd r e l a ps epr e v e nt i on( Ha r t ma nn) . Iwi l le mpa t h i z ewi t hAr i e l ’ sbod yi ma g er e l a t e ddi s t r e s si ns t e a d ofdi r e c t l yq ue s t i oni n gt hev a l i di t yofh e rb e l i e f s . Wewi l ldi s c us st hedi s c r e pa nc ybe t we e nBDD s ymp t omsa ndh e rg oa l ’ s . Wewoul da l s oe xpl or ef a c t or si nhe rc ur r e ntl i f et ha ta r es e r vi n gt o ma i nt a i nhe rbod yi ma g ec onc e r ns , s uc ha st r i g g e r sf orn e g a t i v et hou ght sa bouta ppe a r a nc e , i nt e r pr e t a t i onsoft h e s et h ou ght s , e mo t i ona lr e a c t i ons , a ndma l a da pt i v ec opi n gs t r a t e gi e s ( Ha r t ma nn) .Do wnf a l l sf orAr i e li nCBTt r e a t me ntwoul dbehe rh a vi n gl a c kofi ns i gh t , notbe i n g mot i v a t e dt oa t t e ndt r e a t me ntora c c e pti t , orb e l i e v et ha ts hene e dsc os me t i ct r e a t me ntr a t he rt ha n me nt a lhe a l t ht r e a t me nt . Ariel needs to acknowledge and stop dismissing certain crucial emotions, as well as, be guided into repressing her wild impulses. Ariel needs to be able to feel some anxiety and guilt about the choices she is making into making less destructive ones, but not be overwhelmed by these emotions. Ariel must not repress the anxiety and guilt that her rule breaking, theft, deceitfulness, engaging in witchcraft, and leaving her family entails. Family support is very important in the treatment for Ariel. Family members need to understand and learn to recognize these disorder’s signs and symptoms; therefore, group or family therapy would be helpful.

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Re f e r e nc e s

Ame r i c a nPs y c hi a t r i cAs s oc i a t i on( 20 13) . Di agn os t i c al l yandSt at i s t i c alMan ualofMe nt al Di s o r de r s( 5the d. ) . Wa s hi n gt on, DC:Aut hor .

Ha r t ma nn, A. Ph D. , Gr e e nbe r g , J . ,Ps y D. , & Wi l he l m,S. PhD. AThe r a pi s t sGui def ort h e Tr e a t me ntofBod yDy s mo r ph i cDi s or de r .Ov e r v i e wof CBTf orBDDan di t se mpi r i c al t ps : / / bd d. i oc df . or g / pr of e s s i ona l s / t he r a pi s t s gui de t ob ddt x/ s u ppor t .Re t r i e v e df r om:ht

Journal Psyche. (2015). Jung and his Individation Process. Retrieved from: http://journalpsyche.org/jung-and-his-individuation-process/

Maddux, J. & Winstead, B (2012). Psychopathology. Foundations for a Contemporary Understanding. 3rd Ed. Taylor & Francis Group, LLC: Routledge.

Mus k e r , J . , Cl e me nt s , R. , As hma n, A. , Me nk e n, A.Bue naVi s t aHomeEnt e r t a i nme nt( Fi r m) . ( 2 006 ) .TheLi t t l eMe r mai d.Bur ba nk, CA:Wa l t Di s ne yCo.

Schneider, S. Internet Encyclopedia of Philosophy. Identity Theory. Retrieved from: http://www.iep.utm.edu/identity/...