Posted: April 10th, 2015

Case Study- Kathy

Case Study- Kathy

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Vignette 1:  Kathy

“Kathy” is a 29 year old white married female who after having taken an overdose of sleeping pills in her home, was discovered by her husband and admitted to a hospital. This overdose was attributed to her inability to cope with her responsibility as a wife and mother. The husband reported that several times he had found food burning in the oven. On one occasion the patient was saved from a fire in the home but was unable to recall how it started. The patient also denied ever having had a sexual relationship with her husband, although she was the mother of his three children.

The patient’s early development was uneventful except for temper tantrums and nightmares. The nightmares began at about age three when the parents would entertain in their home leaving the child to cry for hours. She would eventually fall asleep only to wake up frightened and screaming.

At age four, she had her first traumatic experience. One night she found her father naked in bed with her five year old neighbor. She said that she was stunned with fear and surprise and ran away to her room. Her father followed her and gently persuaded her to take off her clothes and to join him and the other girl in their sexual play. Later, alone in her room, she felt guilty and cried for several hours, denying to herself what had taken place, and only got relief when she attributed what had happened to someone else, whom she called “Pat.” The second day when approached by her father and the girl, she insisted on being called ‘Pat.” Also, she continued to engage in oral sex with the father, for nearly five years.

At age nine she experienced her second traumatic event, when her mother caught her with her father. The mother became angry with the father, wept for some time and insisted on taking her daughter in her bed every night. After a short time, the mother became attached to her daughter sexually in what the mother described as a safer relationship. “Kathy” could not accept this, denied to herself what was happening and attributed it to a new person, “Vera”, who continued the relationship with the mother for another five years.

At age 14, she suffered her third traumatic experience. This was rape by an older man, who was her father’s best friend. “Kathy” became very depressed, called herself “Debby” and slept away from the mother. At that time, she was described by the parents as being very miserable. She became mute and was admitted to a hospital. According to the hospital records, she showed a mixture of depression and trance-like symptoms, with irritability and extensive manipulation
which caused confusion and frustration among the hospital staff.

Following discharge she was seen by a therapist to whom she became very attached. He showed marked curiosity about the different personalities and became fascinated with her case. He suggested hypnosis as a treatment for her condition. His hypnotherapy sessions focused on the rape incident. He felt that “Debby” was the strongest of the personalities.
Instead of concentrating on “Kathy”, he encouraged “Debby” to dominate the therapy sessions and talk about “Pat” and “Vera”, reinforcing their roles as dominant personalities. It was at this period, she terminated her therapy and began to call herself “Kathy”, “Pat”, “Vera”, and “Debby” at different times.

At the age of 18, she made another suicide attempt which resulted in admittance to a mental hospital  It was there she met her husband who was also a patient there due to an attempt to take his own life.

This case study is based on a paper presented in the JIMA (Journal of Indian Medical Association) by Abdel-Aziz A. Salama, M.D in 2005.