Nina Sayers Case Study

Nina Sayers is known as a timid, fragile childlike Caucasian female in her mid-twenties, currently working as a ballerina for the ambiguous New York Ballet Company. Most of her daily activity consist of improving her abilities as a ballerina. If she is not at the academy practicing she is at home practicing or doing anything to make her reach perfection. She is a talented ballerina with great potential, who strives for perfection in every aspect of her life. Her greatest desire is to become a prima ballerina. Nina currently lives with her mother, Erica Sayers. Her mother is controlling. She controls every part of Nina’s life, from undressing her to cutting her nails. She tries to keep her from the outside world, and when it comes to a father, he is not existent. In regards to her mother, it is understood that Nina has no close friends or social support in her daily life and even at the ballet company. Nina’s physical appearance is also very worrisome. She is visibly underweight and has apparent scratches, bruises and cuts on her body. She also has gruesome wounds on her feet, which probably occur from her rigorous time sent dancing, and the amount of stress and pressure

it puts on her physically and mentally. Most of her physical problems are seen as if they are self-manipulated, but she denies doing any of these things to herself.
Nina Sayers has come to my office today for an assessment. Many of the ballerinas dancing with her in the ballet and even her mother have been concerned with her behavior over the past six months since she took on the role of the swan queen. They all believe she has been acting out of character over this period of time. For example, her mother explained that when she asked Nina what happened to her sweet girl, Nina replied with “she’s gone” (Aronofsky & Avnet, 2010). Her problems have made her personal and work like dysfunctional. She has been late for multiple rehearsals and has made a big disturbance among her co-workers. After assessing and gaining knowledge on her life, the role she was given and what it all means to her, I now understand that these external conflicts and disturbances her peers are experiencing are internal conflicts coming to life.
Nina Sayers, being the great ballerina she is, is given the challenge of playing the prominent role of the Swan queen in the ambitious play of “Swan Lake” by Pyotr Ilyich Tcahikovsky. This part requires her to play both the white and black swan, which both have two different personalities. The white swan represents the good, while the black swan represents evil. Nina has the ruthless task to break free from her timid, innocent reserved life, and change into a sensual adult like woman, which ultimately brings conflict into her daily life among herself and her peers. When Nina obtains the role of the Swan Queen, she is confronted with overbearing pressure and abuse from home and work. Nina explains that ever since she gained the role of the swan queen, her everyday life is a battle between the white and black swan. She has a hard time deciphering between what is real life and what is the play. She puts all of her time and effort into embodying a different personality than her normal one. She explains that she is being pulled in two different directions. Her mother is keeping her in her innocent ways, while the director is pulling her towards a sensual side that the black swan embodies.
Nina also stated in the assessment that she has been experiencing persistent hallucinations and delusions. She explained that she continually saw her face on people passing, and that her reflection was watching her from the mirrors. She also sees herself bleeding and scratching her body when in reality she is not. In other hallucinations, she was physically being transformed into the black swan, gaining feathers and webbed feet. Nina also feels as if one of the other dancers, Lily, her alternate is out to harm her and take her role, which leads to delusions of her trying to kill her and seeing her wherever she goes. Along with Lily trying to take her lead role from her, she believes her mother is also doing everything in her power to take her away from her big performance. She also has experiencing outrages of anger, which is out of character for her. She and others have also noticed that she has lost weight with the process of obtaining the lead role of the play. When we preceded to talk about how she thought her life is going, she stated that all of these things happening were visions and precursors for the perfection she is destined to reach as a ballerina in the role of the swan queen. From assessment, it can be inferred that Nina could be suffering from multiple psychological problems including schizophrenia, dissociative identity disorder and anorexia nervosa.
Schizophrenia is a complex mental disorder that makes it hard to tell the difference from real and unreal experiences, think logically, have normal emotional responses, and behave normally in social situations. According to the DSM, symptoms for schizophrenia include: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms. In the DSM IV, schizophrenia has multiple subtypes. Paranoid schizophrenia is considered to be one. The symptoms needed to meet criteria for paranoid schizophrenia are hallucinations or delusions, intact cognitive skills, intact affect, and little to no disorganized behavior. Nina meets many symptoms to be diagnosed with paranoid subtype of schizophrenia. Nina suffers from both hallucinations and delusions that expand over six months, and has persistent symptoms over the time span of two months that significally impair her ability to work or perform everyday task. From what she previously stated, she experienced many hallucinations, delusions and paranoia that people were out to get her and take her lead role in the play. There is no single cause to why people develop this disorder, but many factors could play into why Nina developed this disorder. It could have been inherited, but in Nina’s case, the stressful life circumstances and the pressure from home and work provide her with the greatest opportunity to develop this disorder.
Nina also exhibited symptoms of Dissociative Identity Disorder (DID). DID is the disruption of identity characterized by two or more distinct personality states that take control of the person. A person with DID experiences alternations in affect, behavior, consciousness, memory, perception, cognition, and sensory- motor functioning. People with this also have trouble recalling events, and even personal information, more than the average forgetfulness. With this disorder, a person can be seen as aggressive and self-destructive. This disorder also affects a person’s social and occupational life. Nina can be diagnosed with this disorder because of the black and white swan personas she tries to embody. For example, the white swan is most closely related to herself. It embodies innocence and virtue, which is who Nina is, whereas the black swan is her alter. It embodies a more violent sensual persona. She also shows symptoms of trouble recalling events. For example, she finds scratches on her body that she can’t recall doing. This disorder could also be cause from abuse in her childhood, which she could have experienced from her mother.
Along with other disorders, Nina can also be thought to have Anorexia nervosa.

Anorexia nervosa is characterized by self-starvation and excessive weight loss with several symptoms including severe weight loss, the fear of gaining weight, inadequate food intake and many more. In Nina’s case, the factors that determine her producing anorexia nervosa is most prominently caused by her profession as a ballerina and the stress it puts on you to be perfect. An example of her having the symptoms of anorexia is when given a cake from her mother as a celebratory present, Nina is repulsed by the thought of eating something with that much fat. She also is seen to have a noticeable lose in weight, and is proud of what she has lost. She finds it as an example of reaching ballerina

perfection.
Based on the DSM, I diagnose Nina Sayers with these disorders:
Axis I: Clinical Disorders
• Paranoid Schizophrenia
• Anorexia Nervosa
• Dissociative Identity Disorder
Axis II: Personality Disorders
• Borderline Personality Disorder
Axis III: General Medical Conditions
• Anxiety from her mother being overprotective
• Eating disorder causing her to be underweight
Axis IV: Psychosocial and Environmental Stressors
• Deficit in support from her mother
• Deficit of support from work
• Occupational problems- stressful work schedule and the pressure to be perfect
Axis V: Global Assessment of Functioning
• None
In terms of treatment options, there are several different things Nina Sayers can do to try and improve her behavior and function. For Paranoid Schizophrenia, I recommend that she first starts taking antipsychotic medication. Although medication has a large role in improving her life, it alone is not enough. She should find treatment in psychotherapy, social and vocational skill training, family therapy, and electroconvulsive therapy (ECT). Psychotherapy will aim to help Nina understand her feelings, helping her learn coping skills for when she recognizes the positive or negative effects. Social and vocational skill training would be used as treatment because according to research by Cameron M. Clark (2016), 50% of people diagnosed with Schizophrenia have deficits in their social skills compared to others that do not have Schizophrenia. With the help of social and vocational skill training, Nina will learn how to communicate with others, which could gain her social support and friends at the dance company. It could also provide her with the abilities to live independently. Family therapy could be used for Nina and her mother. It could provide them with an understanding of each other and help Nina gain a support system that she desperately needs. Electroconvulsive therapy (ECT) could also be used for treatment, but as a therapist I would use this as the last option. I would view her progress on the medication and the other treatment she does and if no progress is seen, then I would use this technique.
Treatment options for Dissociative Identity Disorder, are aimed to improve their daily lives by allowing them the ability to identify that their other identities are a part of themselves. Allowing them to connect to their true self. To obtain this goal, psychotherapy would be the best treatment option for Nina. It will help her learn how to suppress her other identity as the black swan by talking about it with her therapist. I would only use therapy sessions and psychotherapy as her treatment options instead of medicating her. According to the Journal of Trauma and Dissociation (2011), these types of treatment options can be the leading factor in improving a patient’s well-being and functioning, as well as reduce the chances of the patient using medication and the problems that can come from that process.
With the eating disorder, anorexia nervosa, there are several treatment options that Nina could use. Because Nina’s anorexia isn’t at the severe state, putting her in immediate danger, hospitalization would not be recommended. Instead, she could use ongoing therapy and medical care. The first thing that she would focus on is gaining a healthy weight. According to the article “Dietary Energy Density and Diet Variety as Risk Factors for Relapse in Anorexia Nervosa: A Replication” (2012), patients trying to gain a healthy weight that consume limited food with energy were more likely to relapse than those whose diet contained food of high energy. To ensure she is gaining the appropriate weight back, she would have help from a dietitian. She would also learn behavioral strategies from therapy sessions. Nina would also use psychotherapy such as cognitive behavioral therapy, individual therapy and family therapy to help her defeat this disorder. Medical care would also be recommended to make sure her psychical conditions are kept stable.