Marilyn is a 23-year-old M.B.A. student at the business schoolof a large Midwestern university. For years she has been frustratedand dissatisfied with her life. She has always done wellacademically, but lately she has had little interest in doing herschoolwork and little confidence that she can do it well. Shedescribes herself as a person with \"big plans,\" who ultimatelywon't \"cut it.\" She also fears that she will never be satisfiedwith life, even if she does succeed. She frequently feelsirritable, despondent, and helpless. Marilyn said, \"It's as if myentire life has been laid out for me. I don't feel like I have anychoice about what I do. Worst of all, I think that it may all be atotal waste.\" Lately her persistent negative cognitions haveinterfered with her ability to work on her thesis and to fulfillher duties as a teaching assistant. She is easily distracted fromher work and usually puts it off until weeks after it is due. Shesays that sometimes she hesitates because she fears that heradviser will reject the work as substandard (although this hasnever actually happened), and sometimes she puts it off because she\"doesn't really care about it anymore.\" Marilyn describes herselfnot only as having problems with academic work but also as havingtrouble establishing relationships with men. She describes along-standing habit of picking up men (either at bars or at partieson campus) and quickly pressuring them to have sex with her. Withina week she then 'dumps\" them without an explanation, understandablyengendering a good deal of hostility. Marilyn describes a recentexample. Several weeks ago she met a man in one of her classes andasked him to come over for dinner. They slept together that night,despite his initial hesitancy. Marilyn described their sex as\"boring and routine.\" Two days later they saw a movie. When hisreactions to the movie differed from hers, she decided to stopseeing him because he was uninteresting and a relationship with himwould be \"a pointless waste.\" Marilyn began drinking heavily duringthe past year. She usually drinks socially at campus bars andparties, especially when she is trying to pick up someone. She hasfound that her drinking often makes her pass out after sex or after\"cruising\" the local bars. She complains that her drinking is alsointerfering with her academic work by making her tired and easilydistractible. Marilyn complained about her problems to a fellowstudent, who recommended a psychodynamically oriented therapist heknew. At first Marilyn was put off by this suggestion, but sheeventually came to the conclusion that it might be a good idea.After an initial interview, the therapist decided that Marilynshould be seen for individual therapy three times a week. Marilynagreed. PERSONAL HISTORY Marilyn is the oldest of four children.Her father is a dermatologist. Her mother has a bachelor's degreein advertising, but she did not pursue a career after graduation.Both grandfathers died young, leaving both parents to grow up insingle-parent homes. Marilyn's overall impression of her parents isthat they were generally attentive and supportive, althoughparadoxically they seemed somewhat neglectful of her true needs.For example, when Marilyn had difficulty learning to read, herparents' response was to push her to try harder. They becamefrustrated at her slow progress. It was not until after severalmonths that her need for corrective eyeglasses was finally noticed.After medical school, Marilyn's father did his residency inChicago, where both parents' families were located. However, he hadalways wanted to live in a rural area, so after his residency thefamily moved to a small town in Colorado. Marilyn, who had become avociferous reader after she got her glasses, felt very unpopular inthis small town, mostly because education and intelligence were nothighly valued. After high school she applied to her father's almamater but was rejected, partly, she believes, because of hersubstandard education. She grudgingly settled for the stateuniversity, which she felt was far below her intellectualcapabilities. Marilyn described her first two years of college asunremarkable. She spent her junior year of college in Europe, whereshe initiated her pattern of sleeping with men and then quicklybreaking up with them. This pattern has persisted for the pastthree and a half years. When her therapist asked her how she feltabout her relationships, Marilyn stated that she felt compelled tosleep with a man for him to really accept her. After a only a weekor so, however, she would begin to feel bored and would look forsomeone new. Upon her graduation Marilyn applied to several M.B.A.programs. She was bitterly disappointed when her first two choicesturned her down, and she began worrying about whether she wouldever be successful. In particular, she complained about having tomiss out on the best schools and the most interesting cities,saying, \"In my entire life I could never get anywhere that reallymattered.\" What are the abnormal behaviors worth noting and whatdiagnosis would be given. What is her diagnosis? Is it apersonality disorder?
