CASE STUDY
Sarah (bipolar disorder)

Sarah is a 42-year-old married woman who has a long history of both depressive and hypomanic episodes.  Across the years she has been variable diagnoses as having major depression, borderline personality disorder, and most recently, bipolar disorder.  Review of symptoms indicates that she indeed have multiple episodes of depression beginning in her late teens, but that clear hypomanic episodes later emerged.  Her elevated interpersonal conflict, hyper-sexuality and alcohol use during her hypomanic episodes led to the provisional borderline diagnosis, but in the context of her full history, bipolar disorder appears the best diagnosis.  Sarah notes that she is not currently in a relationship and that she feels alienated from her family.  She has been taking mood stabilizers for the last year, but continues to have low level symptoms of depression.  In the past, she has gone off her medication multiple times, but at present she says she is “tired of being in trouble all the time” and wants to try individual psychotherapy.