Problem
Diane Miller, age 25, entered a long-term treatment unit of a psychiatric hospital after a serious suicide attempt. Alone in her enormous suburban house, with her parents away on vacation, depressed and desperately lonely, she made herself a Valium and Scotch cocktail, drank it, and then called her psychiatrist.
Diane had been a tractable child with a mediocre school record until she turned age 12. Then her disposition, which had been cheerful and outgoing, changed drastically: she became demanding, sullen, and rebellious, shifting precipitously from a giddy euphoria to tearfulness and depression. She took up with a "fast" crowd, and became promiscuous, abused marijuana and hallucinogens, and ran away from home at 15 with a 17-year-old boy. Two weeks later, having eluded the private investigators her parents had hired, they both returned. She reentered school, but dropped out for good in her junior year of high school. Her relationships with men were stormy, full of passion, unbearable longing, and violent arguments. She craved excitement and would get drunk, dance wildly on tabletops in discos, leave with strange men, and perhaps have sex in their cars. If she refused their sexual advances, she was sometimes put out on the street. After one such incident, at 17, she made her first suicide attempt, cutting her wrist severely, which led to her first hospitalization.
After her first hospitalization, Diana was referred to a therapist for intensive, twice-weekly dynamic psychotherapy, for which she had little aptitude. She filled up most of her sessions with a litany of complaints against her family, from whom she expected "100 percent" attention." She called her therapist several times a day about one "crisis" or another.
During her long period of unsuccessful outpatient treatment, punctuated by several brief hospitalizations, she had many symptoms. She was afraid to travel even to her doctor's office without one of her parents. She was depressed, with suicidal preoccupations and feelings of hopelessness. She drank excessively and used up to 40mg/day of Valium. She had eating binges, followed by crash diets to get back to her normal weight. She was obsessed with calories and with the need to have her food cut into particular shapes and arranged on her plate in a particular manner before she could eat. If her mother failed to comply with these rules, she had tantrums, sometimes so extreme that she broke dishes and had to be physically restrained by her father.
Diane has never worked, except for a few months as a receptionist in her father's company. She has never had an idea of what she wants to do with her life, apart from being with a "romantic man." She has never had female friends, and her only source of solace is her dog. She has often been "eaten alive" with boredom.
Efforts by her therapist to set limits have had little effect. She refused to join Alcoholics Anonymous or attend a day program or vocational rehabilitation center, regarding these as "beneath" her. Instead, she languished at home, grew more depressed and agoraphobic, and escalated her Valium use to 80mg/day. It was a serious suicide attempt this time that led to her current (seventh) psychiatric hospitalization.
What kind of Socioenvironmental Problems does Diana have?