Diagnosis Of Black Swan
In Darren Aronofsky’s (2010) film, Black Swan, a ballet dancer experiences significant difficulty in adjusting to fulfill the dual role of the white swan. In order to achieve this role, Nina must traverse the dual relationship between the innocence of the white swan and the seductive black swan. In Nina’s desire to reach this goal, she experiences a major transformation in herself that reflects the transition from the white and black swan in the ballet. This paper in particular will focus Nina’s diagnosis in the DSM-5 (American Psychiatric Association, 2013), the criterion that matches the diagnosis, psychosocial and environmental stressors, portrayal of treatment, recommended therapy, and possible improvement over the course of the film. According
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to the DSM-5 (APA, 2013) and the symptoms that match specific criterion, Nina Sayer would be diagnosed with the following: (F20.61) Schizophreniform Disorder, with Anorexia Nervosa, purging type.
Schizophreniform Disorder
Throughout the film, Nina experiences incidences of hallucinations and delusions. However, it is important to note that the diagnosis for Nina was schizophreniform disorder rather than schizophrenia itself. According to the DSM-5 (2013), the key difference between the two disorders is the duration of the disorder, where schizophreniform must last at least 1 month and no longer than 6 months (p. 97). Schizophrenia, on the other hand, lasts longer than 6 months (APA, 2013). Unfortunately, the time frame of the film is ambiguous, so one can only guess the duration of Nina’s experiences. Specifically, the viewer is not completely aware of the time between Nina starting her rehearsals to the end of the film. One deciding factor that shifts the diagnosis to schizophreniform disorder is that this was the first psychotic episode that the viewer is aware of. Even though the time frame of the movie was ambiguous, it is more likely that Nina fits the duration criteria for schizophreniform disorder rather than for schizophrenia.
According to the DSM-5, at least two of the following criterion must be met for an individual to be diagnosed with schizophreniform disorder: delusions, hallucinations, disorganized speech, catatonic behavior, and negative symptoms (APA, 2013). In the film, Nina meets the first criteria for experiencing delusions during her time in New York. One of the predominant and reoccurring delusions that Nina experiences in the film is her belief that Lily is Thomas’s favorite and that the two of them are having sexual encounters, which Nina believes is the cause of this favoritism (Aronofsky, 2010). Specifically, there is an overarching delusion of Nina thinking that Lily will replace her in the ballet (Aronofsky, 2010). The DSM-5 states that a delusion is a “false belief based on incorrect inference about external reality that is firmly held despite what almost everyone else believes…” (p. 819). In this instance of the film, Nina firmly believes that Lily and Thomas’s sexual relations are the cause of lily’s preferential treatment over her. The second criteria that Nina matches in the film are hallucinations. One example of this is towards the end of the film in the scene where Nina stabs Lily with a shard of glass, but it turns out that Nina was the one who was stabbed (Aronofsky, 2010). This instance in the film is considered a hallucination because the DSM-5 (2013) states that a hallucination is a “perception-like experience with the clarity and impact of a true perception but without the external stimulation of the relevant sensory organ” (p. 822). What is perplexing about this is that Nina’s experience had clarity, but she also had a piece of glass in her. The definition identifies that there is no relevant organ that is attributed to this hallucination, but Nina clearly experiences a hallucination in the film. There is also the confusing aspect that if Nina did have an external experience (shard of glass), then why did she believe that she stabbed someone else? Another predominant example is at the end of the film where Nina perceives herself as transforming (literally) into a black swan (Aronofsky, 2010). Specifically, there is a scene in the film where Nina sees that she is growing feathers and begins to pick them out of her skin (Aronofsky, 2010). In terms of the other criteria that are required for the diagnosis of schizophreniform disorder, Nina does not experience disorganized speech, catatonic behavior, or negative symptoms (APA, 2013, p. 96). In the film, Nina does not experience any verbal evidence of disorganized speech, however, the viewer only sees a glimpse into Nina’s life. Nina also does not experience catatonic behavior, as it would be clearly noticeable if a ballet performer had difficulty with motor functioning. Finally, it does not appear that Nina is experiencing any negative symptoms because the film does not portray any reduced change of affect (as far as the viewer knows). This criterion may need more investigation as Nina has a change in affect, but the viewer does not know with certainty that it is diminished affect.
Another criterion that Nina fulfills in the film is that schizoaffective disorder and depressive/bipolar disorder with psychotic features have been ruled out (APA, 2013, p. 97). Again, this is based on the behaviors and emotions that are purely based in the film. When diagnosing a client with schizophreniform disorder, the therapist should investigate if there was a history of manic/depressive episodes. The final criterion for this diagnosis is that the individual’s experiences are not attributed to the effects of a substance (APA, 2013, p. 97). What is important to note about this criteria is that Nina experienced the symptoms of schizophreniform disorder (delusions and hallucinations) before taking drugs and alcohol at the nightclub (Aronofsky, 2010). Although the viewer can’t be certain if the drug/alcohol intake contributed to Nina’s experiences later on in the film, the fact that Nina exhibited these behaviors prior to the drugs/alcohol fulfills the last criteria for schizophreniform disorder.
Anorexia Nervosa, Purging Type
According to the DSM-5 (2013), anorexia nervosa, purging type has the following three essential features: restriction of energy intake, fear of gaining weight, and disturbance in perceived self-body image (p. 338-339). In relation to the first criteria, the viewer sees that Nina does make the effort to restrict energy intake in order to reduce her weight. In the film, Nina is pressured to perform at her best ability in order to get the role she desires. In order to do so, Nina refuses to intake certain foods, specifically when she refuses to eat cake from her mother (Aronofsky, 2010). Within this scene, the viewer also sees Nina meeting the second criteria for this disorder, which is the intense fear of gaining weight. Again, the instance in the movie where Nina refuses to eat the cake can make the viewer infer that there may be an intense fear of gaining weight. This instance in the movie also fulfills the third criteria, which is the disturbance is self-perceived body image. Nina experiences tremendous pressure in her work as a dancer, which may indicate a disturbance in perceived weight when she refused the cake. Even though this seems to fulfill the criteria for anorexia nervosa, it is still somewhat speculative considering that there was not an interview with a therapist concerning this issue. Even though an inference can be made with the film, a study done by Toro, Guerrero, Sentis, Castro, and Puértolas (2009) found that dancers “at risk of eating disorders perceived greater pressure from coaches concerning eating, appearance, weight and artistic performance; they felt less satisfied with their weight and weighed themselves more often; they avoided performing so as not to exhibit their body in public, disliked comparing their body with their peers and believed that audiences paid a great deal of attention to their bodies” (p. 40). In the film, Nina experiences a large amount of pressure from Thomas that may have contributed to her eating disorder. The research done by Toro et al. (2009) would lend support to Nina’s diagnosis of anorexia nervosa.
Another specifier for the diagnosis of anorexia nervosa is binge-eating/purging type.
Specifically, Nina would fulfill the specifier of purging type because she routinely vomited in the toilet over the course of 3 months. This specifier is a little more difficult and ambiguous to diagnose Nina with because the film isn’t clear whether her vomiting was a result of anxiety or pressure to monitor weight. According to the research done by Toro et al. (2009), there is the increased likelihood of Nina having anorexia nervosa, which may also increase the likelihood of fulfilling the specifier of the purging type. Again, it can only be inferred that Nina has this specifier. More research and interviews would need to occur for a more informed …show more content…
diagnosis.
Psychosocial and Environmental Stressors
In the film, there are two dominant stressors that impacted the development of Nina’s schizophreniform and anorexia nervosa disorders. The first dominant stressor in the film was the ballet/performance that Nina is involved with. As mentioned before Toro et al. (2009), dancers are at an increased risk for eating disorders as a result of a lot of pressure from their coaches (p. 40). This psychosocial stressor is one factor in the development of Nina’s anorexia nervosa. Interestingly, the DSM-5 (APA, 2013) mentions that a stressful life event could be associated with the onset of anorexia nervosa (p. 341). The DSM-5 (APA, 2013) also mentions that there is an increased risk for this disorder in societies that value thinness (p. 342). When looking at North American culture (the same culture that is portrayed in the film), there is an increased value placed on thinness and sex appeal for women, especially in advertisement and media. This cultural expectation could be a contributing factor in the development of Nina’s anorexia nervosa. When looking at Nina’s current occupation, ballet, there is a strong emphasis placed on physical physique and thinness. Again, the DSM-5 (2013) mentions that occupations that value physical prowess and thinness are associated with a greater risk for this disorder (p. 342).
The second dominant stressor in the Black Swan is Nina’s mother. Even though the DSM-5 does not mention family relationships as having direct relationships with the development of schizophreniform and anorexia nervosa, the strained relationship between the two could not have helped. Specifically, the lack of support that Nina had with her mother when she was having behavioral difficulties towards the end of the film. There was also a constant pressure from Nina’s mother to perform well. This could have also contributed to Nina’s overall stress level.
Lack of Treatment
In the film, Nina does not receive any treatment for the symptoms she is experiencing with schizophreniform and anorexia nervosa. The closet thing she retrieved as a treatment was when her mother put cloth over her hands to stop Nina from scratching herself. One of the reasons that could have been a contributing factor in Nina not receiving any treatment was the pressure of both the upcoming performance and the necessity to achieve the role of the white swan. Even the mother’s attempts to cover up Nina’s hands with cloth were only a temporary fix to get Nina ready to fulfill her role. With no intervention for the development of schizophreniform and anorexia nervosa, Nina was eventually admitted to a hospital for her injury. Specifically, the unhindered development of Nina’s schizophreniform symptoms was a main factor for the eventual admittance into the hospital. Without treatment, Nina couldn’t tell reality from delusions and hallucinations.
Again, the absence of treatment of Nina’s symptoms ultimately leads to her being admitted into a hospital for a physical injury. The film showed a progression of severity in Nina’s symptoms, specifically in regards to schizophreniform disorder. Specifically, the viewer observed cognitive, behavioral, affective, and physiological changes over the course of the film. Nina experiences cognitive changes when she experiences delusions of persecution, where she has the belief that Lily will take over her role. This cognitive thought process is mostly seen towards the end of the film. The viewer also sees Nina preoccupation with her role, where she believes that she is the white swan at the end of the film. Specifically, she begins to identify herself as the swan, rather than focusing on her portrayal of the role. In terms of Nina’s behavioral development, she shifts from being very obedient to her mother to becoming more defiant towards her. For example, when Nina comes back home late with Lily intoxicated and becomes verbally defiant towards her mother once she starts questioning where Nina has been (Aronofsky, 2010). During the course of the film, Nina’s behavior shifts dramatically towards the end once she starts experiencing more horrific hallucinations. The viewer also see a change in Nina’s affect, where she had a more controlled affect at the beginning of the film and then shifting to a very emotional affect towards the end. This can be seen in the seen where Nina won’t let her mother in her room while she was experiencing the hallucination of her forming wings (Aronofsky, 2010). Finally, there is a physiological change when Nina begins to scratch herself where she believes that she is sprouting wings. This is related to the development of Nina’s schizophreniform symptoms, specifically in regards to her hallucinations.
Treatment Recommendations
The suggested treatment for Nina would occur in the following two phases: medication/hospitalization and family therapy.
Medication/hospitalization involves getting immediate help for the client in relation to the current severity of symptoms present. For Nina, this first phase of treatment should occur immediately considering the severity of her shizophreniform symptoms. This process involves admitting the client into a hospital to protect, calm, and alleviate the acute symptoms of the disorder (Seligman & Reichenberg, 2014, p. 420). During this period of hospitalization, the client should also be exposed to antipsychotic medication because like immediate hospitalization, it protects the client from harm (Seligman & Reichenberg, 2014, p. 420). The rationale behind using antipsychotic medications is that around 75% of clients with schizophreniform respond to the medication within eight days (Sadock, 2007). The focus on the first stage is reducing the acute symptoms of shizophreniform disorder and grounding the client in reality. According to Seligman and Reichenberg (2014), “brief treatment strategies with clear goals seem best and long-term medication or extended inpatient treatment are unusual” (Seligman & Reichenberg, 2014, p. 420). This form of immediate therapy should then be followed up with intervention strategies and family therapy once the psychotic symptoms have been
reduced.
Family therapy is especially important for Nina because her mother seemed to add to her stress rather than to help alleviate it. Family therapy for this circumstance would focus on the aftermath of the disorder as well as to help the client restore social/occupational functioning (Seligman & Reichenberg, 2014, p. 420). According to Seligman and Reichenberg (2014), “strong family support has been linked with reduced stress, increased medication compliance, and better treatment outcomes” (p. 420). This, in turn, would help the client to utilize support systems during time of crisis and improve on interpersonal relation. Luckily, the prognosis for the combined treatment looks good for clients with schizophreniform disorder (Seligman & Reichenberg, 2014, p. 420).
One of the major hurdles facing Nina with the first phase of treatment is her current physical health. However, if Nina is able to recover, then the difficulty is going to be for her to accept treatment right away considering that she is a professional in ballet. Since the first phase of treatment requires hospitalization, Nina would have to push her occupation aside and focus solely on herself. This may be a career ending experience for Nina. With the medication, Nina would most likely take Risperdal or Zyprexa to reduce the psychotic symptoms. Unlike older forms of antipsychotic medication, this newer medication has been found to have a lower risk for extrapyramidal symptoms (Seligman & Reichenberg, 2014, p. 413). However, there still may be some side effects to this medication that Nina needs to overcome. If Nina does accept this first phase and moves to the second phase, the challenge that she will face is her mother. Family therapy for this situation would have to be the acceptance of this disorder on both ends, a situation that Nina’s mother may find difficult. The mother was so focused on Nina’s success for such a long duration that she might feel like her daughter is throwing it all away.
Through examining specific examples in the film, Black Swan (Aronofsky, 2010), and using the DSM-5 (APA, 2013) to evaluate these examples, Nina Sayer would be diagnosed with (F20.61) Schizophreniform Disorder, with Anorexia Nervosa, purging type. This paper examined Nina’s occupation as a ballet dancer and her mother as potential psychosocial/environmental stressors related to the psychological diagnosis. Treatment recommendations, specifically medication/hospitalization and family therapy, were also examined that would most effectively help Nina with her symptoms. Overall, the movie’s portrayal of the difficulties dancers face seemed very Hollywood, specifically in regards to the dramatization on Nina’s psychological disorders. In the end, the movie does speak to the problems and expectations that dancers face in reality, where physical competency and body image are daily stressors for real dancers in the professional world of ballet.
to the DSM-5 (APA, 2013) and the symptoms that match specific criterion, Nina Sayer would be diagnosed with the following: (F20.61) Schizophreniform Disorder, with Anorexia Nervosa, purging type.
Schizophreniform Disorder
Throughout the film, Nina experiences incidences of hallucinations and delusions. However, it is important to note that the diagnosis for Nina was schizophreniform disorder rather than schizophrenia itself. According to the DSM-5 (2013), the key difference between the two disorders is the duration of the disorder, where schizophreniform must last at least 1 month and no longer than 6 months (p. 97). Schizophrenia, on the other hand, lasts longer than 6 months (APA, 2013). Unfortunately, the time frame of the film is ambiguous, so one can only guess the duration of Nina’s experiences. Specifically, the viewer is not completely aware of the time between Nina starting her rehearsals to the end of the film. One deciding factor that shifts the diagnosis to schizophreniform disorder is that this was the first psychotic episode that the viewer is aware of. Even though the time frame of the movie was ambiguous, it is more likely that Nina fits the duration criteria for schizophreniform disorder rather than for schizophrenia.
According to the DSM-5, at least two of the following criterion must be met for an individual to be diagnosed with schizophreniform disorder: delusions, hallucinations, disorganized speech, catatonic behavior, and negative symptoms (APA, 2013). In the film, Nina meets the first criteria for experiencing delusions during her time in New York. One of the predominant and reoccurring delusions that Nina experiences in the film is her belief that Lily is Thomas’s favorite and that the two of them are having sexual encounters, which Nina believes is the cause of this favoritism (Aronofsky, 2010). Specifically, there is an overarching delusion of Nina thinking that Lily will replace her in the ballet (Aronofsky, 2010). The DSM-5 states that a delusion is a “false belief based on incorrect inference about external reality that is firmly held despite what almost everyone else believes…” (p. 819). In this instance of the film, Nina firmly believes that Lily and Thomas’s sexual relations are the cause of lily’s preferential treatment over her. The second criteria that Nina matches in the film are hallucinations. One example of this is towards the end of the film in the scene where Nina stabs Lily with a shard of glass, but it turns out that Nina was the one who was stabbed (Aronofsky, 2010). This instance in the film is considered a hallucination because the DSM-5 (2013) states that a hallucination is a “perception-like experience with the clarity and impact of a true perception but without the external stimulation of the relevant sensory organ” (p. 822). What is perplexing about this is that Nina’s experience had clarity, but she also had a piece of glass in her. The definition identifies that there is no relevant organ that is attributed to this hallucination, but Nina clearly experiences a hallucination in the film. There is also the confusing aspect that if Nina did have an external experience (shard of glass), then why did she believe that she stabbed someone else? Another predominant example is at the end of the film where Nina perceives herself as transforming (literally) into a black swan (Aronofsky, 2010). Specifically, there is a scene in the film where Nina sees that she is growing feathers and begins to pick them out of her skin (Aronofsky, 2010). In terms of the other criteria that are required for the diagnosis of schizophreniform disorder, Nina does not experience disorganized speech, catatonic behavior, or negative symptoms (APA, 2013, p. 96). In the film, Nina does not experience any verbal evidence of disorganized speech, however, the viewer only sees a glimpse into Nina’s life. Nina also does not experience catatonic behavior, as it would be clearly noticeable if a ballet performer had difficulty with motor functioning. Finally, it does not appear that Nina is experiencing any negative symptoms because the film does not portray any reduced change of affect (as far as the viewer knows). This criterion may need more investigation as Nina has a change in affect, but the viewer does not know with certainty that it is diminished affect.
Another criterion that Nina fulfills in the film is that schizoaffective disorder and depressive/bipolar disorder with psychotic features have been ruled out (APA, 2013, p. 97). Again, this is based on the behaviors and emotions that are purely based in the film. When diagnosing a client with schizophreniform disorder, the therapist should investigate if there was a history of manic/depressive episodes. The final criterion for this diagnosis is that the individual’s experiences are not attributed to the effects of a substance (APA, 2013, p. 97). What is important to note about this criteria is that Nina experienced the symptoms of schizophreniform disorder (delusions and hallucinations) before taking drugs and alcohol at the nightclub (Aronofsky, 2010). Although the viewer can’t be certain if the drug/alcohol intake contributed to Nina’s experiences later on in the film, the fact that Nina exhibited these behaviors prior to the drugs/alcohol fulfills the last criteria for schizophreniform disorder.
Anorexia Nervosa, Purging Type
According to the DSM-5 (2013), anorexia nervosa, purging type has the following three essential features: restriction of energy intake, fear of gaining weight, and disturbance in perceived self-body image (p. 338-339). In relation to the first criteria, the viewer sees that Nina does make the effort to restrict energy intake in order to reduce her weight. In the film, Nina is pressured to perform at her best ability in order to get the role she desires. In order to do so, Nina refuses to intake certain foods, specifically when she refuses to eat cake from her mother (Aronofsky, 2010). Within this scene, the viewer also sees Nina meeting the second criteria for this disorder, which is the intense fear of gaining weight. Again, the instance in the movie where Nina refuses to eat the cake can make the viewer infer that there may be an intense fear of gaining weight. This instance in the movie also fulfills the third criteria, which is the disturbance is self-perceived body image. Nina experiences tremendous pressure in her work as a dancer, which may indicate a disturbance in perceived weight when she refused the cake. Even though this seems to fulfill the criteria for anorexia nervosa, it is still somewhat speculative considering that there was not an interview with a therapist concerning this issue. Even though an inference can be made with the film, a study done by Toro, Guerrero, Sentis, Castro, and Puértolas (2009) found that dancers “at risk of eating disorders perceived greater pressure from coaches concerning eating, appearance, weight and artistic performance; they felt less satisfied with their weight and weighed themselves more often; they avoided performing so as not to exhibit their body in public, disliked comparing their body with their peers and believed that audiences paid a great deal of attention to their bodies” (p. 40). In the film, Nina experiences a large amount of pressure from Thomas that may have contributed to her eating disorder. The research done by Toro et al. (2009) would lend support to Nina’s diagnosis of anorexia nervosa.
Another specifier for the diagnosis of anorexia nervosa is binge-eating/purging type.
Specifically, Nina would fulfill the specifier of purging type because she routinely vomited in the toilet over the course of 3 months. This specifier is a little more difficult and ambiguous to diagnose Nina with because the film isn’t clear whether her vomiting was a result of anxiety or pressure to monitor weight. According to the research done by Toro et al. (2009), there is the increased likelihood of Nina having anorexia nervosa, which may also increase the likelihood of fulfilling the specifier of the purging type. Again, it can only be inferred that Nina has this specifier. More research and interviews would need to occur for a more informed …show more content…
diagnosis.
Psychosocial and Environmental Stressors
In the film, there are two dominant stressors that impacted the development of Nina’s schizophreniform and anorexia nervosa disorders. The first dominant stressor in the film was the ballet/performance that Nina is involved with. As mentioned before Toro et al. (2009), dancers are at an increased risk for eating disorders as a result of a lot of pressure from their coaches (p. 40). This psychosocial stressor is one factor in the development of Nina’s anorexia nervosa. Interestingly, the DSM-5 (APA, 2013) mentions that a stressful life event could be associated with the onset of anorexia nervosa (p. 341). The DSM-5 (APA, 2013) also mentions that there is an increased risk for this disorder in societies that value thinness (p. 342). When looking at North American culture (the same culture that is portrayed in the film), there is an increased value placed on thinness and sex appeal for women, especially in advertisement and media. This cultural expectation could be a contributing factor in the development of Nina’s anorexia nervosa. When looking at Nina’s current occupation, ballet, there is a strong emphasis placed on physical physique and thinness. Again, the DSM-5 (2013) mentions that occupations that value physical prowess and thinness are associated with a greater risk for this disorder (p. 342).
The second dominant stressor in the Black Swan is Nina’s mother. Even though the DSM-5 does not mention family relationships as having direct relationships with the development of schizophreniform and anorexia nervosa, the strained relationship between the two could not have helped. Specifically, the lack of support that Nina had with her mother when she was having behavioral difficulties towards the end of the film. There was also a constant pressure from Nina’s mother to perform well. This could have also contributed to Nina’s overall stress level.
Lack of Treatment
In the film, Nina does not receive any treatment for the symptoms she is experiencing with schizophreniform and anorexia nervosa. The closet thing she retrieved as a treatment was when her mother put cloth over her hands to stop Nina from scratching herself. One of the reasons that could have been a contributing factor in Nina not receiving any treatment was the pressure of both the upcoming performance and the necessity to achieve the role of the white swan. Even the mother’s attempts to cover up Nina’s hands with cloth were only a temporary fix to get Nina ready to fulfill her role. With no intervention for the development of schizophreniform and anorexia nervosa, Nina was eventually admitted to a hospital for her injury. Specifically, the unhindered development of Nina’s schizophreniform symptoms was a main factor for the eventual admittance into the hospital. Without treatment, Nina couldn’t tell reality from delusions and hallucinations.
Again, the absence of treatment of Nina’s symptoms ultimately leads to her being admitted into a hospital for a physical injury. The film showed a progression of severity in Nina’s symptoms, specifically in regards to schizophreniform disorder. Specifically, the viewer observed cognitive, behavioral, affective, and physiological changes over the course of the film. Nina experiences cognitive changes when she experiences delusions of persecution, where she has the belief that Lily will take over her role. This cognitive thought process is mostly seen towards the end of the film. The viewer also sees Nina preoccupation with her role, where she believes that she is the white swan at the end of the film. Specifically, she begins to identify herself as the swan, rather than focusing on her portrayal of the role. In terms of Nina’s behavioral development, she shifts from being very obedient to her mother to becoming more defiant towards her. For example, when Nina comes back home late with Lily intoxicated and becomes verbally defiant towards her mother once she starts questioning where Nina has been (Aronofsky, 2010). During the course of the film, Nina’s behavior shifts dramatically towards the end once she starts experiencing more horrific hallucinations. The viewer also see a change in Nina’s affect, where she had a more controlled affect at the beginning of the film and then shifting to a very emotional affect towards the end. This can be seen in the seen where Nina won’t let her mother in her room while she was experiencing the hallucination of her forming wings (Aronofsky, 2010). Finally, there is a physiological change when Nina begins to scratch herself where she believes that she is sprouting wings. This is related to the development of Nina’s schizophreniform symptoms, specifically in regards to her hallucinations.
Treatment Recommendations
The suggested treatment for Nina would occur in the following two phases: medication/hospitalization and family therapy.
Medication/hospitalization involves getting immediate help for the client in relation to the current severity of symptoms present. For Nina, this first phase of treatment should occur immediately considering the severity of her shizophreniform symptoms. This process involves admitting the client into a hospital to protect, calm, and alleviate the acute symptoms of the disorder (Seligman & Reichenberg, 2014, p. 420). During this period of hospitalization, the client should also be exposed to antipsychotic medication because like immediate hospitalization, it protects the client from harm (Seligman & Reichenberg, 2014, p. 420). The rationale behind using antipsychotic medications is that around 75% of clients with schizophreniform respond to the medication within eight days (Sadock, 2007). The focus on the first stage is reducing the acute symptoms of shizophreniform disorder and grounding the client in reality. According to Seligman and Reichenberg (2014), “brief treatment strategies with clear goals seem best and long-term medication or extended inpatient treatment are unusual” (Seligman & Reichenberg, 2014, p. 420). This form of immediate therapy should then be followed up with intervention strategies and family therapy once the psychotic symptoms have been
reduced.
Family therapy is especially important for Nina because her mother seemed to add to her stress rather than to help alleviate it. Family therapy for this circumstance would focus on the aftermath of the disorder as well as to help the client restore social/occupational functioning (Seligman & Reichenberg, 2014, p. 420). According to Seligman and Reichenberg (2014), “strong family support has been linked with reduced stress, increased medication compliance, and better treatment outcomes” (p. 420). This, in turn, would help the client to utilize support systems during time of crisis and improve on interpersonal relation. Luckily, the prognosis for the combined treatment looks good for clients with schizophreniform disorder (Seligman & Reichenberg, 2014, p. 420).
One of the major hurdles facing Nina with the first phase of treatment is her current physical health. However, if Nina is able to recover, then the difficulty is going to be for her to accept treatment right away considering that she is a professional in ballet. Since the first phase of treatment requires hospitalization, Nina would have to push her occupation aside and focus solely on herself. This may be a career ending experience for Nina. With the medication, Nina would most likely take Risperdal or Zyprexa to reduce the psychotic symptoms. Unlike older forms of antipsychotic medication, this newer medication has been found to have a lower risk for extrapyramidal symptoms (Seligman & Reichenberg, 2014, p. 413). However, there still may be some side effects to this medication that Nina needs to overcome. If Nina does accept this first phase and moves to the second phase, the challenge that she will face is her mother. Family therapy for this situation would have to be the acceptance of this disorder on both ends, a situation that Nina’s mother may find difficult. The mother was so focused on Nina’s success for such a long duration that she might feel like her daughter is throwing it all away.
Through examining specific examples in the film, Black Swan (Aronofsky, 2010), and using the DSM-5 (APA, 2013) to evaluate these examples, Nina Sayer would be diagnosed with (F20.61) Schizophreniform Disorder, with Anorexia Nervosa, purging type. This paper examined Nina’s occupation as a ballet dancer and her mother as potential psychosocial/environmental stressors related to the psychological diagnosis. Treatment recommendations, specifically medication/hospitalization and family therapy, were also examined that would most effectively help Nina with her symptoms. Overall, the movie’s portrayal of the difficulties dancers face seemed very Hollywood, specifically in regards to the dramatization on Nina’s psychological disorders. In the end, the movie does speak to the problems and expectations that dancers face in reality, where physical competency and body image are daily stressors for real dancers in the professional world of ballet.