It becomes evident that Nina grapples with a multitude of psychological challenges. These include her obsessions with dance and perfectionism, an eating disorder, and a complex relationship with her mother, who exhibits signs of mental illness such as narcissistic personality traits and depressive features. Nina's unusual habits becomes more consistent as the date of the show's best approaches. Her disorder establishes more as she shows patterns of impulsivity with high levels of instability and stress and anxiety. Borderline personality condition is understood to show a prevalent pattern of unstable self-image that may later on result in an unpredictable self-destructive habits. Another symptom that is known to be common with this condition is having minor to extreme episodes of delusions, hallucinations, and/or certain dissociative impacts.
It is also noted that many people that suffer from borderline personality disorder partake in self-mutilating actions or in more extreme cases much like Nina’s, commit suicide. In the DSM-IV-TR, there are a total of nine criteria for the borderline personality disorder, of which to be characterized with this disorder you must demonstrate five characteristics. Nina Sayers demonstrated 6 criterions and if treated with the behavioral psychotherapy, in time it would have saved her from her ultimate demise.
Behavioral therapy focuses on changing observable behavior with the use of learning theory-based principles. Since the development of such learning theories, therapists have been able to control anxiety type behaviors. In the case of Nina, where she is constantly scratching her shoulder under severe stress and partakes in impulsive actions by sleeping with multiple partners, behavioral therapy can model theses pathological behaviors and emphasize learning rather than point fault on herself that may even cause more distress.
By decreasing the number of undesirable behaviors that Nina begins to demonstrate throughout the film, a behavioral therapist could use operant conditioning to change future behavior as a function of its previously experienced reinforcement. For the purpose of this case study, I will demonstrate that by using behavioral therapy Nina would have gained control of her impulses and stopped her from harming herself with the use of operant conditioning and even later introduce her onto Dialectical Behavior Therapy.
As any therapy session should begin, Nina would first go through a behavioral assessment. Considering Nina’s shy and timid personality, a clinical interview would suit her more efficiently. It is important that Nina should feel that the therapy session is a safe and secure environment where she can talk freely about any concerns especially such deeply personal issues like hallucinations or delusions that come with the territory of those who suffer under borderline personality disorders.
This clinical interview should be conducted unstructured in Nina’s case that will strengthen the relationship between the therapist and patient. Remember we want Nina to feel safe and comfortable to freely confine in her therapist of her most personal issues. Another important interview component would be the mental status exam that will try to reveal any signs of symptoms of any psychological problems. An easy observable behavior of Nina would be her low and brief responses to any one she feels inferior to. Nina rarely keeps eye contact to whoever speaks to her directly.
She may even reveal delusions, specifically about Lily, another dancer in the film, whom Nina believes is out to steal her role as the Swan Queen. Nina also might share an experience of her night out with Lily where Nina engages in alcohol and drug abuse, as well as promiscuity. All of these observable behaviors may help lead to the overall diagnosis of borderline personality disorder. Once diagnosed Nina will then be able to undergo the behavioral therapy process to identify her issues and resolve them through reinforcements.
Behavioral therapy revolves around the idea of changing one’s observable behavior that can be controlled through stimulus or reinforcements. Nina portrays many insecurities and a lack of social skills that can be interpreted due to poor modeling by her mother. Her mother is very controlling and aggressive over Nina, which is shown in one specific scene where Nina’s mother is undressing her adult submissive daughter. Another case is where Nina develops a social avoidance towards others, only to have regular social interactions with her mother.
With no subsequent positive reinforcement from other people, other than maybe her mother, Nina has become very suspicious of the intentions of those around her, which might explain why she is often alone and has no friends. A treatment approach for Nina would include the operant conditioning. By identifying the undesired behaviors (i. e. , self-mutilating), we wish to decrease in frequency and use negative reinforcement that will allow Nina to avoid an aversive state that would later decrease the likelihood of that undesired behavior.
We would first want to identify the cause to her self-mutilation and attribute a particular behavior to carry on the negative reinforcement. So as Nina’s anxiety begins to escalate and begins to profusely scratch her shoulder, Nina should practice certain breathing exercises that will reduce her stress and possibly even decrease her chance of experiencing a hallucination. Self-monitoring would help to ensure that this conditioning technique is being applied and progressing.
More importantly, to successfully treat this disorder it is best to use an approach that was developed for these difficult-to-treat patients with the borderline personality disorder. This therapy is known as the dialectical behavior therapy that places much emphasis on the interaction between patient and therapist. Dialectical behavior therapy uses individual therapy, group skills training, telephone contact, and therapist consultation to add more variety within this unconditional relationship. Within this course of therapy, it is organized into stages of hierarchies of targets in each stage.
Stage one focuses on suicidal behavior and therapy-interfering behaviors. Nina would reveal her underlying reason for self-mutilation and delusions that interfere with her daily life. She finds herself having hallucinations of harming herself, like peeling the skin off her finger, that later advances to other behaviors such as excessive scratching on the shoulder. The delusions against Lily, the other ballerina, interfere with her ability to perform the second act of the show because she is on constant alert of what she believes Lily is going to try next to sabotage her lead role.
She would need to come to terms with her behavior and find ways to eliminate them from acting out. Next, stage two in the dialectical behavior therapy deals with post-traumatic stress disorders. Here we can attribute the abusive stress Nina has to endure with her mother. Since her mother had to give up her own dreams of becoming a star ballerina due to her pregnancy, she now lives her unfinished dreams through Nina’s career. Nina’s mother keeps Nina in a submissive child-like mentality; minimize her freedom with no lock doors and a child-like room despite the fact that Nina is past twenty years of age.
Such trauma makes it difficult for Nina to secure an emotional connection with another person, therefore explains why she is alone most of the time. Others easily victimize Nina, for example Thomas the director, often abuses Nina sexually to arouse her to perform the Black Swan character more vividly for the show. In this stage, Nina should learn new mechanisms of which to deal or completely bypass these situations. The last stage focuses on self-esteem and individual treatment goals. Nina will be able to work on her self-image that can lead her to accept herself for who she really is.
Nina seems to have a problem with not being able to naturally satisfy her desires without conflicting with her own moral. In the case where she goes out with Lily for the night, Nina is very intrigued with how promiscuous Lily is with other men. Nina shows signs of sexual deprivation that later, on impulse, Nina engages in drug abuse that later leads to sexual interactions with multiple partners. In this stage of therapy, Nina will be able to build up her self-esteem that is constantly brought down by her mother and production director.
Nina is shown submissive to both characters throughout the beginning of the film, until she has a complete psychotic meltdown and begins to act on impulse and hallucinations. As unfortunate as Nina’s death was in the end, it’s not hard to notice there were many chances for which intervention would have been great aid before matters had gotten worse. Although it is common that individuals with borderline personality disorder do not consider themselves ill-willed and seldom seek help, if Nina had, she would have been able to decrease her undesired behaviors and had found more appropriate measures of dealing with her problems.
