The patient was a single, female college student age twenty.
Present Illness: The patient said that all through high school she was nervous with headaches, menstrual complaints, poor appetite, tenseness, and quarrels with her family. She took many headache and sleeping pills. Once she attempted suicide with aspirin. She was never particularly happy. Once she had trouble walking which was diagnosed as hysterical gait disturbance.
With supportive treatment from her family doctor, medication and some helpful counseling at school, she managed to function adequately and graduated from high school at nineteen. That fall she then left home to a city some fifty miles away to go to college. Initially she did fine, feeling better being away from home and getting good grades. She became emotionally involved with a male fellow student and was dating steadily. During Christmas vacation when she returned home there were some recurrences of her symptoms of anxiety and trouble sleeping, but they were brief and during the winter back in school she was doing well.
In March she had a quarrel with her boyfriend. He stopped seeing her and soon afterward she had a marked recurrence of her symptoms. She was unable to concentrate on her studies, felt tired, felt she could not go on because the future was hopeless, and was doing a great deal of crying. On some days when she was active socially she might feel well but next day she would relapse into the same state. She lost ten pounds. Since she had so much trouble going to sleep, she took increasing amounts of sleeping pills until finally some two months after the initial episode, she took an overdose of sleeping pills early one evening, was found by her roommate, and admitted to the hospital.
Past History: The patient's mother has been ill for many years with complaints somewhat similar to her daughter's. However, she functioned fairly well and kept house satisfactorily. The father had his own small business and was a good provider although not conspicuously successful. The patient had never been admitted to a hospital before and had never had any serious physical illnesses.
Mental Status Examination: Several days after the suicide attempt, she was contrite and sorry for what she had done. She still expressed a good deal of pain over the breakup of her love affair, feeling that she was not worthy of the young man in question. She still had little appetite and still had trouble going to sleep. With psychotherapy she soon became more spontaneous, but several days later while talking about her mother became depressed again and unwilling to participate in ward activities.
What is the disorder, symptoms, and suggested treatment?