Well hello my dear Steemeers!!

Let's take a brief look into a case that seems obvious at first, screaming schizophrenia all the way.

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Ok, this movie clearly depicts an acute onset of psychotic disorder, but if we take a closer look on clinical features of our lovely ballerina we'll get totally confused. Hands down to Natalie Portman's performance and vivid directing by Darren Aronofsky, but in reality Nina Sayer would appear slightly different.

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Main features of schizophrenia

Positive symptoms - florid psychotic symptoms, such as hallucinations, which are usually auditory; delusions; and disorganized speech and behavior

Negative symptoms - blunted or flat affect, poverty of speech, and loss of interests and drive; anhedonia, autism (loss of interest for social relations)

Schizophrenia is a neurodegenerative disorder with progressive neurocognitive deficits (deficits in working memory and attention and in executive functions, such as the ability to organize and abstract)

Mood symptoms - Patients often seem cheerful or sad in a way that is difficult to understand; they often are depressed

ROUGH ANALYSIS OF NINA SAYERS'S MENTAL STATUS (I've pin pointed few features, not the whole status)

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APPEARENCE

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Fragile, very slim, malnourished. Reserved in social interactions, indicating certain degree of anxiety. Other than that, you won't see any other sings of a serious mental disorder, from the outside.

THOUGHT PROCESS

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While person suffering from schizophrenia, at least in the acute phase of illness, would show some pathological production in their thought process. Nina's thoughts doesn't seem disorganized, not even in a sense of huge amount associations, blurring the determining tendency. In most progressive stages of the disorder schizophrenic would easily produce a so called "word salad", or even neologisms. Form of her thought process seems intact.

AFFECT, PSYCHOMOTORICS

Seems intact as well. Her affect is well modulated and you can clearly see what's her emotional state in most scenes.

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MOOD

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Shows some sings of depression, but not in clinical ways. Some para-suicidal patterns in her behavior would make you think she suffers from a borderline personality disorder.

WILL

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Extremely motivated, even in a pathological sense. Total opposite of usual presentation of schizophrenia, as loss of will is one of the core symptoms in reality. Her drive could be compared to one of a highly narcissistic person, rather than psychotic.

INTERPERSONAL RELATIONS AND SELF ORGANISATION

Clear symbiotic relationship with her over controlling mother. Lack of social interactions. Obvious self disturbances, primarily in a self image and sexual identity, indicating borderline personality organisation.

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Why did she took this role so seriously? She's in need crush this cute and fragile persona, totally dependent on her mother. In order to do so she needs to and embrace her shadow to be complete (Jungian concept of individuation). In this process of separation from her mother, her symbiotic, disintegrated self splits and psychotic features pops out.

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COGNITIVE FUNCTIONING

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Doesn't seem impaired at all.

FUNCTIONALITY

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Schizophrenia heavily interferes with a person's ability to function. They could seem functional if their reality allows them. For example artists can perform despite the presence of psychosis. But to maintain that level of motivation and organisation day to day as Nina is, it's almost impossible for a person in a acute state of sch.

INSIGHT

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She gradually losses her sense of what's real and whats not, finally embodying her shadow.

PSYCHOTIC FEATURES

Visual hallucinations and delusion of metamorphosis into a black swan. Again, schizophrenic would suffer from auditory hallucinations, as visual occurs in organic damaging of the brain (tumor, delirant states, hallucinogens intoxication...)

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So, is she schizophrenic?

According to this movie, not. More likely a borderline personality organisation with a psychotic decompensation precipitated by an extremely stressful period in Nina's life (stressful competition in a ballet world, conflicted relationships with her mother, sexual assaults by her director...)

DIFFERENTIAL DIAGNOSIS

Nina would meet chriteria for several mental disorders (BPD - borderline personality disorder, NPD - narcissistic personality disorder, eating disorders (anorexia nervosa, bulimia), OCD, anxiety disorder and finally psychosis which is not that probable in real life.

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DIAGNOSIS

Diagnosis according to ICD (International Statistical Classification of Diseases ) - 10th revision

F23 Brief psychotic disorder (reactive psychosis ?)

F60.9 Personality disorder, unspecified

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You really can't be more specific about her diagnosis as the clinical features in this movie goes crazy, practically covering the whole spectrum of mental disorders in full intensity. MRi scan could even show some organic substrate in Nina's brain as well (tumor or encephalitis) due to the visual hallucinations. Electrolyte imbalance and nutritional deficits could also be the cause of her psychotic features.

TREATMENT

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Only after full diagnostics is done (MRi, blood test, lumbal punction, neurological examination) and real cause of her psychotic features is reviled we could start the proper treatment.

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Is there any other character you'd like to dissect?

Psychologically of course! ;)

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Feel free to Upvote and comment, suggest for movie analysis :)

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