Running head: CASE STUDY OF MARILYN MONROE
Case Study of Marilyn Monroe
Sarah Brothwell and Rachel Miller
State University at Buffalo New York
1
CASE STUDY OF MARILYN MONROE
Case Study of Marilyn Monroe
1) Introduction. (Maximum length: One-half to one page)
Provide a general description of the case and your goals for the report. Answer the
following questions: How was the case located? What is your relationship to the person?
Did you obtain informed consent and assure the person that their rights of voluntary
participation and confidentiality will be maintained? Provide a brief background
statement on the overall clinical issue.
2) Background & Medical Assessment. (Maximum length: Three pages)
a) Identifying information (age, gender, socio-cultural background, educational level,
employment status)
b) Medical History
1) Personal medical history (Based on patient report with corroboration from
treating medical personnel whenever possible. Note especially any conditions
that may contribute to current mental status.)
Developmental issues, Diagnoses, Medications, Eating problems (over/undereating, bingeing/purging), Sleep (too much/too little), Major injuries (esp.
head trauma), Chronic illness, Current health self-assessment, Treatment for
current diagnoses, Prognosis, Genetic conditions or concerns.
2) Family medical history. Note any historical or current medical conditions that
may be relevant to the case.
3) Psychological Assessment (Maximum length: Three pages)
a) Mental Status: Orientation, Appearance, Mood, Affect, Attention, Alertness,
Psychomotor, Eye contact, Speech, Thought content (delusions, ideas of reference),
Preoccupations, Hallucinations, Organization, Thought process, Memory, Estimated
intelligence, Insight, Judgment, Attitude toward interviewer.
b) Presenting Problems: Onset, Frequency, Intensity, Duration, Any previous treatment.
c) Family: Describe relationship with parents & siblings, birth order, family problems
inc. mental health, illness/death, divorce, abuse (of substances or family members).
Level of family support.
d) Substance Use: History (family hx, age started), Tobacco, Alcohol, Street drugs.
Current use pattern (substance & times per day/week). Abuse/Dependence.
Awareness of consequences. Motivation to change
e) Social Support: Number & quality of friends, History of peer relationships, Any
traumatic prior relationships, Cultural support, Status of romantic relationship,
Satisfaction with support & social network, Geographic relocations, Stability of
employment
f) Coping & Strengths: Primary/secondary coping strategies/skills, Leisure activities,
Optimism/pessimism; Spirituality/religion; Avoidance; Problem/Emotion focus;
Resilience/Confidence
g) Lethality: Current thoughts/means; Prior attempts; Family or close friend attempt or
commit suicide Self-injurious behavior. Thoughts of hurting anyone else; History of
violence; Ever arrested
4) Supplementary Data (reports from family, friends, medical reports, psychometrics, etc.)
CASE STUDY OF MARILYN MONROE
Diagnoses
DSM.5- (F60.3) Borderline Personality Disorder, (F13.20) Sedative-Hypnotic or AnxiolyticRelated Disorder (Server), Post-Traumatic Stress Disorder Traits
Biopsychosocial formulation
There are several factors that have influenced the progression of Marilyn Monroe’s mental
illness. Genetically, she has a predisposition towards experiencing a mental illness, as her
mother, grandmother and uncle suffered from sever mental illnesses, including schizophrenia
and major depression. Marilyn also had a plethora of negative and traumatic early life
experiences that may have facilitated the development of her disorder. Furthermore, her lifestyle
as an actress may have also had exacerbated her BPD symptoms. Due to Marilyn’s significant
substance abuse, insecure relationship with others and suicidal ideation, her current overall
functioning is low.
Evidence-based Intervention Plan
1) What treatment/intervention might be hypothesized to be effective with this
person?
What treatment/intervention might be hypothesized to be effective with this person?
● Inpatient, dual diagnosis treatment for BPD and addiction
● Individual psychotherapy
● Classes and counseling session on relapse prevention
● Peer run support groups
Psychiatric medication- selective serotonin reuptake inhibitor (SSRI)
2) What is the evidence for the recommended plan? (Cite specific studies).
Therapeutic Approach: Dialectical Behavior Therapy (DBT)
● DBT is a well established treatment for individuals with multiple and severe
psychological disorders. Dialectic means the synthesis of two opposites (e.g change and
acceptance).
● DBT classifies behavioral targets hierarchically. In MM’s case to decrease behaviors that
are life threatening (e.g. suicide) and then substance abuse-specific behaviors.
CASE STUDY OF MARILYN MONROE
● The treatment includes five essential functions
Improving patients motivation to change
Enhancing patient capabilities
Generalizing new behaviors
Structuring new environment
Enhancing therapist capabilities and motivation
● DBT has been shown to be effective for treating individuals with borderline personality
disorders (Koerner & Linehan, 2000).
● Research has also demonstrated that DBT can be effective when treating individuals with
co-occurring borderline personality disorder and substance abuse ( Dimeff & Linehan,
2008).
● Meta analysis conducted to examine the use of DBT to treat borderline personality
disorder found a moderate global effect size and a moderate effect size for suicidal and
self-injurious behaviors (Kliem, Kröger, & Kosfelder, 2010).
3) What moderators or mediators might be relevant in this case?
● Marilyn Monroe’s determination to be an actress may limit her ability to structure a new
environment for herself. It seems to me that her vocational choice may be detrimental to
her progress in treatment.
4) What practical considerations might limit the feasibility of using the intervention
in this case?
● Marilyn may be hesitant to enter into inpatient treatment, due to her traumatic past
experience of being hospitalized. Motivation and insight into the need for therapy is often
a challenge for this population. Her high status may enable her to leave treatment early.
5) How might you plan for possible complications?
I would try to send her to a clinic that felt more “home” like. When Marilyn was hospitalized,
she complained about her room feeling like a prison cell. In terms of helping her trust trust new
counselors, education on the characteristics and symptoms of BPD would go a long way. This
way she will know what to expect from her counselors, as well as from her overall experience in
treatment.
6) How will you evaluate the intervention in this case?
● Self report measures- Pre and Post-treatment Personality Assessment InventoryBorderline Features Scale (Kathryn Gardner & Pamela Qualter 2009).
● Pre and Post-treatment FFM Borderline Index (Maddux & Winstead 2012)
CASE STUDY OF MARILYN MONROE
● Clinician reports and progress notes
7) Prognosis/expectations regarding outcome?
● Prognosis/expectations regarding outcome? There is considerable variability in the
developmental course of BPD. The most common involves serious affective and impulse
dysregulation in early adulthood, which is when risk of suicide is the greatest.
● Although these clients may struggle with intense emotions and interpersonal instability
throughout their lifetime, they often show improvements within the first year of therapy.
After 10 years of therapy roughly 50% of individuals will no longer meet the diagnostic
criteria for BPD (American Psychiatric Association, 2013)