CASE STUDY TWO Louise Larkin is a pale, stooped woman of 39 years, whose childlike face is surrounded by straggly blond braids tied with pink ribbons. She was referred for a psychiatric evaluation for possible hospitalization by her family doctor, who was concerned about her low level of functioning. Her only complain to him was, "I have a decline in self- care and a low life level." Her mother reports that there has indeed been a decline, but that it has been over many years. In the last few months, Louise has remained in her room, mute and still. Twelve years ago, Louise was a supervisor in the occupational therapy department of a large hospital, living in her own apartment, and engaged to a young man. He broke the engagement, and she became increasingly disorganized, wandering aimlessly in the street, wearing mismatched clothing. She was fired from her job, and eventually the police were called to hospitalize her. They broke into her apartment, which was in shambles, filled with papers, food, and broken objects. No information is available from this hospitalization, which lasted three months, and from which she was discharged to her mother's house with ha prescription for an unknown medication that she never filled. After her discharge, her family hoped that Louise would gather herself together and embark again on a real life, but over the years, she became more withdrawn and less functional. Most of her time was spent watching TV and cooking. Her cooking consisted of mixing bizarre combinations of ingredients, such as broccoli and cake mix, cooking them, and then eating them alone because no one else in the family would eat her meals. She collected cookbooks and recipes, cluttering her room with stacks of them. Often when her mother would enter her room, she would quickly grab a magazine and pretend too be reading, when in fact she had apparently just been sitting and staring into space. She stopped bathing and brushing her hair or her teeth. She ate less and less, although she denied loss of appetite, and over a period of several years lost twenty pounds. She would sleep at odd hours. Eventually, she became enuretic, wetting her bed frequently and filling the room with the pungent odor of urine. On admission to the psychiatric hospital, Louise sat with her hands tightly clasped in her lap and avoided looking at the doctor who interviewed her. She answered questions readily and did not appear suspicious or guarded, but her affect was shallow. She denied depressed mood, delusions, or hallucinations. However, her answers became increasingly idiosyncratic and irrelevant as the interview progressed. In response to a question about her strange cooking habits, she replied that she did not wish to discuss recent events in Russia. When discussing her decline in functioning, she said, "There's more of a take-off mechanism when you're younger." Asked about ideas of reference, she said, "I doubt it's true, but if one knows the writers involved, it could be an element that would be directed in a comical way." Her answers were interspersed with the mantra, "I'm safe. I'm safe." What is the most appropriate diagnosis and your detailed rationale for the same?