What are the past and present symptoms of Raven Lundquist?

Case of Raven Lundquist

Raven Lundquist arrived half an hour late for her psychiatric evaluation. A 24-year-old graduate student in philosophy, she was dressed in black, appeared sullen, and avoided eye contact. She had recently moved home to live with her parents. With some encouragement, Ms. Lundquist explained that the appointment was her mother's idea. Until 2 weeks earlier, Ms. Lundquist had been living in a lesbian relationship with Sandy Morrison. The relationship collapsed when Ms. Morrison caught Ms. Lundquist kissing her (Ms. Morrison's) brother. Furious, she sent the diary kept by Ms. Lundquist to the latter's mother, after first writing "SADIST" across the cover. The diary was filled with explicit descriptions of bondage, control, and whipping. Much of it involved Ms. Lundquist's feelings when she disciplined Ms. Morrison, but other entries discussed "BDSM [bondage, domination/discipline, sadism/submission, and masochism] sex parties" in which Ms. Lundquist appeared to enjoy being paid to inflict pain and humiliation on older men. Ms. Lundquist said the consultation was "absurd. There's no problem, except that if I don't get psychiatric 'help,' I'll be kicked out to the curb. I'm a top [dominant sexual partner]. So what?" Ms. Lundquist agreed to return for a second session with the understanding that the psychiatrist would "hear my side of the story and decide whether therapy would be a good idea." At the second session, Ms. Lundquist said she decided to study philosophy after reading Justine by the Marquis de Sade. "It's not as good as Lolita, but it struck a chord." She said she intended to specialize in the ethics of medical treatment. "Yeah, there's a control issue there, but I also like the idea that individuals have rights. I never tied anyone up who didn't ask for it." Ms. Lundquist admitted to drinking more than she should, often drinking to intoxication when she meant to only have a drink or two. Most of her fights with her mother and her with her girlfriend occurred after she had "been really drunk," and often missed early morning classes because of a hangover. She avoided illegal drugs ("I don't like to lose control, and alcohol is bad enough"). She had no criminal history. She did get paid to attend the BDSM parties, but "all I did was look threatening, wear something skimpy, and spank these old guys. They wanted it and were so pathetic. Tying up my girlfriend was much more fun." Her childhood history was notable for having lived in foster homes before being adopted by the woman she calls her "intrusive but well-meaning mother." She had memory gaps from her childhood and thought she might have been molested "It would make sense, wouldn't it? But I really don't remember." Ms. Lundquist described sexual attraction to both men and women but preferred women because "they are typically more submissive." When she masturbated, she fantasized about "power and control," but she could not be more specific. She found herself attracted to her girlfriend's brother and would probably date him "even if he's not a sub." ("Sub" usually describes a person who assumes a subservient, submissive role in the relationship, although appearances can be deceptive.) Ms. Lundquist's medical history was pertinent for having had scoliosis, for which, as a child, she was treated with a Harrington rod and spent a lot of time in the hospital. On examination, Ms. Lundquist was guarded in the description of her emotions. She said that she had been "bummed out" since breaking up with her girlfriend, but she denied other symptoms of depression. She added that she was less upset about missing her girlfriend than about having to move back in with her mother. She tended to stay up at night and sleep in. her appetite fluctuated, and she occasionally put herself on crash diets to "prove I have control over my urges." She had never been suicidal. She had thoughts of killing others and admitted to some "arousal" at the idea but had no plans or known targets. She had no delusions or hallucinations and no anxiety-related symptoms. She was intelligent and cognitively intact.