Give a comparison between the Executive's disorder and Connie's disorder. Explain the factors that might make it difficult to differentiate between and diagnose the disorders.

Case 1:

A 28 year-old junior executive complained of being "depressed" about everything: her job, her husband, and her prospects for the future... Her complaints were of persistent feelings of depressed mood, inferiority and pessimism, which she claims to have had since she was 16 or 17 years old. Although she did reasonably well in college, she constantly ruminated about those students who were "genuinely intelligent." She dated during college and graduate school but claimed she would never go after a guy she thought was "special," always feeling inferior and intimidated.

Just after graduation, she had married the man she was going out with at the time. She thought of him as reasonably desirable, though not "special," and married him primarily because she felt she "needed a husband" for companionship. Shortly after their marriage, the couple started to bicker. She was very critical of his clothes, his job and his parents; and he, in turn, found her rejecting, controlling and moody. She began to feel that she had made a mistake in marrying him.

Recently she has also been having difficulties at work. She is assigned the most menial tasks at the firm and is never given an assignment of importance or responsibility. She admits that she frequently does a "slipshot" job of what is given her, never does more than is required, and never demonstrates any assertiveness or initiative. She feels that she will never go very far in her profession because she does not have the right "connections: and neither does her husband, yet she dreams of money, status and power. Her social life with her husband involves several other couples. The man in these couples is usually a friend of her husband. She is sure that the women find her uninteresting and unimpressive and that the people who seem to like her are probably no bettter off than she.

Under the burden of her dissatisfaction with her marriage, her job and her social life, feeling tired and uninterested in "life," she now enters treatment for the third time.

Case 2:

Connie, a 33-year-old homemaker and mother of a 4-year-old son, Robert, is referred to a psychiatric outpatient program because she has been depressed and unable to concentrate ever since she separated from her husband 3 months previously. Connie left her husband, Donald, after a 5-year marriage. Violent arguments between them, during which Connie was beaten by her husband, had occurred for the last 4 years of their marriage, beginning when she became pregnant with Robert. There were daily arguments during which Donald
hit her hard enough to leave bruises on her face and arms.

Before her marriage, she was close to her parents and had many friends who she also saw regularly. In high school she had been a popular cheerleader and a good student. She had no personal history of depression, and there was no family history of mental illness.

During the first year of marriage, Donald became increasingly irritable and critical of Connie. He began to request that Connie stop calling and seeing her friends after work, and refused to allow them or his in-laws to visit their apartment. Despite her misgivings about Donald's behavior toward her, Connie decided to become pregnant. During the seventh month of the pregnancy, Donald began complaining and began hitting her with his fists. She left him and went to live with her parents for a week. He expressed remorse and Connie returned to her apartment. No further violence occurred until after Robert's birth. At that time, Donald began using cocaine every weekend and often became violent when he was high.

In the three months since she left Donald, Connie has become increasingly depressed. Her appetite has been poor and she has lost 10 pounds. She cries a lot and often wakes up at 5am and is unable to get back to sleep. Connie is pale and thin. She speaks slowly, describing her only pleasure is being with her son. She is able to take care of him physically but feels guilty because her preoccupation with her own bad feelings prevents her from being able to play with him. She now has no contacts other than with her parents and her son. She feels worthless and blames herself for her marital problems, saying that if she had been a better wife, maybe Donald would have been able to give up the cocaine.