Effects Of Social Media On Mental Health And Body Image

Youngkeun Choi / Journal of Asian Finance, Economics and Business Vol 5 No 2 (2018) 95-104 95

 

Print ISSN: 2288-4637 / Online ISSN 2288-4645 doi:10.13106/jafeb.2018.vol5.no2.95

Narcissism and Social Media Addiction in Workplace

Youngkeun Choi1

Received: April 12, 2018. Revised: April 23, 2018. Accepted: May 15, 2018.

Abstract

The purpose of this study is to investigate the impact of narcissism on employees’ social media addiction and how it influences their job satisfaction and organizational commitment. And this study explores if perceived organizational support can moderate the relationship between narcissism and social media addiction. For this, this study collected data from 285 employees in Korean companies through a survey method and uses SPSS 18.0 for hierarchical regression analysis in the hypothesis test. First, organizational politics increases mood modification, withdrawal and tolerance among the sub-factors of social media addiction. Second, each phenomena of social media service addiction such as salience, withdrawal and tolerance decrease each relevant factors of job satisfaction and organizational commitment. Third, withdrawal and tolerance among the sub-factors of social media addiction play the mediating roles between narcissism and each relevant factors of job satisfaction/organizational commitment. Finally, perceived organizational support decrease the effect of narcissism on mood modification, withdrawal and tolerance among the sub-factors of social media addiction. This study provides some of managerial implications to corporate executives who try to manage organizational attitudes.

Keywords: Narcissism, Social Media Addiction, Perceived Organizational Support.

JEL Classification Code: C12, C83, M12, M14.

 

 

1. Introduction 1

Recently, social media has become increasingly popular across the world (Kuss & Griffiths, 2011). People enjoy social media in many various types of social activity including playing games, socializing, passing time, communicating, and posting pictures (Allen, Ryan, Gray, Mclnerney, & Waters, 2014; Ryan, Chester, Reece, & Xenos, 2014). Although it has been a normal activity, researchers have concerned about the potential addictive use of social media (Andreassen, 2015; Griffiths, Kuss, & Demetrovics, 2014).

General addiction model have explained such excessive and compulsive use (Griffiths, 2005). Scholars have suggested cyber-sexual addiction, social media addiction, net compulsions (e.g., stock trading, gambling, shopping), information overload, and computer addiction (e.g., games, programming) (Young, 1999). Therefore, addictive social media use is defined as being overly concerned about social media, driven by an uncontrollable motivation to log on to or use social media, and devoting so much time and effort to social media that it impairs other important life areas (Andreassen & Pallesen, 2014).

1 Associate Professor, Division of Business Administration, College

of Business, Sangmyung University, Seoul, Korea. E-mail: penking1@smu.ac.kr

As the social media enter the workplace, more needs of to be learned about its effects on the organizational behaviors of employees. However, most of the previous studies have focused on individual behaviors when examining this excessive consumption of new media (Echeburua & de Corral, 2010; Kuss & Griffiths, 2011), while research about social media addiction in the context of workplace is rare. Recently, employees use and commit social media excessively rather than work hard, which makes a matter of great concern in the workplaces. Thus, social media addiction should be viewed as one of the serious organizational problems arising in today’s workplace. Therefore, the present study will examine the antecedent and consequences of social media addiction in the context of workplace. And it will explore the mediating effects of social media addiction and find out the factors which can manage social media addiction in the workplace.

 

 

2. Literature Review and Hypothesis Development

 

2.1. Antecedents

A lot of researchers have suggested that personality influences addictive use of social media (e.g., Andreassen et al., 2012, 2013; Hong, Huang, Lin, & Chiu, 2014; Wilson,

 

 

96 Youngkeun Choi / Journal of Asian Finance, Economics and Business Vol 5 No 2 (2018) 95-104

Fornasier, & White, 2010). Some recent research have argued that the popularity of social media are an increase in the levels of narcissism in today’s society (Mehdizadeh, 2010; Buffardi & Campbell, 2008). Especially, social media involve the features of communication that differ from offline communication and that might suit narcissistic tendencies (Valkenburg & Peter, 2011). First, social media provide easy access to a large number of other individuals. Users have the opportunity to send self-related information to a large audience and to receive feedback about oneself and information about others. Second, users can select the information they reveal about themselves. They can use pictures and words to communicate success and superiority. Third, the asynchronicity of communication on social media gives users the opportunity to craft their self-presentations meticulously.

Buffardi and Campbell (2008) showed that users’ self- reported grandiose narcissism was significantly related to the quantity of their social interactions (a composite measure of number of friends and number of wall posts) but not to the quantity of information listed in the “about self” section. Furthermore, they rated the extent of self-promoting content (mainly self-promotion in pictures and quotes) on the participants’ Facebook pages and correlated these ratings with self-reported grandiose narcissism. Several Facebook content indicators such as self-promoting quotes yielded a positive relationship with self-reported narcissism, whereas others (e.g., self-promoting pictures) did not. These results show that narcissists appear to be particularly attracted to activities that reinforce their sense of self- importance and provide the means to present themselves favorably to others. They further strive for a large audience by gathering a large number of Facebook friends and craft frequent status updates that reflect their grandiose self- image.

This seems to be meaningful as social media use allows people to show their ambitions and successes to a potentially large audience, and to obtain highly visible rewards and recognition through “likes” and positive comments from other social media users. Recent studies appear to refer to narcissism as a relatively broad behavioral trait domain, expressed by, among others, self- centered grandiosity, arrogance, manipulativeness, and similar features (Alarcón & Sarabia, 2012). Diagnostic and Statistical Manual of Mental Disorders formally recognize narcissistic personality disorder which is a pathological form of narcissism in terms of high levels of self-importance, fantasies of unlimited success, feeling special and unique, lack of empathy, envy, and arrogance (American Psychiatric Association, 2013). However, more moderate and non- clinical levels of narcissistic traits have sometimes been regarded as healthy by providing an outlet for self-

confidence and self-assertion (Cambell, Reeder, Sedikides, & Elliot, 2000; Muller, 2014). Although the definition of social media addiction is inconsistent, social media may serve as a gratifying medium for people with high level of narcissistic traits particularly. When they repeat this iterative patterns of showing their ambitions and successes and obtaining highly visible rewards and recognition in social media world, the level of their psychological dependency on social media increases. Accordingly, the following hypothesis is established.

 

<Hypothesis 1> Narcissism will be positively associated with social media addiction.

 

2.2. Consequences

Most of researches concerning social media addiction have argued that it made many kinds of negative influence on users. Social network service usage can lead to a variety of negative consequences that imply a potential decrease in involvement in real-life communities (Nyland, Marvez, & Beck, 2007) and worse academic performance (Kirschner & Karpinski, 2010), as well as relationship problems (Tokunaga, 2011) in the various context. For example, the results of 184 Internet users’ online survey indicated that people who use SNS more in terms of time spent on usage are less involved with their real life communities (Nyland, Marvez, & Beck, 2007). According to the recent study (Kirschner & Karpinski, 2010), which assessed relationships between Facebook usage and academic performance in a sample of 219 university students, Facebook users had lower Grade Point Averages and spent less time for studying than students who did not use Facebook. 26% of students recognized an impact of their SNS usage on their lives, three-quarters (74%) claimed that it had a negative impact, namely procrastination, distraction, and poor time- management. A potential explanation for this may be that students who used the Internet to study may have been distracted by the simultaneous engagement in SNS as this multitasking is detrimental to academic achievements (Kirschner & Karpinski, 2010). The usage of Facebook also may produce negative consequences for romantic relationships in some circumstances. The disclosure of rich private information on one’s Facebook page including status updates, comments, pictures, and new friends, can result in jealous cyberstalking (Phillips, 2009), including interpersonal electronic surveillance (Tokunaga, 2011) by one’s partner. This was reported to lead to jealousy (Muise, Christofides, & Desmarais, 2009; Persch, 2007) and, in the most extreme cases, divorce and associated legal actions (Luscombe, 2009).

However, few studies of social media addiction have been interested in the context of workplace. Similar to the above contexts, although social media use provides users psychological rewards, they are likely to engage in the

 

 

Youngkeun Choi / Journal of Asian Finance, Economics and Business Vol 5 No 2 (2018) 95-104 97

 

activity more and more, which eventually leads to many problems in workplace. If employees spend a lot of time using and committing social media excessively rather than work hard, it will make a matter of negative consequences in the workplace. I suggest job satisfaction and organizational commitment as two kinds of the organizational attitudes of employees which are negatively influenced by social media addiction.

First, job satisfaction conveys useful information about an individual’s economic, social, and personal life as it is a major determinant of labor market mobility (Freeman, 1978; Park et al., 2016), job performance (Mount et al., 2006), and personal well-being (Rode, 2004). Similar to other context, if employees use social media more in terms of time spent on usage, they are less interested in their real life in workplace, which their job satisfaction decreases. Second, relevant studies defined organizational commitment in terms of nature of relationship (Grusky, 1996; Chun et al., 2016; Kwon & Yang, 2015), loyalty to employer (Kim et al. 1996), integration of individual and organizational goals (Hall, 1970), identification with or attachment to the organization (Romsek, 1989), readiness to exert considerable effort on behalf of the organization, and strong desire to remain a member of the organization (Balaji, 1985). When employees are more addictive in social media use, they are more likely not only to ignore their real life in workplace, which their organizational commitment decreases. Accordingly, the following hypothesis is established.

 

<Hypothesis 2> Social media addiction will be negatively associated with job satisfaction.

<Hypothesis 3> Social media addiction will be negatively associated with organizational commitment.

 

2.3. Mediating effect

Recently, narcissism in organization management has become a growing area. Although the growth of research on narcissism has not yet been integrated with a model of organizational management, narcissism seems to have some significant implications for organizational management. Organizational management tries to align employees’ efforts in pursuit of organizational goals through planning, assessing performance, providing feedback, and adapting accordingly (Aguinis, 2013; Aguinis & Poerce, 2008; DeNisi & Pritchard, 2006). Organizational management leads to higher employee performance if it strengthen the linkages between employees’ action and their need satisfaction (DeNisi & Pritchard, 2006).

Research focused on the antecedents of job satisfaction has shifted appreciably since the mid-eighties from a focus on role perceptions and organizational variables to how

personality traits might influence these feelings. Narcissistic employees with more ego threats from their jobs are less satisfied with their jobs. Because of the exploitiveness/ entitlement and superiority/arrogance components of their narcissistic personality (Wallace & Baumeister, 2002; Judge et al., 2006; Maynard et al., 2015).

Narcissism has been linked to workplace deviance and contextual performance (Judge, LePine, & Rich, 2006, O’Boyle, Forsyth, Banks, & McDanel, 2012). This issue become important due to the growth in narcissism, which researchers consider an epidemic (Twenge & Campbell, 2009). Due to their selfish nature, sense of entitlement, exploitive personalities, sense of superiority, and social callousness, they seem quite likely to engage in deviant organizational and deviant interpersonal dimensions of salesperson deviant behaviors described by Jelinek and Ahearne (2006). Therefore, those with the higher level of narcissism are less committed to their organizations. As results, they shows more counterproductive work attitudes.

I explore the possibility of mediating effect of SNS addiction between the narcissism and the work attitudes of employees. The employees with high level of narcissistic traits in workplaces can use social media to show their ambitions and successes and obtain highly visible rewards and recognition in social media world. However, although they may have self-confidence and self-assertion (Cambell, Reeder, Sedikides, & Elliot, 2000; Muller, 2014), they cannot help repeating this iterative patterns through using social media addictively, so that their job satisfaction and organizational commitment will decrease. Accordingly, the following hypothesis is established.

 

<Hypothesis 4> Social media addiction will mediate the relationship between narcissism and job satisfaction.

<Hypothesis 5> Social media addiction will mediate the relationship between narcissism and organizational commitment.

 

2.4. Moderator

Organizational support theory (OST) suggests that employees form expectancies of support based on the degree to which the organization both values employees’ contributions and demonstrates concern for their well-being (Eisenberger, Huntington, Hutchinson, & Sowa, 1986). Based on OST, I expect perceived organizational support (POS) to buffer the positive relationship between narcissism and work attitudes. A supportive work environment signals that the employee is a valued member of the organization, which can lead to resource accumulation through its positive impact on one’s sense of self-worth and its satisfaction of

 

 

98 Youngkeun Choi / Journal of Asian Finance, Economics and Business Vol 5 No 2 (2018) 95-104

the fundamental human need for belongingness (Rhoades & Eisenberger, 2002). Self-esteem and feeling a sense of belonging are both important socio-emotional resources and so events or experiences that replenish or increase them can potentially counteract the socio-emotional resources that narcissism demands.

Narcissism is referred to as a relatively broad behavioral trait domain, expressed by, among others, self-centered grandiosity, arrogance, manipulativeness, and similar features (Alarcón & Sarabia, 2012). These traits provide an outlet for self-confidence and self-assertion (Cambell, Reeder, Sedikides, & Elliot, 2000; Muller, 2014). Because social media use allows people to show their ambitions and successes to a potentially large audience, and to obtain highly visible rewards and recognition and positive comments from other social media users, the level of their psychological dependency on social media increases. However, more employees perceive that the organization values employees’ contributions and demonstrates concern for their well-being, less they need to be addictive in social media. Accordingly, the following hypothesis is established.

 

<Hypothesis 6> POS will decrease the positive relationship between narcissism and social media addiction.

 

 

3. Methodology

3.1. Data collection and sample

The objective of the study is to identify behavioral factors related to social media addiction by an empirical test. The factors of organizational behaviors can be identified by measuring organization’s members’ perceptions in the workplace situations. I adopted an online survey method using a convenience sampling for data collection as it is very useful in collecting data from a large number of individuals in a relatively short period of time and at better cost.

To test our hypotheses of this study, a self-completion questionnaire was administered to business office workers (20-59 years old) in South Korea. All participants received an email requesting for this online survey with an accompanying email that explains the purpose of the survey, emphasized a voluntary participation, and guaranteed confidently. Participants were asked to fill out the questionnaire.

The survey questionnaire consisted of three parts. In the first part of survey questionnaire, participants were instructed to read the purpose of the survey. The second part of the questionnaire included the items measuring the respondent’s narcissism, social media addiction, job satisfaction, organizational commitment. The third part of the study consisted of basic information about firm profiles

and respondents’ characteristics, using nominal scales (e.g., demographic variables, the industry of their companies, the number of employee, tenure, etc.)

Finally, I collected 285 complete responses from the online survey. The characteristics of respondents is reported in Table 1 (e.g., age, gender, the industry of their companies, the number of employees in their companies, tenure, the level of their education, the marital status). Table 1. Sample Profile

Variables Items Percentages

Age

20’s 24.6

30’s 27.4

40’s 22.4

50’s 25.6

Gender Male 46.3

Female 53.7

Industry of their company

Manufacturing 28.8

Construction 10.2

Service 32.2

Public agency 5.6

Wholesale/retail 8.1

Etc. 15.1

Number of Employee

in their company

Less than 10 20.7

11~50 29.8

51~300 29.5

301~1000 7.1

More than 1001 12.9

Tenure

Less than 5 years 53.3

6~9 years 23.5

10~14 years 12.3

15~19 years 4.2

More than 20 years 6.7

Level of their education

Middle school 0.7

High school 15.8

Community college 20.8

Undergraduate school 52.9

Graduate school 9.8

Position

Staff 44.6

Assistant manager 18.2

Manager 15.4

Senior manager 13.3

Director 6.3

Etc. 2.1

Marital Status Married 54.7

Single 45.3

 

 

Youngkeun Choi / Journal of Asian Finance, Economics and Business Vol 5 No 2 (2018) 95-104 99

 

3.2. Measurement

Table 2 show the measurements of variables in the present study.

 

Table 2. The measurements of variables

Variables Sub-factors References

Narcissism – Ames et al.(2006)

Social media addiction

Salience

Andreassen et al.(2017)

Conflict

Mood modification

Withdrawal

Tolerance

relapse

Job satisfaction

Work

Smith et al.(1969)

Pay

Promotion

Colleague

Supervision

Organizational commitment

Affective commitment

Allen & Meyer(1990) Continuance commitment

Normative commitment

Perceived organizational support – Wayne et al.(1987)

 

Table 3. Variables’ correlation coefficient and other statistics

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Narcissism 1

Salience -.062 1

choose, at random, three (3) people (preferably different ages and cultural backgrounds;

(1) review and summarize Positive psychology research to answer the following three questions: (a) “what does it mean to live a pleasant life”? (b) “what does it mean to live an engaged (full) life”?, and (c) “what does it mean to live a meaningful life”? End this section with general purpose of your project (e.g., “The purpose of our final project was to conduct a qualitative survey study to gather information as to whether pursuit of pleasant, engaging, and meaningful life leads to high level of life satisfaction as suggested by Positive Psychology research summarized above.”) must be at least one FULL page long, based on at least five (5) primary sources (be sure to include APA style format in-text citations).

2) choose, at random, three (3) people (preferably different ages and cultural backgrounds; your Methods/Participants section) to interview them about their views of what does it mean to live a pleasant/engaged/meaningful life and whether (if so, how?) pursuit of all three contributes to their life satisfaction (your Methods/Procedure section). Type up the summary of your findings in detail (who said what; your Results section). In your Discussion section, reflect on the activity’s general findings (i.e., do they support past research results summarized in your lit. review?) and share your own answer to the question, reflecting whether (if so, how) your view about pleasant, engaged, and meaningful life characteristics has changed due to the knowledge you gained through readings, and presenting on Positive Psychology theory and research.1 full page

2 FULL pages in length, APA style format: double-spaced and in Times New Roman 12-point font, black ink, 1” margins on all sides, our references list must include at least 5 primary sources (i.e, scholar peer-reviewed articles) published within the past 10 years

see example below

FINAL PROJECT 1

 

FINAL PROJECT 5

 

 

 

 

 

 

 

 

 

Your Chosen Title: Must be Relevant to the Main Idea of the Project

 

Your First and Last Name

Florida International University

 

 

 

 

 

 

 

 

 

 

 

 

Abstract

Begin a new page. Your abstract page should include the page header, without the “Running Head” phrase (see above). Your abstract should contain at least your research topic and purpose, participants’ information, methods, results, and general conclusions on your findings. You may also include possible implications of your project and future research you see connected with your findings. Your abstract should be a single double-spaced paragraph. Your abstract should be no more than 180 words and include at least five key words keywords/key phrases. To do this, indent as you would if you were starting a new paragraph, type Keywords: (italicized), and then list your keywords. The purpose of your keywords is to help researchers find your work in databases. The following are the key phrases examples (please do not copy and paste these into your paper).

Keywords: subjective well-being, mindfulness, happiness, positive psychology

 

 

 

 

 

 

 

 

 

 

 

Copy and Paste the Title of your Paper Here

Review and summarize Positive psychology research to answer the following three questions: (a) “what does it mean to live a pleasant life”? (b) “what does it mean to live an engaged (full) life”?, and (c) “what does it mean to live a meaningful life”? The literature review is worth ten points; it must be at least one FULL page long, based on at least five primary sources (Seligman et al., 2005). Be sure to include APA style format 7th Ed. in-text citations for at least five peer-reviewed articles (i.e., primary sources) published within the past ten years. End this section with general purpose of your project. For example, “The purpose of our final project was to conduct a qualitative survey study to gather information as to whether pursuit of pleasant, engaging, and meaningful life leads to high level of life satisfaction as suggested by Positive Psychology research summarized above (Seligman et al., 2005)”. This is just an example; please do not commit plagiarism by copying and pasting the sentence above, or anything else for that matter, into your paper.

Method

Participants

You are required to randomly choose at least three participants for your qualitative research study. Make sure to provide their demographic information (i.e., age, gender) as well as ethnic/cultural and academic background.

Materials and Procedure

Describe the procedure you used to conduct the project (i.e., interview). What questions did you ask exactly? The following are the questions I posted for you on Canvas: “What does it mean to live a pleasant/engaged/meaningful life and whether (if so, how?) pursuit of all three contributes to their life satisfaction.” Feel free to paraphrase the questions to your liking; just keep them the same across your three interviews (i.e., standardized).

Results

What were your participants’ responses to your questions? Provide a summary of your findings in great detail (i.e., who said what?).

Discussion

In this final section, reflect on the activity’s general findings (i.e., do they support past research results summarized in your lit. review?) and share your own answer to the question, reflecting whether (if so, how) your view about pleasant, engaged, and meaningful life characteristics has changed due to the knowledge you gained through readings, presenting on Positive Psychology theory and research, and completing the weekly Discussions’ activities (e.g., engaging in random acts of kindness, expressing gratitude, exploring and using your strengths, to name a few). This part of your paper is worth 10 pts and must be at least one FULL page long.

Scroll down to continue with the APA style 7th ed. References list. Note that it must begin on a new page and include at least five primary sources (e.g., your textbook) that you cited in your Literature review section. You are welcome to use the source included in my list. Be sure to use APA style format (i.e., hanging indentation, proper capitalization, use of italics, doi. etc). See and follow the example below.

 

 

 

 

References

Seligman, M. E. P., Steen, T. A., Park, N., & Peterson, C. (2005). Positive psychology progress: Empirical validation of interventions. American Psychologist, 60(5), 410-421. doi:10.1037/0003-066X.60.5.410

Evaluating Assessment Instruments

See Chapter 11 from the textbook attached, the article by Baez (2013), the assigned chapters in the U.S. Department of Labor Employment and Training Administration (2006) guide, and view the video Psychometric testing and employment.?

Use the PSY640 Checklist for Evaluating Tests document attached to compare two assessment instruments used in industrial and organizational (I-O) psychology assessment? Based on the information in the text and assigned readings, select and evaluate two psychological tests used in industrial-organizational psychological assessment. Do not evaluate any of the tests evaluated in Applications in Personality Testing document attached?

In addition to chapter 11 from text attached, locate a minimum of two appropriate scholarly and/or peer-reviewed sources to aid in the analysis of the psychometric properties of the instruments based on published data. Provide the names of the two tests you evaluated, and attach your completed PSY640 Checklist for Evaluating Tests document.Please maintain the original format of the PSY640 Checklist for Evaluating Tests document attached and include the chapter 11 from the textbook and two additional scholarly and/or peer-reviewed sources in the references section?.

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Personality Tests in Employment Selection: Use With Caution

Abstract [Excerpt] Many employers utilize personality tests in the employment selection process to identify people who have more than just the knowledge and skills necessary to be successful in their jobs.[1] If anecdotes are to be believed—Dilbert must be getting at something or the cartoon strip would not be so popular—the work place is full of people whose personalities are a mismatch for the positions they hold. Psychology has the ability to measure personality and emotional intelligence (“EQ”), which can provide employers with data to use in the selection process. “Personality refers to an individual’s unique constellation of consistent behavioral traits”[2] and “emotional intelligence consists of the ability to perceive and express emotion, assimilate emotion in thought, understand and reason with emotion, and regulate emotion.”[3] By using a scientific approach in hiring, employers can increase their number of successful employees.

Keywords HR Review, Human Resources, employment selection, personality tests

Disciplines Human Resources Management | Labor Relations

Comments Suggested Citation: Baez H. (2013, January 26). Personality tests in employment selection: Use with caution. Cornell HR Review. Retrieved [insert date] from Cornell University, ILR School site: http://digitalcommons.ilr.cornell.edu/chrr/ 59

This article is available at DigitalCommons@ILR: http://digitalcommons.ilr.cornell.edu/chrr/59

 

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  • Personality Tests in Employment Selection: Use With Caution
    • H. Beau Baez
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      • Abstract
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  • www.cornellhrreview.org/…Personality-Testing.pdf

Explain how diagnosing a client with a personality disorder may affect their treatment.

Provide the full DSM-5 diagnosis. Remember, a full diagnosis should include the name of the disorder, ICD-10-CM code, specifiers, severity, and the Z codes (other conditions that may need clinical attention). Keep in mind a diagnosis covers the most recent 12 months.

  • Explain the diagnosis by matching the symptoms identified in the case to the specific criteria for the diagnosis.
  • Support your decision by identifying the symptoms which meet specific criteria for each diagnosis.
  • Identify any close differentials and why they were eliminated. Concisely support your decisions with the case materials and readings.
  • Explain how diagnosing a client with a personality disorder may affect their treatment.
  • Analyze how power and privilege may influence who is labeled with a personality disorder and which types of personality disorders.
  • Identify how trauma affects the case, either precipitating the diagnosis and/or resulting from related symptoms or treatment of diagnosis.
  • Please provide a reference page and references throughout the discussion.
  • Make sure the discussion is Zero percent plagiarism.CASE of OLIVIA

    Intake Date: September 2020

    DEMOGRAPHIC DATA:

    This was an emergency, voluntary admission for this 28-year-old single white female. This was her fourth psychiatric hospitalization. Olivia lives with a 24-year-old female roommate in New York City. She has a bachelor’s degree in art history and is employed by a major New York Museum.

    CHIEF COMPLAINT: “My therapist said I was decompensating because I broke my leg, and I was despondent.”

    HISTORY OF PRESENT ILLNESS:

    Olivia stated that approximately one month prior to admission, she started to “decompensate” and had difficulty maintaining control at work. She had several altercations with coworkers. One week prior to admission, Olivia reported that her NA sponsor “said something nasty, and I lost it.” According to her mother, the sponsor made a reference to Olivia being overweight. Olivia reported that she was angry and “hit everything I knew I could—but that did not help.” She then kicked a brick wall, fracturing her right leg.

    Olivia complained of depression with insomnia and sleeping only a few hours per night, feeling confused, decreased concentration, irritability, anger, and frustration. She admitted to suicidal ideation. She complained of feeling paranoid over the past few weeks and believed the police were after her and that she heard them outside her door. She believed the police had her under surveillance. Olivia also complained of a fear of dirt, taking time to frequently bathe and brush her teeth.

    PAST PSYCHIATRIC HISTORY:

    Olivia’s mother reported that Olivia saw a clinical social worker briefly when Olivia was 10 years old. Olivia reported that she was hospitalized at a New York hospital 3 years ago for 3 months. Six months after that, Olivia took an overdose of Xanax and was treated at the same hospital, and then was transferred to a state hospital. After discharge in the next month, Olivia attended a partial hospitalization program for drugs and alcohol every day for 5 weeks. Since then, Olivia has been seeing a clinical social worker and psychiatrist and continues to the present with them.

    MEDICAL HISTORY:

    At 17 years old, Olivia suffered from bulimia with bingeing, purging, and the use of laxatives. She reported she had not purged for 3 years until she began the diet 3 months ago. Although Olivia is currently not bingeing, she admitted to purging and using laxatives. Olivia is allergic to penicillin and has a lactose intolerance. She wears glasses for reading.

    Olivia reported that she began a new diet and although she was supposed to be eating 600 calories a day, she was only eating between 200 and 400 calories a day. She also admitted to purging and frequent use of laxatives. Olivia reported her weight was being monitored, and she had lab work done to be sure she remained healthy. In the past 3 months, Olivia lost approximately 80 pounds.

    Olivia complained of panic attacks and reported that she controlled them by taking Klonopin, but there was no evidence of this.

    SUBSTANCE ABUSE HISTORY:

    Olivia reported a history of drug and alcohol use, but she stated that she has been clean and sober for two years. She had gone to partial hospitalization two years ago and currently attends Alcoholics Anonymous and Narcotics Anonymous meetings. Olivia admitted to using marijuana, cocaine, opiates, and hallucinogens in the past. Valium was her drug of choice in addition to the alcohol. She denied IV drug use but admitted to “skin popping” cocaine.

    PSYCHOSOCIAL AND DEVELOPMENTAL HISTORY:

    Olivia’s parents were married when her mother was 19 years old, and Olivia was born the following year. Olivia’s mother described Olivia as a wonderful, even-tempered, and happy baby. Two years later, Olivia’s sister was born; mother stated Olivia’s personality changed; she became stubborn and difficult. Olivia’s mother said that Olivia began biting and having temper tantrums and has been moody since then. Olivia’s mother stated her marriage was conflicted because she has a communication problem with her husband and he was “never an active parent.” Olivia’s mother reported that Olivia “adores her father” because he is not the disciplinarian. Olivia frequently caused conflict between her parents. When Olivia was 12 years old, her parents separated for 2 weeks. Olivia reported her mother quit college after Olivia’s birth and returned to college after her sister’s birth. She said her father worked all the time, and there was a housekeeper who cared for the children.

    Olivia reported that the family moved to Arizona when Olivia was in sixth grade, where she began using marijuana that she reported stealing from her parents. The family returned to New York when Olivia was in seventh grade.

    Olivia’s mother reported that when Olivia was in high school, her maternal aunt, who was dying of cancer, came to live with the family and that this was very stressful for Olivia. During those years, Olivia told the school counselor that her mother was abusive, and school officials visited the family. During the visit, Olivia had a temper tantrum and there was no further investigation.

    Olivia reported she was always an above-average student who rarely studied. She said she was always hyperactive and had difficulty sitting in school. Olivia stated that in college she had a 3.8 GPA and was on the Dean’s list.

    Olivia reported that in high school, most of her friends were athletes. She stated that she had one close friend. She changed her friendships often in high school, never keeping a best friend for so long. Currently, Olivia is friendly with her roommate but never keeps friends for long.

    Olivia’s mother reported that when Olivia returned from college she moved in with her parents. Olivia has always been very moody and this was apparent again for the short time she lived with her parents again. Conflict increased in the household, and Olivia’s parents began marital therapy. Olivia’s mother stated that she and her husband became united and finally asked Olivia to move out.

    Olivia reported that she has a very stressful job. Olivia reported that she currently has financial problems because she does go on spending sprees periodically to feel better. Olivia also reported being under stress due to applying for her master’s degree in art history and difficulties with her boyfriend.

    MENTAL STATUS EXAMINATION:

    Olivia presented as an overweight, somewhat disheveled, white female who had a cast on her right leg. She was relaxed but very restless during the interview. Her facial expression was mobile. Her affect during the initial interview was constricted and her mood dysphoric. Olivia’s speech was pressured and often circumstantial or tangential, and she spoke in a loud voice. At times her thinking was logical, and at other times it was illogical. Olivia denied hallucinations but complained of hearing policemen outside her door prior to admission. She denied homicidal ideation and initially admitted to suicidal ideation and noted that is not new since she has thought about suicide since she was a teenager.

    Olivia was oriented to person, place, and time. Her fund of knowledge was excellent. Olivia was able to calculate serial sevens easily and accurately. Olivia repeated 7 digits forward and 3 in reverse. Her recent and remote memory was intact, and she recalled 3 items after five minutes. Olivia was able to give appropriate interpretations for 3 of 3 proverbs. Her social and personal judgment was appropriate.