Crystal Methamphetamine, Body Dysmorphia, and Shame: A Psychodynamic Case Report from the Trainee Perspective

Abstract

Shame is an affect common to many pathological as well as nonpathological states. It is rarely described in academic psychiatry, and the reasons are probably more sociocultural than physiologic or scientific. Whether identified as shame or termed something else altogether, it is often the target of effective therapies addressing anxiety, depression, substance abuse, personality conflicts, and even delusions. It is particularly common within lesbian, gay, bisexual, and transgender (LGBT) populations given the difficulties of confronting and accepting the self. Using a clinical case experienced by a psychiatry resident trainee as a framework, this paper explores the phenomenon of shame as a common pathway to several psychiatric diagnoses within the same patient. Psychodynamic aspects of the patient's relationships with family members, his interactions with the resident, and the resident's countertransferential reactions are explored as well.