Psychological Problems in Black Swan

Background and History

Description of character and general psychological problem

Released in 2010, Black Swan is a psychological thriller movie directed by Darren
Aronofsky. The movie is built around the psychological illness of Nina Sayers, the movie’s
main character. Nina is beautiful, delicate and disturbed ballerina. She dances for a ballet
company based in New York which is preparing for a production of Pyotr Tchaikovsky’s
“Swan Lake”. She strives to play the lead role in Swan Lake, a role that will require her to
express not just the good White Swan but also the bad Black Swan. She manages to beat off
intense competition to win the part she so desired. After she wins the part, she experiences
mounting stress. She has difficulty connecting with the part of Black Swan, faces her artistic
director’s unwanted sexual advances, has constant conflicts with her narcissistic mother, and
has to endure jealousy from fellow ballerinas. As the stress continues to increase, her various
psychological problems become apparent. Some of the psychological problems that she
exhibits include schizophrenia and borderline personality disorder.

Types of specific symptoms

Throughout the movie, Nina exhibits symptoms for different psychological problems.
For instance, she self-mutilates through scratching and pulling off chunks of her skin until
blood oozes out. She also suffers from delusions, paranoia, and hallucinations. She
experiences erotic hallucinations of herself in lesbian relationship with Lily, a fellow
ballerina, she hallucinates that she has turned into a bird and has real wings, and also sees a
black-clad version of herself while crossing the subway. Her hallucinations are so bad that
she sometimes sees the pink stuffed animals in her bedroom coming to life and then mocking
her. Lastly, she also starves herself and frequently throws up (Aronofsky, 2010).

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Beginning of the symptoms and the course of the disorder

In the movie’s beginning, Nina is an obedient and docile dancer. However, in the
course of the movie, she transforms into a psychotic person. Even though her symptoms such
as self-harm begin early in the movie, it is only when she fully gets immersed in preparing for
her role of Black Swan that they become severe. The severity of the symptoms continues
until the movie’s end when they climax with Nina’s complete mental breakdown.

How psychological disorders affected Nina’s life

Nina’s psychological problems had a major impact on her family and social life. The
problems worsened her already tense relationship with her mother. They also made it had for
her to maintain healthy friendships. Partly because of her psychological problems, she
literally did not have any friends.

How Nina coped with her disorder

There is no evidence in the movie of Nina exhibiting any coping mechanism for her
condition. It could be because she was not aware that she had a psychological problem.

Areas of functionality that were affected by Nina’s psychological disorders

Nina’s psychological disorder did not have any significant effect on her ability to
perform various functions in her life. For instance, she continued practicing and excellently
performing as a ballerina.

Did Nina believe that she had a problem?

There is no evidence that Nina ever thought that she had a problem. She, however,
frequently felt inadequate and incomplete.

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Did Nina get treatment

Nina did not get any treatment for her condition. By the time the movie ended, her
condition remained untreated.

Diagnostic Impressions

Most likely DSM-5 diagnosis

Borderline personality disorder (BPD) is a mental health condition where the affected
person shows pervasive patterns of instability in their emotions, self-image, and interpersonal
relationships (Choi-Kain et al., 2017). They also impulsivity in their actions. Nina is likely
suffering from borderline personality disorder. According to the diagnostic and statistical
manual of mental disorders (DSM), borderline personality disorder has nine major symptoms.
One is considered to suffer from the condition if they exhibit five or more of the nine
symptoms.

The nine symptoms include chronic feeling of emptiness, frantic efforts to avoid
imagined or real abandonment, and emotional instability when reacting to day-to-day events
as characterized by intense episodes of anxiety, irritability, and sadness. The person also
exhibits identity disturbance with persistently unstable sense of self, impulsive behaviors in
two or more areas that can potentially lead to self-damage, such as substance abuse, binge
eating, sex, and spending. The other symptoms include recurrent suicidal and self-harming
behavior, severe dissociative symptoms or stress-related paranoid ideation, pattern of intense
and unstable interpersonal relationships that are characterized by extremes of devaluation and
idealization, and inappropriate display of intense anger (Choi-Kain et al., 2017).

Criteria met with evidence from the movie

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In the movie, Nana shows many symptoms that are consistent with borderline
personality disorder. For instance, she expresses feelings of emptiness through her recurrent
thoughts of not being perfect enough. She also exhibits emotional instability by irritability
and extreme rage such as when on one night she threw away stuffed animals in a fit of rage.
Nana also exhibits unstable sense of self and impulsive behaviors. Even though she is only
acting when she plays both the good White Swan and the bad Black Swan, the real life begins
to show this split personality. At one moment she can be a very good girl like the White
Swan and in the next moment be the bad girl like the Black Swan. She also acts impulsively.
For instance, she once impulsively decided to go out in a club instead of doing her dance
practices. While at the club with her fellow ballerina, Lily, she experimented with ecstasy
drug in an impulsively manner. In additional to impulsive behavior, Nana also exhibits self-
harming behavior. She cuts herself and removes her skin until blood oozes out. The
relationship with her mother shows patterns of unstable interpersonal relationship
characterized by extreme devaluation and idealization. In her relationship with her mother,
she vacillates between admiration and extreme hatred for her. The same is true for her
relationship with Lily, her fellow ballerina (Aronofsky, 2010).

Missing symptoms

Nina does not exhibit all the symptoms of borderline personality disorder. For
instance, she does not make frantic efforts to avoid real or imagined abandonment. She also
does not exhibit recurrent suicidal thoughts.

Differential diagnosis

Nina also exhibits symptoms that are consistent with schizophrenia. According to
DSM-5, schizophrenia is characterized by three symptoms. These are delusions,

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hallucinations, and disorganized thinking, speech and behavior (Biedermann &
Fleischhacker, 2016). Nina exhibits delusions such as when she believes that she has become
a bird with real wings. She also exhibits hallucinations, such as when she has hallucinations
of having sexual intercourse with Lily or when she sees a version of herself in black clad at
the subway. There is, however, no evidence that Nina has disorganized thinking, speech, or
behavior. Given the extreme discipline required to become a ballerina, it is highly unlikely
that she would be able to perform at such high levels if her behaviors and thinking were
disorganized.

Brief description of borderline personality disorder

Borderline personality disorder is a mental health condition that affects the way one
feels and thinks about themselves as well as others. Persons with the conditions often have
problems functioning normally in everyday life. Some of the issues that they face include
problems with their self-image, patterns of unstable relationships, and difficulties in
managing their behaviors and emotions. The condition begins in early adulthood and is
characterized by, among others, inappropriate anger, frequent mood swings, impulsiveness,
and emotional instability (Choi-Kain et al., 2017).

Etiology

According to Biopsychosocial model, in order to understand a person’s medical
condition, one needs to consider not just biological factors but also social and psychological
factors (Wade & Halligan, 2017). In the case of Nina, there is little information about some
of the biological factors that could have contributed to her developing borderline personality
disorder. However, there is evidence that psychological and social factors could have
contributed to the development of her condition. As a perfectionist, Nina is never satisfied

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with her herself. Despite putting in a lot of work to perfect her dance moves as a ballerina,
she still always feels not good enough.

Social factors also contributed to Nina’s eventual mental breakdown. The world of a
ballerina is an extremely stressful one. Ballerina’s are expected not just to make perfect dance
moves but also to maintain a very slim body. In quest for the latter, Nina develops eating
disorder while in the quest to perfectly play the role of the evil Black Swan she experiences
mental breakdown.

Nina’s mother, Erica, is another source of her stress. Having failed in her quest to
become a top ballerina, she is determined to have Nina achieve what she could not. Erica
treats Nina as if she is a small girl. She monitors all her moves and seeks to have complete
control over her. Her presence overwhelms Nina and makes her life extremely stressful.

Treatment recommendations

Even though borderline personality disorder can be worsened by social and
psychological factors, its causes are mainly biological (Choi-Kain et al., 2017). The condition
is treated using a combination of psychotherapy and medications. The medications improve
the function of chemical processes that are needed for proper functioning of the brain (Choi-
Kain et al., 2017). Borderline personality disorder usually interferes with the working of such
chemical processes. The medications reduce the severity of the condition’s symptoms and
also enhance the effectiveness of psychotherapy (Choi-Kain et al., 2017).

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References

Aronofsky, D. (2010). Black Swan. Twentieth Century Fox.

Biedermann, F., & Fleischhacker, W. W. (2016). Psychotic disorders in DSM-5 and ICD-
11. CNS spectrums, 21(4), 349-354.

Choi-Kain, L. W., Finch, E. F., Masland, S. R., Jenkins, J. A., & Unruh, B. T. (2017). What
works in the treatment of borderline personality disorder? Current behavioral
neuroscience reports, 4(1), 21-30.

Wade, D. T., & Halligan, P. W. (2017). The biopsychosocial model of illness: a model whose
time has come. Clinical Rehabilitation, 31(8),
995–1004. https://doi.org/10.1177/0269215517709890