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Heath Ledger

A Case Formulation on General Anxiety Disorder
by

Sarah Rosch

on 1 March 2013

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Transcript of Heath Ledger

Heath Ledger A Case Formulation General Anxiety Disorder Family History Born in Perth, Australia to
mother Sally Ledger Bell, a French teacher
father Kim Ledger, a race-car driver.
Heath’s parents separated when Heath was 11-years-old Siblings
one sister named Katherine (sparked Heath's interest in acting)
two half sisters (Olivia and Ashleigh) Early Life In Junior High, chose Drama as a mandatory elective (over cooking)
Age 16
drove to Syndey, Austrailia to pursue a career in acting
1st role: Clowning Around (1992)
In 1996, he portrayed homosexual cyclist on an Australian T.V. show called Sweat
chose a more challenging role, over that of a swimmer, to distinguish himself
1st big break: 10 Things I Hate About You
afterward, Heath fought to distinguish himself as an adult actor Adult Life Often dated women much older than himself
May have been an influence from Mother, who raised him primarily after his parents' separation
sought out support

Met girlfriend, Michelle Williams in the filming of Brokeback Mountain in Summer of 2004
a year later, baby Matilda Rose was born
the couple broke up in September 2007 Career Realized scope of his career after premier of "A Knight's Tale" in 2001
"more concerned with having a good time than with focusing on work"

Pressured himself to portray difficult characters
Brokeback Mountain (2005)-homosexual cowboy
The Dark Knight (2008)-"a psychopathic, mass-murdering, schizophrenic clown with zero empathy..." the Joker
premiered in July, 2008 after his death on January 22

Constantly tried to reinvent himself as an actor
"I can't say I was proud of my work... The day I say, 'It's good', is the day I should start doing something else.

At night, Heath's mind would race about his roles DSM: IV General Anxiety Disorder A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not and for at least 6 months, about a number of
events or activities (such as work or school performance)
B. The person finds it difficult to control the worry
C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for
more days than not for the past 6 months). Note: only one item is required in children
(1) restlessness or feeling keyed up or on edge
(2) being easily fatigued
(3) difficulty concentrating or mind going blank
(4) irritability
(5) muscle tension
(6) sleep disturbance (difficulty falling or staying asleep, or restless
unsatisfying sleep) D. The focus of the anxiety and worry is not confined to features of
an Axis I disorder. Eg., the anxiety or worry is not about having a panic attack (as in panic disorder), being embarrassed in public (as
in social phobia), being contaminated (as in obsessive compulsive disorder), being away from home or close relatives (as in separation anxiety disorder), gaining weight (as in anorexia nervosa), having multiple physical complaints (as in somatization disorder), or having serious illness (as in hypochondriasis), and the anxiety and worry do not occur exclusively during posttraumatic stress disorder
E. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
F. The disturbance is not due to the direct physiological effects of a substance (e.g, a drug of abuse, a medication) or general medical condition (e.g., hyperthyroidism) and does not occur exclusively during a mood disorder, a psychotic disorder or a pervasive developmental disorder Diagnosis A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not and for at least 6 months, about a number of events or activities (such as work or school performance)

B. The person finds it difficult to control the worry Experienced anxiety as early as age 17 while filming the T.V. show Sweat

Anxiety began to worsen while filming Brokeback Mountain (2005) as well as The Dark Knight (2008).

Ledger’s anxiety results in chronic insomnia Diagnosis Continued... C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months). Note: only one item is required in children
(1) restlessness or feeling keyed up or on edge
(2) being easily fatigued
(3) difficulty concentrating or mind going blank
(4) irritability
(5) muscle tension
(6) sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep) Quoted in the New York Times “Last week I probably slept an average of two hours a night,” he said. “I couldn’t stop thinking. My body was exhausted, and my mind was still going.”
One night, he took an Ambien, which failed to work. He took a second one and fell into a stupor, only to wake up an hour later, his mind still racing. Diagnosis Continued... D. The focus of the anxiety and worry is not confined to features of an Axis I disorder. Eg., the anxiety or worry is not about having a panic attack (as in panic disorder), being embarrassed in public (as in social phobia), being contaminated (as in obsessive compulsive disorder), being away from home or close relatives (as in separation anxiety disorder), gaining weight (as in anorexia nervosa), having multiple physical complaints (as in somatization disorder), or having serious illness (as in hypochondriasis), and the anxiety and worry do not occur exclusively during posttraumatic stress disorder Diagnosis Continued... E. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Not Social Anxiety or Panic Disorder? Differential diagnosis criterion of GAD and panic disorder is difficult when GAD individuals have occasional occasional panic attacks.

73% of individuals diagnosed with DSM-IV-IR GAD reported experiencing at least one panic attack in their lifetime.

Patients with GAD do not demonstrate the fear of panic symptoms or apprehension about future attacks that is present in individuals with a clinical diagnosis of panic disorder.

Heath "ran into the men's room, sequestering himself in a stall where he had a panic attack." I: Heath Ledger: Personal History II: Heath Ledger: Diagnosis III: Heath Ledger: Psychodynamic Perspective Psychodynamic Perspective of GAD When diagnosing GAD, the criteria listed in the DSM distinguish the boundaries between anxiety and normal worrying:

Anxiety must be pervasive: a patient pinpoints multiple activities/events as anxiety targets

A patient's quality of life is affected by continual thoughts about future, current life circumstances, financial situation, possible harm to family, etc (Campbell & Brown, 2002) Uncontrollable and Unpredictable Events likelihood of childhood trauma in patients with GAD (Mikeha & Zinbarg 2006: 20). Could the separation of Heath's parents (at the age of 11) cause some of the aspects of his anxiety?
he left to pursue acting at the age of 16
his increasing need to portray more difficult characters may be as a result of attempting to impress his parents Worrying: Persistent Process in GAD Perceived Benefits of Worry
avoidance of catastrophe & dealing with emotions
suppress emotional/physiological responses, causes more worrying
extinction of worry requires full processing
generally avoided with anxious worrisome thoughts in which emotional and physiological responses are suppressed.

How does worry become uncontrollable? Wouldn't it be easier if we all just took time to worry, realize what we are worrying about, deal with it, and move on? In attempt to control our worries, we often suppress or repress our emotional and physiological responses (Mineka and Zinbarg, 2006). IV: Heath Ledger: Reflection on Inner Experience Can Your Life Hold Up to These Scrutinies? "If Heath Ledger can't make it [...], how are we supposed to?"


"There is nothing noble or beautiful about the so-called accidental death of Heath Ledger, a man with everything to live for – a beautiful daughter, a blossoming career, and a Victoria’s Secret catalogue-full of willing babes.




"we are all different persons, with different personalities and background, it's not because a celebrity couldn't 'make it' that we are all doomed and that everything is hopeless" Diagnosis Continued... F. The disturbance is not due to the direct physiological effects of a
substance (e.g, a drug of abuse, a medication) or general medical
condition (e.g., hyperthyroidism) and does not occur exclusively
during a mood disorder, a psychotic disorder or a pervasive
developmental disorder Heath was taking the following medications:
Pain (causing drowsiness)
Hydrocodone
Oxycontin
Anxiety
Valium
Xanax
Sleep Disturbances
Doxylamine
Ambien
Restoril Heath's anxiety symptoms were not related to his medication. He was prescribed all of these medications, took them at various times, and on the night of his death, took them all at once, in attempt to sleep and recover from pneumonia while filming "The Imaginarium of Doctor Parnassus".

At this point, Heath's anxiety was very high:
he had not seen his daughter Matilda in months
Michelle was filming in Europe, and had taken Matilda with her A. A marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing.

Even though Heath has anxiety revolving around taking on increasingly complex character roles, his fear is not based on social or performance situations. The scrutiny that Heath faces is more of his own, than of others. Cycle of Anxiety with Avoidance Response Reinforced Avoidance Response, suppressing emotional/physiological symptoms uncontrollable worry revolving around life situations and bad outcomes Increased anxiety
Is my worry uncontrollable? Heath's Avoidance Response After Heath's doctor said his pnemonia prevented him from flying to Europe to see his daughter, Matilda, Heath's anxiety and health began to worsen.

Likely, to avoid feelings of uncontrollable worry and anxiety surrounding this and his lack of sleep, Heath agreed to film "The Imaginarium of Doctor Parnassus", where he would play Tony.

References Campbell, L., & Brown, T. (2002). Generalized anxiety disorder. In M. Antony & D. Barlow (Eds.), Handbook of Assessment and Treatment Planning for Psychological Disorders. Retrieved from http://cs5594.userapi.com/u11728334/docs/df7fe99f07eb/Martin_M_Antony_PhD_Handbook_of_Assessment_a.pdf

Grose, J. (2009). Heath ledger profile shows how fame can destroy the psyche. Retrieved from http://www.slate.com/blogs/xx_factor/2009/07/02/vanity_fair_heath_ledger_profile_shows_how_fame_can_destroy_the_psyche.html


Heath ledger: It's time to set things straight. (2010). Biographies, Retrieved from http://www.mibba.com/Articles/Biographies/3106/Heath-Ledger-Its-Time-to-Set-Things-Straight/


Mineka, S., & Zinbarg, R. (2006). A contemporary learning theory perspective on the etiology of anxiety disorders. American Psychologist, 61(1), 10-26. Retrieved from http://clclinic.cos.ucf.edu/Documents and Files/Mineka & Zinbarg, 2006.pdf Functional Benefits of Worry Mineka & Zinbarg, 2006
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