A young woman with noise intolerance

Case scenario

Anastasia, a 26-year-old woman who works in a grocery store, presents to her GP saying she feels unable to continue in her employment. She has been working in the store for 18 months and was happy there until a new store manager was appointed six months ago. She feels the manager has preconceived ideas about her based on her appearance (she has a tattoo that is not completely concealed by clothing and a nose ring). She has recently noted in herself an increasing intolerance to noise – initially to the manager’s voice and now to more general noise, particularly speech and noises made by people who are eating. She feels she is unable to work any longer and wants to receive a disability pension.

Anastasia has a long history of probable borderline personality disorder (problems with both family and romantic relationships, a past history of bulimia) and she lives alone. She has seen a psychologist, who, like her GP, has suspicions about whether she has another psychological disorder, and whether her noise intolerance is genuine or part of a hysteria or the borderline spectrum or paraphrenia. Anastasia does not appear to have depression or anxiety and she is taking no medications.

Is there another diagnosis for Anastasia? How should she be managed?

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