In Session with “Sharp Objects”

March 31, 2021

Travel with Dr. Sam and Dr. Fran to Wind Gap with Camille Preaker as they investigate HBO’s Sharp Objects.

Who is murdering children in Wind Gap? What is going on with Camille, Amma, and Adora? The doctors solve those questions quicker than Detective Richard and the police chief solve the town’s crimes. Dr. Sam and Dr. Fran review complex topics seen in the show including Camille’s history of abuse, alcohol use, and non-suicidal self-injury. Would we expect someone to engage in self-harm the unique way Camille does? Given Camille’s difficult history and current challenges, what could treatment for her ideally look like?

Learn more about an uncommon disorder which is commonly portrayed in entertainment. Dr. Sam and Dr. Fran dive into Adora poisoning her children and review a new diagnosis—factitious disorder imposed on another (previously called Munchausen syndrome by proxy). That also brings us to a new Diagnosis Graveyard.

We will tell mama if you don’t listen to this week’s session!

Content Warning: episode discusses suicide, non-suicidal self-injury/self-harm, and child abuse

Glossary of Terms

Non-suicidal self-injury (NSSI) – intentional harm of one’s own body tissue without suicidal intent (e.g., cutting, burning, scratching)

Negative self-talk – inner dialogue that is self-critical, often times inaccurate or unrealistic and self-defeating

Maladaptive coping strategies – ways of coping that are harmful and are only helpful in the short-term (e.g., substance use, self-harm, avoidance)

Factitious disorder imposed on another – formerly referred to as Munchausen’s by proxy; when someone produces or fabricates symptoms of illness in others under their care (e.g., children, elderly adults, disabled persons or pets) even in the absence of external rewards or secondary gain

Secondary gain – any positive advantage that accompanies physical or psychological symptoms

Malingering – exaggerating or faking illness to achieve an external reward or escape an undesired outcome (e.g., faking an illness to get out of work)

Dialectical behavior therapy (DBT) – evidence-based treatment developed by Marsha Linehan originally developed to treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD); focused on building mindfulness skills, effectiveness in interpersonal relationships, emotion regulation strategies, and tolerating distress

Dialectical – synthesis or integration of two seemingly opposite statements or ideas (e.g., the primary dialectic within DBT is between the seemingly opposite strategies of acceptance and change)

References

If you or someone you know is struggling with or at risk for suicidal ideation and/or self-harm, you can get help by calling the National Suicide Prevention Lifeline (Hours: Available 24 hours. Languages: English, Spanish) 1-800-273-8255.

We discuss Camille’s engagement in self-harm throughout the session–learn more about what NSSI is and why some people engage in self-harm

Many listeners have heard of Munchausen’s by proxy, but we put this disorder in our Diagnosis Graveyard this session and introduced the formal diagnosis: Factitious disorder imposed on another

Take a deep dive into the history of this diagnosis here

Interested in hearing an expert’s perspective on how Adora’s character was portrayed in Sharp Objects? Check out this interview with Dr. Marc D. Feldman.

We discuss how Dialectical Behavior Therapy (DBT) would be a good fit for Camille’s presenting concerns. Learn more about the treatment and the biosocial theory.