Being Unmarried

Psychological Case Report

Abstract

Sara, a 32-year-old unmarried woman, presented with feelings of anxiety, low self-worth, and social withdrawal stemming from persistent societal pressure and stigmatization regarding her marital status. Psychological assessment included measures of depression (BDI-II), personality (Ten-Item Personality Inventory), social functioning (Social Adjustment Scale), and cognitive ability (Raven’s Standard Progressive Matrices). Results indicated moderate depression, high neuroticism with low extraversion, impaired social adjustment, and average intellectual functioning. These findings highlight the negative impact of cultural expectations and lack of autonomy on her mental health, personality expression, and social wellbeing. Interventions including CBT for self-esteem, assertiveness training, and empowerment-based social support are recommended to enhance her psychological resilience and quality of life.

Identifying Information

  • Client ID: 2025-003

  • Name: S.B

  • Age: 32 years

  • Gender: Female

  • Date of Assessment: May 29, 2025

  • Assessor: Muzna Touheed, Psychology Student Intern

  • Institution: Govt. Graduate College

I. Presenting Problem

CategoryPresenting Complaints
Emotional SymptomsPersistent sadness, loneliness, shame due to being unmarried, feelings of inadequacy.
Cognitive SymptomsNegative self-evaluation (“I am incomplete without marriage”), preoccupation with societal criticism, difficulty focusing on career.
Behavioral SymptomsAvoidance of social events, excessive comparison with peers, withdrawal from relatives.
Physiological SymptomsSleep problems, fatigue, headaches, low appetite during stress.
Mood SymptomsAnxiety, irritability, loss of interest in hobbies.

II. Referral Information

Reason for Referral:
Sara was referred by a local women’s NGO after she sought help for low mood and lack of confidence. The purpose was to assess her psychological functioning, emotional health, and coping resources for counseling and empowerment planning.

III. Background Information

  • Family History: Father retired, mother homemaker. Two younger siblings, both married, causing Sara to feel additional societal pressure. No psychiatric illness in the family.

  • History of Present Illness: Over the past three years, Sara’s distress has escalated due to constant comments about her unmarried status. Reports low self-worth and reduced confidence in decision-making.

  • Academic History: Above-average student, holds a Master’s degree in English Literature.

  • Social History: Socially active in early adulthood; progressively withdrawn due to stigma. Limited supportive friendships.

  • Medical History: Generally healthy; history of mild iron deficiency.

IV. Behavioral Observations

  • Anxious and tearful during interview.

  • Speech soft, hesitant; avoided eye contact.

  • Affect flat at times; mood low.

  • Insight partial; judgment fair.

  • No psychotic symptoms.

V. Psychological Testing

Table 1. Beck Depression Inventory (BDI-II) Results

ScoreSeverityInterpretation
24Moderate DepressionSadness, worthlessness, self-criticism, fatigue.

Qualitative Analysis:
Depressive symptoms reflect internalized stigma and ongoing emotional distress related to marital expectations.

Table 2. Ten-Item Personality Inventory (TIPI) Results

TraitScore / TrendInterpretation
ExtraversionLowWithdrawn, avoids social situations.
AgreeablenessHighCooperative but conflict-avoidant.
ConscientiousnessAverageManages responsibilities but with low motivation.
NeuroticismHighEmotionally sensitive, prone to stress.
OpennessAverageSome interest in creativity, but limited due to low mood.

Qualitative Analysis:
Personality suggests emotional vulnerability, avoidance of conflict, and reduced resilience in facing societal stressors.

Table 3. Social Adjustment Scale Results

Total ScoreInterpretation
40 / 75Moderate Social Maladjustment

Qualitative Analysis:
Findings indicate difficulty forming and maintaining relationships, social withdrawal, low confidence in expressing opinions, and feelings of rejection in social circles.

Table 4. Raven’s Standard Progressive Matrices (SPM) Results

ScorePercentileInterpretation
45 / 6055th PercentileAverage Intellectual Functioning

Qualitative Analysis:
Sara’s cognitive functioning is intact. Emotional issues, not intellectual capacity, hinder her adjustment.

VI. Diagnostic Impression

ICD-11 / DSM-5 Formulation:

  • F32.1 – Moderate Depressive Episode

  • Z60.4 – Social Exclusion and Rejection (due to unmarried status)

  • Z63.5 – Disruption of Family by Separation/Unmarried Status Pressure

VII. Treatment Plan

Goals:

  • Reduce depressive and anxious symptoms.

  • Challenge negative self-beliefs linked to marital status.

  • Improve confidence and coping strategies.

  • Strengthen social and family support.

Interventions:

  1. Cognitive Behavioral Therapy (CBT): Restructure negative thoughts about self and societal judgment.

  2. Assertiveness Training: Build confidence in handling criticism and pressure.

  3. Psychoeducation: Normalize delayed or non-marriage as a life choice.

  4. Social Support Mobilization: Engage supportive peers, women’s groups, and career networks.

  5. Relaxation Training: Stress reduction through breathing, mindfulness, and journaling.

Duration: Weekly sessions for 2–3 months.

VIII. Conclusion and Recommendations

Sara demonstrates average intellectual functioning but significant emotional distress due to marital stigma. Moderate depression, high neuroticism, and maladjustment underline her vulnerability.

Recommendations:

  • Continue CBT and assertiveness training.

  • Facilitate support from family and NGOs.

  • Encourage career development and hobbies to enhance self-worth.

  • Link with women’s empowerment groups to build resilience.

  • Schedule regular follow-ups to monitor progress.

IX. Counseling Sessions

Session 1 – Rapport Building & Psychoeducation
Established a safe and empathetic environment, allowing Sara to share her feelings of loneliness and shame. Provided psychoeducation about depression and societal pressure, helping her normalize her struggles. Built trust to encourage regular participation in therapy.

Session 2 – Cognitive Restructuring (CBT)
Explored Sara’s negative core beliefs, such as “I am incomplete without marriage.” Used CBT techniques to identify and challenge these thoughts, introducing healthier alternatives. Encouraged journaling of positive affirmations.

Session 3 – Assertiveness Training
Focused on building communication skills to handle criticism from relatives and peers. Role-play exercises were used to practice setting boundaries and saying “no” without guilt. Reinforced confidence by validating her right to personal choices.

Session 4 – Social Support & Empowerment
Explored Sara’s limited social circle and identified potential sources of support. Encouraged reconnection with supportive friends and participation in women’s NGO groups. Highlighted career and community engagement as protective factors.

Session 5 – Stress Management & Future Planning
Taught relaxation techniques including mindfulness and deep breathing to manage anxiety. Collaboratively developed a long-term plan for self-care, career focus, and maintaining resilience. Prepared Sara for independence in applying coping strategies outside therapy.

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