Sandra’s inability to complete an undergraduate degree was due largely to her chronic difficulties with a type of Obsessive-Compulsive Disorder perfectionism combined with untreated ADHD. However, Sandra also felt intense social anxiety and was very fearful about growing up and separating from her mother. Her emotional turmoil and underlying depression led to occasional episodes of cutting herself which she described as a way to help herself feel emotions that otherwise she could not experience. She needed a writing tutor and a course of psychotherapy to develop more self-acceptance and better understanding of her conflict