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What Is a Case Study?

Weighing the pros and cons of this method of research

Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

Cara Lustik is a fact-checker and copywriter.

Verywell / Colleen Tighe

• Pros and Cons

What Types of Case Studies Are Out There?

Where do you find data for a case study, how do i write a psychology case study.

A case study is an in-depth study of one person, group, or event. In a case study, nearly every aspect of the subject's life and history is analyzed to seek patterns and causes of behavior. Case studies can be used in many different fields, including psychology, medicine, education, anthropology, political science, and social work.

The point of a case study is to learn as much as possible about an individual or group so that the information can be generalized to many others. Unfortunately, case studies tend to be highly subjective, and it is sometimes difficult to generalize results to a larger population.

While case studies focus on a single individual or group, they follow a format similar to other types of psychology writing. If you are writing a case study, we got you—here are some rules of APA format to reference.  

At a Glance

A case study, or an in-depth study of a person, group, or event, can be a useful research tool when used wisely. In many cases, case studies are best used in situations where it would be difficult or impossible for you to conduct an experiment. They are helpful for looking at unique situations and allow researchers to gather a lot of˜ information about a specific individual or group of people. However, it's important to be cautious of any bias we draw from them as they are highly subjective.

What Are the Benefits and Limitations of Case Studies?

A case study can have its strengths and weaknesses. Researchers must consider these pros and cons before deciding if this type of study is appropriate for their needs.

One of the greatest advantages of a case study is that it allows researchers to investigate things that are often difficult or impossible to replicate in a lab. Some other benefits of a case study:

• Allows researchers to capture information on the 'how,' 'what,' and 'why,' of something that's implemented
• Gives researchers the chance to collect information on why one strategy might be chosen over another
• Permits researchers to develop hypotheses that can be explored in experimental research

On the other hand, a case study can have some drawbacks:

• It cannot necessarily be generalized to the larger population
• Cannot demonstrate cause and effect
• It may not be scientifically rigorous
• It can lead to bias

Researchers may choose to perform a case study if they want to explore a unique or recently discovered phenomenon. Through their insights, researchers develop additional ideas and study questions that might be explored in future studies.

It's important to remember that the insights from case studies cannot be used to determine cause-and-effect relationships between variables. However, case studies may be used to develop hypotheses that can then be addressed in experimental research.

Case Study Examples

There have been a number of notable case studies in the history of psychology. Much of  Freud's work and theories were developed through individual case studies. Some great examples of case studies in psychology include:

• Anna O : Anna O. was a pseudonym of a woman named Bertha Pappenheim, a patient of a physician named Josef Breuer. While she was never a patient of Freud's, Freud and Breuer discussed her case extensively. The woman was experiencing symptoms of a condition that was then known as hysteria and found that talking about her problems helped relieve her symptoms. Her case played an important part in the development of talk therapy as an approach to mental health treatment.
• Phineas Gage : Phineas Gage was a railroad employee who experienced a terrible accident in which an explosion sent a metal rod through his skull, damaging important portions of his brain. Gage recovered from his accident but was left with serious changes in both personality and behavior.
• Genie : Genie was a young girl subjected to horrific abuse and isolation. The case study of Genie allowed researchers to study whether language learning was possible, even after missing critical periods for language development. Her case also served as an example of how scientific research may interfere with treatment and lead to further abuse of vulnerable individuals.

Such cases demonstrate how case research can be used to study things that researchers could not replicate in experimental settings. In Genie's case, her horrific abuse denied her the opportunity to learn a language at critical points in her development.

This is clearly not something researchers could ethically replicate, but conducting a case study on Genie allowed researchers to study phenomena that are otherwise impossible to reproduce.

There are a few different types of case studies that psychologists and other researchers might use:

• Collective case studies : These involve studying a group of individuals. Researchers might study a group of people in a certain setting or look at an entire community. For example, psychologists might explore how access to resources in a community has affected the collective mental well-being of those who live there.
• Descriptive case studies : These involve starting with a descriptive theory. The subjects are then observed, and the information gathered is compared to the pre-existing theory.
• Explanatory case studies : These   are often used to do causal investigations. In other words, researchers are interested in looking at factors that may have caused certain things to occur.
• Exploratory case studies : These are sometimes used as a prelude to further, more in-depth research. This allows researchers to gather more information before developing their research questions and hypotheses .
• Instrumental case studies : These occur when the individual or group allows researchers to understand more than what is initially obvious to observers.
• Intrinsic case studies : This type of case study is when the researcher has a personal interest in the case. Jean Piaget's observations of his own children are good examples of how an intrinsic case study can contribute to the development of a psychological theory.

The three main case study types often used are intrinsic, instrumental, and collective. Intrinsic case studies are useful for learning about unique cases. Instrumental case studies help look at an individual to learn more about a broader issue. A collective case study can be useful for looking at several cases simultaneously.

The type of case study that psychology researchers use depends on the unique characteristics of the situation and the case itself.

There are a number of different sources and methods that researchers can use to gather information about an individual or group. Six major sources that have been identified by researchers are:

• Archival records : Census records, survey records, and name lists are examples of archival records.
• Direct observation : This strategy involves observing the subject, often in a natural setting . While an individual observer is sometimes used, it is more common to utilize a group of observers.
• Documents : Letters, newspaper articles, administrative records, etc., are the types of documents often used as sources.
• Interviews : Interviews are one of the most important methods for gathering information in case studies. An interview can involve structured survey questions or more open-ended questions.
• Participant observation : When the researcher serves as a participant in events and observes the actions and outcomes, it is called participant observation.
• Physical artifacts : Tools, objects, instruments, and other artifacts are often observed during a direct observation of the subject.

If you have been directed to write a case study for a psychology course, be sure to check with your instructor for any specific guidelines you need to follow. If you are writing your case study for a professional publication, check with the publisher for their specific guidelines for submitting a case study.

Here is a general outline of what should be included in a case study.

Section 1: A Case History

This section will have the following structure and content:

Background information : The first section of your paper will present your client's background. Include factors such as age, gender, work, health status, family mental health history, family and social relationships, drug and alcohol history, life difficulties, goals, and coping skills and weaknesses.

Description of the presenting problem : In the next section of your case study, you will describe the problem or symptoms that the client presented with.

Describe any physical, emotional, or sensory symptoms reported by the client. Thoughts, feelings, and perceptions related to the symptoms should also be noted. Any screening or diagnostic assessments that are used should also be described in detail and all scores reported.

Your diagnosis : Provide your diagnosis and give the appropriate Diagnostic and Statistical Manual code. Explain how you reached your diagnosis, how the client's symptoms fit the diagnostic criteria for the disorder(s), or any possible difficulties in reaching a diagnosis.

Section 2: Treatment Plan

This portion of the paper will address the chosen treatment for the condition. This might also include the theoretical basis for the chosen treatment or any other evidence that might exist to support why this approach was chosen.

• Cognitive behavioral approach : Explain how a cognitive behavioral therapist would approach treatment. Offer background information on cognitive behavioral therapy and describe the treatment sessions, client response, and outcome of this type of treatment. Make note of any difficulties or successes encountered by your client during treatment.
• Humanistic approach : Describe a humanistic approach that could be used to treat your client, such as client-centered therapy . Provide information on the type of treatment you chose, the client's reaction to the treatment, and the end result of this approach. Explain why the treatment was successful or unsuccessful.
• Psychoanalytic approach : Describe how a psychoanalytic therapist would view the client's problem. Provide some background on the psychoanalytic approach and cite relevant references. Explain how psychoanalytic therapy would be used to treat the client, how the client would respond to therapy, and the effectiveness of this treatment approach.
• Pharmacological approach : If treatment primarily involves the use of medications, explain which medications were used and why. Provide background on the effectiveness of these medications and how monotherapy may compare with an approach that combines medications with therapy or other treatments.

This section of a case study should also include information about the treatment goals, process, and outcomes.

When you are writing a case study, you should also include a section where you discuss the case study itself, including the strengths and limitiations of the study. You should note how the findings of your case study might support previous research. 

In your discussion section, you should also describe some of the implications of your case study. What ideas or findings might require further exploration? How might researchers go about exploring some of these questions in additional studies?

Need More Tips?

Here are a few additional pointers to keep in mind when formatting your case study:

• Never refer to the subject of your case study as "the client." Instead, use their name or a pseudonym.
• Read examples of case studies to gain an idea about the style and format.
• Remember to use APA format when citing references .

Crowe S, Cresswell K, Robertson A, Huby G, Avery A, Sheikh A. The case study approach .  BMC Med Res Methodol . 2011;11:100.

Crowe S, Cresswell K, Robertson A, Huby G, Avery A, Sheikh A. The case study approach . BMC Med Res Methodol . 2011 Jun 27;11:100. doi:10.1186/1471-2288-11-100

Gagnon, Yves-Chantal.  The Case Study as Research Method: A Practical Handbook . Canada, Chicago Review Press Incorporated DBA Independent Pub Group, 2010.

Yin, Robert K. Case Study Research and Applications: Design and Methods . United States, SAGE Publications, 2017.

By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

Understanding Case Study Method in Research: A Comprehensive Guide

Table of Contents

Have you ever wondered how researchers uncover the nuanced layers of individual experiences or the intricate workings of a particular event? One of the keys to unlocking these mysteries lies in the qualitative research focusing on a single subject in its real-life context.">case study method , a research strategy that might seem straightforward at first glance but is rich with complexity and insightful potential. Let’s dive into the world of case studies and discover why they are such a valuable tool in the arsenal of research methods.

What is a Case Study Method?

At its core, the case study method is a form of qualitative research that involves an in-depth, detailed examination of a single subject, such as an individual, group, organization, event, or phenomenon. It’s a method favored when the boundaries between phenomenon and context are not clearly evident, and where multiple sources of data are used to illuminate the case from various perspectives. This method’s strength lies in its ability to provide a comprehensive understanding of the case in its real-life context.

Historical Context and Evolution of Case Studies

Case studies have been around for centuries, with their roots in medical and psychological research. Over time, their application has spread to disciplines like sociology, anthropology, business, and education. The evolution of this method has been marked by a growing appreciation for qualitative data and the rich, contextual insights it can provide, which quantitative methods may overlook.

Characteristics of Case Study Research

What sets the case study method apart are its distinct characteristics:

• Intensive Examination: It provides a deep understanding of the case in question, considering the complexity and uniqueness of each case.
• Contextual Analysis: The researcher studies the case within its real-life context, recognizing that the context can significantly influence the phenomenon.
• Multiple Data Sources: Case studies often utilize various data sources like interviews, observations, documents, and reports, which provide multiple perspectives on the subject.
• Participant’s Perspective: This method often focuses on the perspectives of the participants within the case, giving voice to those directly involved.

Types of Case Studies

There are different types of case studies, each suited for specific research objectives:

• Exploratory: These are conducted before large-scale research projects to help identify questions, select measurement constructs, and develop hypotheses.
• Descriptive: These involve a detailed, in-depth description of the case, without attempting to determine cause and effect.
• Explanatory: These are used to investigate cause-and-effect relationships and understand underlying principles of certain phenomena.
• Intrinsic: This type is focused on the case itself because the case presents an unusual or unique issue.
• Instrumental: Here, the case is secondary to understanding a broader issue or phenomenon.
• Collective: These involve studying a group of cases collectively or comparably to understand a phenomenon, population, or general condition.

The Process of Conducting a Case Study

Conducting a case study involves several well-defined steps:

• Defining Your Case: What or who will you study? Define the case and ensure it aligns with your research objectives.
• Selecting Participants: If studying people, careful selection is crucial to ensure they fit the case criteria and can provide the necessary insights.
• Data Collection: Gather information through various methods like interviews, observations, and reviewing documents.
• Data Analysis: Analyze the collected data to identify patterns, themes, and insights related to your research question.
• Reporting Findings: Present your findings in a way that communicates the complexity and richness of the case study, often through narrative.

Case Studies in Practice: Real-world Examples

Case studies are not just academic exercises; they have practical applications in every field. For instance, in business, they can explore consumer behavior or organizational strategies. In psychology, they can provide detailed insight into individual behaviors or conditions. Education often uses case studies to explore teaching methods or learning difficulties.

Advantages of Case Study Research

While the case study method has its critics, it offers several undeniable advantages:

• Rich, Detailed Data: It captures data too complex for quantitative methods.
• Contextual Insights: It provides a better understanding of the phenomena in its natural setting.
• Contribution to Theory: It can generate and refine theory, offering a foundation for further research.

Limitations and Criticism

However, it’s important to acknowledge the limitations and criticisms:

• Generalizability : Findings from case studies may not be widely generalizable due to the focus on a single case.
• Subjectivity: The researcher’s perspective may influence the study, which requires careful reflection and transparency.
• Time-Consuming: They require a significant amount of time to conduct and analyze properly.

Concluding Thoughts on the Case Study Method

The case study method is a powerful tool that allows researchers to delve into the intricacies of a subject in its real-world environment. While not without its challenges, when executed correctly, the insights garnered can be incredibly valuable, offering depth and context that other methods may miss. Robert K\. Yin ’s advocacy for this method underscores its potential to illuminate and explain contemporary phenomena, making it an indispensable part of the researcher’s toolkit.

Reflecting on the case study method, how do you think its application could change with the advancements in technology and data analytics? Could such a traditional method be enhanced or even replaced in the future?

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Research Methods in Psychology

1 Introduction to Psychological Research – Objectives and Goals, Problems, Hypothesis and Variables

• Nature of Psychological Research
• The Context of Discovery
• Context of Justification
• Characteristics of Psychological Research
• Goals and Objectives of Psychological Research

2 Introduction to Psychological Experiments and Tests

• Independent and Dependent Variables
• Extraneous Variables
• Experimental and Control Groups
• Introduction of Test
• Types of Psychological Test
• Uses of Psychological Tests

3 Steps in Research

• Research Process
• Identification of the Problem
• Review of Literature
• Formulating a Hypothesis
• Identifying Manipulating and Controlling Variables
• Formulating a Research Design
• Constructing Devices for Observation and Measurement
• Sample Selection and Data Collection
• Data Analysis and Interpretation
• Hypothesis Testing
• Drawing Conclusion

4 Types of Research and Methods of Research

• Historical Research
• Descriptive Research
• Correlational Research
• Qualitative Research
• Ex-Post Facto Research
• True Experimental Research
• Quasi-Experimental Research

5 Definition and Description Research Design, Quality of Research Design

• Research Design
• Purpose of Research Design
• Design Selection
• Criteria of Research Design
• Qualities of Research Design

6 Experimental Design (Control Group Design and Two Factor Design)

• Experimental Design
• Control Group Design
• Two Factor Design

7 Survey Design

• Survey Research Designs
• Steps in Survey Design
• Structuring and Designing the Questionnaire
• Interviewing Methodology
• Data Analysis
• Final Report

8 Single Subject Design

• Single Subject Design: Definition and Meaning
• Phases Within Single Subject Design
• Requirements of Single Subject Design
• Characteristics of Single Subject Design
• Types of Single Subject Design
• Advantages of Single Subject Design
• Disadvantages of Single Subject Design

9 Observation Method

• Definition and Meaning of Observation
• Characteristics of Observation
• Types of Observation
• Advantages and Disadvantages of Observation
• Guides for Observation Method

10 Interview and Interviewing

• Definition of Interview
• Types of Interview
• Aspects of Qualitative Research Interviews
• Interview Questions
• Convergent Interviewing as Action Research
• Research Team

11 Questionnaire Method

• Definition and Description of Questionnaires
• Types of Questionnaires
• Purpose of Questionnaire Studies
• Designing Research Questionnaires
• The Methods to Make a Questionnaire Efficient
• The Types of Questionnaire to be Included in the Questionnaire
• Advantages and Disadvantages of Questionnaire
• When to Use a Questionnaire?

12 Case Study

• Definition and Description of Case Study Method
• Historical Account of Case Study Method
• Designing Case Study
• Requirements for Case Studies
• Guideline to Follow in Case Study Method
• Other Important Measures in Case Study Method
• Case Reports

13 Report Writing

• Purpose of a Report
• Writing Style of the Report
• Report Writing – the Do’s and the Don’ts
• Format for Report in Psychology Area
• Major Sections in a Report

14 Review of Literature

• Purposes of Review of Literature
• Sources of Review of Literature
• Types of Literature
• Writing Process of the Review of Literature
• Preparation of Index Card for Reviewing and Abstracting

15 Methodology

• Definition and Purpose of Methodology
• Participants (Sample)
• Apparatus and Materials

16 Result, Analysis and Discussion of the Data

• Definition and Description of Results
• Statistical Presentation
• Tables and Figures

17 Summary and Conclusion

• Summary Definition and Description
• Guidelines for Writing a Summary
• Writing the Summary and Choosing Words
• A Process for Paraphrasing and Summarising
• Summary of a Report
• Writing Conclusions

18 References in Research Report

• Reference List (the Format)
• References (Process of Writing)
• Reference List and Print Sources
• Electronic Sources
• Book on CD Tape and Movie
• Reference Specifications
• General Guidelines to Write References

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What Is a Case Study in Psychology?

Categories Research Methods

A case study is a research method used in psychology to investigate a particular individual, group, or situation in depth . It involves a detailed analysis of the subject, gathering information from various sources such as interviews, observations, and documents.

In a case study, researchers aim to understand the complexities and nuances of the subject under investigation. They explore the individual’s thoughts, feelings, behaviors, and experiences to gain insights into specific psychological phenomena. 

This type of research can provide great detail regarding a particular case, allowing researchers to examine rare or unique situations that may not be easily replicated in a laboratory setting. They offer a holistic view of the subject, considering various factors influencing their behavior or mental processes. 

By examining individual cases, researchers can generate hypotheses, develop theories, and contribute to the existing body of knowledge in psychology. Case studies are often utilized in clinical psychology, where they can provide valuable insights into the diagnosis, treatment, and outcomes of specific psychological disorders. 

Case studies offer a comprehensive and in-depth understanding of complex psychological phenomena, providing researchers with valuable information to inform theory, practice, and future research.

Table of Contents

Examples of Case Studies in Psychology

Case studies in psychology provide real-life examples that illustrate psychological concepts and theories. They offer a detailed analysis of specific individuals, groups, or situations, allowing researchers to understand psychological phenomena better. Here are a few examples of case studies in psychology: 

Phineas Gage

This famous case study explores the effects of a traumatic brain injury on personality and behavior. A railroad construction worker, Phineas Gage survived a severe brain injury that dramatically changed his personality.

This case study helped researchers understand the role of the frontal lobe in personality and social behavior. 

Little Albert

Conducted by behaviorist John B. Watson, the Little Albert case study aimed to demonstrate classical conditioning. In this study, a young boy named Albert was conditioned to fear a white rat by pairing it with a loud noise.

This case study provided insights into the process of fear conditioning and the impact of early experiences on behavior. 

Genie’s case study focused on a girl who experienced extreme social isolation and deprivation during her childhood. This study shed light on the critical period for language development and the effects of severe neglect on cognitive and social functioning. 

These case studies highlight the value of in-depth analysis and provide researchers with valuable insights into various psychological phenomena. By examining specific cases, psychologists can uncover unique aspects of human behavior and contribute to the field’s knowledge and understanding.

Types of Case Studies in Psychology

Psychology case studies come in various forms, each serving a specific purpose in research and analysis. Understanding the different types of case studies can help researchers choose the most appropriate approach. 

Descriptive Case Studies

These studies aim to describe a particular individual, group, or situation. Researchers use descriptive case studies to explore and document specific characteristics, behaviors, or experiences.

For example, a descriptive case study may examine the life and experiences of a person with a rare psychological disorder. 

Exploratory Case Studies

Exploratory case studies are conducted when there is limited existing knowledge or understanding of a particular phenomenon. Researchers use these studies to gather preliminary information and generate hypotheses for further investigation.

Exploratory case studies often involve in-depth interviews, observations, and analysis of existing data. 

Explanatory Case Studies

These studies aim to explain the causal relationship between variables or events. Researchers use these studies to understand why certain outcomes occur and to identify the underlying mechanisms or processes.

Explanatory case studies often involve comparing multiple cases to identify common patterns or factors. 

Instrumental Case Studies

Instrumental case studies focus on using a particular case to gain insights into a broader issue or theory. Researchers select cases that are representative or critical in understanding the phenomenon of interest.

Instrumental case studies help researchers develop or refine theories and contribute to the general knowledge in the field. 

By utilizing different types of case studies, psychologists can explore various aspects of human behavior and gain a deeper understanding of psychological phenomena. Each type of case study offers unique advantages and contributes to the overall body of knowledge in psychology.

How to Collect Data for a Case Study

There are a variety of ways that researchers gather the data they need for a case study. Some sources include:

• Directly observing the subject
• Collecting information from archival records
• Conducting interviews
• Examining artifacts related to the subject
• Examining documents that provide information about the subject

The way that this information is collected depends on the nature of the study itself

Prospective Research

In a prospective study, researchers observe the individual or group in question. These observations typically occur over a period of time and may be used to track the progress or progression of a phenomenon or treatment.

Retrospective Research

A retrospective case study involves looking back on a phenomenon. Researchers typically look at the outcome and then gather data to help them understand how the individual or group reached that point.

Benefits of a Case Study

Case studies offer several benefits in the field of psychology. They provide researchers with a unique opportunity to delve deep into specific individuals, groups, or situations, allowing for a comprehensive understanding of complex phenomena.

Case studies offer valuable insights that can inform theory development and practical applications by examining real-life examples. 

Complex Data

One of the key benefits of case studies is their ability to provide complex and detailed data. Researchers can gather in-depth information through various methods such as interviews, observations, and analysis of existing records.

This depth of data allows for a thorough exploration of the factors influencing behavior and the underlying mechanisms at play. 

Unique Data

Additionally, case studies allow researchers to study rare or unique cases that may not be easily replicated in experimental settings. This enables the examination of phenomena that are difficult to study through other psychology research methods . 

By focusing on specific cases, researchers can uncover patterns, identify causal relationships, and generate hypotheses for further investigation.

General Knowledge

Case studies can also contribute to the general knowledge of psychology by providing real-world examples that can be used to support or challenge existing theories. They offer a bridge between theory and practice, allowing researchers to apply theoretical concepts to real-life situations and vice versa. 

Case studies offer a range of benefits in psychology, including providing rich and detailed data, studying unique cases, and contributing to theory development. These benefits make case studies valuable in understanding human behavior and psychological phenomena.

Limitations of a Case Study

While case studies offer numerous benefits in the field of psychology, they also have certain limitations that researchers need to consider. Understanding these limitations is crucial for interpreting the findings and generalizing the results. 

Lack of Generalizability

One limitation of case studies is the issue of generalizability. Since case studies focus on specific individuals, groups, and situations, applying the findings to a larger population can be challenging. The unique characteristics and circumstances of the case may not be representative of the broader population, making it difficult to draw universal conclusions. 

Researcher bias is another possible limitation. The researcher’s subjective interpretation and personal beliefs can influence the data collection, analysis, and interpretation process. This bias can affect the objectivity and reliability of the findings, raising questions about the study’s validity. 

Case studies are often time-consuming and resource-intensive. They require extensive data collection, analysis, and interpretation, which can be lengthy. This can limit the number of cases that can be studied and may result in a smaller sample size, reducing the study’s statistical power. 

Case studies are retrospective in nature, relying on past events and experiences. This reliance on memory and self-reporting can introduce recall bias and inaccuracies in the data. Participants may forget or misinterpret certain details, leading to incomplete or unreliable information.

Despite these limitations, case studies remain a valuable research tool in psychology. By acknowledging and addressing these limitations, researchers can enhance the validity and reliability of their findings, contributing to a more comprehensive understanding of human behavior and psychological phenomena. 

While case studies have limitations, they remain valuable when researchers acknowledge and address these concerns, leading to more reliable and valid findings in psychology.

Alpi, K. M., & Evans, J. J. (2019). Distinguishing case study as a research method from case reports as a publication type. Journal of the Medical Library Association , 107(1). https://doi.org/10.5195/jmla.2019.615

Crowe, S., Cresswell, K., Robertson, A., Huby, G., Avery, A., & Sheikh, A. (2011). The case study approach. BMC Medical Research Methodology , 11(1), 100. https://doi.org/10.1186/1471-2288-11-100

Paparini, S., Green, J., Papoutsi, C., Murdoch, J., Petticrew, M., Greenhalgh, T., Hanckel, B., & Shaw, S. (2020). Case study research for better evaluations of complex interventions: Rationale and challenges. BMC Medicine , 18(1), 301. https://doi.org/10.1186/s12916-020-01777-6

Willemsen, J. (2023). What is preventing psychotherapy case studies from having a greater impact on evidence-based practice, and how to address the challenges? Frontiers in Psychiatry , 13, 1101090. https://doi.org/10.3389/fpsyt.2022.1101090

Yin, Robert K. Case Study Research and Applications: Design and Methods . United States, SAGE Publications, 2017.

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• Published: 22 November 2022

Single case studies are a powerful tool for developing, testing and extending theories

• Lyndsey Nickels   ORCID: orcid.org/0000-0002-0311-3524 1 , 2 ,
• Simon Fischer-Baum   ORCID: orcid.org/0000-0002-6067-0538 3 &
• Wendy Best   ORCID: orcid.org/0000-0001-8375-5916 4  

Nature Reviews Psychology volume  1 ,  pages 733–747 ( 2022 ) Cite this article

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Psychology embraces a diverse range of methodologies. However, most rely on averaging group data to draw conclusions. In this Perspective, we argue that single case methodology is a valuable tool for developing and extending psychological theories. We stress the importance of single case and case series research, drawing on classic and contemporary cases in which cognitive and perceptual deficits provide insights into typical cognitive processes in domains such as memory, delusions, reading and face perception. We unpack the key features of single case methodology, describe its strengths, its value in adjudicating between theories, and outline its benefits for a better understanding of deficits and hence more appropriate interventions. The unique insights that single case studies have provided illustrate the value of in-depth investigation within an individual. Single case methodology has an important place in the psychologist’s toolkit and it should be valued as a primary research tool.

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Acknowledgements

The authors thank all of those pioneers of and advocates for single case study research who have mentored, inspired and encouraged us over the years, and the many other colleagues with whom we have discussed these issues.

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Lyndsey Nickels

NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia

Psychological Sciences, Rice University, Houston, TX, USA

Simon Fischer-Baum

Psychology and Language Sciences, University College London, London, UK

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Nickels, L., Fischer-Baum, S. & Best, W. Single case studies are a powerful tool for developing, testing and extending theories. Nat Rev Psychol 1 , 733–747 (2022). https://doi.org/10.1038/s44159-022-00127-y

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Psychology Case Study Examples: A Deep Dive into Real-life Scenarios

Peeling back the layers of the human mind is no easy task, but psychology case studies can help us do just that. Through these detailed analyses, we’re able to gain a deeper understanding of human behavior, emotions, and cognitive processes. I’ve always found it fascinating how a single person’s experience can shed light on broader psychological principles.

Over the years, psychologists have conducted numerous case studies—each with their own unique insights and implications. These investigations range from Phineas Gage’s accidental lobotomy to Genie Wiley’s tragic tale of isolation. Such examples not only enlighten us about specific disorders or occurrences but also continue to shape our overall understanding of psychology .

As we delve into some noteworthy examples , I assure you’ll appreciate how varied and intricate the field of psychology truly is. Whether you’re a budding psychologist or simply an eager learner, brace yourself for an intriguing exploration into the intricacies of the human psyche.

Understanding Psychology Case Studies

Diving headfirst into the world of psychology, it’s easy to come upon a valuable tool used by psychologists and researchers alike – case studies. I’m here to shed some light on these fascinating tools.

Psychology case studies, for those unfamiliar with them, are in-depth investigations carried out to gain a profound understanding of the subject – whether it’s an individual, group or phenomenon. They’re powerful because they provide detailed insights that other research methods might miss.

Let me share a few examples to clarify this concept further:

• One notable example is Freud’s study on Little Hans. This case study explored a 5-year-old boy’s fear of horses and related it back to Freud’s theories about psychosexual stages.
• Another classic example is Genie Wiley (a pseudonym), a feral child who was subjected to severe social isolation during her early years. Her heartbreaking story provided invaluable insights into language acquisition and critical periods in development.

You see, what sets psychology case studies apart is their focus on the ‘why’ and ‘how’. While surveys or experiments might tell us ‘what’, they often don’t dig deep enough into the inner workings behind human behavior.

It’s important though not to take these psychology case studies at face value. As enlightening as they can be, we must remember that they usually focus on one specific instance or individual. Thus, generalizing findings from single-case studies should be done cautiously.

To illustrate my point using numbers: let’s say we have 1 million people suffering from condition X worldwide; if only 20 unique cases have been studied so far (which would be quite typical for rare conditions), then our understanding is based on just 0.002% of the total cases! That’s why multiple sources and types of research are vital when trying to understand complex psychological phenomena fully.

In the grand scheme of things, psychology case studies are just one piece of the puzzle – albeit an essential one. They provide rich, detailed data that can form the foundation for further research and understanding. As we delve deeper into this fascinating field, it’s crucial to appreciate all the tools at our disposal – from surveys and experiments to these insightful case studies.

Importance of Case Studies in Psychology

I’ve always been fascinated by the human mind, and if you’re here, I bet you are too. Let’s dive right into why case studies play such a pivotal role in psychology.

One of the key reasons they matter so much is because they provide detailed insights into specific psychological phenomena. Unlike other research methods that might use large samples but only offer surface-level findings, case studies allow us to study complex behaviors, disorders, and even treatments at an intimate level. They often serve as a catalyst for new theories or help refine existing ones.

To illustrate this point, let’s look at one of psychology’s most famous case studies – Phineas Gage. He was a railroad construction foreman who survived a severe brain injury when an iron rod shot through his skull during an explosion in 1848. The dramatic personality changes he experienced after his accident led to significant advancements in our understanding of the brain’s role in personality and behavior.

Moreover, it’s worth noting that some rare conditions can only be studied through individual cases due to their uncommon nature. For instance, consider Genie Wiley – a girl discovered at age 13 having spent most of her life locked away from society by her parents. Her tragic story gave psychologists valuable insights into language acquisition and critical periods for learning.

Finally yet importantly, case studies also have practical applications for clinicians and therapists. Studying real-life examples can inform treatment plans and provide guidance on how theoretical concepts might apply to actual client situations.

• Detailed insights: Case studies offer comprehensive views on specific psychological phenomena.
• Catalyst for new theories: Real-life scenarios help shape our understanding of psychology .
• Study rare conditions: Unique cases can offer invaluable lessons about uncommon disorders.
• Practical applications: Clinicians benefit from studying real-world examples.

In short (but without wrapping up), it’s clear that case studies hold immense value within psychology – they illuminate what textbooks often can’t, offering a more nuanced understanding of human behavior.

Different Types of Psychology Case Studies

Diving headfirst into the world of psychology, I can’t help but be fascinated by the myriad types of case studies that revolve around this subject. Let’s take a closer look at some of them.

Firstly, we’ve got what’s known as ‘Explanatory Case Studies’. These are often used when a researcher wants to clarify complex phenomena or concepts. For example, a psychologist might use an explanatory case study to explore the reasons behind aggressive behavior in children.

Second on our list are ‘Exploratory Case Studies’, typically utilized when new and unexplored areas of research come up. They’re like pioneers; they pave the way for future studies. In psychological terms, exploratory case studies could be conducted to investigate emerging mental health conditions or under-researched therapeutic approaches.

Next up are ‘Descriptive Case Studies’. As the name suggests, these focus on depicting comprehensive and detailed profiles about a particular individual, group, or event within its natural context. A well-known example would be Sigmund Freud’s analysis of “Anna O”, which provided unique insights into hysteria.

Then there are ‘Intrinsic Case Studies’, which delve deep into one specific case because it is intrinsically interesting or unique in some way. It’s sorta like shining a spotlight onto an exceptional phenomenon. An instance would be studying savants—individuals with extraordinary abilities despite significant mental disabilities.

Lastly, we have ‘Instrumental Case Studies’. These aren’t focused on understanding a particular case per se but use it as an instrument to understand something else altogether—a bit like using one puzzle piece to make sense of the whole picture!

So there you have it! From explanatory to instrumental, each type serves its own unique purpose and adds another intriguing layer to our understanding of human behavior and cognition.

Exploring Real-Life Psychology Case Study Examples

Let’s roll up our sleeves and delve into some real-life psychology case study examples. By digging deep, we can glean valuable insights from these studies that have significantly contributed to our understanding of human behavior and mental processes.

First off, let me share the fascinating case of Phineas Gage. This gentleman was a 19th-century railroad construction foreman who survived an accident where a large iron rod was accidentally driven through his skull, damaging his frontal lobes. Astonishingly, he could walk and talk immediately after the accident but underwent dramatic personality changes, becoming impulsive and irresponsible. This case is often referenced in discussions about brain injury and personality change.

Next on my list is Genie Wiley’s heart-wrenching story. She was a victim of severe abuse and neglect resulting in her being socially isolated until she was 13 years old. Due to this horrific experience, Genie couldn’t acquire language skills typically as other children would do during their developmental stages. Her tragic story offers invaluable insight into the critical periods for language development in children.

Then there’s ‘Little Hans’, a classic Freudian case that delves into child psychology. At just five years old, Little Hans developed an irrational fear of horses -or so it seemed- which Sigmund Freud interpreted as symbolic anxiety stemming from suppressed sexual desires towards his mother—quite an interpretation! The study gave us Freud’s Oedipus Complex theory.

Lastly, I’d like to mention Patient H.M., an individual who became amnesiac following surgery to control seizures by removing parts of his hippocampus bilaterally. His inability to form new memories post-operation shed light on how different areas of our brains contribute to memory formation.

Each one of these real-life psychology case studies gives us a unique window into understanding complex human behaviors better – whether it’s dissecting the role our brain plays in shaping personality or unraveling the mysteries of fear, language acquisition, and memory.

How to Analyze a Psychology Case Study

Diving headfirst into a psychology case study, I understand it can seem like an intimidating task. But don’t worry, I’m here to guide you through the process.

First off, it’s essential to go through the case study thoroughly. Read it multiple times if needed. Each reading will likely reveal new information or perspectives you may have missed initially. Look out for any patterns or inconsistencies in the subject’s behavior and make note of them.

Next on your agenda should be understanding the theoretical frameworks that might be applicable in this scenario. Is there a cognitive-behavioral approach at play? Or does psychoanalysis provide better insights? Comparing these theories with observed behavior and symptoms can help shed light on underlying psychological issues.

Now, let’s talk data interpretation. If your case study includes raw data like surveys or diagnostic tests results, you’ll need to analyze them carefully. Here are some steps that could help:

• Identify what each piece of data represents
• Look for correlations between different pieces of data
• Compute statistics (mean, median, mode) if necessary
• Use graphs or charts for visual representation

Keep in mind; interpreting raw data requires both statistical knowledge and intuition about human behavior.

Finally, drafting conclusions is key in analyzing a psychology case study. Based on your observations, evaluations of theoretical approaches and interpretations of any given data – what do you conclude about the subject’s mental health status? Remember not to jump to conclusions hastily but instead base them solidly on evidence from your analysis.

In all this journey of analysis remember one thing: every person is unique and so are their experiences! So while theories and previous studies guide us, they never define an individual completely.

Applying Lessons from Psychology Case Studies

Let’s dive into how we can apply the lessons learned from psychology case studies. If you’ve ever studied psychology, you’ll know that case studies offer rich insights. They shed light on human behavior, mental health issues, and therapeutic techniques. But it’s not just about understanding theory. It’s also about implementing these valuable lessons in real-world situations.

One of the most famous psychological case studies is Phineas Gage’s story. This 19th-century railroad worker survived a severe brain injury which dramatically altered his personality. From this study, we gained crucial insight into how different brain areas are responsible for various aspects of our personality and behavior.

• Lesson: Recognizing that damage to specific brain areas can result in personality changes, enabling us to better understand certain mental conditions.

Sigmund Freud’s work with a patient known as ‘Anna O.’ is another landmark psychology case study. Anna displayed what was then called hysteria – symptoms included hallucinations and disturbances in speech and physical coordination – which Freud linked back to repressed memories of traumatic events.

• Lesson: The importance of exploring an individual’s history for understanding their current psychological problems – a principle at the heart of psychoanalysis.

Then there’s Genie Wiley’s case – a girl who suffered extreme neglect resulting in impaired social and linguistic development. Researchers used her tragic circumstances as an opportunity to explore theories around language acquisition and socialization.

• Lesson: Reinforcing the critical role early childhood experiences play in shaping cognitive development.

Lastly, let’s consider the Stanford Prison Experiment led by Philip Zimbardo examining how people conform to societal roles even when they lead to immoral actions.

• Lesson: Highlighting that situational forces can drastically impact human behavior beyond personal characteristics or morality.

These examples demonstrate that psychology case studies aren’t just academic exercises isolated from daily life. Instead, they provide profound lessons that help us make sense of complex human behaviors, mental health issues, and therapeutic strategies. By understanding these studies, we’re better equipped to apply their lessons in our own lives – whether it’s navigating personal relationships, working with diverse teams at work or even self-improvement.

Challenges and Critiques of Psychological Case Studies

Delving into the world of psychological case studies, it’s not all rosy. Sure, they offer an in-depth understanding of individual behavior and mental processes. Yet, they’re not without their share of challenges and criticisms.

One common critique is the lack of generalizability. Each case study is unique to its subject. We can’t always apply what we learn from one person to everyone else. I’ve come across instances where results varied dramatically between similar subjects, highlighting the inherent unpredictability in human behavior.

Another challenge lies within ethical boundaries. Often, sensitive information surfaces during these studies that could potentially harm the subject if disclosed improperly. To put it plainly, maintaining confidentiality while delivering a comprehensive account isn’t always easy.

Distortion due to subjective interpretations also poses substantial difficulties for psychologists conducting case studies. The researcher’s own bias may color their observations and conclusions – leading to skewed outcomes or misleading findings.

Moreover, there’s an ongoing debate about the scientific validity of case studies because they rely heavily on qualitative data rather than quantitative analysis. Some argue this makes them less reliable or objective when compared with other research methods such as experiments or surveys.

To summarize:

• Lack of generalizability
• Ethical dilemmas concerning privacy
• Potential distortion through subjective interpretation
• Questions about scientific validity

While these critiques present significant challenges, they do not diminish the value that psychological case studies bring to our understanding of human behavior and mental health struggles.

Conclusion: The Impact of Case Studies in Understanding Human Behavior

Case studies play a pivotal role in shedding light on human behavior. Throughout this article, I’ve discussed numerous examples that illustrate just how powerful these studies can be. Yet it’s the impact they have on our understanding of human psychology where their true value lies.

Take for instance the iconic study of Phineas Gage. It was through his tragic accident and subsequent personality change that we began to grasp the profound influence our frontal lobes have on our behavior. Without such a case study, we might still be in the dark about this crucial aspect of our neurology.

Let’s also consider Genie, the feral child who showed us the critical importance of social interaction during early development. Her heartbreaking story underscores just how vital appropriate nurturing is for healthy mental and emotional growth.

Here are some key takeaways from these case studies:

• Our brain structure significantly influences our behavior.
• Social interaction during formative years is vital for normal psychological development.
• Studying individual cases can reveal universal truths about human nature.

What stands out though, is not merely what these case studies teach us individually but collectively. They remind us that each person constitutes a unique combination of various factors—biological, psychological, and environmental—that shape their behavior.

One cannot overstate the significance of case studies in psychology—they are more than mere stories or isolated incidents; they’re windows into the complexities and nuances of human nature itself.

In wrapping up, I’d say that while statistics give us patterns and trends to understand groups, it’s these detailed narratives offered by case studies that help us comprehend individuals’ unique experiences within those groups—making them an invaluable part of psychological research.

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What Is A Case Study In Psychology?

When people think about psychology studies, they are most likely to think about studies involving several participants split across a number of experimental and control groups. Studies like this are a good way to investigate the effect of a certain treatment or activity, but they are not always the best option. For example, if a scientist is interested in a specific rare disease, they cannot always find enough people with that disease to participate in a useful study. Similarly, one cannot give a group of participants a rare disease (for obvious reasons) and compare them to a group of participants without that disease. For situations like this, there are case studies.

What is a case study?

A case study is, as the name suggests, a study of a single case. For example, if someone has an extremely rare disease, a group of scientists might conduct a case study of that disease rather than attempting to set up an experimental study. In that case study, the researchers might test the effectiveness of a certain drug in treating that disease and carefully document the response of that participant over time.

Of course, the results seen in that one participant will not necessarily apply to all people with that rare disease. However, if the case study shows promising results, that treatment can then be tested in a larger experimental study. If it does not, it indicates that the treatment is not necessarily effective, at least in people that are similar to the original participant in the case study.

Why are case studies useful in psychology?

When people are still learning about psychology, they might think that group studies showing group effects are always better than individual studies showing individual effects. Of course, there is some truth to this notion, as results obtained from a large number of people are likely to be more generalizable than results obtained from a single person. However, this does not mean that we should discount the importance of individual effects.

Consider the following: In studies looking solely at group effects, individual effects can be masked. In other words, certain statistical quirks can lead to the appearance of a group effect despite the fact that no single individual showed that effect. While this is rare, it is possible. For this reason, it is important to consider individual effects. That is why, even in experimental studies examining groups, it can be useful to examine individual effects within that group. This underlines the value of case studies.

Wrapping up

At the end of the day, there are many good reasons that experimental studies examining groups are the most common types of psychological studies. However, case studies are also extremely valuable, particularly when group experiments are less feasible. Just as psychology is a large topic encompassing a wide variety of factors, both case studies and experimental group studies should be used in the larger overall strategy of psychology research.

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n. an in-depth assessment and investigation conducted on a target individual, family unit, or social group. It requires a researcher to collect multiple types of data that would prove to be useful in creating a complete biographical, psychological, physiological, and environmental background on the case.

What is a case study in psychology?

In psychology, a case study is a comprehensive, qualitative research of a single person or occasion that offers in-depth knowledge and insight into the subject's behavior, experiences, and thought processes. Observation, interviews, and the investigation of records, papers, and other artifacts are frequently used in case studies.

What is the purpose of a case study?

A case study in psychology is designed to produce rich, comprehensive data that can be utilized to comprehend a specific phenomenon or person in deeper detail. Researchers can use case studies to investigate the complexity of human behavior and mental processes, spot trends and themes, and develop hypotheses for more study. They are a useful tool for psychology teaching and learning because they may be used to demonstrate concepts or theories in a practical setting.

Types of psychology case studies

A case study is a method used in psychology to gather comprehensive data that would help researchers better understand a particular occurrence or individual. Case studies are a useful tool for researchers because they let them explore the complexity of human thought and behavior, identify patterns and themes, and provide hypotheses for further investigation. Because they can be used to demonstrate ideas or theories in a real-world situation, they are a helpful tool for psychology teaching and learning.

The following are the five main types of case studies in psychology:

• Exploratory case studies: These case studies are designed to investigate new or under-researched areas within the field of psychology. The primary purpose of exploratory case studies is to generate hypotheses or initial theories, which can then be tested using more rigorous research methods .
• Descriptive case studies: Descriptive case studies aim to provide a comprehensive account of a specific individual, event, or phenomenon.
• Explanatory case studies: Explanatory case studies seek to identify the underlying causes or mechanisms responsible for a particular outcome or behavior. They often involve the analysis of relationships between various factors, with the goal of uncovering causal connections. These case studies may employ quantitative methods, such as statistical analyses or experiments, in addition to qualitative data collection techniques.
• Intrinsic case studies: Intrinsic case studies focus on a unique, rare, or unusual case that is of particular interest to the researcher. The primary goal of this type of case study is to gain a deep understanding of the specific individual or event, rather than generalizing the findings to a broader population.
• Instrumental case studies: Instrumental case studies use a specific case as a means to gain insight into a broader issue or to support or challenge a theory. In this type of case study, the focus is not on the individual case itself, but on the wider implications it has for understanding psychological phenomena.
• Phineas Gage : Phineas Gage was a railroad construction worker who survived a catastrophic brain injury in 1848 and is a well-known case study in the history of psychology. His example has been utilized to examine the connection between brain make-up and personality as well as the function of the frontal lobes in social cognition and judgment.
• Little Hans: Little Hans, a 5-year-old boy, was the subject of a psychoanalytic case study by Sigmund Freud in the early 20th century. The study aimed to explore the development of anxiety and phobias in children and provided support for some of Freud's theories on psychosexual development and the Oedipus complex.
• Genie: Genie was a young girl who was discovered in 1970 after being locked in isolation for most of her life. Her case has been used to study the effects of extreme social isolation on cognitive and linguistic development, as well as the critical period hypothesis in language acquisition .

References:

Baxter, P., & Jack, S. (2008). Qualitative Case Study Methodology: Study Design and Implementation for Novice Researchers. The Qualitative Report, 13(4), 544-559. https://doi.org/10.46743/2160-3715/2008.1573

Creswell, J.W. and Poth, C.N. (2018) Qualitative Inquiry and Research Design Choosing among Five Approaches. 4th Edition, SAGE Publications, Inc., Thousand Oaks. https://www.scirp.org/(S(lz5mqp453edsnp55rrgjct55))/reference/ReferencesPapers.aspx?ReferenceID=2155979

Hollweck, T. (2016). Robert K. Yin. (2014). Case Study Research Design and Methods (5th ed.). Thousand Oaks, CA: Sage. 282 pages. The Canadian Journal of Program Evaluation , 30, 108. https://doi.org/10.3138/cjpe.30.1.108

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Henry Gustav Molaison: The Curious Case of Patient H.M. 

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Henry Gustav Molaison, known as Patient H.M., is a landmark case study in psychology. After a surgery to alleviate severe epilepsy, which removed large portions of his hippocampus , he was left with anterograde amnesia , unable to form new explicit memories , thus offering crucial insights into the role of the hippocampus in memory formation.

• Henry Gustav Molaison (often referred to as H.M.) is a famous case of anterograde and retrograde amnesia in psychology.
• H. M. underwent brain surgery to remove his hippocampus and amygdala to control his seizures. As a result of his surgery, H.M.’s seizures decreased, but he could no longer form new memories or remember the prior 11 years of his life.
• He lost his ability to form many types of new memories (anterograde amnesia), such as new facts or faces, and the surgery also caused retrograde amnesia as he was able to recall childhood events but lost the ability to recall experiences a few years before his surgery.
• The case of H.M. and his life-long participation in studies gave researchers valuable insight into how memory functions and is organized in the brain. He is considered one of the most studied medical and psychological history cases.

Who is H.M.?

Henry Gustav Molaison, or “H.M” as he is commonly referred to by psychology and neuroscience textbooks, lost his memory on an operating table in 1953.

For years before his neurosurgery, H.M. suffered from epileptic seizures believed to be caused by a bicycle accident that occurred in his childhood. The seizures started out as minor at age ten, but they developed in severity when H.M. was a teenager.

Continuing to worsen in severity throughout his young adulthood, H.M. was eventually too disabled to work. Throughout this period, treatments continued to turn out unsuccessful, and epilepsy proved a major handicap and strain on H.M.’s quality of life.

And so, at age 27, H.M. agreed to undergo a radical surgery that would involve removing a part of his brain called the hippocampus — the region believed to be the source of his epileptic seizures (Squire, 2009).

For epilepsy patients, brain resection surgery refers to removing small portions of brain tissue responsible for causing seizures. Although resection is still a surgical procedure used today to treat epilepsy, the use of lasers and detailed brain scans help ensure valuable brain regions are not impacted.

In 1953, H.M.’s neurosurgeon did not have these tools, nor was he or the rest of the scientific or medical community fully aware of the true function of the hippocampus and its specific role in memory. In one regard, the surgery was successful, as H.M. did, in fact, experience fewer seizures.

However, family and doctors soon noticed he also suffered from severe amnesia, which persisted well past when he should have recovered. In addition to struggling to remember the years leading up to his surgery, H.M. also had gaps in his memory of the 11 years prior.

Furthermore, he lacked the ability to form new memories — causing him to perpetually live an existence of moment-to-moment forgetfulness for decades to come.

In one famous quote, he famously and somberly described his state as “like waking from a dream…. every day is alone in itself” (Squire et al., 2009).

H.M. soon became a major case study of interest for psychologists and neuroscientists who studied his memory deficits and cognitive abilities to better understand the hippocampus and its function.

When H.M. died on December 2, 2008, at the age of 82, he left behind a lifelong legacy of scientific contribution.

Surgical Procedure

Neurosurgeon William Beecher Scoville performed H.M.’s surgery in Hartford, Connecticut, in August 1953 when H.M. was 27 years old.

During the procedure, Scoville removed parts of H.M.’s temporal lobe which refers to the portion of the brain that sits behind both ears and is associated with auditory and memory processing.

More specifically, the surgery involved what was called a “partial medial temporal lobe resection” (Scoville & Milner, 1957). In this resection, Scoville removed 8 cm of brain tissue from the hippocampus — a seahorse-shaped structure located deep in the temporal lobe .

Bilateral resection of the anterior temporal lobe in patient HM.

Further research conducted after this removal showed Scoville also probably destroyed the brain structures known as the “uncus” (theorized to play a role in the sense of smell and forming new memories) and the “amygdala” (theorized to play a crucial role in controlling our emotional responses such as fear and sadness).

As previously mentioned, the removal surgery partially reduced H.M.’s seizures; however, he also lost the ability to form new memories.

At the time, Scoville’s experimental procedure had previously only been performed on patients with psychosis, so H.M. was the first epileptic patient and showed no sign of mental illness. In the original case study of H.M., which is discussed in further detail below, nine of Scoville’s patients from this experimental surgery were described.

However, because these patients had disorders such as schizophrenia, their symptoms were not removed after surgery.

In this regard, H.M. was the only patient with “clean” amnesia along with no other apparent mental problems.

H.M’s Amnesia

H.M.’s apparent amnesia after waking from surgery presented in multiple forms. For starters, H.M. suffered from retrograde amnesia for the 11-year period prior to his surgery.

Retrograde describes amnesia, where you can’t recall memories that were formed before the event that caused the amnesia. Important to note, current research theorizes that H.M.’s retrograde amnesia was not actually caused by the loss of his hippocampus, but rather from a combination of antiepileptic drugs and frequent seizures prior to his surgery (Shrader 2012).

In contrast, H.M.’s inability to form new memories after his operation, known as anterograde amnesia, was the result of the loss of the hippocampus.

This meant that H.M. could not learn new words, facts, or faces after his surgery, and he would even forget who he was talking to the moment he walked away.

However, H.M. could perform tasks, and he could even perform those tasks easier after practice. This important finding represented a major scientific discovery when it comes to memory and the hippocampus. The memory that H.M. was missing in his life included the recall of facts, life events, and other experiences.

This type of long-term memory is referred to as “explicit” or “ declarative ” memories and they require conscious thinking.

In contrast, H.M.’s ability to improve in tasks after practice (even if he didn’t recall that practice) showed his “implicit” or “ procedural ” memory remained intact (Scoville & Milner, 1957). This type of long-term memory is unconscious, and examples include riding a bike, brushing your teeth, or typing on a keyboard.

Most importantly, after removing his hippocampus, H.M. lost his explicit memory but not his implicit memory — establishing that implicit memory must be controlled by some other area of the brain and not the hippocampus.

After the severity of the side effects of H.M.’s operation became clear, H.M. was referred to neurosurgeon Dr. Wilder Penfield and neuropsychologist Dr. Brenda Milner of Montreal Neurological Institute (MNI) for further testing.

As discussed, H.M. was not the only patient who underwent this experimental surgery, but he was the only non-psychotic patient with such a degree of memory impairment. As a result, he became a major study and interest for Milner and the rest of the scientific community.

Since Penfield and Milner had already been conducting memory experiments on other patients at the time, they quickly realized H.M.’s “dense amnesia, intact intelligence, and precise neurosurgical lesions made him a perfect experimental subject” (Shrader 2012).

Milner continued to conduct cognitive testing on H.M. for the next fifty years, primarily at the Massachusetts Institute of Technology (MIT). Her longitudinal case study of H.M.’s amnesia quickly became a sensation and is still one of the most widely-cited psychology studies.

In publishing her work, she protected Henry’s identity by first referring to him as the patient H.M. (Shrader 2012).

In the famous “star tracing task,” Milner tested if H.M.’s procedural memory was affected by the removal of the hippocampus during surgery.

In this task, H.M. had to trace an outline of a star, but he could only trace the star based on the mirrored reflection. H.M. then repeated this task once a day over a period of multiple days.

Over the course of these multiple days, Milner observed that H.M. performed the test faster and with fewer errors after continued practice. Although each time he performed the task, he had no memory of having participated in the task before, his performance improved immensely (Shrader 2012).

As this task showed, H.M. had lost his declarative/explicit memory, but his unconscious procedural/implicit memory remained intact.

Given the damage to his hippocampus in surgery, researchers concluded from tasks such as these that the hippocampus must play a role in declarative but not procedural memory.

Therefore, procedural memory must be localized somewhere else in the brain and not in the hippocampus.

H.M’s Legacy

Milner’s and hundreds of other researchers’ work with H.M. established fundamental principles about how memory functions and is organized in the brain.

Without the contribution of H.M. in volunteering the study of his mind to science, our knowledge today regarding the separation of memory function in the brain would certainly not be as strong.

Until H.M.’s watershed surgery, it was not known that the hippocampus was essential for making memories and that if we lost this valuable part of our brain, we would be forced to live only in the moment-to-moment constraints of our short-term memory .

Once this was realized, the findings regarding H.M. were widely publicized so that this operation to remove the hippocampus would never be done again (Shrader 2012).

H.M.’s case study represents a historical time period for neuroscience in which most brain research and findings were the result of brain dissections, lesioning certain sections, and seeing how different experimental procedures impacted different patients.

Therefore, it is paramount we recognize the contribution of patients like H.M., who underwent these dangerous operations in the mid-twentieth century and then went on to allow researchers to study them for the rest of their lives.

Even after his death, H.M. donated his brain to science. Researchers then took his unique brain, froze it, and then in a 53-hour procedure, sliced it into 2,401 slices which were then individually photographed and digitized as a three-dimensional map.

Through this map, H.M.’s brain could be preserved for posterity (Wb et al., 2014). As neuroscience researcher Suzanne Corkin once said it best, “H.M. was a pleasant, engaging, docile man with a keen sense of humor, who knew he had a poor memory but accepted his fate.

There was a man behind the data. Henry often told me that he hoped that research into his condition would help others live better lives. He would have been proud to know how much his tragedy has benefitted science and medicine” (Corkin, 2014).

Corkin, S. (2014). Permanent present tense: The man with no memory and what he taught the world. Penguin Books.

Hardt, O., Einarsson, E. Ö., & Nader, K. (2010). A bridge over troubled water: Reconsolidation as a link between cognitive and neuroscientific memory research traditions. Annual Review of Psychology, 61, 141–167.

Scoville, W. B., & Milner, B. (1957). Loss of recent memory after bilateral hippocampal lesions . Journal of neurology, neurosurgery, and psychiatry, 20 (1), 11.

Shrader, J. (2012, January). HM, the man with no memory | Psychology Today. Retrieved from, https://www.psychologytoday.com/us/blog/trouble-in-mind/201201/hm-the-man-no-memory

Squire, L. R. (2009). The legacy of patient H. M. for neuroscience . Neuron, 61 , 6–9.

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Blog Beginner Guides What is a Case Study? [+6 Types of Case Studies]

What is a Case Study? [+6 Types of Case Studies]

Written by: Ronita Mohan Sep 20, 2021

Case studies have become powerful business tools. But what is a case study? What are the benefits of creating one? Are there limitations to the format?

If you’ve asked yourself these questions, our helpful guide will clear things up. Learn how to use a case study for business. Find out how cases analysis works in psychology and research.

We’ve also got examples of case studies to inspire you.

Haven’t made a case study before? You can easily  create a case study  with Venngage’s customizable templates.

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What is a case study, what is the case study method, benefits of case studies, limitations of case studies, types of case studies, faqs about case studies.

Case studies are research methodologies. They examine subjects, projects, or organizations to tell a story.

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Numerous sectors use case analyses. The social sciences, social work, and psychology create studies regularly.

Healthcare industries write reports on patients and diagnoses. Marketing case study examples , like the one below, highlight the benefits of a business product.

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Now that you know what a case study is, we explain how case reports are used in three different industries.

What is a business case study?

A business or marketing case study aims at showcasing a successful partnership. This can be between a brand and a client. Or the case study can examine a brand’s project.

There is a perception that case studies are used to advertise a brand. But effective reports, like the one below, can show clients how a brand can support them.

Hubspot created a case study on a customer that successfully scaled its business. The report outlines the various Hubspot tools used to achieve these results.

Hubspot also added a video with testimonials from the client company’s employees.

So, what is the purpose of a case study for businesses? There is a lot of competition in the corporate world. Companies are run by people. They can be on the fence about which brand to work with.

Business reports  stand out aesthetically, as well. They use  brand colors  and brand fonts . Usually, a combination of the client’s and the brand’s.

With the Venngage  My Brand Kit  feature, businesses can automatically apply their brand to designs.

A business case study, like the one below, acts as social proof. This helps customers decide between your brand and your competitors.

Don’t know how to design a report? You can learn  how to write a case study  with Venngage’s guide. We also share design tips and examples that will help you convert.

Related: 55+ Annual Report Design Templates, Inspirational Examples & Tips [Updated]

What is a case study in psychology?

In the field of psychology, case studies focus on a particular subject. Psychology case histories also examine human behaviors.

Case reports search for commonalities between humans. They are also used to prescribe further research. Or these studies can elaborate on a solution for a behavioral ailment.

The American Psychology Association  has a number of case studies on real-life clients. Note how the reports are more text-heavy than a business case study.

Famous psychologists such as Sigmund Freud and Anna O popularised the use of case studies in the field. They did so by regularly interviewing subjects. Their detailed observations build the field of psychology.

It is important to note that psychological studies must be conducted by professionals. Psychologists, psychiatrists and therapists should be the researchers in these cases.

Related: What Netflix’s Top 50 Shows Can Teach Us About Font Psychology [Infographic]

What is a case study in research?

Research is a necessary part of every case study. But specific research fields are required to create studies. These fields include user research, healthcare, education, or social work.

For example, this UX Design  report examined the public perception of a client. The brand researched and implemented new visuals to improve it. The study breaks down this research through lessons learned.

Clinical reports are a necessity in the medical field. These documents are used to share knowledge with other professionals. They also help examine new or unusual diseases or symptoms.

The pandemic has led to a significant increase in research. For example,  Spectrum Health  studied the value of health systems in the pandemic. They created the study by examining community outreach.

The pandemic has significantly impacted the field of education. This has led to numerous examinations on remote studying. There have also been studies on how students react to decreased peer communication.

Social work case reports often have a community focus. They can also examine public health responses. In certain regions, social workers study disaster responses.

You now know what case studies in various fields are. In the next step of our guide, we explain the case study method.

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A case analysis is a deep dive into a subject. To facilitate this case studies are built on interviews and observations. The below example would have been created after numerous interviews.

Case studies are largely qualitative. They analyze and describe phenomena. While some data is included, a case analysis is not quantitative.

There are a few steps in the case method. You have to start by identifying the subject of your study. Then determine what kind of research is required.

In natural sciences, case studies can take years to complete. Business reports, like this one, don’t take that long. A few weeks of interviews should be enough.

The case method will vary depending on the industry. Reports will also look different once produced.

As you will have seen, business reports are more colorful. The design is also more accessible . Healthcare and psychology reports are more text-heavy.

Designing case reports takes time and energy. So, is it worth taking the time to write them? Here are the benefits of creating case studies.

• Collects large amounts of information
• Helps formulate hypotheses
• Builds the case for further research
• Discovers new insights into a subject
• Builds brand trust and loyalty
• Engages customers through stories

For example, the business study below creates a story around a brand partnership. It makes for engaging reading. The study also shows evidence backing up the information.

We’ve shared the benefits of why studies are needed. We will also look at the limitations of creating them.

Related: How to Present a Case Study like a Pro (With Examples)

There are a few disadvantages to conducting a case analysis. The limitations will vary according to the industry.

• Responses from interviews are subjective
• Subjects may tailor responses to the researcher
• Studies can’t always be replicated
• In certain industries, analyses can take time and be expensive
• Risk of generalizing the results among a larger population

These are some of the common weaknesses of creating case reports. If you’re on the fence, look at the competition in your industry.

Other brands or professionals are building reports, like this example. In that case, you may want to do the same.

There are six common types of case reports. Depending on your industry, you might use one of these types.

Descriptive case studies

Explanatory case studies, exploratory case reports, intrinsic case studies, instrumental case studies, collective case reports.

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We go into more detail about each type of study in the guide below.

Related:  15+ Professional Case Study Examples [Design Tips + Templates]

When you have an existing hypothesis, you can design a descriptive study. This type of report starts with a description. The aim is to find connections between the subject being studied and a theory.

Once these connections are found, the study can conclude. The results of this type of study will usually suggest how to develop a theory further.

A study like the one below has concrete results. A descriptive report would use the quantitative data as a suggestion for researching the subject deeply.

When an incident occurs in a field, an explanation is required. An explanatory report investigates the cause of the event. It will include explanations for that cause.

The study will also share details about the impact of the event. In most cases, this report will use evidence to predict future occurrences. The results of explanatory reports are definitive.

Note that there is no room for interpretation here. The results are absolute.

The study below is a good example. It explains how one brand used the services of another. It concludes by showing definitive proof that the collaboration was successful.

Another example of this study would be in the automotive industry. If a vehicle fails a test, an explanatory study will examine why. The results could show that the failure was because of a particular part.

Related: How to Write a Case Study [+ Design Tips]

An explanatory report is a self-contained document. An exploratory one is only the beginning of an investigation.

Exploratory cases act as the starting point of studies. This is usually conducted as a precursor to large-scale investigations. The research is used to suggest why further investigations are needed.

An exploratory study can also be used to suggest methods for further examination.

For example, the below analysis could have found inconclusive results. In that situation, it would be the basis for an in-depth study.

Intrinsic studies are more common in the field of psychology. These reports can also be conducted in healthcare or social work.

These types of studies focus on a unique subject, such as a patient. They can sometimes study groups close to the researcher.

The aim of such studies is to understand the subject better. This requires learning their history. The researcher will also examine how they interact with their environment.

For instance, if the case study below was about a unique brand, it could be an intrinsic study.

Once the study is complete, the researcher will have developed a better understanding of a phenomenon. This phenomenon will likely not have been studied or theorized about before.

Examples of intrinsic case analysis can be found across psychology. For example, Jean Piaget’s theories on cognitive development. He established the theory from intrinsic studies into his own children.

Related: What Disney Villains Can Tell Us About Color Psychology [Infographic]

This is another type of study seen in medical and psychology fields. Instrumental reports are created to examine more than just the primary subject.

When research is conducted for an instrumental study, it is to provide the basis for a larger phenomenon. The subject matter is usually the best example of the phenomenon. This is why it is being studied.

Assume it’s examining lead generation strategies. It may want to show that visual marketing is the definitive lead generation tool. The brand can conduct an instrumental case study to examine this phenomenon.

Collective studies are based on instrumental case reports. These types of studies examine multiple reports.

There are a number of reasons why collective reports are created:

• To provide evidence for starting a new study
• To find pattens between multiple instrumental reports
• To find differences in similar types of cases
• Gain a deeper understanding of a complex phenomenon
• Understand a phenomenon from diverse contexts

A researcher could use multiple reports, like the one below, to build a collective case report.

Related: 10+ Case Study Infographic Templates That Convert

What makes a case study a case study?

A case study has a very particular research methodology. They are an in-depth study of a person or a group of individuals. They can also study a community or an organization. Case reports examine real-world phenomena within a set context.

How long should a case study be?

The length of studies depends on the industry. It also depends on the story you’re telling. Most case studies should be at least 500-1500 words long. But you can increase the length if you have more details to share.

What should you ask in a case study?

The one thing you shouldn’t ask is ‘yes’ or ‘no’ questions. Case studies are qualitative. These questions won’t give you the information you need.

Ask your client about the problems they faced. Ask them about solutions they found. Or what they think is the ideal solution. Leave room to ask them follow-up questions. This will help build out the study.

How to present a case study?

When you’re ready to present a case study, begin by providing a summary of the problem or challenge you were addressing. Follow this with an outline of the solution you implemented, and support this with the results you achieved, backed by relevant data. Incorporate visual aids like slides, graphs, and images to make your case study presentation more engaging and impactful.

Now you know what a case study means, you can begin creating one. These reports are a great tool for analyzing brands. They are also useful in a variety of other fields.

Use a visual communication platform like Venngage to design case studies. With Venngage’s templates, you can design easily. Create branded, engaging reports, all without design experience.

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Empathy is the ability to recognize, understand, and share the thoughts and feelings of another person, animal, or fictional character. Developing empathy is crucial for establishing relationships and behaving compassionately. It involves experiencing another person’s point of view, rather than just one’s own, and enables prosocial or helping behaviors that come from within, rather than being forced.

Some surveys indicate that empathy is on the decline in the United States and elsewhere, findings that motivate parents, schools, and communities to support programs that help people of all ages enhance and maintain their ability to walk in each other’s shoes.

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Empathy helps us cooperate with others, build friendships, make moral decisions, and intervene when we see others being bullied. Humans begin to show signs of empathy in infancy and the trait develops steadily through childhood and adolescence . Still, most people are likely to feel greater empathy for people like themselves and may feel less empathy for those outside their family, community, ethnicity , or race.

Empathy helps us connect and help others, but like other traits, it may have evolved with a selfish motive: using others as a “social antenna” to help detect danger. From an evolutionary perspective, creating a mental model of another person's intent is critical: the arrival of an interloper, for example, could be deadly, so developing sensitivity to the signals of others could be life-saving.

Babies display an understanding that people’s actions are guided by intentions and are able to act on that understanding before they are 18 months old , including trying to comfort a parent. More advanced reasoning about other people’s thoughts develops by around age 5 or 6, and research shows that parents who promote and model empathy raise more empathetic children.

Empathy, sympathy, and compassion are often used interchangeably, but they are not the same . Sympathy is feeling of concern for someone else, and a desire that they become happier or better off, while empathy involves sharing the other person’s emotions. Compassion is an empathic understanding of a person's feelings accompanied by altruism , or a desire to act on that person's behalf. 

Researchers believe people can choose to cultivate and prioritize empathy. People who spend more time with individuals different from themselves tend to adopt a more empathic outlook toward others. Other research finds that reading novels can help foster the ability to put ourselves in the minds of others. Meditation has also been shown to help cultivate brain states that increase empathy.

Some neuroscientists have advanced the concept of "mirror neurons” as a possible source of empathy . These neurons, it is theorized, enhance the capacity to display, read, and mimic emotional signals through facial expressions and other forms of  body language , enhancing empathy. But whether mirror neurons actually operate this way in humans is a subject of longstanding scientific debate, and some scientists question their very existence. 

The ability to convey support for a partner, relative, or friend is crucial to establishing positive relationships. Empathy enables us to establish rapport with another person , make them feel that they are being heard, and, through words and body language, mimic their emotions. Perspective-taking , or the empathic ability to assume the cognitive state of another person and see a problem through their eyes, can further cement a connection.

In healthy relationships, people expect their partners to empathize with them when they face hardship or personal struggles, but the ability to empathize with a partner in good times may be at least as important. In one study, displaying empathy for a partner’s positive emotions was five times more beneficial for relationship satisfaction than only empathizing with his or her negative emotions.

People high in narcissism, or who have narcissistic personality disorder , can exhibit empathy and even compassion. However, that ability only goes so far, as ultimately their own needs come first. Some researchers believe narcissists can develop greater empathy by developing greater self-compassion, which can increase their own feelings of security and self-worth and enable them to open up to hearing others.

Putting yourself in someone else’s shoes can be beneficial, but when it becomes one’s default mode of relating to others, it can blind an individual to their own needs and even make them vulnerable to those who would take advantage of them.

People who regularly put the feelings and perspectives of others above their own may experience feelings of emptiness or alienation and develop generalized anxiety or low-level depression . Psychopaths, on the other hand, are capable of empathic accuracy , or correctly inferring thoughts and feelings, but may have no experiential referent for it: a true psychopath does not feel empathy.

First responders, humanitarian aid workers, doctors, therapists, journalists, and others whose work involves opening themselves up to others’ pain tend to be highly empathic. However, they may come to share the heartbreak of those they help or whose stories they record. As such “emotional residue” accumulates, they may shut down , burn out , and become less willing or able to give of themselves.

Empaths are often characterized as being highly sensitive and overly focused on the needs of others. They may benefit from time alone, as they find it draining to be in the presence of other people. People who are very empathic are more likely to be targeted by manipulative individuals. For this reason, it is important to create healthy boundaries in all relationships, and to be cognizant of relationships with "energy vampires," who are draining to empaths and non-empaths alike.

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Effect of high-risk pregnancy on prenatal stress level: a prospective case-control study

• Open access
• Published: 11 May 2024

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• Hülya Türkmen   ORCID: orcid.org/0000-0001-6187-9352 1 ,
• Bihter Akın   ORCID: orcid.org/0000-0002-3591-3630 2 &
• Yasemin Erkal Aksoy   ORCID: orcid.org/0000-0002-7453-1205 2  

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The study aimed to determine the effects of high-risk pregnancy on prenatal stress levels. The study was conducted with a case-control design in Turkey in September-December 2019. The sample included pregnant women diagnosed with high-risk pregnancy and were at their 36th or later gestational weeks as the case group ( n  = 121) and healthy pregnant women as the control group ( n  = 245). The Antenatal Perceived Stress Inventory (APSI) and the Revised Prenatal Distress Questionnaire (NUPDQ-17 Item Version) were used to assess the stress levels of the participants in the study. It was determined that high-risk pregnancy was associated with higher rates of prenatal stress (APSI: p  < 0.001, effect size = 0.388; NUPDQ: p  = 0.002, effect size = 0.272) compared to the control group. The results of the linear regression analysis showed that high-risk pregnancy affected APSI (R 2  = 0.043, p  < 0.001) and NUPDQ (R 2  = 0.033, p  = 0.009) scores, but education levels, number of pregnancies, and number of abortions did not affect APSI and NUPDQ scores. According to the results of this study, high-risk pregnant women are in a risk group for stress. It is of great importance for the course of a pregnancy that healthcare professionals assess the stress levels of pregnant women in the high-risk pregnancy category and provide psychological support to pregnant women who have high stress levels or are hospitalized.

Avoid common mistakes on your manuscript.

Introduction

A high-risk pregnancy is a significant health problem that threatens the health of the pregnant woman, the health of her fetus, and ultimately the health of her newborn, increases the risk of morbidity and mortality, and has physiological, psychological, social, and economic aspects (Cincioğlu et al., 2020 ; Gözüyeşil & Düzgün, 2021 ; Sinaci et al., 2020 ). Chronic diseases existing before pregnancy and problems that arise during pregnancy can make a pregnancy risky. Pregnant women with gestational diabetes mellitus, preeclampsia/eclampsia, potential threat of preterm labor, cervical insufficiency, premature rupture of membranes, vaginal bleeding, Rh incompatibility, intrauterine growth retardation, and infections are in the high-risk category (Gözüyeşil & Düzgün, 2021 ; Sinaci et al., 2020 ; ACOG, 2019 ; Soğukpınar et al., 2018 ; Üzar-Özçetin & Erkan, 2019 ; ACOG, 2018 ).

Approximately 10% of all pregnancies in the world are considered to be in the high-risk category (Cincioğlu et al., 2020 ; Gourounti et al., 2015a , b ; Göüyeşil & Düzgün, 2021 ; Sinaci et al., 2020 ; Soğukpınar et al., 2018 ; Üzar-Özçetin & Erkan, 2019 ). According to Turkey Demographic and Health Survey (TNSA) 2018 data, 35% of pregnancies in Turkey are in the high-risk category (Hacettepe University Institute of Population Studies, 2019 ).

Good mental health during pregnancy is important for the health of both the pregnant woman and her fetus (Gümüşdaş et al., 2014 ). In a high-risk pregnancy, the normal outcome of the pregnancy and the birth of a healthy baby are threatened. These pregnant women have a variety of health needs that must be met. If these needs are not met, the mother may experience extreme stress and anxiety (Ölçer & Oskay, 2015 ). In the case of intense stress caused by the risks of pregnancy, the elevation of catecholamines such as cortisol and epinephrine may increase the possibility of pregnancy complications (e.g., preeclampsia) and adversely affect pregnancy outcomes (e.g., intrauterine growth retardation) (Atasever & Çelik, 2018 ; Cetin et al., 2017 ; Deshpande, 2016 ; Gözüyeşil & Düzgün, 2021 ; Riggin, 2020 ; Traylor et al., 2020 ; Yüksel et al., 2013 ). Moreover, newborns exposed to extreme stress during the intrauterine period may have permanent health problems later in their lives (Graignic-Philippe et al., 2014 ; MacKinnon et al., 2018 ; Van De Loo et al., 2016 ).

It is seen that distress in pregnancy has a high prevalence ranging between 11.9% and 63.5% in studies conducted in Turkey (Yüksel et al., 2013 ; Çapık et al., 2015 ; Gözüyeşil & Düzgün, 2021 ). It is very important that health professionals identify pregnant women at risk of stress to ensure a healthy pregnancy process and protect the fetus and newborn from the harmful effects of stress. This way, more careful monitoring of pregnant women at risk of stress can be ensured, and the negative consequences of stress can be prevented with appropriate interventions (Williamson et al., 2023 ; Atasever & Çelik, 2018 ; Pinar et al., 2022 ). It is reported in the international literature that mental problems such as anxiety and stress are more common in high-risk pregnancies than in healthy pregnancies (Byatt et al., 2014 ; Abedian et al., 2015 ; Gourounti et al., 2015a , b ). In Turkey, there are few studies examining the prenatal stress levels of high-risk pregnant women. However, in these studies, the prenatal stress levels of women with healthy and high-risk pregnancies were not compared, and only the stress levels of high-risk pregnancies were determined (Gözüyeşil & Düzgün, 2021 ; Üzar-Özçetin & Erkan, 2019 ). Current evidence indicates that studies describing the concept of prenatal stress in high-risk pregnancies with different diagnoses are needed to learn more about the complex aspects of prenatal stress and identify the sociodemographic and obstetric factors that may lead to high-risk pregnancies for early diagnosis (Pinar et al., 2022 ; Hung et al., 2021 ; Gözüyeşil & Düzgün, 2021 ; Mete et al., 2020 ; Üzar-Özçetin & Erkan, 2019 ; Atasever & Çelik, 2018 ). For this reason, it is thought that this study will guide healthcare professionals who provide care for women with high-risk pregnancies about the services they will provide.

This study aims to prospectively determine the effects of high-risk pregnancies on prenatal stress levels compared to healthy pregnant women, using two different measurement instruments.

Materials and methods

Research questions.

Does high-risk pregnancy have an impact on prenatal stress?

What are the factors affecting the prenatal distress levels of women diagnosed with high-risk pregnancy?

Is there a difference in prenatal stress levels among different high-risk pregnancy diagnoses?

Design and settings

This case-control study was conducted to determine the difference between the stress levels of women with healthy and high-risk pregnancies. In other words, it was aimed to determine the suspected causal effect of high-risk pregnancy on prenatal stress levels. This case-control study was carried out between September and December 2019 at the Obstetrics and Gynecology Inpatient and Outpatient Clinics of Atatürk City Hospital in the Balıkesir province of Turkey. The case and control groups included women who were selected from the same hospital.

The hospital where the study was conducted hosted a total of 4,152 deliveries in 2018. Approximately 10% of all pregnancies are considered to be in the high-risk category (Sinaci et al., 2020 ). The sample size required to conduct the study was calculated as 134 high-risk pregnant women using the Epi Info StatCalc program based on an assumed population size of 4152, prevalence of 10%, margin of error of 5%, and in a 95% confidence interval. The study was completed with a total of 384 pregnant women, including 134 high-risk pregnant women and 250 healthy pregnant women, who accepted to participate in the study and filled out the consent form. However, the data of 13 pregnant women in the case group and 5 pregnant women in the control group were excluded from the study because they filled out the data collection forms incompletely. For the case group ( n  = 121), the post hoc power analysis (G*Power 3.1) revealed a medium effect size and a power of 0.421.

The inclusion criteria of the study were being in a gestational week further than 36 weeks, not having a psychiatric diagnosis, and being 18 years old or order. Pregnant women who were hospitalized in the Obstetrics and Gynecology Inpatient Clinic, were diagnosed with high-risk pregnancy by a physician, and met the inclusion criteria were included in the high-risk pregnancy group. In the control group, pregnant women who were healthy, were at or above their 36th gestational week, and visited the Outpatient Clinics were included. Women who wanted to leave the study or responded incompletely to the data collection forms were excluded. After those who met the inclusion criteria were included, no pregnant women withdrew from the study by their own accord. However, 18 pregnant women were excluded from the study because they filled out the forms incompletely.

High-risk pregnancies were defined as the presence of one or more of the following: pre-existing chronic diseases, preeclampsia, gestational diabetes mellitus (GDM), vaginal bleeding, placenta previa, threat of preterm labor, premature rupture of membranes, intrauterine growth retardation (IUGR), fetal anomaly/distress, multiple pregnancy, polyhydramnios/oligohydramnios, Rh incompatibility, and infectious diseases (Cincioğlu et al., 2020 ; Gözüyeşil & Düzgün, 2021 ; Sinaci et al., 2020 ; Üzar-Özçetin & Erkan, 2019 ).

Data collection

A Personal Information Form, the Antenatal Perceived Stress Inventory, and the Prenatal Distress Questionnaire were administered to the participants. The participants were informed about the study, the purpose of the study was explained to them, and their written consent was obtained. The data collection forms were administered to the participants by the first author. The data were collected based on the self-reports of the participants. The data collection period was between September and December 2019. The interviews lasted about 15 min for each participant.

Personal information form

The form which was prepared by the researchers in line with the literature consisted of a total of 20 questions on some characteristics of the participants, including their sociodemographic characteristics and obstetric history (Gözüyeşil & Düzgün, 2021 ; Mete et al., 2020 ; Üzar-Özçetin & Erkan, 2019 ; Atasever & Çelik, 2018 ).

Antenatal perceived stress inventory (APSI)

The Turkish validity and reliability study of the inventory developed by Razurel et al. ( 2014 ) to assess perceived stress in the prenatal period was performed by Atasever and Çelik ( 2018 ). The inventory is applied to pregnant women at the 36th -39th gestational weeks. It is a 5-point Likert-type scale (very much = 5 points, much = 4 points, quite = 3 points, a little = 2 points, none = 1 point) and consists of 12 items and 3 dimensions. Its dimensions are Medical and Obstetric Risks/Fetal Health, Psychosocial Changes during Pregnancy, and Prospect of Childbirth. The minimum and maximum scores that can be obtained from the inventory are 12 and 60. High scores indicate high levels of stress perceived by pregnant women. In the study conducted by Atasever and Çelik, Cronbach’s alpha internal consistency coefficient for APSI was found to be 0.70, while this coefficient was found as 0.81 in this study.

Revised prenatal distress questionnaire ((NUPDQ)-17 Item Version)

The questionnaire developed by Yali and Lobel ( 1999 ) to determine the levels of stress experienced by women regarding pregnancy-related issues was revised by Lobel ( 2008 ). The Turkish validity and reliability study of the questionnaire was performed by Yüksel et al. ( 2011 ). The questionnaire is in the form of a 3-point Likert-type scale (very much = 2 points, a little = 1 point, none = 0 point) and consists of 17 items. The questionnaire is unidimensional. The minimum and maximum scores that can be obtained from the questionnaire are 0 and 34. High scores indicate that pregnant women have high levels of prenatal distress. Cronbach’s alpha internal consistency coefficient for NUPDQ was found to be 0.85 in the study performed by Yüksel et al., while it was found as 0.82 in this study.

Statistical analysis

Frequency, percentage, mean, and standard deviation values were used in the data analyses. Whether the data had normal distribution was tested using the Kolmogorov-Smirnov test. The Chi-squared test and independent-samples t-test methods were used to identify the differences between groups in terms of the sociodemographic and obstetric information of the participants. The Mann-Whitney U Test was used to determine the differences between the case and control groups in terms of their total APSI, APSI subscale, and total NUPDQ scores. The Type I error level was accepted as p  < 0.05. A Cohen’s d value of 0.20 is considered to indicate a small effect size, a value of 0.50 is considered to show a medium effect size, and a value of 0.80 or greater is interpreted as a large effect size (Özsoy & Özsoy, 2013 ). Since education, number of pregnancies, and number of miscarriages, which are thought to have an impact on stress levels, may be confounding factors, the linear regression analysis in this study was carried out to determine whether these factors or high-risk pregnancy affected the stress levels of the participants (Models 1 and 2). As a result of the Mann-Whitney U Test, a significant difference was found between high-risk pregnancies and healthy pregnancies in terms of “psychosocial changes during pregnancy” and “prospect of childbirth”. For this reason, APSI dimensions were collected in a single model, and a linear regression analysis was performed for the further analysis of the relationship between high-risk pregnancy and the APSI dimension scores of the participants (Model 3). The variable with the highest β coefficient was considered the relatively most significant independent variable. Multicollinearity was ignored in case of Tolerance > 0.20 and variance inflation factors (VIF) < 10. R 2 shows what percentage of the dependent variable is explained by the independent variables. According to Cohen, R 2 values of 0.0196, 0.1300, and 0.2600 are the lower thresholds for small, medium, and large effect sizes, respectively (Özsoy & Özsoy, 2013 ). One-Way MANOVA was also conducted to see whether there was a difference in stress levels during pregnancy between the case and control groups. The comparison of the stress levels of the participants in the case group based on their diagnoses was conducted with the Kruskal-Wallis test.

Ethical considerations

For the study to be carried out, approval was obtained from the Clinical Research Ethics Committee of the Faculty of Medicine of the University, and written permission was obtained from the institution where the study would be conducted (2019/123). The purpose of the study was explained to the pregnant women who agreed to participate, and they were informed that their identifying information would be kept confidential. The written consent of the participants was obtained with the Volunteer Information Form. The participants in both the case and control groups who were thought to need counseling were referred to a specialist for psychological support.

Table  1 shows the sociodemographic and obstetric characteristics of the participants. There was no significant difference between the women in the case and control groups in terms of age, whether they had an income-generating job, income status, place of residence, parity, number of living children, status of having a planned pregnancy, and smoking status ( p  > 0.05). It was determined that the participants in the case group had significantly lower education levels than those in the control group ( p  < 0.001). Moreover, the number of pregnancies ( p  = 0.036) and the number of abortions ( p  = 0.012) in the case group were found significantly higher than those in the control group. These results supported the hypothesis that some sociodemographic and obstetric characteristics of women are associated with high-risk pregnancies.

According to the Kolmogorov-Smirnov test results, the total APSI and NUPDQ scores of the participants were not normally distributed ( p  < 0.001). Table  2 shows the stress levels of the participants compared based on their scale scores. The total APSI ( p  < 0.001, Cohen’s d = 0.388) and total NUPDQ ( p  = 0.002, Cohen’s d = 0.272) scores of the participants in the case group were significantly higher than those of the participants in the control group. The APSI Psychosocial Changes during Pregnancy ( p  < 0.001, Cohen’s d = 0.473) and Prospect of Childbirth ( p  < 0.001, Cohen’s d = 0.314) dimension scores of the participants in the case group were also significantly higher than those of the participants in the control group. These results supported the hypothesis that prenatal stress levels are higher in high-risk pregnancies than in healthy pregnancies.

Table  3 shows the stress levels of the participants with different diagnoses in the case group. In terms of risky pregnancies, the most frequently observed diagnoses were the threat of preterm labor in 37.2% of the participants in the case group, vaginal bleeding/placenta previa in 20.7%, and gestational diabetes mellitus in 10.7%. No statistically significant correlation was found between the diagnoses of the participants in the case group and their total APSI or NUPDQ scores ( p  > 0.05). This result did not support the hypothesis that there is a difference in prenatal stress levels based on differences in high-risk pregnancy diagnoses.

In the linear regression analysis, Model 1 included APSI on education, gravidity, number of abortions, and high-risk pregnancy, and it was determined that there was a significant relationship between APSI and high-risk pregnancies, where the former explained 4.3% of the total variance in the latter (R 2  = 0.043) ( p  < 0.001). Model 2 included NUPDQ on education, gravidity, number of abortions, and high-risk pregnancy, and it was determined that there was a significant relationship between NUPDQ and high-risk pregnancies, where the former explained 3.3% of the total variance in the latter (R 2  = 0.033) ( p  = 0.009). Model 3 included APSI dimensions, and it was determined that there was a significant relationship between psychosocial changes during pregnancy and high-risk pregnancy, where the former explained 5.7% of the total variance in the latter ( R  = 0.057) ( p  < 0.001) (Table  4 ).

As a result of the MANOVA, it was determined that having a high-risk or a pregnancy was associated with significant differences in the combined set of dependent variables (APSI and NUPDQ total scores), F = 6.231, p  = 0.002, Wilk’s Lambda = 0.967. There were significant differences between the case and control groups in terms of their APSI psychosocial changes during pregnancy and prospect of childbirth dimension scores, F = 7.258, p  < 0.001, Pillai’s Trace = 0.057. (Table  5 ).

This study determined the stress levels of pregnant women with high-risk and healthy pregnancies. Stress experienced in high-risk pregnancies can have negative effects in terms of the pregnancy process and maternal and fetal health (Atasever & Çelik, 2018 ; Gözüyeşil & Düzgün, 2021 ; Riggin, 2020 ; Traylor et al., 2020 ; Yüksel et al., 2011 ). Therefore, it is thought that the results of this study will contribute to the literature.

It was determined in this study that the education levels of the high-risk pregnant women, who constituted the case group, were lower compared to the healthy pregnant women in the control group. Other studies in the literature have shown that risk factors in pregnancy are at higher rates in women with low educational levels (Annagür et al., 2014 ; Soğukpınar et al., 2018 ; Topalahmetoğlu et al., 2017 ; Türkmen, 2019 ). It is thought that as education levels increase, the knowledge levels of pregnant women about the management of risk factors in pregnancy increase, and these situations are intervened with in the early period. Moreover, high education levels can also prevent factors that may cause a high-risk pregnancy such as malnutrition, ill-advised exercise practices, and lack of antenatal care. For this reason, considering the results of our study, it is recommended that health professionals provide education to pregnant women with low education levels about prenatal care, proper nutrition, exercise, and antenatal follow-ups.

The numbers of pregnancies and abortions among the participants in the case group in this study were significantly higher compared to those in the control group. In the study by Orbay et al. ( 2017 ), the number of pregnancies among pregnant women with GDM was lower than the number of pregnancies among those without GDM. Cincioğlu et al. ( 2020 ) found the mean number of abortions among pregnant women with risky pregnancies to be 1.31 ± 0.71. As the number of pregnancies increases, the potential risks of pregnancy also increase. More frequent monitoring of pregnant women with a high number of abortions by health professionals and providing information about family planning methods to women with a high number of pregnancies will prevent high-risk pregnancies.

High-risk pregnancies consist of many obstetric pathologies including maternal chronic diseases. Every pathologic condition experienced during pregnancy can affect the women’s stress levels (Sinaci et al., 2020 ). In this study, two different scales were used to measure the stress levels of the participants, and the stress levels of the participants in the case group were found to be higher than the stress levels of those in the control group. Gözübebek and Düzgün (2021) stated that 63.5% of pregnant women diagnosed with risky pregnancies experienced distress. Üzar-Özçetin and Erkan ( 2019 ) reported high perceived stress levels in high-risk pregnant women. In their meta-analysis study, Amiri and Behnezhad ( 2019 ) revealed that diabetes during pregnancy was a risk factor for anxiety symptoms, and diabetes increased the risk of anxiety by up to 48%. Other studies in the literature have shown that high-risk pregnant women also have high anxiety levels (Byatt et al., 2014 ; Denis et al., 2012 ; Gourounti et al., 2015a , b ; McDonald et al., 2021 ; Orbay et al., 2017 ; Sinaci et al., 2020 ; Hung et al., 2021 ).

It was reported that low education levels, having a history of abortion, and a high number of pregnancies may cause prenatal stress (Atasever & Çelik, 2018 ). In this study, lower education levels and higher numbers of pregnancies and abortions were found in the case group than in the healthy control group. Since low education levels and high numbers of pregnancies and abortions were thought to be potential confounding factors in terms of prenatal stress, further analyses tests were performed, and it was determined that these factors did not affect stress levels to a significant extent. The research in this field may benefit from a more in-depth exploration of potential implications and confounding factors related to education.

In the studies performed by Üzar-Özçetin and Erkan ( 2019 ) and Yüksel et al. ( 2013 ), it was found that the stress levels of pregnant women who had experienced hospitalization due to any risk during pregnancy were high. It is considered that diagnosis methods, treatment methods, symptoms, complications, and their effects on the fetus for high-risk pregnancies cause great stress in pregnant women, and the fact that some pregnant women spend this process in the hospital increases their stress levels even further. For this reason, considering the results of our study, it is recommended that healthcare professionals inform the pregnant woman about her diagnosis and symptoms and explain each procedure to be performed, and that healthcare institutions provide more comfortable hospital rooms.

In this study, it was seen that the prenatal stress levels of the participants were high in terms of psychosocial changes during pregnancy. Intense stress can cause a sense of helplessness and hopelessness by depleting the energy of individuals, as well as negatively affecting their physical and mental health (Sharma & Rush, 2014 ). For this reason, healthcare professionals have an important role in the care of pregnant women with high-risk pregnancies. They should take an active role in the early diagnosis of at-risk pregnant women through qualified home visits and by initiating and continuing treatment. Advanced clinical guidelines and case management models should be developed for women having high-risk pregnancies.

In the study by Pinar et al. ( 2022 ), women with high-risk pregnancies were given training on stress management. After the training program, it was determined that 51.4% of the women in the intervention group and 75.7% in the control group experienced stress. Based on these results, it is recommended that healthcare professionals provide training, to ensure the active participation of the pregnant woman and her partner, on stress management to reduce the perceived stress, anxiety, and hopelessness levels of women in high-risk pregnancy cases. Additionally, these pregnant women should be provided with methods to cope with stress such as breathing exercises, relaxation exercises, appropriate physical exercises, visualization/yoga, massage therapy, music therapy, explanations about social support factors, and practices strengthening their spirituality (Ölçer & Oskay, 2015 ).

In this study, no significant difference was found in the prenatal stress levels of the participants in the case group based on their obstetric diagnoses of high-risk pregnancy. In the study by Byatt et al. ( 2014 ), no significant difference was identified between obstetric diagnoses in terms of anxiety levels in pregnant women. A high-risk pregnancy causes high stress levels in pregnant women due to similar diagnostic tests, treatment methods, hospitalization, complications, and fetal outcomes (Kent et al., 2015 ).

It is thought that high stress levels are not associated with obstetric diagnoses, and similar stress levels are experienced by all pregnant women aware of any risky situation during their pregnancies. Nevertheless, an increase in stress levels in risky pregnancies such as cases of preeclampsia may cause a further aggravation in the clinical status of women. Healthcare professionals should be aware of the higher stress levels of these pregnant women, they should help the pregnant woman express her feelings and thoughts by providing a reassuring communication environment, and plan appropriate consultancy, intervention, and care routines to help reduce their stress levels. These professionals can also coach high-risk pregnant women in terms of stress reduction and coping mechanisms. Pregnant women with high stress levels should be referred to a specialist for psychological support and therapy.

Strengths and limitations

The strength of this study was its prospective design with a control group. In this study, the use of two similar scales in terms of measuring the stress levels of pregnant women provided rigor and transparency compared to data obtained in previous studies. Since these scales were included in studies in Turkey only in the context of testing their validity and reliability in Turkish, it was decided to use them in the study as they measure stress levels in the prenatal period. A limitation of the study was that the pre-pregnancy stress levels of the participants, which would affect their present condition, were not measured in the study. Women with high stress levels before pregnancy have a higher risk of high-risk pregnancy. In other words, instead of high-risk pregnancy increasing stress levels, high stress levels may have affected the high-risk pregnancy statuses of the women. The results of the study also revealed a significant difference in education levels between the case and control groups. However, as a result of further analyses, it was determined that education did not affect prenatal stress levels.

In this study, it was determined that high-risk pregnancy affected prenatal stress. Moreover, it was found that the participants in the case group who had high-risk pregnancies had lower education levels and higher numbers of pregnancies and abortions compared to the participants in the control group with healthy pregnancies. This is why healthcare professionals are recommended to bear in mind that pregnant women with low education levels and a high number of pregnancies and abortions are at risk of high-risk pregnancies and monitor these pregnant women more frequently and carefully.

It is of great importance for the course of a pregnancy that healthcare professionals assess the stress levels of pregnant women in the high-risk pregnancy category, provide psychological support to pregnant women who have high stress levels or are hospitalized, offer them counseling and training opportunities (e.g., relaxation exercises, breathing exercises, practices strengthening their spirituality, music therapy), take appropriate precautions, and refer these pregnant women to specialists if needed. Moreover, since the stress levels of these pregnant women will increase even more during childbirth, alternative methods to reduce the fear of childbirth and childbirth pain should be explained.

It is recommended to organize educational programs such as trainings, seminars, and conferences on stress management during pregnancy for health professionals working in family health centers, community health centers, and gynecology departments.

Consequently, more studies with larger sample sizes are needed to compare diagnostic stress levels in high-risk pregnancies. In addition to prenatal stress and childbirth fear levels, future studies should also determine the stress levels of women before pregnancy for similar comparisons between high-risk and healthy pregnancies.

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors express thanks to the mothers for participation in the study.

Open access funding provided by the Scientific and Technological Research Council of Türkiye (TÜBİTAK). No funding was received to conduct the study.

Open access funding provided by the Scientific and Technological Research Council of Türkiye (TÜBİTAK).

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Contributions

Study conception and design: Hülya TÜRKMEN.  Data collection:  Hülya TÜRKMEN.  Data analysis and interpretation:  Hülya TÜRKMEN.  Drafting of the article:  Hülya TÜRKMEN, Bihter AKIN, Yasemin ERKAL AKSOY.  Critical revision of the article:  Hülya TÜRKMEN, Bihter AKIN, Yasemin ERKAL AKSOY.

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For the study to be carried out, approval was obtained from the Clinical Research Ethics Committee of the Faculty of Medicine of the University, and written permission was obtained from the institution where the study would be conducted (2019/123).

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Türkmen, H., Akın, B. & Erkal Aksoy, Y. Effect of high-risk pregnancy on prenatal stress level: a prospective case-control study. Curr Psychol (2024). https://doi.org/10.1007/s12144-024-05956-z

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Accepted : 28 March 2024

Published : 11 May 2024

DOI : https://doi.org/10.1007/s12144-024-05956-z

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