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ADVANCES IN PSYCHOLOGY STUDY
VOL. 1, NO. 2, FEBRUARY 2012
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Obsessive-Compulsive Spectrum Disorder in
Darren Aronofsky’s Black Swan
Danielle Vanier and H. Russell Searight
Department of Psychology-Lake Superior State University; Sault Sainte Marie, MI USA

Abstract—
In the past decade, there has been growing controversy
about the scope of Obsessive Compulsive Disorder (OCD)
with some investigators suggesting that it should be removed
from the “Anxiety Disorders” category and considered a
spectrum syndrome. Support for the spectrum view of OCD
comes from studies suggesting strong associations between
OCD and other syndromes including psychogenic dermatomes,
eating disorders, self-harm, and delusional disorders. The
OCD spectrum is illustrated very effectively by Darren
Aronofsky’s film, Black Swan. The film features a ballet
dancer whose transformation from the role of the controlled,
technically perfect White Swan to the impulsive, sexually
seductive, Black Swan is accompanied by a growing number
of OCD spectrum symptoms including delusions. The film
would be very useful for triggering discussion of the OCD
spectrum among mental health professionals and those in
training
Index Terms—Psychology and the Arts; Psychopathology;
Obsessive –Compulsive Disorder; Psychology Education
I. INTRODUCTION
Obsessive-compulsive disorder, characterized by a
repetitive pattern of intrusive thoughts that are briefly quelled
by engaging in some ritualistic action, has historically, and is
currently, classified as an anxiety disorder. However, as a
result of accumulating research and the current revision of the
Diagnostic and Statistical Manual of Mental Disorders
(American Psychiatric Association, 2012), the classification
and unitary nature of OCD is being re-evaluated. A number of
investigators and clinicians have suggested that OCD is a
continuum of conditions including compulsive weight control,
hypochondriasis, tic disorders, body dysmorphic disorder, and
trichotillomania and self-harm, as well as "grooming
disorders” such as psychogenic excoriation (“skin
picking”) (Hollander, Braun, & Simeon, 2008). The film,
Black Swan, depicts the OCD spectrum as it emerges in a
ballet dancer-a profession in which OCD is likely to be
particularly prevalent (Taylor, 1997).
Darren Aronofsky’s film, “Black Swan,” centers on Nina
Sayers (Natalie Portman) a ballet dancer desiring to be cast in
the lead of Swan Lake. In this version of the ballet, the lead
dancer must portray both a “white” (undefiled, innocent,
controlled) as well as a “black” (sexually seductive,
spontaneous, uncontrolled), swan. Throughout the movie,
Nina is torn between her long standing perfectionistic, rigid,
and controlled personality and her director’s desire for her to
explore a more spontaneous side of herself. As a result, Nina is
fighting between the persona of an innocent perfectionist (the
white swan) and the impulsive, emotional self she has never
faced before (the black swan). A theme in Aronofsky’s recent
films is the intense all-consuming drive for individuals to be
become perfect masters of their craft. He also uses
cinematography very effectively to draw the viewer into the
experience of his protagonists. The film is of considerable
educational value-- both in terms provoking academic
discussions about the obsessive compulsive spectrum and for
helping therapists better appreciate patients’ experience of
OCD spectrum syndromes.
Black Swan: A Synopsis
Manuscript received January 28, 2012
Danielle Vanier is with the Psychology Department at Lake Superior State
University, Sault Sainte Marie, MI USA.; e-mail: [email protected]
H. Russell Searight (corresponding author) is with the Psychology
Department; Lake Superior State University, Sault Sainte Marie, MI USA
(phone: 906-635-2278) (fax: 906-635-6618) (e-mail: [email protected])
Nina's life revolves around ballet. All she seems to do is
work at a prestigious dance company, come home, and attempt
to further refine her technique. Her facial expression during
the dancing is one of concentration and over-controlled
tension. Aronofksy’s close-up shots of Nina’s face, together
ADVANCES IN PSYCHOLOGY STUDY
with her swollen feet, effectively convey this tension to the
viewer. The dance company is a highly competitive
atmosphere and one can feel the underlying hostility and
jealousy that the other dancers have towards their successful
peers.
`The dancers are presented with a surprise audition by
Thomas, the director (Vincent Cassel) who is seeking a lead
dancer who must be able to transcend between the innocent
white swan and the sexually seductive black swan. Initially,
Nina’s audition did not go over well because Thomas believed
she was too controlled and too much of a perfectionist to be
able to switch between these contradictory roles. Nina’s
determination to embody both roles resulted in her practicing
to the point where she ended up splitting her toenail. She then
decided to try to convince Thomas to change his mind, which
resulted in an impulsive kiss between the two.
Nina’s mother (Barbara Hershey) is very controlling,
obsessive, and appears to have no life outside of her ballet
dancer daughter. Nina’s mother has a room filled with
drawings of her daughter. When Nina wins the role of the
swan queen, her mother purchases a large beautiful cake (their
favorite flavor) in order to celebrate this achievement in her
daughter’s life. When Nina declines a piece of cake, her
mother suddenly becomes angry and hurt and starts to put the
expensive cake in the trash. When she is not checking Nina’s
skin for signs of excoriation, Nina’s mother is querying her
daughter in detail about her daily ballet routine.
During Nina’s initial practice, Thomas tells her that with her
technically correct dancing, she is an effective white swan, but
that dropping her control to become the Black Swan will be a
major challenge. After this criticism, Nina observes her
understudy, Lily (Mila Kunis), dancing with passion and
spontaneity. Thomas comments that although Lilly’s technique
is not perfect “She is not faking it”.
Soon, Nina becomes growingly suspicious of Lily to the
eventual point of apparent paranoia. However, Aronofsky
challenges the viewer with ambiguity about whether Lily is
really out to dethrone Nina or whether this is Nina’s paranoid
delusion. Lily initially comes across as warm and friendly, but
as the movie progresses her behavior is seen as underhanded.
It seems that she is trying to take the role away from Nina. For
example when Lily sees Nina crying and talks to her about it,
she then tells Thomas to be easier on Nina. Nina sees this
gesture as an attack to make her seem weak. Later, Lily takes
Nina out for dinner and dancing. This gesture is normally seen
as a way to bond and let go of things a little bit, but after the
night had passed, Nina ends up late to practice the next day.
This only confirms Nina’s suspicion that Lilly is out to take
away her role.
As it gets closer to the ballet’s opening night, Nina begins to
experience more jealousy and competition with Lily. However,
Nina also becomes more uncontrolled, spontaneous, and
sexual--closer to the role of the black swan. For example,
Nina becomes more experimental in her behavior at the
nightclub by accepting the drugs and having a sexual
encounter with Lilly. Nina also confronts Thomas about his
perceived favoritism towards Lily.
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At the opening night, Nina’s transformation becomes
complete. After Nina accidentally falls on stage in the role of
the white swan, Lily approaches her in the representation of
the black swan and Nina stabs her with a piece of broken glass.
Nina’s murder of her perceived rival presents no obstacles to
successfully fulfilling the role of the black swan to audience
acclaim. Again, the viewer is challenged at the film’s
conclusion to distinguish between delusion and reality.
However, this struggle likely parallels the conflicts
experienced by Nina and those with severe OCD spectrum
disorder.
Natalie Portman is believable in her role as the
disturbed Nina Sayers and the transformation that overcomes
her. The quality of the acting, cinematography, and music all
combine to bring the audience into the conflicted, frightening,
over-and under-controlled emotional life of the protagonist.
For example as Nina’s identity changes from the white to the
black swan, the color of her clothing changes from pink to
combined pink and black, to black alone. During the movie, it
is hard to follow what is real and what is imagined. The movie
makes one ask the question: Where do Nina’s delusions end
and reality begin?
Eating Disorders
Ballet dancers, in particular, experience particular pressure
to be thin and physically light— for appearance, ease of
movement and because they are frequently lifted by another
dancer during performances. Ballet dancers have been found
to be at higher risk for eating disordered behavior and body
image distress. (Ravaldi, Vannacci, Bolognesi, Mancini,
Faravelli, & Ricca, 2006). However, Black Swan illustrates the
limitations of our current formulations of eating disorders.
Nina appears to minimize and monitor her diet with little
effort. While apparently very controlled in her food intake,
she also has frequent periods of what appears to be selfinduced vomiting. At times, it is unclear whether the vomiting
occurs as part of a surge in anxiety or is for weight control, or
both. However, Nina appears to experience some temporary
emotional relief immediately after these episodes. Similar to
compulsive rituals, the vomiting appears to, at least
temporarily, reduce anxiety. While research on the linkage
between DSM-IV obsessive compulsive disorder and anorexia
and bulimia nervosa is unclear, these eating disorders are
associated with deliberate self-harm such as cutting (YryuraTobias, Neziroglu, & Kaplan, 1995) and psychogenic
dermatoeses such as skin picking (Whitelock, Eckenrode, &
Silverman, 2006). The DSM formulation of eating disorders as
categories is at some variance with research suggesting that in
many young women, these symptoms exist on a continuum
with subclinical eating disorders (Eating Disorder-NOS) that
are likely to be more prevalent than categorical bulimia or
anorexia nervosa (Franko & Omori, 1999)
Psychogenic Dermatoses
At several points in the film, Nina is distressed by a lesion
on her upper back—at times covering it with makeup. It
quickly becomes apparent that Nina has a history of severe
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scratching and accompanying pruritic lesions (Arnold,
Auchenbach, & McElroy, 2001). Nina often appears to be
somewhat startled by the appearance of these wounds. This
pattern is also consistent with “dermatitis artefacta” in which
the patient typically is unaware of the origin and even denies
any type of rubbing, scratching, or skin picking (Gupta, Gupta,
Ellis & Koblenzer, 2005). The excoriation is often an
automatic response to high levels of anxiety and at least
temporarily, reduces emotional tension. The lesions on Nina’s
back persist throughout the film and appear to signal her
growing anxious turmoil. The unconscious nature of
excoriation becomes apparent when Nina awakens with
mittens on her hands. Her mother tells her that her scratching
had become so intense while Nina was sleeping that she
resorted to this preventive measure to prevent further skin
damage,
Self-harm
While perhaps demonstrating some overlap with
excoriation, Nina also exhibits deliberate self-harming
behaviors. At multiple points in the film, Nina tears at her
cuticles and the skin around her nails. When the skin around
her nail beds becomes jagged and bloody, Nina engages in a
disturbing ritual of pulling the skin along the length of the
finger from the nail area. In a ritual that is terribly painful to
observe, she then runs the raw skin under hot water. While
most clinicians and researchers are familiar with deliberate
cutting and burning of arms and legs as a form of self-harm,
these behaviors actually exist on a continuum. In a study of
university students, tearing at the skin around the cuticles was
one of the most commonly reported forms of self-injurious
behavior (Williams, 2000). Those engaging in self-harm often
describe a sense of tension that precedes the act followed by a
feeling of calm immediately afterwards (Crowe & Bunclarck,
2000). From an experiential perspective, the emotional
dynamics of self-injury appear very similar to the anxiety
reduction following execution of a compulsive ritual. While
more research is warranted on the association of self-harm
with other OCD symptoms, several studies have found selfmutilation, eating disordered behaviors, and OCD to be
common comorbid conditions (Yaryura-Robias, Neziroglu, &
Kaplan, 1995).
Delusions
While Black Swan’s viewers, and probably Nina, herself,
are never entirely sure where delusions end and reality begins,
this experience does occur with a small group of patients with
OCD spectrum disorder. The cognitive rigidity characterizing
OCD may, in some instances, escalate to psychotic
symptomatology. O’Dwyer and Marks (2000) note that while
most OCD patients demonstrate insight into their condition
and recognize that the obsessions are irrational, there are a
small number of atypically psychotic OCD patients with
delusions. While early descriptions of OCD conditions noted
the overlap between obsessions and severe disorders of
thought content, this perspective was replaced by a view that
these patients had a psychotic condition—most commonly
schizophrenia (O’Dwyer & Marks, 2000). However, Lelliot
and Marks (1987) describe a 17 year old male with OCD who
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“[w]hile watching television …looked up and saw a man’s
face at the glass kitchen door and heard a voice say” ‘Do the
habits and things will go right.’” (Cited in O’Dwyer & Marks,
2000; p. 281.)
During the turmoil of embracing the role of the black swan,
Nina has an analogous experience while riding the subway.
She sees a much older, well-dressed man, who initially makes
kissing noises while staring at her, followed by lascivious
gestures with his mouth, and finally repeatedly grabs his
crotch. The film suggests that Nina appears to experience the
man as real, becomes frightened by him, and that the event is
connected to her own distress about her sexual desires being
triggered by her ballet role.
Family Dynamics
Nina's mother is very controlling and treats her daughter
like a much younger child. Nina’s bedroom, in the apartment
she shares with her mother, is more fitting for an eight-yearold girl than an adult woman. There are pink butterflies on the
wallpaper, a frilly bedspread, an array of stuffed animals, and
children's furniture. Nina’s mother repeatedly communicates
contradictory messages to her daughter which likely reflect her
own ambivalence about her daughter’s success. While
encouraging Nina to achieve the success in ballet she was
unable to attain, she also placates Nina into possibly accepting
a lesser role and discourages her from working too hard
Aronofksy’s cinematography of the apartment that Nina and
her mother share communicates the growing claustrophobia
that Nina experiences at home. However, mother’s presence
extends beyond their shared apartment. Nina’s cell phone rings
throughout the movie – it is always "mom" on the phone’s
pink screen backdrop. If Nina does not answer the phone,
mom persists in calling. While there are certainly genetic
influences on OCD spectrum conditions, parents also support
and accommodate OCD behaviors. Of interest, OCD
symptoms are more severe among children whose parents
accommodate and participate in their rituals as well as provide
frequent reassurance about their child’s fears (Storch, Gefken,
Merlo, et al., 2007).
This tightly ordered, self-contained universe does not allow
outsiders. When Lily comes by the apartment to ask Nina to go
out with her, mother answers the door and tells Lily that Nina
is not there. Nina however immediately goes to the door and
seeks out Lily before she leaves the outer hallway. During
their brief hallway exchange, Nina’s mother twice opens the
door urging Nina to come back inside for dinner. The only
way that Nina can do the unthinkable—leave the household for
an evening with Lilly--- is to quickly snatch up her things and
rush out the door while mother is calling anxiously behind her.
Aronofsky effectively conveys Minuchin’s concept of
enmeshment – the absence of individual emotional and even,
appropriate physical, boundaries between parent and child
(Minuchin, Rosman, & Baker, 1978). The pressures on Nina
coming from her mother are initially accepted as part of the
burden of success. However, through Lily, and to some extent
with the aid of Thomas, Nina is able to see herself apart from
the cocoon in which she is wrapped with her mother. At
Thomas's urging, Nina masturbates as a means of bringing out
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the sexuality needed for successful portrayal of the Black
Swan. While the film’s ambiguity between delusion and reality
leaves the viewer wondering whether some of these disturbed
mother-daughter boundaries are perceived or “real,” a
dramatic boundary breakdown occurs when Nina is
masturbating- only to become panic stricken when she glances
over and sees her mother asleep in a chair by her bed.
II. CONCLUSION
. The term “Cinemeducation” describes the use of feature films
to depict diseases, their treatment, as well as professionalethical conflicts in medical education (Alexander, Lenahan, &
Pavlov, 2005 ). While these cinematic portrayals may, at
times, overly simplify or exaggerate symptoms of psychiatric
illness, film can make learning about these conditions both
enjoyable as well as memorable. Film has a vivid quality not
typically conveyed through textbooks or lectures. As the
director of Black Swan, Aronofsky has successfully conveyed
the experience of obsessive –compulsive spectrum disorder.
The film has a powerful ability to make the viewer experience
viscerally the anxious preoccupation with control
characterizing those who have OCD spectrum symptoms. In
the context of the controversies surrounding the potential
revision of obsessive compulsive disorder in the upcoming
DSMV, Black Swan highlights how the related symptoms of
obsessions, ritualistic behavior, eating disorders, self-harm and
even transient delusions may co-exist and worsen under stress.
As such, the film should provoke much educational discussion
among mental health professionals, students, and those in
clinical training.
REFERENCES
[1]
Alexander, M., Lenahan, P. & Pavlov, A, (Eds.) (2005).
Cinemeducation: A guide to using film in medical education. Milton
Keynes, UK: Radcliffe..
[2] American Psychiatric Association (2012). DSM -5 development.
http://www.dsm5.org/Pages/Default.aspx (Retrieved January 29, 2012).
[3] Arnold, L.M., Auchenbach, M.B., & McElroy, S. L. (2001).
Psychogenic excoriation: Clinical features, proposed diagnostic criteria,
epidemiology and approaches to treatment. CNS Drugs, 15; 351-359.
[4] Crowe, M., & Bunclarck, J. (2000). Repeated self-injury and its
management. International Review of Psychiatry, 12(1), 48–53..
[5] Franko, D. & Omori, M. (1999). Subclinical eating disorders in
adolescent women: A test of the continuity hypothesis and its
psychological correlates. Journal of Adolescence, 22; 389- 96.
[6] Gupta, M., Gupta, A., Ellis, C. & Koblenzer, C. (2005). Psychiatric
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[9] O’Dwyer, A. & Marks, I. (2000). Obsessive-compulsive disorder and
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[11] Storch, E.A., Geffken, G.R., Merlo, L.J., Jacob, M. L., et al. (2007).
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Danielle Vanier is completing her psychology studies at Lake Superior State
University. She is co-author of a chapter on the use of documentary film in
medical education in the upcoming book, Cinemeducation-Volume II.. She is
currently conducting research on the relationship between academic
motivation, family-of-origin climate, and post-formal thought in emerging
adulthood.
H. Russell Searight, is Associate Professor of Psychology at Lake Superior
State University. He received his M.S. and Ph.D in clinical psychology from
Saint Louis University and his Master’s in Public Health from Saint Louis
University’s School of Public Health. He has previously held faculty positions
at Saint Louis University, Southern Illinois University-Edwardsville and Saint
Louis University School of Medicine.