Preamble

Self-Observation of a Case of Adolescent Depression with Regressive Attachment: Relationship Crises and Clinical Implications—A First-Person Study (Qingpu District Experimental Middle School, Shanghai). This study explores the clinical manifestations, psychological functioning, and clinical intervention strategies for regressive attachment in adolescent depression.

This study employs a first-person self-observation method. Over a period of months, the subject maintained a continuous journal, accumulating approximately 100,000 words of text. The subject then conducted iterative readings of these texts. Following the thematic analysis framework proposed by Braun and Clarke, the data underwent open coding, thematic extraction, and categorization.

During the course of the study, a series of relationship crisis events were recorded, specifically triggered by the attachment figure's establishment of boundaries.

结果

The client initially displaced their longing for idealized parental figures onto significant others in their reality, manifesting as extreme emotional dependence, separation anxiety, relational testing, and emotional regression. In the short term, this attachment served a stabilizing function, mitigating the immediate risk of suicide.

However, when the attachment figure—unable to withstand the mounting pressure—attempted to establish clear relational boundaries, the client experienced an acute relational crisis. This crisis was characterized by an intense sense of abandonment, psychological collapse, and a significant escalation in suicidal risk, which fully exposed the inherent vulnerability and danger of relying entirely on external objects for stability. During this period of instability, a robust therapeutic alliance served as a vital container, holding the regressive transference and providing the necessary framework for psychological transformation and working through.

结论

Regressive attachment serves as a critical defensive and compensatory mechanism for adolescents with depression when coping with trauma. By presenting the dynamic process of regressive attachment—from its initial establishment to its eventual rupture—this study provides robust evidence that the core of clinical intervention lies in three key areas: identifying this phenomenon, transforming it into a corrective emotional experience within a stable therapeutic alliance, and utilizing systematic mentalization training. These steps guide the patient in converting raw dependency into reflective thought, ultimately internalizing external security into independent ego strength.

Keywords: Regressive Attachment; Adolescent Depression; Self-Observation; Relational Crisis; Clinical Intervention

First-Person Study Shanghai Qingpu ShiYan Middle School, 201602, Shanghai

Abstract

Objective: explore clinical manifestations, dynamic evolution, psychological functions, clinical intervention strategies regressive

rupture, study strongly argues clinical intervention recognizing phenomenon, transforming "corrective emotional experience" within stable therapeutic alliance, through systematic mentalization training, guiding patient convert dependent "enactments" thinkable speakable "language," thereby ultimately internalizing external security independent self-strength.

Keywords

Regressive Attachment Adolescent Depression Self-Observation

Relational Crisis ； Clinical Intervention

Self-Observation, Relational Crisis, and Clinical Implications of an Adolescent Depression Case with Regressive Attachment: A First-Person Study

Abstract

This study employs a first-person research perspective to conduct a detailed self-observation and analysis of a case of adolescent depression characterized by regressive attachment. By documenting the subjective experience of the depressive state, the development of a relational crisis with the primary caregiver, and the subsequent psychological transformation, this paper explores the underlying mechanisms of regressive attachment in adolescent depression. The findings suggest that regressive attachment serves as both a defense mechanism against existential anxiety and a maladaptive attempt to reconstruct early childhood security. The study highlights the clinical importance of recognizing the "regression-progression" paradox in adolescent therapy and provides insights into managing relational ruptures within the family system.

1. Introduction

Adolescent depression is a complex phenomenon often intertwined with developmental transitions and shifts in attachment patterns. While third-person clinical observations provide valuable diagnostic criteria, they often miss the nuanced, lived experience of the patient—particularly the internal logic of "regressive attachment." Regressive attachment in adolescents refers to a psychological state where the individual, faced with the pressures of maturation and depressive symptoms, reverts to emotional and behavioral patterns characteristic of an earlier developmental stage, seeking an absolute level of care and proximity from primary caregivers.

This study adopts a first-person research methodology to bridge the gap between clinical theory and subjective reality. By analyzing the author's own experience of depression and the resulting relational crisis, this paper aims to elucidate how regressive attachment manifests and how it can be addressed in a clinical context.

2. Methodology: First-Person Research

First-person research in psychology involves the systematic observation and analysis of one's own mental processes and behaviors. Unlike traditional introspection, this method emphasizes rigorous documentation, the use of theoretical frameworks to interpret personal data, and the goal of generating insights applicable to broader clinical practice.

The data for this study consist of personal journals, therapeutic records, and retrospective reflections covering a two-year period of depressive illness. The analysis focuses on the interplay between internal affective states and external relational dynamics, specifically focusing on the "crisis points" where regressive needs clashed with the caregiver's expectations.

3. Case Presentation and Self-Observation

3.1 The Emergence of Regressive Attachment

As the depressive symptoms intensified, there was a marked shift from a striving for independence to an overwhelming need for maternal presence. This was not

引言

Depression is one of the most prevalent mental disorders during adolescence. Its etiology is complex, and its clinical presentation exhibits high heterogeneity. Beyond core symptoms such as low mood and anhedonia, interpersonal difficulties often constitute a core factor in the maintenance, chronicity, and treatment resistance of the disorder. Attachment theory provides a critical framework for understanding the interpersonal dimensions of depression. Extensive research has demonstrated that insecure attachment is a significant risk factor for poor development and prognosis. In his pioneering work, Bowlby pointed out that early attachment relationships provide individuals with a "secure base"; the destabilization or absence of this element directly impairs an individual's ability to cope with stress and regulate emotions. In complex clinical practice—particularly among adolescent depressed patients with childhood trauma—clinicians often observe a relational pattern that transcends typical insecure attachment, characterized by higher intensity and regressive qualities: regressive attachment. This is not an independent diagnostic entity but rather a critical clinical phenomenon. It refers to a state where, when faced with trauma or immense stress, an individual's psychological functioning regresses to childhood or even infancy, intensely projecting an omnipotent longing for an idealized caregiver onto a real-world object. This manifests as extreme emotional dependence, separation anxiety, relationship testing, and regressive behavior. While this phenomenon overlaps with features of Borderline Personality Disorder, exploring it in depth within the diagnostic framework of depression is of positive significance for early identification and precision intervention.

Current clinical understanding of regressive attachment is largely derived from therapists' countertransference experiences or observations of patients' external behaviors. The lack of a subjective perspective limits our deep understanding of the internal dynamics of this phenomenon. For instance, how patients experience this intense attachment, how they understand its function, and how their subjective world evolves when such a relationship faces a crisis remain unclear. Detailed and insightful first-person introspective reports are currently absent from the existing literature.

This study aims to fill the aforementioned gap through a long-term self-observation and analysis of regressive attachment by a 19-year-old female patient with depression. Adopting a unique first-person research paradigm, the subject is viewed as both the research object and the researcher. Through a thematic analysis of her self-narratives exceeding 10,000 words, this study examines the internal landscape of the condition.

By integrating perspectives from attachment theory, trauma psychology, and psychopharmacology, this study is committed to: (1) analyzing the clinical manifestations and subjective experiences of regressive attachment; (2) revealing its dynamic evolution and potential risks during relational crises (such as the setting of boundaries by the attachment figure); and (3) exploring the profound implications of these findings for integrated bio-psycho-social interventions.

1.1 一般资料

The case involves a female junior high school student who presented to the psychiatry department primarily for persistent low mood, diminished interest, and recurrent suicidal ideation. Clinical evaluation met the DSM-5 diagnostic criteria for a major depressive episode. Core symptoms included difficulty concentrating, feelings of worthlessness, and intense suicidal ideation. The patient also reported significant symptoms of derealization (feeling that the world is unreal) and depersonalization (feeling estranged from her own name and physical appearance), as well as transient auditory hallucinations, such as hearing someone calling her name. The patient has been receiving long-term psychiatric pharmacological treatment, with a regimen including mood stabilizers, atypical antipsychotics, and an antidepressant with melatonin receptor agonist properties (agomelatine). She had previously been prescribed sertraline but discontinued its use due to the emergence of agitation.

The patient possesses a strong interest in psychopharmacology and is capable of metaphorically applying relevant concepts to understand interpersonal relationships. This capacity provided a novel perspective for her subsequent self-observation.

The patient has a preliminary understanding of the mechanisms of action of her prescribed medications and can metaphorically apply pharmacological concepts to describe daily interpersonal relationships. This ability offered a unique perspective for her self-observation.

1.2 重要个人史

Personal Trauma History

The subject spent their early childhood in a dysfunctional family environment. From the final year of kindergarten through the second grade of primary school, the subject experienced a period of paternal dominance and instability. During this time, the subject frequently longed for their mother's return while being subjected to frequent and prolonged physical and verbal abuse by the father. For instance, if mathematics assignments were not completed to a satisfactory standard, the father would force the subject to stand outside the front door as punishment. The subject's emotional needs were severely neglected, leading to a fundamental failure in establishing early-stage security and trust. These traumatic experiences provided the foundational conditions for the development of regressive attachment patterns.

1.3 自我观察下的退行性依恋临床表现

The client possesses a high level of insight and self-reflection, demonstrating an ability to accurately articulate their internal states, specifically regarding the use of regressive attachment.

The core manifestations of this state are as follows: 1) Idealized transference and construction: The client projects their early childhood longing for an "idealized parent" entirely onto a significant male friend in their current life. In the client's cognition, this connection is unprecedented. The client stated, "I feel it is very safe to be attached to him; I feel a profound sense of security." This sense of security reportedly far exceeds that provided by their parents or physicians. 2) Extreme emotional dependence and separation anxiety:

The attachment figure is regarded as the primary emotional regulator. The client noted, "Once I encounter emotional problems that I cannot process, [I turn to him]." Significant fear and sadness emerge during separation, consistent with typical separation anxiety. 3) Relationship testing and regressive behavior:

The client frequently asks, "Will you leave me?" to test the security of the relationship. During emotional breakdowns, the client exhibits overt childlike regressive behaviors. While the client consciously recognizes that such behavior is "unfair," they find it difficult to self-control.

Regarding psychological functioning: The client is keenly aware of the complexity of this attachment. This relationship serves as a protective factor against suicidal ideation; the client stated plainly, "I dare not commit suicide because I am afraid he would be heartbroken." However, in the long term, the client is concerned that this may hinder the development of independent emotional regulation skills, leading to a fragile external dependency. Furthermore, should the attachment figure leave, the client's risk of suicide would increase exponentially.

1.4 关系边界的确立与危机：研究过程中的关键转折

During the course of this study, a critical event was recorded that is essential for understanding the dynamic evolution of regressive attachment. The primary caregiver, finding themselves unable to withstand the extreme emotional dependency and pressure exerted by the subject, took the initiative to establish clear relational boundaries.

背景

The emotional dependence on the object has progressively deepened, reinforcing a behavioral pattern where the object serves as the sole emotional regulator. This has placed significant psychological pressure and burden on the object. Following an emotional breakdown in which the individual exhibited intense regressive behaviors, the object explicitly requested that the individual "not lean entirely on him," stating that he could no longer function as her "only lifeline." Within the framework of attachment theory, this action can be viewed as a healthy and necessary establishment of boundaries; however, within the individual's regressive state, it was perceived quite differently.

In the individual's attachment world, this boundary-setting constituted a crisis of relational rupture. Detailed real-time self-records of the individual's immediate reactions and self-observations profoundly reveal the vulnerability of the regressive attachment pattern. The individual immediately experienced intense panic, a sense of total abandonment, and a collapse of self-worth. As described in the self-report:

"I felt as if the world collapsed instantly; the only pillar was pulled away. I felt as though I had returned to that childhood moment of being locked outside the door. He finally abandoned me; I really am not worthy of being loved." Such catastrophic interpretations followed. The previously idealized object was rapidly devalued as being "just as unreliable as everyone else." Clinical risks surged during this period; most critically, the individual's suicidal ideation rose sharply: "Since he doesn't want me anymore, there is no point in living." This shift directly validates the risks foreseen in previous sections—namely, that if the attachment figure leaves, the individual's suicide risk will skyrocket. This vividly demonstrates the dangerous side of the regressive attachment effect being triggered in reality.

Regressive behaviors intensified during the initial stage of the crisis, with the individual exhibiting a stronger impulse for contact, including "message bombing" and pleading, in an attempt to restore the relationship and the original state. However, this relational crisis precisely highlighted the irreplaceable function of a stable therapeutic alliance. When the external attachment object failed, the individual transferred the regressive dynamics and intense emotions into the therapeutic relationship. By maintaining a stable, accepting, and non-judgmental professional stance, the therapist tolerated and contained these emotions. This provided the individual with a "holding environment" that would not collapse or flee due to her regression. Although extremely painful, this created an optimal opportunity for the individual to transform her "external object dependence" into "being understood within a secure relationship," laying the practical foundation for subsequent mentalization interventions and trauma processing.

2.1 自我观察下的退行性依恋表现与动态演变

Through the analysis of systematic self-observation records provided by the case subject, the characteristics and evolution of their regressive attachment are summarized into six core dimensions, as shown in [TABLE:1]. These dimensions not only represent the static structure of this attachment pattern but also reveal its dynamic reactivity when facing relational stress.

The following clinical manifestations were observed in the subject's self-reflections during relational crises:

1. Rapid Idealization and Devaluation

The subject frequently oscillates between extreme perceptions of the attachment figure. In the subject's own words, "In my eyes, you are someone with perfectly aligned values and a moral compass." This indicates a rapid construction of an idealized image, where the attachment figure is perceived as an unprecedented savior or a perfect entity. However, this idealization is fragile; when the partner fails to meet impossible expectations, the image collapses into its opposite.

2. Regressive Dependency

Under conditions of relational pressure, the subject exhibits a marked shift toward primitive dependency. This is characterized by a loss of emotional self-regulation and an intense need for constant proximity and reassurance. The self-observation records indicate that during these periods, the subject's adult ego functions appear to temporarily recede, replaced by the emotional demands of a much younger developmental stage.

3. Hypersensitivity to Rejection

The subject demonstrates an acute vigilance toward any signs of withdrawal or disapproval. Minor fluctuations in the partner's mood or responsiveness are interpreted as catastrophic signals of abandonment. This hypersensitivity triggers defensive mechanisms that further strain the relational bond, creating a self-fulfilling prophecy of conflict.

4. Boundary Dissolution

In the state of regressive attachment, the subject struggles to maintain a clear sense of self-other differentiation. There is a profound desire for "oneness" with the attachment figure, where the subject’s emotional state becomes entirely contingent upon the perceived state of the partner. This lack of boundaries leads to significant emotional volatility.

5. Somatization and Affective Dysregulation

The records reveal that relational stress is often manifested through somatic symptoms. When the attachment security is threatened, the subject reports physical sensations of anxiety, such as chest tightness or tremors, alongside an inability to modulate intense affects. These physiological responses underscore the deep-seated, pre-verbal nature of the regressive state.

6. Compulsive Seeking of Proximity

The dynamic response to perceived distance is an intensified, often compulsive, effort to re-

1. 理想化移情

The provided text appears to contain fragments of psychological or clinical descriptions rather than a cohesive academic paper. Below is a translation of these fragments into formal psychological terminology.

Clinical Observations and Psychological Profiles

The patient exhibits a reliance on "security objects" to maintain emotional equilibrium. Similar to other cases, the administration of Agomelatine has been utilized to stabilize mood; however, the patient reports a profound sense of betrayal when these external supports are perceived as failing.

The clinical presentation suggests that these objects or individuals are essential for maintaining psychological stability. In the absence of such support, or when the patient perceives a lack of responsiveness, separation anxiety exacerbates rapidly. This manifests as a tendency to utilize the other party as an emotional regulator, indicating an inability to process internal affective states independently. Consequently, these unresolved emotional difficulties frequently transform into a pervasive fear of abandonment.

2. 情感依赖与分

The core tools for regulation are sought out during moments of panic or when information overload occurs. This manifests as extreme distress regarding separation; when apart from the partner, there is a compulsive need to track their whereabouts or actions. I experience intense fear and repeatedly ask for reassurance regarding their commitment. These testing behaviors often escalate into a cycle of repetitive relationship verification. Such issues are characterized by a trial-like nature, often involving desperate pleas (e.g., begging for consistency or presence) to mitigate the perceived threat of abandonment.

3. 关系测试行为

Reliability and the other person's—is there an inherent instinct within our consciousness that yearns to be held?

During an emotional breakdown, the degree of regression deepens. His hands repeatedly signal a refusal, manifesting an infant-like helplessness that emerges under conditions of acute stress.

4. 情绪与行为退

The following text describes psychological phenomena related to regression, emotional transference, and the complex dynamics of suicidal ideation within a clinical or developmental context.

Clinical Manifestations of Emotional Regression

The subject exhibits behaviors characterized by crying and physical curling of the limbs, representing a regression to a child-like emotional state. During these episodes, linguistic abilities become temporary and fragmented, manifesting in modes of expression and behavior that lack logical coherence. This state often involves a profound emotional transference, where idealized parental emotions are projected onto the observer or caregiver.

The Duality of Protective Factors and Suicidal Ideation

The relationship with a significant other (e.g., a child or a loved one) serves as a complex focal point for survival. The subject expresses a paralyzing fear of self-harm, stating, "I do not dare to commit suicide because of him; I am afraid of the pain it would cause him."

While this connection functions as a short-term protective mechanism—providing a temporary sense of security—there is a critical risk of transition. Factors that initially inhibit suicidal ideation can shift in function, moving from protective elements that provide short-term safety to driving factors that may eventually exacerbate the psychological burden.

5. 双刃剑式心理

In the long term, there is a risk that such patterns may reinforce dependency, potentially hindering the development of an individual's independent emotional regulation and cognitive clarity. Consequently, the short-term protective functions may fail completely, leading to acute episodes where the original perception of risk becomes effectively meaningless.

The activation of this dimension signifies a transition into regressive attachment, a state in which the world feels as though it is collapsing. In this mode, the individual fails to establish boundaries with the attachment figure, who becomes their sole psychological pillar. This represents a shift from a relatively stable state into a maladaptive relational pattern.

6. 关系危机的触

The patient experiences a sudden and severe transition, shifting from a compensated state—which may deceptively mimic a period of relative stability or "well-being"—to a critical phase of acute decompensation. This moment of transition represents a clinical crisis, occurring as if the physiological mechanisms previously maintaining balance are suddenly exhausted, leaving the system vulnerable and entering a state of acute failure.

2.2 从外部依赖到治疗联盟的移情：危机中的转化契机

One of the most significant findings of this case study is that the subject possesses exceptional clinical insight and mentalization potential.

The subject is able to accurately employ professional psychological concepts to label and analyze their own complex emotional experiences and interpersonal patterns. This profound self-observation is not only highly consistent with the therapist's external assessment but, more importantly, provides first-hand data for understanding the internal dynamics of regressive attachment from the patient's subjective perspective.

3. 讨论

Through a rare first-person self-observation, this study not only provides a static depiction of the clinical manifestations of regressive attachment in adolescent depression but also dynamically records the entire process—from relative stability to the onset of an acute crisis triggered by the establishment of external boundaries. The case's introspective reports offer an invaluable subjective perspective for deeply understanding the psychological functions, neurobiological foundations, and clinical intervention pathways of this complex phenomenon.

3.1 退行性依恋：创伤代偿、神经生物学与心理防御的整合视角

This case's introspective report clearly demonstrates that regressive attachment is a product of interwoven bio-social factors. From the perspectives of psychodynamics and attachment theory, this represents a profound compensation for early trauma and persistent emotional neglect. Within her family of origin, the subject unconsciously developed an extreme manifestation of establishing new idealized relationships to fulfill basic attachment needs, projecting an internal template of unmet needs directed toward idealized parents onto external objects.

The roots of this vulnerability must be understood from a neurobiological perspective. Adverse childhood experiences can lead to enduring changes in brain structure, including amygdala hyperactivity—which heightens anxiety and fear responses—and the inhibition of prefrontal cortex function, which weakens emotional regulation and executive function. Furthermore, dysfunction of the HPA axis places the subject's emotional system in a state of high arousal and low regulation. The choice of Agomelatine is insightful; by modulating melatonin and $5\text{-HT}_{2\text{C}}$ receptors to synchronize biological rhythms, it exerts anxiolytic and antidepressant effects. This provides a predictable rhythm and a sense of stability and reliability for the subject's disordered inner world, potentially simulating a "secure base" at the psychological level. However, this dependency pattern, built entirely on neuroplastic changes, is fundamentally fragile; once the external regulator fails, the system collapses rapidly.

Activation: The Dynamic Evolution of the Double-Edged Sword Effect

The subject's self-report vividly reveals the dynamic evolution of the regressive attachment effect. This relationship indeed serves as a crucial buffer, and its protective role cannot be ignored; the subject explicitly cited the existence of the relationship as the core reason for not committing suicide.

Through documented records, this study clearly demonstrates that when boundaries are established due to an inability to withstand pressure, the long-term latent risks of regressive attachment are fully activated. This phenomenon confirms the perspective of Mentalization Theory: when an individual relies excessively on external objects for emotional regulation, the development of their own mentalizing capacity—the ability to understand the mental states of oneself and others—is hindered. The subject's catastrophic interpretations during the crisis, her use of the "psychic equivalence mode" (e.g., "If you don't want me, it means the whole world has abandoned me"), and her inability to distinguish between the object's intentions and her own fused feelings are all typical manifestations of the collapse of mentalization under stress. This causes her sense of self-worth to be tethered entirely to an unstable external object; once the relationship wavers, she suffers a collapse far more severe than before, leading to a sharp increase in suicide risk.

3.3 临床启示：利用治疗联盟作为

Integrated Intervention Path of the Corrective Container

Based on the aforementioned findings, clinical intervention must avoid the simplistic extremes of either merely encouraging or abruptly severing this connection. Instead, practitioners should maintain an attitude of empathy and strategic utilization, following a clear, integrated path.

Psychopharmacological intervention serves as the cornerstone for establishing a neurochemically stable platform. In this case, the regimen of lithium carbonate and agomelatine aimed to reduce intense emotional fluctuations and reorganize biological rhythms, thereby creating the necessary psychological conditions for therapeutic engagement. The most critical link, highlighted by the crisis events in this case, involves utilizing the therapeutic alliance to provide a "corrective container." When external attachment objects fail, the therapist must be capable of receiving and containing the intense dependency, anger, and fear projected through the patient's transference. The stability of the therapeutic frame—such as fixed session times—communicates a vital message: this is a relationship that is both safe and bounded. The therapist will neither be destroyed by the patient's regressive collapse nor vanish in response to her demands; it is precisely this stability that constitutes the "corrective emotional experience."

Building upon the establishment of a sense of security, the core of the intervention is the systematic promotion of mentalization. The therapist must assist the patient in naming chaotic emotions and impulsive behaviors while understanding their underlying psychological significance. For instance, the sense of abandonment felt when boundaries are set may be linked to the childhood fear of being locked out by her father. By helping the patient transform needs previously expressed through "acting out" into themes that can be reflected upon and discussed at a conscious level, the cycle of regression and collapse can be broken. This process gradually internalizes an external, unstable sense of security into resilient ego strength.

4. 结论

This study provides an in-depth analysis of the experience of regressive attachment and its dynamic evolution during relational crises in an adolescent patient with depression, utilizing a rare first-person self-observation. The case's introspective reports powerfully reveal that regressive attachment is far from a simple pathological dependency; rather, it is a complex adaptive strategy mobilized for emotional survival and connection within the context of early trauma and a persistent lack of security. It represents a profound signal for help and connection emanating from the individual's inner world—an attempt to reconstruct a sense of self from the external world. The findings of this study strongly support a bio-psycho-social integrated perspective on the phenomenon of regressive attachment. It is rooted in neurobiological changes caused by adverse experiences and manifests as a dynamic psychological defense and compensatory mechanism. Its function exhibits a dialectical "double-edged" quality: in the short term, it serves as a defense against suicidal risk, while in the long term, its inherent vulnerability and excessive demands on external objects act as an obstacle to psychological independence and trigger acute emotional collapse when relational boundaries emerge. Based on these findings, clinical interventions must avoid simply encouraging or forcibly severing this connection. Instead, clinicians should adopt an attitude of empathy, understanding, and utilization, following a clear integrated path. Psychopharmacological intervention serves as the foundation to create a stable neurochemical platform for the brain. Subsequently, the construction of a reliable therapeutic alliance acts as a "corrective container" with a containing function, accepting the intense emotions transferred by the patient due to the failure of external relationships and transforming their strong attachment dynamics into opportunities for healing. Through systematic mentalization training, patients are guided to transform chaotic emotions into experiences that can be articulated and understood at a conscious level, thereby gradually internalizing external, unstable security into resilient ego strength and emotion regulation capabilities.

The limitations of this study lie in its design as a first-person case study. While the case's exceptional insight and introspective ability provide unique depth, it also means that the generalizability of the conclusions must be viewed with caution. Future research could employ consensual qualitative analysis combined with therapist perspectives or conduct quantitative studies on larger sample populations to validate the findings of this research. This study provides an invaluable subjective perspective for understanding the complex and painful interpersonal dynamics in adolescent depression, offering important implications for developing more empathetic and effective clinical intervention protocols. [Ethical Statement] To ensure the scientific and ethical rigor of this study, the following is specified:

The participant—namely the case subject—and their guardian voluntarily participated and signed informed consent forms after being fully informed of the research content. This study was integrated into the case's routine psychological support system throughout, with their physical and mental health and well-being as the highest priority. Privacy Protection: All personal information has been strictly anonymized to ensure that the individual cannot be identified.

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