I would suggest a different understanding of this case based on my extensive work with the emotion of shame. Elizabeth has low self-worth and is submissive, resulting in fatigue when around others or “introversion.” People with low self-worth have poor shame tolerance, causing them to struggle with even simple social interactions, because for them every conversation includes the experience of their own inner critic abusing them about their faults and failures, then additional fear that others will find fault. This causes stress and eventual exhaustion and a desire to retreat to solitude. I label these type of people Self-blamers and they are often raised by abusive, domineering, narcissistic parents, such as Elizabeth’s mother, who is what I call an Other-Blamer. Notice how the mother criticizes relentlessly? Who wouldn’t feel shame and low self-worth under that onslaught? Who wouldn’t want to avoid that abuse by hiding in her room? Notice also the boundary violations by the mother — arranging unwanted social engagements — a typical narcissistic or Other-Blamer behavior. The core of poor shame tolerance for Other-Blamers is lack of accountability, which results in things like impulsivity and poor financial management, which the mother presented with. I strongly suggest mental health professionals gain an understanding of shame and how it affects human behavior, especially relationships. Certainly, there are some people who are more prone to valuing solitude and others who a temperamentally more outgoing, but If find with clients that the urge to retreat from human contact not only violates evolutionary urges to connect and bond with others, but is far more due to being raised by a narcissistically abusive person than anything else. The clinical intervention to use is Compassion-Focused Therapy or Mindful Self-Compassion which directly address improving shame tolerance and secure self-attachment, along with education on the effect of Other-blamers who blame shift to their victims. which increases shame intolerance and low self-worth.