A sad history of self-harm, anxiety and depression
Elaine O'Hara was admitted to a psychiatric hospital 14 times over the years but was not suicidal when she disappeared, the Central Criminal Court has heard.
Medical notes read out to the jury described her having a "play in her head in which she was being persecuted" and as having a "very lonely life with no friends" as far back as 2005.
However, Stuart Colquhoun, cognitive behavioural therapist (CBT) at St Edmundsbury Hospital, said the childcare assistant was cheerful, smiling and excited about volunteering at the Tall Ships festival when he saw her on August 21, 2012.
The court heard Ms O'Hara had suffered from recurrent depression, anxiety, low self esteem and paranoia, and that the background to her admission to hospital in 2012 was that she rang the Samaritans and said she had made a noose.
Sean Guerin SC, prosecuting, asked Mr Colquhoun if there was any indication Ms O'Hara was suicidal the day before she vanished.
"No," Mr Colquhoun replied, as he gave evidence at the trial of Graham Dwyer, who denies murdering Ms O'Hara on August 22, 2012.
The court heard Mr Colquhoun had previously seen cuts on Ms O'Hara's arms and stomach, which she said was caused by harming herself and by someone else, and back in 2008 she had asked someone to kill her.
Defence counsel Remy Farrell SC also told the court that in his statement to gardaí on August 30, 2012, Mr Colquhoun had said Ms O'Hara was involved in the BDSM lifestyle and "it was what she liked, it was what she was into".
She had also told him she had gone to a fetish night at one point.
Mr Farrell said there was clearly a background of suicidal ideation and asked if it went beyond that.
"There's suicidal ideation and suicidal intent and I'm not sure it stretched to intent," the therapist replied.
The jury heard Ms O'Hara had first presented to psychiatric services at the age of 16, but her problems began much earlier, and her admissions related to episodes of self harm, depression and anxiety.
A series of records and discharges summaries from St Edmundsbury Hospital were read to her family GP Dr Matthew Corcoran.
The reason given for admittance from February 29, 2000 to May 19, 2000, stated that Ms O'Hara was "sad and angry" and had low self-esteem and appetite.
Her final diagnosis on that occasion was: "Recurrent depressive disorder and strong possibility of emotionally unstable personality disorder."
The reason for another admission in 2005 was: "She believes people are watching her and talking about her and is preoccupied with some intrusive thoughts which she describes as a play in her head, in which she is being persecuted. She became agitated when asked to expand on this."
Dr Corcoran normally saw Ms O'Hara for asthma, mild diabetes and cholesterol and was not aware of her ever having been pregnant, he added. He last saw her in July 2012.