The Central Role of Anxiety in the Psychodiagnostic Evaluation

An extremely complex and shifting network of factors occurs in the process of experiencing the discomfort of anxiety. When the problem finally surfaces and begins to cause intense concern and confusion, those involved in the referral process, from the patient to the referring source and even the testing psychologist, invariably become enmeshed in a sense of urgency, desperation, and duress to produce the report. This flurry of expectation and activity will not solve the problem, but instead can...

The Referral and the Clinical Interview

The questions asked by a referring source may not faithfully reflect what needs to be considered as the central concern about the patient. For example, a psychiatrist asking for a differential diagnosis between endogenous character depression and psychotic depression may be avoiding his or her own anxiety about the patient's potential for suicidal acting-out. The referring person frequently needs help in sorting out and clarifying such major issues. This implies that the psychologist need not...

Reality Testing and Cognitive Functioning

In the previous chapter, issues of diagnosis with respect to broad conceptions of psychosis, organic impairment, character or personality disorder, and neurosis or the range of anxiety disorders were discussed. At this point it is important to estimate the central concern inherent in formulating such diagnoses, namely reality testing and the nature and qualities of cognitive functioning. Problems with the intactness of reality testing and the integrity of cognitive functioning relate to...

Is the Anxiety Somatized

One of the most distressing ways in which patients attempt to manage anxiety without directly experiencing it involves channeling it to aspects of their own body. Parts of the body, internal organs, and physiologial functioning become the transformation equivalents of this anxiety. Somatizers are variably referred to as persons with psychophysiological, psychosomatic, conversion symptoms, or somatoform disorders. The somatizer attempts to manage anxiety by binding it or containing it with the...

Intelligence Test Scales

The major intelligence tests used by clinicians and educators today are the Wechsler and Stanford-Binet scales. The Weschsler series involves three tests covering roughly three age groups the Wechsler Adult Intelligence Scale-III (WAIS-III), the Wechsler Intelligence Scale for Children-IV (WISC-IV), and the Wechsler Preschool and Primary Scale for Infants-III (WPPSI-III).** In the WAIS-III, various subtests are grouped into verbal and performance areas and, in addition, four index scores can...

Is the Anxiety Consciously Experienced

The question of whether anxiety is consciously experienced concerns the patient's reaction to his or her own behavior, personality, and character traits. Is the patient's reaction one of acceptance, or are the traits viewed as being foreign When the patient perceives such behavior or traits in an accepting or benign fashion, they are considered to be ego-syntonic, and no particular anxiety is experienced. On the other hand, when the person experiences internal qualities as foreign or unusual,...

The Pathological Context and Diagnosis

Because the patient was referred for testing and evaluation as a result of presenting complaints and the confusion surrounding them, it is logical to address the context of the presenting complaint when developing and formalizing the diagnostic summary. Simply restating the problem in diagnostic terms is not sufficient because it fails to enhance the explanatory power of the assessment and does not summarize the test findings. For example, simply reporting alcohol abuse does not clarify any...

Implications of Verbal Performance Discrepancy

When the discrepancy between the verbal and performance I.Q. scores is unusually large, it can be a sign of substantial disturbance in the individual. For this reason, it is important for the psychologist to explore all the test results in order to formulate a hypothesis that would account for such discrepancies when they are obtained. An especially important point is that a large discrepancy (of approximately 2 standard deviations, or 30 points on the Wechsler scales) is statistically unusual...

Character Traits as Controls

In terms of their function and operation, character traits in the personality are distinctly different from individual defense mechanisms. Character traits reflect an aspect of the control system that can be referred to as the pattern of control that is, a person displays a configuration of behavior that becomes the person's behavioral signature. In this respect, the pattern of traits displayed during the testing situation is likely to reflect in microcosm the same pattern of behavior that...