Orientation to Time Place and Person

During the interview, the extent to which reality orientation is intact can be noted from the patient's responses, questions, mannerisms, and answers to questions from the examiner. In the conventional psychiatric interview, this data is analyzed in terms of the patient's relationship to the important reality and cognitive factors of time, place, and person, which provide some estimate of the patient's current state of consciousness, stability, and reality testing. The patient's overall state...

Narcissistic Personality

Persons of this type are frequently difficult to differentiate from those with a histrionic personality. Whereas the histrionic person is focused largely on romantic fantasies, the narcissistic person is additionally concerned with achievement in fact, any and all achievement is over-valued. The major problem for the narcissistic person, however, revolves around concerns with self-esteem. An exaggerated sense of self is reinforced by any meager evidence as well as diminished by minor slights....

Nonpsychotic Mood Disorders

Another kind of bipolar disorder included in DSM-IV is the cyclothymic type. Essentially, this diagnosis involves a mood disorder with periods of elation and depression that are considered less severe than in the bipolar disorder. In the dysthymic disorder, depression is the unipolar dimension to be considered and this diagnosis of the dysthymic disorder roughly corresponds to the reactive depression of DSM-II where the depression was designed in the...

Defenses and the Report

In discussing the operation of defense mechanisms in the report, the first effort the psychologist can make is to identify the defenses that play a prominent role in the individual's functioning and to indicate how they are employed in managing tension and emotions. The use of defenses is reasonable and appropriate and does not necessarily imply the presence of pathological conditions. For example, in a protocol in which intellectualization appears without emphasis on rationalization and...

Defenses Used to Manage Individual Emotions

This defense reduces anxiety by keeping aspects of personality apart so that contradictions do not register. The usual integration of personality functioning is disrupted by these dissociations so that parts of the personality can become unaware of each other in dramatic ways. Histrionic disorders often reflect use of compartmentalization and this defense is utilized especially in multiple personality disorders. COMPENSATION. This defense mechanism is frequently utilized...

Autism

In a general sense, this key diagnostic concept is based on the degree to which the patient is withdrawn and the effects of the withdrawal on functioning, especially with respect to how the subject relates. The phenomenon of autism and its implications for relating always seem to impress the clinical observer. When autism is seen, the psychologist should be concerned with estimating its extent. Autistic relating appears somewhat unusual or strange. The responses of a person who displays...

The Bridge Between Intrapersonal and Interpersonal Functioning

The connection between the intrapersonal and the interpersonal involves a theoretical view about the existence of derivatives. This means that basic personality conflicts, which correspond to particular early developmental difficulties, ultimately lead to current interpersonal behaviors. Thus, current behaviors are linked theoretically to the specific developmental stages from which it is hypothesized that they derive. Relating intrapersonal conflicts to interpersonal behavior involves, then,...

Performance Subtests Wechsler Scales

This subtest involves the ability to concentrate and focus on details in order to differentiate between the essential and nonessential aspects of a situation. Conceptual and perceptual skills are required to enable the person to organize the picture that is presented and to compare it with internal knowledge of the objects involved. Paranoid ideation can interfere with success on this task because of an overconcern with irrelevant details and a focus on the presumed personal...

Types of Impulses

Anger is part of a sequence of events, including feelings, thoughts, fantasies, and behaviors. It may be helpful to define anger as the emotion, hostility as the main ingredient of fantasy and rumination, and aggression as the behavior. When the psychologist is analyzing the anger impulse, it is important to indicate the emotion of anger as an impulse vying for expression. An analysis of the nature of the anger will include whether it appears as an emotion whether it is translated into...

Sources of Anxiety in the Personality

As can be seen from the previous discussion, mobilizing and managing anxiety can assume several forms. For example, individuals readily experience anxiety when challenged with novel circumstances such as a testing situation. The patient can be observed to handle this source of tension by any number of approaches, including dedicated efforts at problem solving, impulsive acting-out, nonreflec-tive responding, avoidance and withdrawal, criticism of the test requirements, or complaints about...

Language in the Intelligence Test Report

The consideration of possible recommendations emphasizes the requirement of clear communication in meaningful, nontechnical terms that will present the human qualities of the subject and relate them to statements easily absorbed by parents. In fact, the entire report as it is addressed to teachers, counselors, or guidance personnel is best served if technical concepts are as unencumbered as possible. For example, simple terms reflecting complex diagnostic issues can include confusion, sadness,...

Subdividing Groups of Verbal and Performance Subtests

It has been found to be clinically valuable to group certain subtests on the basis of the cognitive and intellectual factors they have in common. By analyzing and reporting the results of intelligence testing at this level of organization, the pooled information from more than one subtest can be summarized and conveyed. This grouped analysis further clarifies the cognitive strengths and weaknesses of the patient. Such groupings of subtests have been introduced to the Wechsler scales as index...

Defense Mechanisms as Controls

A third element of the aggregate of control features on the protocol are the individual defensive operations that are designed to manage and direct specific emotions. If it were not for the various individual defenses, such as repression, denial, regression, reaction formation, rationalization, undoing, compensation, projection, and displacement, emotions would be experienced as urges requiring immediate expression. This relation of the individual defenses to emotion reveals the management...

The Nature of Anxiety

This section of the psychological report concerns the nature of anxiety, its quality and intensity in the personality, and how it is experienced, channeled, and manifested. At this point, the logic of considering the nature and role of anxiety follows from previous discussions of cognitive and intellectual functioning and the impairments in such functioning that can occur through the effects of anxiety. These impairments are significant ways in which the presence of anxiety becomes...

Diagnostic Formulations Based on the Clinical Interview

Partial diagnostic steps may be taken prior to the refined diagnostic statement offered at the conclusion of the report after all of the relevant findings have been considered. One practical consideration in connection with the partial diagnosis that appears early in the report concerns locating the patient's observed behavior within a relatively broad diagnostic class. Although not yet establishing a final, refined, and specific diagnosis, this preliminary step does establish a definite...

Defenses Forming Character Trait Patterns

This mechanism may be considered in terms of its importance to the development of enduring trait patterns in the same way that repression is a common underlying element of individual defense mechanisms. Through identification, the developing individual aims to form himself or herself isomorphically in relation to an important person (albeit in a generally automatic and unconscious manner) in terms of overt mannerisms as well as internal dispositions. This identification process...

Samples versus Evidence

What is the difference between evaluating samples of the patient's behavior versus the accumulation of evidence about the patient Clearly, the role of the psychologist is to support or refute hypotheses. This task requires objectivity and scrutiny of information in order to develop a picture of the patient's personality. The psychologist is not interested in proving anything for or against the patient. Instead, a focus is maintained on strengths and weaknesses, abilities and incapacities, and...

Fantasy as Control

The nature and makeup of fantasies are another type of control mechanism of personality. Fantasy may be considered a mechanism of control in the personality insofar as it represents a mediating phenomenon between feelings and behavior. Fantasies can be a harmless staging area for experiencing a host of emotions. The control feature inherent in the mechanism of fantasy is the imagining of a specific behavior without actually engaging in it. Thus, acting-out behavior might occur more frequently...

Phallic Assertion Conflict

A third developmental theme in the formation of early character and derivative interpersonal behavior is the phase of development that requires a person to become assertive in the pursuit of needs and goals. The focus on assertion presupposes a foundation based on the relatively successful resolution of dependency and control needs derived from earlier stages. Then, when there are disturbances in the phallic-assertion period, certain specific problematic character formations are likely to...

Testing of Preschool Children

One of the areas currently receiving pronounced clinical interest concerns the development of preschool children. A collateral emphasis is on the early observation of preschoolers in order to detect any signs of pathology or a potential learning disability that might interfere with later personal adjustment and school success. Often, such disturbances surface as a result of problems in the child's home life that can be alleviated by intervention. Some disturbances can also reflect the need for...

Inadequate Personality

Closely allied to both the dependent and passive-aggressive personalities is the inadequate personality disorder. Although no longer recognized as a specific entity in DSM-IV nomenclature, it is nevertheless included here because its frequent occurrence gives it more than historical interest. The major feature of this diagnosis involves a profound underresponse in virtually every aspect of the person's functioning. This includes underresponsiveness in relationships, school, jobs, and sexual...

Antisocial or Psychopathic Personality

Persons with this character disorder, historically known as psychopathic personalities, show a significant and impelling need to act out unresolved internal conflicts in their behavior. Acting-out, which is the essence of the disorder, however, may or may not be antisocial. The antisocial or psychopathic trait syndrome is associated with aggressiveness, truancy, inability to maintain employment, short attention span, and the need to justify behavior by lying or other manipulative strategies....

Immature Control Dominated

The basic syndrome corresponding to the immature maturation level that was just presented consists of an action-oriented, impulse-dominated level of development. A second kind of immature maturation syndrome associated with excessive controls can also be described. In this profile, the individual consistently adheres to behavioral inhibition. For example, in a decision to commit oneself to action or remain inert, the decision will virtually always be to remain passive. Such a person is guided...

Anxiety Impluse and Defensive Structure

F. (1984). Personality Development and Psychopathology, 2 Vols. (2nd. ed.). New York Columbia University Press Freud, A. (1966). The Ego and the Mechanisms of Defense (rev. ed.). New York International Universities Press. Freud, S. (1936). The Problem of Anxiety. New York W.W. Norton. Gray, P. (1994). The Ego and Analysis of Defense. Northvale, NJ Aronson. Izard, C. E. (Ed.). (1979). Emotions in Personality and Psychopathology. New York Plenum. Izard, C. E. (1972)....

Identity and Interpersonal Behavior

The major focus of each section of the report after the referral and interview has been largely on intrapersonal concerns, including reality testing, cognitive functioning, anxiety, impulse control, and defensive structure. At this point it is necessary to crystallize the information so that its impact on the person's life can be appreciated. Thus, the conflicts within the personality must be viewed as they affect relations with others. Another way of saying this is that what was previously...

Performance Greater than Verbal

The person who scores significantly higher in performance I.Q. than in verbal I.Q. can be described as having a preference for action and activity over reflective inclinations. This preference may result from a variety of factors, including a well-developed interest in mechanical activities, strong capacities for visual analysis, or a well-coordinated motoric response. Another contributing factor may be the subject's background if social and cultural conditioning have deem-phasized verbal...

Estimating Potential Levels of Intellectual Functioning

A discussion of the results of intelligence testing can be considerably enhanced by including estimates of the person's potential level of intellectual functioning. An analysis and discussion of the individual's potential broadens the usefulness of the report on several grounds. The reader of the report learns about an exceedingly important yet not readily visible dimension of the person's makeup. This information specifies the strength that is potentially attainable if impediments did not...

Adaptive Function of the

A discussion of the adaptive function assumes that all other ego functions are intact. For this reason, referrals made for behavior disturbances, personality impairment, or crisis problems will generally not be concerned with an analysis of this particular ego function. However, testing referrals that are made to determine acceptance into special progress classes or to assist in determining job promotions all require estimates of the degree to which this function is operating. The adaptive...

Impulse versus Control

Consideration of the issue of impulse versus control brings focus from a new perspective to the presenting behavior problem. This point of view provides an elaboration of the patient's dynamic forces through an analysis and discussion of the interplay between impulse and controls. Consequently, conclusions from the section on cognition and reality testing can be linked to broader aspects of the individual. For example, problems with issues of judgment, perception, and thinking can be related to...

Conclusion

This analysis has indicated the cognitive and intellectual skills that can be related to each of the subtests on the Wechsler intelligence scales. The particular capacities associated with each subtest can be utilized to compare and contrast the different subtests in order to indicate the relative strengths and weaknesses of the subject. In addition to the information provided by these comparisons, diagnostic hypotheses can be considered by contrasting subtest scores. Whenever possible, these...

The Patients Experience of Anxiety

Whether or not a person is aware of experiencing anxiety, the effects of tension are always affecting the person's behavior. Anxiety's influences may first appear in the person's reactions to its disrupting and debilitating effects. In such instances, the experience of anxiety may interfere with the patient's efforts to marshal cognitive and intellectual strengths. Thus, it is important to report the disruptive, interfering effects of anxiety when they are present. Failure to perform or reduced...

Suggested Outline of Sections The Clinical Interview

The first section of the report concerns an evaluation of the functioning of the person as the person appears clinically. As discussed previously, the patient's behavior calls attention to a problem that creates anxiety, suffering, and distress for the patient or those around the individual. Thus, the observation of behavior by the psychologist in both the interviewing and testing phases of the psychological evaluation is an essential source of highly pertinent clinical information. The...

Reality Testing and Cognitive Functioning

Additional material relevant to the cognitive organization section of the psychodiagnostic report is presented in this chapter. The ego functions described here pertain to the analysis of cognitive organization involving diagnostic formulations of nonpsychotic character or personality problems, neuroses, and normalcy. Neurosis here is referred to as corresponding to the DSM categories of anxiety, somato-form, dissociative, and other nonpsychotic disorders not classified as personality disorders...

Organic Impairment Disorders

Although DSM nomenclature covers a wide range of organic disorders, generally considered as various types of cognitive disorders, psychological testing most usefully clarifies the traditional categories of minimal brain dysfunction and organic brain syndrome. MINIMAL BRAIN DYSFUNCTION. In relation to this localized and generally mild type of neurological impairment, the psychologist can gather response samples throughout the test protocol that suggest minimal brain involvement as the cause of...

Anxiety as a Central Focus in the Report

For several reasons, anxiety plays a central role in the functioning of the personality. It not only can cause cognitive and intellectual impairments, but it also exerts a major influence in the development of emotional, behavioral, and somatic disturbances. Just as anxiety impedes smooth cognitive and intellectual functioning, it also interferes with efforts to utilize inner personality resources. The presence of anxiety and its effects reduce the person's ability to constructively manage...

Communicating Findings

The psychologist can convey the nature and effects of impairment in the integrative ego function by discussing the patient's absorption in and over-focus on personal concerns and inner conflict material. Such conflict undermines efficient involvement in realistic, external goal-directed achievement. Patients with cognitive impairments at this level have great difficulty focusing in a constructive manner on impersonal, external, and task-oriented requirements or on the realistic activities...

Diagnosis and Prognosis

The final diagnosis is valuable as a summarizing and integrating statement of the patient's personality, and it also provides information about any pathology. The diagnosis is formed by understanding the personality in terms of a clinical synthesis. Understanding the structure of the personality and the clinical nature of the disturbance clarifies areas for change, improvement, correction, and stabilization. The diagnosis becomes an important tool in any treatment strategy or remedial plan....

Emotion Attached Dependent Types Dependent Personality

The dependent feature of this character disorder contains an essential ingredient of passivity so that autonomous or independent decision making and functioning is avoided and an effort is made instead to develop parent-child replications in all interpersonal engagements. Such persons tend to avoid demands and responsibilities, and they can also reveal an underlying propensity for depression and covert anger. Depressive feelings may be experienced during periods of separation therefore,...

Is the Anxiety Acted Out

The issue of acting-out is crucial to understanding any problem behavior because of the many subtle forms it may take, its relationship to underlying conflict, and its widely prevalent use as a mode of handling anxiety. The patient who acts out usually does not consciously experience anxiety, primarily because the action is a substitute for the anxiety and accompanying frustration that cannot be tolerated. Acting-out usually is defined as the behavioral substitute for a conflict that is, a...

Intellectual Functioning

The intelligence test is a special measure that primarily helps to assess a wide spectrum of cognitive features. The manner in which such cognitive features operate for the patient needs to be delineated. Departures from sound reality testing often are reflected in quantitative and qualitative results of the overall findings of the intelligence test, as well as in scores of particular subtests of the scale. A substantive and clinically meaningful use of the intelligence test is one in which...

Is the Anxiety Understood by the Patient

The key issue here refers to the most likely underpinning of the anxiety that is, is the anxiety representing another specific emotion Thus, which emotion other than the anxiety itself would be a likely candidate as the real emotional culprit The likely answer is that beneath the anxiety, propelling the anxiety, and covered over by the anxiety, is substantial anger. In addition, this likely store of underlying anger is always related to a person. When anger toward another person is repressed,...

Resolving the Role Anxiety Dilemma

The anxiety associated with anticipated reactions to a report can be caused by the presence of several individuals who may read or evaluate it. All those who have something to do with the final report, including the writer, are viewed as split off from each other and having divergent interests. These divergent interests or parts are further evaluated in positive and negative terms. For example, the patient, who is placed in a pathological role, may represent the bad part. The writer of the...

What does the Term Anxiety Mean

Anxiety derives from the Greek word agon from which such words as anguish and agony are clearly derived. The Greek term described a sport contest and, in particular, the struggle between antagonists in such contests. The Greek agon also relates to the German word Angst, used in modern times by Kierkegaard and Nietzche, for example, to describe a painful feeling of terror. In Kierkegaard's existential focus, subjective feelings of anguish encapsulated by the word Angst are related to people's...

Integrative Function of the

The integrative function of the ego regulates anxiety, thinking, perception, and feeling to promote effective pursuit of goals. The integrative function involves the level of cognitive functioning at which even if impaired essential ego integrity and the capacity for reality contact are no longer in question. In terms of reality testing and cognitive organization, the assumption of nonpsychosis has been established and reality testing is considered intact. In considering this ego function, it...

Cognitive Organization and Reality Testing

A fundamental consideration of behavior concerns the extent to which it is realistic and, accordingly, in the best interest of the individual. If the behavior is not logically related to external reality, then the patient will have basic difficulties in fulfilling aims and interests. In addition, significant problems can develop in managing and coping with the broad range of circumstances that have to be faced in life. Thus, an inherent behavioral or experiential problem is screened by the...

Schizotypal Personality

This character disposition, which was newly introduced in the third edition of the DSM, encompasses various eccentricities and unusual personality qualities although these are not equivalent to typical schizophrenic or psychotic processes. Typical behavior in the schizotypal character type involves social isolation, constricted affect expression, and a variety of idiosyncratic behavioral peculiarities that together restrict usual interpersonal experiences. Thus, the amalgam of these schizotypal...

Secondary Autonomous Ego Function

The secondary autonomous ego function relates specifically to the capacity for directed thought. In evaluating this ego function, the tester is interested in determining if any impediments are interfering with directed thought. The presence of directed thought, even if impaired, differentiates the secondary autonomous function from the primary autonomous function. Patients demonstrating processes of decompensation or depersonalization, persons who are ambulatory schizophrenics, borderline...

Pro Rated IQ

A third, quantitative method of assessing the subject's potential level of intellectual functioning is based on an examination of the range of variability of intersub-test scores. An assumption can be made that the subtest with the highest scaled score indicates a standard level of functioning for all subtests. This is the level at which the individual would be expected to function on all subtests if it were not for the effects of interfering factors. Assigning the highest subtest score to all...

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...

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...