Psychological Assessment

Name: Mrs. A

Date of Birth: June 16, 1969

Age of Testing: 49 years, 10 months, 11 days

Gender: Female

Ethnicity: Caucasian

Language: English

Marital Status: Married

Occupation: unemployed

Reason for Referral: Mrs. A is a 49-year old Caucasian woman who was referred by hospital

for primary presenting complaint of depression.

Referral Question:

1. What is Mrs. A diagnosis, if any?

2. Is Mrs. A’s risk potential?

3. What would her treatment recommendation?

Methodology

Semi-structured Clinical Interview (4/27/2019)

Mental Status Examination (4/27/2019)

 MMPI - Minnesota Multiphasic Personality Inventory (4/28/2019)

MCMI III - Millon Clinical Multi-axial Inventory-III (4/29/2019)

TAT - Thematic Apperception Test (5/1/2019)

Clinical Interview

Background

Mrs. A is a 49-year old married woman. She grew up in Houston, Texas to reported

absentee parents. With no siblings, Mrs. A reports growing up lonely; feeling unwanted and

alone. Her parents were often away on business and vacation trips, leaving her home to fend for

herself with an apathetic aunt. A latchkey kid, she walked to and from school on her own since

the age of 7, this is the time her symptoms began and became pervasively worse. She would

develop severe headaches and stomachaches, which resulted in frequent trips to the nurse’s

office, being sent home from school, or just kept her from attending school for the day.

At the age of 20, Mrs. A married her high school sweetheart and moved away from

home. Having had a few odd jobs, Mrs. A has been unemployed throughout the majority of her

adult life because of her lack of energy, severe headaches, and pervasive fatigue. She reports

having no friends, outside her neighbor who she dog sits for.

Medical History

Mrs. A has a lengthy medical history that extends far into her childhood. She states that she has

always had headaches and stomach problems; which have gotten pervasively worse since her

teenage years. She states that, at the age of 16, after her parents had left for a vacation without
her, she took a large amount of sleeping pills and was hospitalized after disclosing this to her

friend. Her second attempt at overdosing on sleeping pills occurred in her early 20s.

After this age, she had become further quiet and withdrawn; lacking energy, achy, and fatigued.

She reports various visits to the doctor’s office where no issues could be found. She seeks

validation for her physical symptoms. For the last five years, she reports that she was diagnosed

with HIV; despite having no medical proof. She was prescribed and continues to take Zoloft and

Risperidone, although there is no proof of psychotic type symptoms.

Medical/Mental Health Examination

Client reports being diagnosed with HIV five years prior, but there is no medical evidence of this

diagnosis. Medical reports claim that Zoloft was prescribed for depression issues. She claims

Risperidone was prescribed to help her with HIV type symptoms, but physician reports claim

that it was prescribed to help client with preoccupation with phantom illnesses.

Mental Status Examination

Appearance, Behavior, and Mannerisms

Client is nicely dressed in slacks and matching shirt and sweater; and appears to dress for

comfort. As she enters, her shoulders are hunched and she appears smaller than she is. Client

appears 5 years younger than her age of 49. She sits down timidly, but speaks clearly and

concisely.

Attitude
Client was pleasant and friendly during the interview. She was cooperative with the questions

posed, but appeared to close-up and become evasive with a few question posed about her

childhood.

Mood and Affect

Although the client discussed pain, she did not express pain or emotional discomfort during her

session. Instead, choosing to disclose her reported emphasis on the phantom HIV diagnosis.

Client appears relieved that there is an answer to her pervasive symptomatic patterns. Client did

not appear emotional during the session, but spoke clearly and concisely about her issues.

Perpetual Disturbances

Client has no reported instances of experiences

Thought Process

There is no evidence of loose associations. Client’s thinking was also linear and direct. She has

no apparent flight of ideas, racing thoughts, tangential thoughts, or circumstantial thinking,

further inquiry is required to determine communication outside sessions.

Sensorium and Cognition/Impulse Control

Client is responsive to environment, answers questions as posed. Client was attentive, no issues

with short-term memory. There appears to be no issues with severe long-term or declarative

memory issues.

Insight, Judgement, and Reliability

Client’s judgement appears normal, although she complains of feeling “fuzzy” at times. Client

seeks validation for her physical pains, and is eager to improve her depression.
Results from Testing:

MMPI-2 Results

Client was administered the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), a lengthy

objective test of personality, to determine emotional, social factors, structure, and

psychopathology. Results were compared to a normative clinical sample, which showed that the

client’s profile was valid.

Consistency

 Although the client was hesitant in taking a lengthy test, she responded

consistently to all test items.

Test-Taking Attitude

 While the Fb scale showed that the profile may be invalid; due to random

responding, faking information, or severe psychopathology, when compared to

the T score of F, it was not significant.

Distress and Disturbance

 Client has high levels of emotional distress, with F scale at 75, Dep at 75, and

Anx at 79. Client may feel anxious, worried, or nervous; having problems with

sleep or concentration. They may have somatic type symptoms, and report feeling

sad, blue, or depressed. There may be a lack of self-confidence or feelings of

insecurity; often feeling overwhelmed with daily life. With D1 at 85 and D2 at 79,

client may report feeling unhappy or depressed, lacking energy in coping with
 daily life. They may feel inferior, lacking in self-confidence or uneasy in social

situations. Client may feel emotionally immobilized or tend to avoid other people.

 Client may deny that they are in good health, complaining of poor physical health.

Client may not listen to attribution of physical health to psychological related

issues. Client may be open to change if approached, if she does not feel defensive

high score of HEA, Hea1, Hea2, Hea3. Complaints can center around gastro-

intestinal, neurological, and general health issues.

Major Symptoms

 The client appears to exhibit high anxiety with expression of high physical

complaints, somatic complaints, and general body preoccupation, with HY at 111

and HS 97. There may be a denial of problems and denial of social anxiety, and

possibly a self-centered focus and they may reject the assurance that there is

nothing wrong with them.

 With Dep at 105, client may display discouragement, pessimism, and

hopelessness. There appears to be high somatic issues, worry, and tension issues,

along with a denial of difficulty issues, hostile impulses, and problems in

controlling thought processes. D1 and D2 shows that there may be feelings of

unhappiness, lack of energy, issues in coping with everyday life, and disinterest in

what goes on around them. They tend to avoid other people, feeling inferior,

lacking in self-confidence, and socially uneasy. They may deny any hostile or

aggressive impulses.

Underlying Personality
  There appears to be suspicion of other people, with high level of sensitivity,

cynicism, and moral virtue. She may also tend to complain about other people,

with Pa at 92.

 There tends to be a high level of obsessive worrying, compulsiveness in rituals, or

uncontrollable or obsessive thoughts. She may have difficulties in concentration,

experience unhappiness, and exaggerated fears.

 Client may have peculiar perceptions, delusions of persecution, hallucinations,

and social alienations, with high scores in Sc, Sc2, Sc3, and Sc4. She may have

poor family relationships; which is possible as she has very few friends and lack

of intimate relationship with husband. There may be issues with impulse control,

feelings of social alienation, and apathy. There may be strange thought processes,

feelings of unreality, lack of concentration, and memory issues. She may exclaim

feeling as though she is losing her mind. She may feel as though life is a strain,

excessive worrying, and retreating into fantasy life when stressed; as she seems to

do with her HIV diagnosis.

Behavior in Relationship

 Client may be self-centered, showing no interest in what is going on around them,

high D1 and D2 scale. She may avoid other people, and elicit features of social

anxiety, Hy 111.

 She may be suspicious of others, Pa 92, cynical, and hyper-sensitive in social

situations, complaining of other people.

  Due to her delusions of persecution, she may feel socially alienated, choosing to

distance herself from other people. She may have poor family relationships, but

feels the need to be validated and loved, high scores in Sc.

Implications for Treatment:

 Client appears open to alternate forms of therapy to improve mental affect.

 There is a preference for an individual form of therapy, rather than group therapy

o Group therapy may cause her to feel judged

MCMI-III (Millon Clinical Multi-axial Inventory-III)

The MCMI-III is a psychological assessment tool used to provide information on

psychopathology and personality traits. The test reports are normed on clients who were in

within the early phases of psychotherapy for emotional and social difficulties. Participants who

did not fit this population or who taken the MCMI-IV for non-clinical purpose may have

inaccurate results. MCMI should not be considered definitive, and evaluated with the additional

clinical data along with the report.

Client scored 69 on the Dependent scale. Although the score is not high, client may still

have a propensity for dependency; this can be seen in her dependency on husband for financial

care and livelihood responsibility. While Alcohol Dependence is a 73; which is not considered

significant, client may have a propensity for alcohol addiction, but not dependency. If alcohol

dependency is involved, there are possible trauma issues in the past. Further investigation is

required to determine level of alcohol consumption. Client scored high on both Anxiety (76) and

Somatoform (76) features, thus she may tend to express her psychological difficulties; feeling
tense, indecisive, restless, or agitated, through dramatic somatic expressions; body complaints,

illness, weakness, and physical vulnerabilities.

TAT (Thematic Apperception Test)

The Thematic Apperception Test is projective psychological test that allows the client to create a

narrative surrounding a specific picture introduced by the therapist. The test was originally used

to assess certain needs; needs for achievement, power, and intimacy, and also defense

mechanisms, object relations, and problem solving skills. The theme of client’s apperception

dialogue seemed to be consistent with her reports of feeling tired, sad, and wanting to improve

facets of her life. In picture 3GF, client states that the lady in the picture is quite sad because she

may be dying. Client empathizes with the lady in the picture, and states that she knows what it is

like to feel “alone”. It would be prudent to explore the theme of feeling “alone” or “lonely” with

the client in future sessions. Picture 8GF also appears to resonate with the theme of feeling

forlorn and alone for the client. Client states that the woman in the picture appears to be

reminiscing about how her life would have been if she had not missed opportunities in life. The

woman in the picture appears unhappy with the choices that were made in her life and if

something different occurred, she would be in a better place. Perhaps client feels that she would

also have a different life if she had not missed past opportunities. Client may feel sad where her

life is currently going, if she chose differently then she would be in a better place. Client appears

to have a lonely, and persistent view of death. In Picture 15, she states that the individual

standing amongst the gravestones is sad and lonely, yet not in a rush to go anywhere because he

has nowhere to go. Perhaps envisioning herself as the image of death, she has saddened and feels

alone, yet must use death as a source of comfort because she is unsure of what else to do.

Client’s source of comfort and social support appears to be her husband. In picture 10, client
exclaims that the couple in the picture looks very happy, affectionate, and supportive of one

another. When prompted, “Do you feel that love for your husband?” Client responds that they

have been together for a long time and that she is happy to have him.

Diagnostic Considerations/Summary *PERSONALIZE THIS SECTION MORE TO THE

CLIENT*

Client may respond to life stress by using conversion-like symptoms; like fainting, throwing fits,

experiencing blackouts, and even hysteria-like symptoms. In this case, it appears that the various

phantom symptoms and lack of diagnostic evidence in HIV may be a result of life-stress coping.

The type 2 individual may demand attention, affection, reassurance, and support without

reciprocation. While they may be trusting and open, they may also be immature and self-centered

in their interpersonal relationships. They may seek out relationships where the other is highly

patient, nurturing, and under-demanding; however, relationships tend to also be superficial and

immature. She may also appear remote, unengaged, and avoidant within interpersonal

relationships; feeling inferior, apprehensive, and misunderstood.

Client may feel a lack of rapport with herself; she may a sense of apathy or flattened affect.

There may be a depressive tone, emotional deadness, dysphoric detachment; in which life is

simply sustained without a sense of active participation. There may be memory or concentration

issues; and perhaps fear that she is losing her mind. There may be listlessness, loss of interest,

and anhedonia. Client may have issues offering a linear account of events, speech may be

disorganized, allusive, abstract, digressive, and hard to follow. There appears to be abnormal

perception; hallucinations and thought content, and they are quick to retreat into fantasy when

under stress.
Client appears to complain of depression and depressed mood; physical symptoms also appear to

mask depression. Client reports hypersomnia, weakness, fatigue, and exhaustion. She appears to

lack energy, confidence, have low-self-esteem, indecision, tension, anxiety, and worry. She

reports little pleasure in events and activities, feeling discouragement, and pessimism about

future, lacking motivation and initiative.

 Major Depressive Disorder, Recurrent episode, Severe 296.33 (F33.2)

 Illness Anxiety Disorder, Care-seeking type 300.7 (F45.21

1. What is Mrs. A diagnosis, if any?

Mrs. A appears to have a comorbid diagnosis of major depressive disorder and illness

anxiety disorder. While somatic symptoms disorder was considered, the differential

diagnosis toward illness anxiety disorder was more apt; as she has extensive worries

about her health while there are no or minimal somatic symptoms. Client does not appear

resistant to treatment, so best treatment of psychotherapy is possible.

2. Is Mrs. A’s risk potential?

Mrs. A’s risk potential was minimal. Her thoughts about death are sad and forlorn, but

she has hope to change her life circumstances if she was able. She also has regrets about

missed opportunities and wishes life were different.

Recommendations

 Collaborate with primary-care physician to work on getting Mrs. A off Risperidone

 Client may benefit or enjoy Cinema Therapy

 Client is also open to client-centered or a more humanistic form of therapy to elicit a

more compassionate, validating, and empathetic approach

 Psychotherapy, utilizing a form of talk-therapy

o Decrease of avoidance behaviors, situations, and activities

o Decrease behaviors of body checking, and how client responds to body sensations

o Help identify fears, beliefs, and their connection to illness

o Goal treatment to manage anxiety about health

o Improve quality of life and ability to function; develop skills to cope with anxiety

and stress

o Improve daily functioning at home, in relationships, and social settings

o Help deal with depression

 Group therapy may also benefit client

 Possible inclusive therapy with husband; support system