MH – Psychological Assessment II
COMPREHENSIVE PSYCHOLOGY REVIEW of PATIENT PATIENTS PRESENTING CONCERNS: [checkbox name="Emo_Dis" value="Feeling Emotionally Distressed"][conditional field="Emo_Dis" condition="(Emo_Dis).is('Feeling Emotionally Distressed')"]: [checkbox value="anxiety|depression|anxious and depressed|moody|suicidal ideation|performance anxiety|anger|fear|general distress|worrying|global distress|loneliness|guilt|shame|grief and loss"] [textarea cols=60 rows=5 default="attributed to"] [/conditional] [checkbox name="Seles" value="Low self-esteem"][conditional field="Seles" condition="(Seles).is('Low self-esteem')"]: [checkbox value="poor self-concept|low self worth|identity diffusion|gender identity concerns|poor self-efficacy|sexual orientation concerns|adoption concerns|feelings of abandonment|poor sense of belonging"] [textarea cols=60 rows=5 default="attributed to"][/conditional] [checkbox name="Relcon" value="Relationship stress"][conditional field="Relcon" condition="(Relcon).is('Relationship stress')"]: [checkbox value="marital difficulties|friendship problems|fears over impending breakup|recent breakup|social group difficulties|lack of interpersonal effectiveness|poor social supports|family problems|lack of interpersonal coping"] [textarea cols=60 rows=5 default="attributed to"][/conditional] [checkbox name="Lifetran" value="Life transition stress"][conditional field="Lifetran" condition="(Lifetran).is('Life transition stress')"]: [checkbox value="unable to make life decisions|academic problems|retirement anxiety|moving house anxiety|difficulty with stage of life tasks|leaving home anxiety|leaving high school|poor life satisfaction"] [textarea cols=60 rows=5 default="attributed to"] [/conditional] [checkbox name="Physcom" value="Physical complaints"][conditional field="Physcom" condition="(Physcom).is('Physical complaints')"]: [checkbox value="eating difficulty|medical problem|injury|physical problems|mobility problems"] [textarea cols=60 rows=5 default="attributed to"][/conditional] [checkbox name="Subab" value="Substance abuse"][conditional field="Subab" condition="(Subab).is('Substance abuse')"]: [checkbox value="alcohol overuse|substance abuse|substance dependence|spending all available money on addictions|feeling impaired by addiction"] [textarea cols=60 rows=5 default="attributed to"][/conditional] [checkbox name="Selman" value="Poor Self Management"][conditional field="Selman" condition="(Selman).is('Poor Self Management')"]: [checkbox value="compulsive behaviour|uncontrolled behaviour|phobias|obsessions|thought problems|sexual functioning|uncontrolled feelings|overt behaviour|social behavior|leisure time|leisure activities|procrastination|specific performance|coping skills|making friends|social anxiety|cognitive difficulties"] [textarea cols=60 rows=5 default="attributed to"][/conditional] [checkbox name="Trau" value="Trauma"][conditional field="Trau" condition="(Trau).is('Trauma')"]: [checkbox value="reported child abuse|recent trauma|ACE|war|SA|victim of crime|injury|accident|unexpected death|unexpected loss"] [textarea cols=60 rows=5 default="attributed to"][/conditional] [checkbox name="Psychst" value="Psychosocial stresses"][conditional field="Psychst" condition="(Psychst).is('Psychosocial stresses')"]: [checkbox value="poverty|homeless|oppression by others|cultural dislocation|harassment|unemployment|loss of peer group|divorce|separation|job stress|bullying"] [textarea cols=60 rows=5 default="attributed to"][/conditional] [checkbox name="Ach" value="Lack of Achievement"][conditional field="Ach" condition="(Ach).is('Lack of Achievement')"]: [checkbox value="career|life decisions|academic underachievment|life tasks|life satisfaction|specific performance"] [textarea cols=60 rows=5 default="attributed to"][/conditional] [checkbox name="Indef" value="Difficult to Define"][conditional field="Indef" condition="(Indef).is('Difficult to Define')"]: [checkbox value="issues which need to be further explored|my troubled past|a variety of pressing concerns|everything seems to be going wrong at this time|has been avoiding problems for years but they're catching up|Not sure, but wants to find out what is bothering me|general life stress|needs to get back into a regular therapy arrangement|want to talk with someone on a regular basis|need someone to talk with about subjects on my mind|seeking psychological support"] [textarea cols=60 rows=5 default="attributed to"][/conditional] EXAMPLE OF CONCERN: [textarea cols=40 rows=10 default=""]. CONTEXT FOR PRESENTING CONCERNS: [checkbox name="variable_50" value="anywhere at any time|school|home|with strangers|work|evenings|in bed at night|upon waking|morning|feeling trapped|at social gatherings|any family gathering|sexual situations|intimate situations|with other people|with the boss|with work colleagues|with an identified bully|authority figures|parents|with a specific person|specific family member|friends|a particular friend|with ex-partner"] [comment memo="describe the situation or name the specific person if needed"][textarea name="variable_8" default=""] PRECIPITATES CONCERNS: [comment memo="What usually triggers the patient's concern - choose one"] [checkbox name="variable_53" value="Nothing of note|Pt unable to say|Pt unwilling to say|recalls a past trauma|reputational damage|injustice|others aren't following the rules|boring or under-stimulating environments|struggles with parenting duties|frightening events in the news|unpleasant thoughts of any kind|unpleasant feelings of any kind|awareness of being all alone|when anyone is watching|excessive work pressure|intense family friction|threatened with a relationship breakup|not getting replies to messages|hurtful messages on social media|Pt is ruminates on past hurts|Pt receives critical or judgemental comments|teasing or putdowns|financial pressure|feels ignored|feels invalidated|physical illness symptoms|unusual somatic feelings|feels harassed|being yelled at|interpersonal conflict of any kind|when assertiveness is required|unpleasant people|unpleasant smells, tastes, or noises in the environment"] [textarea cols=40 rows=10 default=""] UNHELPFUL THOUGHTS: [checkbox name="variable_54" value="nil identified|there is something wrong with me|I'm no good|I'm stupid|I'm worthless|I don't matter|I can't cope|I can't do this|I'm a failure|I'm boring|I'm better off alone|I don't need anyone|everyone leaves me|I can't be happy|I need someone to love me|everyone rejects me|If I love someone, they will leave me|the world is a dangerous place|I am not good enough|I’m different from others|I don't belong|I don't fit in|no one understands me|there is something wrong with me|I am unlovable|no one likes me|I make others feel bad|everything is my fault|I need to fix other people|I need to help others|I have to be perfect|I am selfish|I'm special|I deserve attention|everyone is stupid|I'm above the rules|I can't go wrong|I'm superior"] FEELINGS TOWARD THE STIMULUS: Pt [select value="able|unable"] to identify feeling toward stimulus [textarea cols=40 rows=10 default="The Pt felt sad when her dog died"]. Pt [select value="agreed|does not agree"] to the clinical formulation of the presenting concern - that [select value="her|his"] defenses are being used to manage mixed or complex feelings towards a [select value="person|situation"] and have become dysfunctional. Pt [select value="willing|unwilling"] to explore complex feelings towards stimulus. The Pt has a [select value="dystonic|syntonic"] stance towards the presenting concern. -- PSYCHOLOGICAL CONFLICT -- When exploring the Presenting Concern, the Pt felt [checkbox value="nothing in particular|anger|sad|afraid|happy|disgusted|ashamed|guilty|surprised"], looked [checkbox value="relaxed|congruent with their feelings|anxious in the striated muscle system|anxious in the smooth muscle system|anxious in the cognitive perceptual system"]. The Pt [checkbox value="did not repress feelings|intellectualized feelings|denied the reality of the situation|rationalized feelings|repressed feeling|negated feelings|isolated feelings|minimized feelings|displaced feelings|reaction formed feelins away"]. The Pt [checkbox value="did not externalise feelings|split feelings|became helpless|became passive|became weepy|excessively complied|turning on the self|became depression|dissociated|hallucinated|became deluded|projected feelings|somatized|externalized|acted out|emotionally discharge"]. Moreover, the Pt [checkbox value="did not employ tactical defenses or interpersonal avoidance|became vague|labeled|changed of subject|joked around too much|watered down terminology|distanced from the concerns|did not commit to opinions|avoided concise descriptions|retracted statements|speculated and hypothesized|laughed excessively|mimicked the author|dismissively sighed|body postured away from the author|avoided eye contact|forget the key issues|argued excessively|rambled|had racing speech"] SUPEREGO, SELF-ATTACK, AND CHARACTER DEFENSES (TRANSFERENCE RESISTANCE) [comment memo="Superego - pathological identifications. It is as if the Pt is enacting a dysfunctional past relationship. Ego ideals - who I am vs who I want to be. The Pt treats themself how they were treated in the past."] SUPER EGO DEFENSES: [checkbox value="nil|ignoring the author|self-neglect|forgetting|identification with the aggressor|self-devaluation|TOSH|SI"]. SELF-ATTACK DEFENSES: [checkbox value="nil|The Pt self-hates. Im not the same as my ideal, but I can be loyal to it by hating myself|Pt hates and devalues ideals rather than self-hate for failing to live up to the ideal. This may risk depression from meaninglesssness|Pt claims to be completely aligned with their ego ideal, denying reality. Pt needs others to reinforce this belief|Pt idealizes someone or something claimed to be ideal. Pt blindly follows the idealized others instructions with the hope of one day becoming the ideal.|Pt tends to project the inner judge onto others, believing they criticise or might criticise|Pt tends to provoke others into punishment scenarios|Pt tends to harshly judge others rather than self-judge|Pt escapes judgment by claiming to be the same as the internal ideal or by having immoral standards"]. [comment memo="The patient avoids an intrapsychic conflict by creating an interpersonal conflict"] CHARACTER DEFENSES: [checkbox value="No indication of resisting the transference with character defenses|Pts passivity encouraged authors over-activity|Pts unawareness of inner life prompted authors over-awareness|Pts opposition towards recovery encouraged authors convincing behaviours|Pts expressed hopelessness elicited authors hope-reassuring|Pts low-energy encouraged authors over-energy|Pts lack of emotion encouraged authors over-emotion|ignoring|neglecting|forgetting|dismissal of oneself as the patient was dismissed by others in the past"] [checkbox value="Pt seemed to express an identification with a parent|Pt projected healthy desires onto the author|Pt invited the therapist to take an omnipotent stance|Pt expressed a regressive wish"] DIAGNOSTIC FEATURES [checkbox value="Developmental Disorder|Schizophrenia Spectrum Disorder|Bipolar Disorder|Depressive Disorder|Anxiety Disorder|OCD|Trauma, Stress and Adjustment related Disorders|Dissociative Disorder|Somatic Symptom related|Feeding and Eating related|Elimination related|Sleep-Wake Disorder|Sexual Dysfunction|Gender Dysphoria|Impulse Control related disorder|Substance related disorder|Neurocognitive Disorder|Personality disorder"], [checkbox value="but would not meet criteria for a diagnosis at this time|and meets criteria for a clinical diagnosis"]. Sx: [checkbox value="stable|improved|worsening|nil reported"] PSYCHOLOGICAL DEFENSES [comment memo="I. (mature) Adaptive defenses:"] [checkbox value="affiliation - regulates mood through social contact.|aim inhibition - accepts realistic ambitions.|altruism - derives satisfaction through helping others.|anticipation - solving problems before they arise.|compensation - overachieving in one area to compensate for struggles in another.|humour - sees amusing or ironic qualities of the situation.|self-assertion - expresses opinions and needs in a respectful and firm way.|self-observation - reflects on one's thoughts, feelings, motivation, and behaviours.|sublimation - channels difficult feelings into socially acceptable activities.|suppression - puts aside difficult inner thoughts, feelings, and desires to get through the day.|distraction - puts off internal distress by focusing on something less threatening.|imitation - emulates the positive behaviours of idealized others."] [comment memo="II. (less mature) Obsessional defenses:"] [checkbox value="isolates affect - separates the event from the emotions that accompany it.|intellectualization - using reason and logic to avoid uncomfortable or anxiety-provoking emotions.|undoing - trying to 'undo' an unhealthy, destructive or otherwise threatening thought by some form of atonement."] [comment memo="III. (Maladaptive) Neurotic defenses:"] [checkbox value="withdraws - removing oneself from distressing stimuli.|repression - is unaware of unacceptable desires, thoughts, or experiences.|reaction formation - deals with inner conflict by behaving in diametric opposition to the denied thought, feelings, and behaviours.|displacement - shifts feelings about one person (or situation) to another, less threatening substitute object.|controlling - tries to excessively manage or regulate the external environment to avoid the underlying feeling of anxiety.|downward comparisons - looks to another individual or comparison group who are considered to be worse off in order to feel better"] [comment memo="IV. (Maladaptive) Minor narcissistic defenses:"] [checkbox value="avoidance - refuses to deal with or encounter unpleasant objects or situations.|devaluation - attributes themselves, an object, or another person as having exaggerated negative qualities.|minimization - denial coupled with rationalisation where complete denial is implausible.|idealization - perceives others as having more desirable qualities than is feasible.|omnipotence - treating another as an extension of oneself."] [comment memo="V. (Maladaptive) Disavowal defenses:"] [checkbox value="denial - refuses to acknowledge a painful truth that is readily apparent to others.|projection - falsely attributes feelings, impulses, or wishes onto others.|rationalization - deals with emotional conflict by developing elaborate reassuring but incorrect explanations for thoughts, feelings, and emotions.|autistic fantasy - tendency to retreat into fantasy in order to resolve inner and outer conflicts|hypochondria - uses the body to displace anxiety away from something even more anxiety-provoking."] [comment memo="VI. (regressive) Major image-distorting (borderline) defenses:"] [checkbox value="splitting - the inability to see an individual as having both positive and negative qualities.|passive-aggression - covertly resisting, resenting, procrastinating, forgetting, or undermining.|introjection - unconsciously emulating behaviors of someone else.|wishful thinking - making decisions according to what might be pleasing to imagine instead of reality.|primitive devaluation - seeing another as completely worthless, with no redeeming qualities whatever."] [comment memo="VII. (regressive) action defenses:"] [checkbox value="acting out - deals with inner emotional conflict through action such as 'bad behavior' or 'bad habit' rather than reflecting on feelings.|help-rejecting complaining - deals with stress by complaining but invariably rejects suggestions, advice, or help that others offer.|projective identification - falsely attributing unacceptable feelings to another and then acts in such a way as to confirm the projection.|dissociation - becoming separated or removed from one's experience.|regression - reverting to patterns of behaviour used earlier in development.|somatization - The transformation of uncomfortable feelings towards others into uncomfortable feelings toward oneself - pain, illness, and anxiety."] [comment memo="VIII. (regressive) Psychotic defenses:"] [checkbox value="psychotic denial - refusal to accept external reality because it is too threatening.|conversion - the expression of an intrapsychic conflict as a physical symptom.|Severe autistic withdrawal - retreating from the world and focusing inwardly.|distortion - a gross reshaping of perceived external reality in order to meet internal needs.|delusional projection - falsely attributing their own unacceptable feelings, impulses, fantasies or wishes onto another that bears no relationship to reality.|fragmentation - a person’s representations of self and others (and their connections) are fragmented in multiple ways, leading to an active and pervasive division of various aspects of the experience. It can be considered active disorganization, leading to a confused and disorganized narrative.|concretization - refers to the transformation of a mental representation into a concrete object, situation, or action. The choice of the concrete form into which a certain mental representation is transformed is not at all random but symbolically connected to its internal and abstract representation - e.g. you blame a chemical imbalance or look for a virus so you won’t think your problematic relationships make you upset"] PATHGENIC BELIEFS [checkbox name="variable_40" value="ABANDONMENT beliefs - significant others providing support are unstable, unreliable or unpredictable.|MISTRUST beliefs - The expectation that others will intentionally hurt, abuse, cheat, or take advantage.|DEPRIVED beliefs - Feels emotionally deprived such that the expectation that one's desire for a normal degree of emotional support is never adequately met by others.|DEFECTIVENESS beliefs - The belief that one is inherently flawed, defective, and unlovable.|ALIENATION beliefs - The feeling that one is fundamentally different from other people, isolated, and not part of a community.|INCOMPETENCE beliefs - The belief that one is dependent of others to handle everyday life.|VULNERABILITY beliefs - The fear that an imminent and unpreventable catastrophe will strike at any time.|ENMESHMENT beliefs - Extensive emotional involvement and closeness with significant others at the expense of full individuation.|INADEQUACY beliefs - Feels a deep sense of failing to achieve, will inevitably fail, or feels fundamentally inadequate relative to one's peers.|SUPERIORITY beliefs - The belief that one is superior and entitled to special rights and privileges.|SELF-CONTROL beliefs - Feels an inability or unwillingness to to exert self-control and tolerance of frustration to achieve one’s goals.|SUBJUGATION beliefs - The belief that one has to surrender control to others and to suppress one’s own needs and emotions.|SELF-SACRIFICE beliefs - An excessive focus on meeting the needs of others at the expense of one’s own needs and well-being.|APPROVAL-SEEKING beliefs - Feels the need to constantly seek-approval with an excessive emphasis on gaining approval, recognition, or attention from other people, or fitting in, at the expense of developing a secure and true sense of self.|NEGATIVITY beliefs - Feels chronically pessimistic, which creates a pervasive, focus on the negative aspects of life - pain, death, loss, disappointment, conflict, guilt, resentment, unsolved problems, potential mistakes, betrayal, things that could go wrong, etc.|INHIBITION beliefs - The belief that one must inhibit spontaneous feelings and actions.|HIGH STANDARDS beliefs - The belief that one must strive to meet high internalized standards.|PUNITIVE beliefs - Feels the need to be excessively punitive which underscores the belief that people should be harshly punished for making mistakes."] GLOBAL ASSESSMENT of FUNCTIONING Overall functioning rated out of 100: [checkbox name="variable_43" value="91 – 100 No symptoms. Superior functioning in a wide range of activities|81 – 90 Absent or minimal symptoms, good functioning in all areas|71 – 80 If symptoms are present, they are transient and expected reactions to psychosocial stressors.|61 – 70 Some mild symptoms, but generally functioning pretty well.|51 – 60 Moderate difficulty in everyday functioning.|41 – 50 Serious impairment in everyday functioning.|31 – 40 Some impairment in reality testing or communication and major impairment in several areas.|21 – 30 Behaviour is considerably influenced by poor reality testing; an inability to function in almost all areas of life.|11 – 20 Some danger of hurting self or others; occasionally fails to maintain minimal personal hygiene; gross impairment in communication.|1 – 10 Persistent danger of severely hurting self or others; persistent inability to maintain minimal personal hygiene or serious suicidal act with clear expectation of death.|0 Unable to rate"]. MALADAPTIVE COPING: [checkbox name="variable_55" value="Nothing of note|restrict calories|becomes over-assertive|feels the need to over-perform|avoids the situation|negatively ruminates|mentally replays unpleasant events|over-exercises|immerse in fantasy|negative self-talk|actively deny the problem|become increasingly passive and helpless|renounce all self-responsibility and blame others|focus completely on external factors|shut down all emotions|daydream|act out with defiance|yell and scream|threaten suicide|self-blame|act with passive-aggression|withdraw and become quiet|blame and justify|play the victim|act in a variety of compulsive ways|frantically seek reassurance|procrastinate|over-eat|binge eat|shoplift|overspend|act promiscuously|abuse substances|abuse alcohol|self-harm"] COGNITIVE DISTORTIONS: [checkbox name="variable_51" value="Nothing of note|filtering (selective attending)|polarization (splitting / all-or-nothing / black-and-white thinking)|over-generalization (concluding from one example)|discounting the positive (devaluing positive events)|jumping to conclusions (assuming things without evidence)|catastrophizing (always expecting the worst)|personalization (taking everything personally)|control fallacies (assuming one exerts too much or too little control)|fallacy of fairness (assuming the world should be fair)|blaming (others are responsible for how one feels)|shoulds (ironclad rules applied to oneself or others)|emotional reasoning (assuming the way one feels makes it a fact)|fallacy of change (expecting others to change if they would only apply more effort)|global labeling (using one concept to describe a complex system)|always being right (viewing ones opinions as facts)"]. ACADEMIC CONCERNS: [checkbox name="acaperf" value="nil|is failing tests and assignments|struggles to keep up with peers|feels that the classes are too difficult|extracurricular activities are interfering with academic performance|lacks order and system in study|is disorganized and careless|is rarely or never prepared|does not seek help when appropriate|copies from peers|engages in cheating or plagiarism|has poor attendance|has a poor relationship with academic staff|just doesn't enjoy school"] SOCIAL CONCERNS: [checkbox name="sofac" value="nil|is a loner|relates poorly to others|struggles to set boundaries and be assertive|is becoming more isolative|does not fit in|feels excluded by others|is easily influenced and highly suggestible|engages in risky activities with peers|verbally criticizes peers|verbally criticizes caregivers|is over-assertive with others|does not participate in group activities|interacts inappropriately with peers|is sexually inappropriate with peers|refuses to complete work assignments|does not follow rules and procedures|is socially disruptive|engages in attention seeking behaviours|is overly demanding of attention from others|has frequent tantrums in groups|frequently acts the clown|plays pranks on others|is overly dependent on others|timid/shy/dependent/anxiety-prone|is not accepted by others|does not sustain friendships|is an object of scorn/ridicule|is scapegoated/picked on|accedes to the needs of others|lives socially isolated"] CONDUCT CONCERNS: [checkbox name="conduct" value="nil|is verbally aggressive|frequently interrupts|is controlling of others|frequently starts fights|does not respect rights and property of others|purposely agitates/disturbs/disrupts others|is pushy and over-assertive|bullies and intimidates|frequently teases|attempts to manipulate|is overactive|is frequently inappropriate|cannot sit still and is generally restless|has numerous disciplinary offenses|is malicious|is cold and calculating|lacks empathy and warmth|is cruel and punitive|has little respect for authority|is generally considered a troublemaker|is aggressive and generally violent|is destructive of own/others property|hits caregivers|is antagonistic|is frequently disobedient|is negativistic|is oppositional|is argumentative|talks back/mouthy|is defiant of authority|refuses to help with chores|feels above the law|complies only when threatened|is needlessly stubborn|is immature relative to peers|demonstrates poor judgment|does not take responsibility for mistakes|does not own their behavior or consequences|demonstrates selective mutism|is prejudiced|is bigoted|insults others|vandalizes|engages in hate crimes|disobeys any authority|dares and provokes others|acts out|uses obscenities|has temper tantrums|falls to floor and tantrums|bangs head|has breath holding episodes|throws objects|screams|weeps|is generally destructive"] COGNITIVE CONCERNS: [checkbox name="cogfac" value="nil|highly distractible|vague reporting style|hyperactive|inattentive|handles novel situations poorly|lacks foresight|low frustration tolerance|easily confused|unable to understand tasks|frequently daydreams|poor concentration|averse to change|excessively concrete|inflexible and rigid thinking style|has unusual and extreme beliefs|appears intellectually delayed|is often confused|frequently forgetful|unable to accept guidance|speech and language expression|speech and language comprehension|poorly understands instructions|declining cognitive performance"] MOTIVATION CONCERNS: [checkbox name="motdif" value="nil|does not try hard with difficult tasks|generally makes little effort|is content to coast along|has the ability to do better work but lacks interest|generally shows no interest in the subject matter|always needs great encouragement to complete work|gives up at first sign of difficulty|has low frustration tolerance|always seems preoccupied|is slow to respond|does not complete work assignments|does not make up for lost time|turns in assignments late|is careless with work|does not spend enough time on important tasks|is known for frequent absenteeism|is always tardy|cuts classes|avoids work|is frequently truant|avoids school|refuses to attend school|refuses to attend work"] BEHAVIOURAL CONCERNS: [checkbox name="becon" value="nil|engages in alcohol/drug/substance abuse| encopresis|enuresis|fire setting|hypochondriasis|malingering|absconds|frequently overactive and restless|engages in self injurious behaviour|hits others|bites others|engages in head banging|sexual preoccupations|engages in public masturbation|demonstrates inappropriate sexual behaviours|frequently obscene|swears|makes sexualized gestures and remarks|exhibits genitals/disrobes/public nudity|wears provocative clothing for attention|demonstrates molestation concerns|threatens others when needs are not met|inappropriately touches others|fondles/rubs against others|engages in battery|has forced sexual intercourse|assaultative|has sexually assaulted|threatens others|purposely slow moving|purposely slow to respond|hypoactive|restless|excessively fidgets|constantly out of seat|impulsive|hyperactive/overactive|thumb sucking|rocking|stereotyped movements|tics|noise or word productions|violence/aggression|struggles to regulate"] AFFECTIVE CONCERNS: [checkbox name="afcon" value="nil|nothing of note|anxiety|depression|anxiety and depression|emotional shut down|fears|phobias|nervous habits|avoidance of particular certain things/actions/situations|anger|irritability|outbursts/rage/tantrums/meltdowns|tearfulness|sulking|whines|complains of hurt feelings|has chronic low moods|always feels flat|joyless and anhedonic|sad|unhappy|grief stricken|cries and is tearful|feels hurt by others|easy fatigued|apathic|feels ashamed|feels guilty|feels suicidal|has a limited range of emotions|expresses only high-intensity feelings|emotionally overactive|histrionic|dramatizes|plays the victim|complains of general distress|always worrying|complains of global distress|complains of loneliness|has performance anxiety"] SELF-ESTEEM CONCERNS: [checkbox name="Seles" value="nil|nothing of note|poor self-concept|low self worth|identity diffusion|sexual identity concerns|poor self-efficacy|sexual orientation concerns|adoption concerns|feelings of abandonment|poor sense of belonging"] RELATIONSHIP CONCERNS: [checkbox name="Relcon" value="nil|nothing of note|marital difficulties|friendship problems|fears over impending breakup|emotional distress after a recent breakup|social group difficulties|lack of interpersonal effectiveness|poor boundaries and lack of assertiveness|poor social supports|family problems|lack of interpersonal coping|unable to make and maintain close friendships"] LIFE TRANSITION CONCERNS: [checkbox name="Lifetran" value="nil|nothing of note|is unable to make life decisions|is experiencing academic / graduation delays|has retirement anxiety|unable to accept stage of life|moving house anxiety|difficulty with stage of life tasks|leaving home anxiety|leaving high school|poor life satisfaction"] PHYSIOLOGICAL CONCERNS: [checkbox name="Physcom" value="nil|has eating difficulties|has starvation syndrome and associated medical problems|has struggles with obesity and associated medical problems|medical problem|has a bad injury|has a range of physical problems|mobility problems|dying|poor health prognosis|poor mobility"] SUBSTANCE CONCERNS: [checkbox name="Subab" value="nil|alcohol overuse|substance abuse|substance dependence|spending all available money on addictions|feeling impaired by addiction"] SELF-MANAGEMENT CONCERNS: [checkbox name="Selman" value="nil|nothing of note|compulsive behaviours|has an uncontrolled behaviour|phobias|obsessions|thought problems|feels ashamed of normal sexual functioning|uncontrolled feelings|overt behaviour|unaware of social behavior|has a lack of leisure time|has a lack of leisure activities|is perfectionistic and procrastinates|specific performance problems|poor coping skills|struggles to make friends|has social anxiety|has cognitive difficulties"] TRAUMA CONCERNS: [checkbox name="Trau" value="nil reported|childhood abuse|a disturbing event|ACE|CSA|war|armed conflict|refugee|victim of crime|serious injury|harshly attacked|an unexpected death|an unexpected loss"] PSYCHOSOCIAL CONCERNS: [checkbox name="Psychst" value="nil|poverty|homeless|oppression by others|cultural dislocation|harassment|unemployment|loss of peer group|divorce|separation|job stress|bullying"] ACHIEVEMENT CONCERNS: [checkbox name="Ach" value="nil|career|life decisions|academic underachievement|life tasks are unfulfilled|has poor life satisfaction|specific performance problems"] VAGUE CONCERNS: [checkbox name="Indef" value="nil|has issues which need to be further explored|wants to talk about a troubled past|has a variety of pressing concerns|everything seems to be going wrong at this time|has been avoiding problems for years but they're catching up|not sure, but wants to find out what is bothering them|has general life stress|needs to get back into a regular therapy arrangement|want to talk with someone on a regular basis|need someone to talk with about subjects on my mind|seeking psychological support"] QUALITY OF LIFE CONCERNS: [checkbox name="Qual" value="nil|want to improve the quality of life|wishes to be happier|wanting to see life in new ways"] RECOVERY PROGRESS: [comment memo="How does the Pt rate their progress since referral"] [checkbox name="variable_61" value="feeling no change|feeling a bit worse|feeling a lot worse|feeling a bit better|feeling a lot better"] STAGE OF CHANGE: [comment memo="What is their stage of change?"] [checkbox name="variable_58" value="no awareness of the problem|pre-contemplation (is becoming aware of the problem)|is contemplating change (is aware of the problem, but struggling with ambivilence)|is preparing to change|is taking action to change|is maintaining positive changes"] PERSONALITY ORGANISATION: [comment memo="Describe their personality organisation?"] [checkbox name="variable_59" value="stable neurotic (can look at personal shortcomings without too much distress)|unstable neurotic (needs a lot of support to address personal shortcomings because it leads to emotional distress)|stable pre-psychotic (cannot look at personal shortcomings without splitting and polarizing)|unstable pre-psychotic (uses childish / regressive defenses to maintain stability)|stable psychotic (is deluded and unrealistic but not distressed)|unstable psychotic (feels constant anhilation anxiety and has lost touch with reality)"] PTS RECOVERY GOAL: [comment memo="What is the therapy goal?"] [checkbox name="variable_44" value="Nil|enhance mood|reduce psychotic Sx|learn relaxation skills|learn mindfulness|meta-cognition skills|develop greater insight|decrease eating|increase eating|decrease ETOH|have more fun|endure withdrawal of substances|enhance distress tolerance skills|boost hope|reduce symptom severity|improve sleep|enhance a sense of self-efficacy|reduce pain|increase knowledge|increase assertiveness|motivate medical treatment|enhance problem-solving|increase resilience|address distorted cognitions and beliefs|treat medical concerns|improve medication adherence and compliance|enhance self-agency|strengthen coping skills"] RECOVERY PROGRESS: [comment memo="What is the rate of progress?"] [checkbox name="variable_45 value="excellent|good|fair|poor|negligible"] FACTORS IMPACTING ON RECOVERY: [comment memo="What factors are impacting on recovery?"] [checkbox name="variable_46" value="nil|unmotivated|poor education background|work stress|housing problems|over-burdening debt|economic disadvantage|not very psychologically minded|lacks meta-cognitions|poor insight|difficult social environment|financial stress|over-identifies with sick role|ongoing legal problems|background of childhood adversity|history of victimization|unemployed|problems related to upbringing|chronic medical problems|pregnancy|religious beliefs|discord with family|discord with most people|extreme beliefs|personality instability|significant lifecycle transition difficulties|substance misuse concerns|low self-efficacy|sexual difficulties|medication adherence and compliance|rigid psychological defenses|relationship problems|feelings of hopelessness|is unaware of problem|denies the problem|secondary gains from the sick role|no motivation to change"] NEURO-VEGETATIVE CONCERNS REPORTED: [checkbox value="nil reported|poor sleep|low energy|high energy levels|poor appetite|over-appetite|poor concentration"] -- OBSERVATION -- -- Appearance and Self-Care -- Pt was [select value="an average height|a small build|a tall build"] [select value="male|female"] [select value="child|adolescent|young adult|adult|older adult"] who looked [select value="average weight|mildly overweight|overweight|obese|mildly underweight|underweight|severely underweight"] for their height. Pt has [select value="fair|tanned|weathered|dark|olive|Mediterranean"] skin with [checkbox value="black|brown|blonde|silver|greying|colourfully dyed|no|red|reddish|platted|straight|frizzy|curly|short|long|shoulder length|tied back|loose|uncombed|unstyled|neatly styled|messy"] hair. Pt wore [checkbox value="neat|clean|casual|tradie|formal business|expensive casual|inappropriate|meticulously|disheveled|dirty|unwashed|bizarre|stylish|quirky|conservative"] styled clothing. Overall, the Pt's grooming was [select value="unremarkable|meticulous|neglected|bizarre"] with [select value="no|minimal|inappropriate for age|excessive"] cosmetics. Their posture was [select value="relaxed|tense|rigid|stooped|slumped|bizarre"] with [select value="unremarkable|slowed|repetitive|restless|agitated|tremulous"] motor activity. Other noticeable aspects: [textarea name="field_name" default="Nil"] -- Sensorium -- Attention: [select value="Unremarkable|Seemed completely unaware|Inattentive|Distractible|Vigilant|Seemed preoccupied with other matters"] Concentration: [select value="Normal|Scattered|Variable|Preoccupied|Confused|Grossly internalised|Focused on irrelevancies"] Orientation Impairment: [checkbox name="Orientation" value="Nil|Time|Person|Place|Situation|Object"] Memory Impairment: [checkbox name="MemImp" value="Nil|Working memory|Short term|Recent|Remote|Particular events|Confabulates|Amnesiac"] -- Relating -- Eye contact: [select value="Normal|Fleeting|Avoidant|angry glaring|None|Staring"] Facial expression: [select value="Responsive|Constricted|Tense|Anxious|Sad|Depressed|Angry|Blank"] Attitude toward author: [select value="Cooperative|Dependent|Dramatic|Passive|Uninterested|Silly|Resistant|Critical|Hostile|Sarcastic|Irritable|Threatening|Suspicious|Guarded|Defensive|Manipulative|Argumentative"] -- Affect and Mood -- Affect: [select value="Appropriate|Labile|Restricted|Blunted|Flat"] Mood: [select value="Euthymic|Anxious|Angry|Apathy|Ashamed|Prideful|Sad|Irritable|Hostile|Pessimistic|Depressed|Hypomanic|Euphoric"] -- [text name="field_name" default="other"] Mood rated out of 10: [select value="Not rated|1|2|3|4|5|6|7|8|9|10"] -- Thought and Language -- Speech flow: [select value="Normal/Unremarkable|Mute|Loud|Blocked|Laconic|Pressured|Flight of ideas|Uninteruptable"] Thought content: [select value="Congruent with mood and circumstances|Incongruent Congruent with mood and circumstances|Personalizations|Persecutions|Indecisions|Suspicions|Delusions|Ideas of reference|Ideas of influence|Illusions"] Thought organisation: [select value="logical and goal directed|Circumstantial|Tangential|Loose associations|Flight of ideas|Neologisms|Blocking|Obsessive"] Preoccupations: [select value="Nil|Phobias|Somatic|Suicide|Homicidal|Guilt|Religion"] - Other: [text name="field_name" default="Nil"] Hallucinations: [select value="Nil|Auditory|Visual"] Hallucination content: [text name="HalCon" default="N/A"] -- Executive Functions -- Fund of knowledge: [select value="Unable to rate|Average|Above average|Impoverished"] Intellectual functioning: [select value="Average|Below average|Above average|Needs further assessment"] Abstraction: [select value="Normal|Concrete|Functional|Popular|Abstract|Overly abstract"] Judgment: [select value="Sound|Fair|Poor|Dangerous"] Reality testing: [select value="Realistic|Adequate|Distorted|Variable|Unaware"] Insight: [select value="Easily makes connections|Partial|Occasional|Completely unaware of the problem|In denial"] Decision making: [select value="Realistic|Simplstic|Impulsive|Vacillates|Confused|Paralyzed|Highly ambivalent"] -- Current Stressors -- Stressors reported: [checkbox name="Stressors" value="Money|Housing|Family conflict|Work|Grief and loss|Illness|Transitions|Legal difficulties|Peer group|Relationship"] Coping ability: [select value="Normal|Resilient|Exhausted|Overwhelmed|Deficient supports"] Skill deficits: [checkbox name="SkillDefs" value="None|Education|Communication|Interpersonal|Decision making|Self control|Responsibility|Self care|Activities of daily living"] Supports: [checkbox name="Supports" value="Self|Family|Friends|Parole officer|Church|NGO|GP"] Other: [text default="nil"] Supports needed: [textarea default="No other supports needs at this time"] -- Social Functioning -- Social maturity: [select value="Responsible|Irresponsible|Self-centered|Childish|Immature|Impulsive|Isolates"] Social judgment: [select value="Normal|Street smart|Naive|Heedless|Playing the victim|Improper"] -- Other Aspects of Mental Status -- [textarea default="Nothing to report"] PSYCHIATRIC MEDICATION (patient report): [checkbox value="I haven't been prescribed any medication|I don't want to take it|I'm thinking about it|feels like the dose is too high|feels like the dose is too low|is working as intended|needs to be reviewed with the Dr|is not being taken as suggested|is not working as intended|is having unpleasant side effects|will need a repeat script"] PERSONALITY FEATURES [checkbox name="DPD" value="DEPENDENT PERSONALITY FEATURES"][conditional field="DPD" condition="(DPD).is('DEPENDENT PERSONALITY FEATURES')"] Pt presents with Dependent Personality Characterology - excessive attachment needs | reassurance seeking when alone | contentment when submerged in a group | emotionally stable in a relationship | easily idealizing | a lack of reference to internal standards | over-reliance on external standards. Themes articulated by the Pt:[/conditional] [checkbox value="emotional weakness|ineptitude|reassurance seeking|others are in charge|I cant cope by myself|I feel better when attached to someone|abandonment phobic|relationship seeking|inoffensive|subservience|isolation phobic|intimacy seeking|autonomy phobic|deferential|expressing helplessness|advice seeking|acopic|content to follow instructions"] [comment memo="Fretful| Abandonment concerns | Institutionalized"] [checkbox name="DPDAF" value="Dependent Personality with Avoidant Features"][conditional field="DPDAF" condition="(DPDAF).is('Dependent Personality with Avoidant Features')"] The Pts disquieted characterology suggests an dependent personality with avoidant features, which includes - fretfulness, restlessness, a feeling of dread, aprehensivly worried about abandonment, chronic lonliness unless near support figures. Pts like this tend to gravitate to institutional settings that minister to chronic ambulatory patients. Others tend to regard their neediness as parasitic as their very existence appears to be sustained by institutional rewards and requirements. Whereas all dependents are submissive and self-effacing, relying on others for guidance and security, meeting external standards, disquieted dependents possess an underlying apprehensiveness that overlies a lack of initiative and an anxious avoidance of autonomy. This manifests psychologically as a general sense of dread and foreboding. It is as if they are worried all external supports could evaporate in an instantly, or attachment figures might abandon them without notice, for no reason. They are particularly vulnerable to separation anxiety and greatly fear loss of support and nurturance. Fearing this, the Pt can have brief outbursts of intense anger when the bonds of external support are perceived to be loosening. Individuals with this characterology, therefore, tend to gravitate towards institutions with where that need for reassurance and external support is granted unconditionally. The avoidant features in the personality architecture create the unsettling feeling of desperately needing others, yet chronically unable to feel close enough, creating lonliness even when others are present. Although such Pt generally attempts to be pleasant and agreeable, he experiences underlying tension, sadness, and guilt. On the surface, he appears quiet and affable in the face of difficulties, but underneath he is likely overwhelmed by fears of abandonment and isolation. Complaints of weakness and tiredness are typical somatic forms of an underlying depression. This means simple responsibilities demand more energy than can be mustered. Life is seen as empty but heavy.[/conditional] [comment memo="Extreme merging | Lack of identity | Self sacrificing"] [checkbox name="DPDMF" value="Dependent Personality with Melancholic Features"][conditional field="DPDMF" condition="(DPDMF).is('Dependent Personality with Melancholic Features')"] The Pts selfless characterology suggests a dependent personality with melancholic features, which includes - a tendency to merge and simbiocally fuse with attachment figures, surrunder one's identity, and become an extenstion of others. For the Pt, idealization and total identification are the major themes. Like all dependents, Pt has a preference to subordinate himself to others but in a much more extreme fashion. Pt is willing to merge himself with others, forfeiting his own identity in the process. His own unique personal potentials are denied and left to atrophy as the residuals of an unwanted independence. Through fusion, he secures a sense of significance, emotional stability, and purpose in life. Eventually, everything he does is performed in the service of extending the status and significance of another, be it a person or an institutional entity. In extreme cases, the Pt is completely defined through his relationships, existing as an extension of his significant other, with no sense of himself as an independent being at all. Because of this fusion, he may adopt values and attitudes that are different from his ordinary preferences. Sometimes, he seems confident and self-assured but only by assuming for himself the qualities of the persons or institutions with whom he has identified. Despite the loss of his own identity, Pt does seem fulfilled by his self- sacrificing lifestyle. Whereas all dependents are submissive to a degree, adopting the values and beliefs of more powerful others to whom they attach themselves, the very essence of the selfless dependent rests on those to whom they sacrifice themselves. In other words, the more he fuses with his idealized other, the more he becomes emotionally attached and the more they feel themselves to have significance in the world. Stereotyped examples include the overbearing stage mother who lives through her successful child and the wife who submerges herself totally in the life and career of her husband. Although most selfless dependents feel vitalized and valuable through their relationships, some eventually wonder whether they have lost too much of themselves. By deriving identity through external sources, they make themselves extremely vulnerable to loss. When relationships run into difficulties, selfless dependents, more than other people, experience episodes of anxiety and depression, which fluctuate in intensity depending on the quality of the attachment. All dependents are devastated when relationships end, but selfless dependents are almost completely destroyed, having essentially been voided of themselves. Sometimes, the anticipation of loss is sufficient to leave them with a chronic hopelessness, a characteristic of the depressive personality.[/conditional] [comment memo="Childlike| Gullible | Passive"] [checkbox name="DPDEmF" value="Dependent Personality with Embryonic Features"][conditional field="DPDEmF" condition="(DPDEmF).is('Dependent Personality with Embryonic Features')"] Pts immature characterology suggests a dependent personality with embryonic features - unsophisticated, childlike, inexperienced, gullible and incapable of undertaking adult responsibilities. Pt is overly passive and easygoing and simply never developed competencies or confidence in his own abilities. Pt lacks a strong gender identity and to find the assumption of adult roles to be somewhat distasteful or frightening. For the most part, the Pt is pleasant and sociable as long as he is permitted to remain pre-adult in their preferences and activities. Pt tends to become difficult, however, when others begin to expect more or demand that he matures and get down to the business of life. To his troubled parents or spouse, he often seems irresponsible and neglectful. I note his failure to develop the abilities necessary to survive on his own leaves him completely incapable of maturing to an adult level.[/conditional] [comment memo="Compliant | Neighbourly | Denies negativity"] [checkbox name="DPDMaF" value="Dependent Personality with Masochistic Features"][conditional field="DPDMaF" condition="(DPDMaF).is('Dependent Personality with Masochistic Features')"] The Pts accomodating characterology suggests an dependent personality with masochistic features, which includes - being gracious, neighbourly, eager, benevolent, compliant, obliging agreeable, denying of negativity, and happy to adopt the inferior role. Pt presents as particularly submissive, agreeable, hungry for affection, nurturance, and security than other dependent typologies. Fears of abandonment leads him to be overly compliant and obliging. Can be socially gregarious and charming and seek to become the center of attention through self-dramatizing behaviors at times. This could suggest an appeasing histrionic flavour. By submerging or allying himself with the abilities and virtues of others, he bolsters himself through an illusion of shared competence and is comforted by the belief that the bond achieved thereby is firm and unbreakable. There is evidence of a naive attitude toward lifes problems. He maintains an air of pleasantry and good spirits, he denies disturbing emotions and covers inner conflicts with selfdistraction. Critical thinking is not his strong point. Having had others do for them most of his life, most areas of knowledge are underdeveloped and immature. Pts characterology is notable for a strong tendency towards self sacrifice and readily adopting the role of inferior or subordinate. He is sympathetic toward the needs of his attachment figures, who almost always feel stronger and more competent as a result. He avoids self-assertion and leave responsibilities in the hands of others. The primary character goal is that others like them, are pleased by him, and are willing to accept his smiles and goodwill as sufficient. Pts agreeableness is instrumental to encourage others to take control, thereby compensating for his feelings of incompetence. Although he always has a smile and a friendly word, he rarely follows through on adult responsibilities. In fact, he usually feels helpless whenever autonomy or initiative is required. The loss of a significant source of support or identification may prompt severe depression. Open displays of guilt, illness, anxiety, and depression are common but serve the purpose of deflecting criticism and transforming threats disapproval or abandonment into support and sympathy.[/conditional] [comment memo="Gainless | Wants to be untroubled | Unproductive"] [checkbox name="DPDScF" value="Dependent Personality with Schizoid Features"][conditional field="DPDScF" condition="(DPDScF).is('Dependent Personality with Schizoid Features')"] The Pts ineffectual characterology suggests an dependent personality with schizoid features, which includes: being unproductive, gainless. Seeking an untroubled life, refusing to deal with difficulties, and untroubled by personal shortcomings. Pt presents with a combination of the dependent and schizoid patterns - a general lack of vitality, low energy level, fatigability, and weakness in expressiveness and spontaneity. An anhedonic temperament, meaning that he is are unable to experience pleasurable emotions in great depth. Moreover, there is a tendency to shun social relationships, including being part of a family, and almost always choose solitary activities. The Pt, unlike the 'pure' schizoid, is more able to empathize and understand the basic emotions of others. There are some ineffectual features, seeking an untroubled life completely free of responsibility, though mainly because of a lack of drive rather than a childish nature. Through his schizoid characteristics, Pt often simply tune out lifes demands. Not wanting to deal with reality, he often appears to sleepwalk through life, half disengaged and half dependent. Pt typically does not want to engage in anything or think too deeply, so they often exhibit a certain fatalism that allows him to ignore difficulties. Pt likely has strong beliefs that nothing ever changes on the basis of human efforts, and he has neither the drive nor the desire to act on his own behalf.[/conditional] [checkbox name="HPD" value="HISTRIONIC PERSONALITY FEATURES"][conditional field="HPD" condition="(HPD).is('HISTRIONIC PERSONALITY FEATURES')"] Pt presents with Histrionic Personality Characterology - Approval seeking | Indentity dysphoria | Drawn to the latest fad | Flamboyant | Easily bored - sensation seeking | Lives as if in a movie | Sexualizes everything | Chronically flirting | Changes to suit love-object | Emotionally superficial | Easily abandons love object | Easily infatuated | Facinated by authority | Prone to pseudologic phantastica | Exciteable | Sexually provocative | Interpersonally demanding | Sexual identity concerns | Prone to unrealistic romanticism | Likes holding centre stage | Accentuates sexual characteristics | Childlike sulking | Aimless | Values relationships over status | Separation anxiety | Low frustration tolerance | Suicidal gestures when rejected. Themes articulated by the Pt:[/conditional] [checkbox value="Im interesting and exciting|Conveys intrigue|Engagement focussed|Attentioning gaining|I need to entertain|If I don't keep others engaged, they won't like me|I need to dazzle|I need to amuse or seduce|You need to enjoy my company|It cant stand being ignored|I should be the center of attention|Gut feelings are more important|I cannot tolerate boredom|I act first and think about it later"] [comment memo="Placating | Compromising | Refereeing | Self sacrificing"] [checkbox name="HPDDSF" value="Histrionic Personality with Compulsive Features"][conditional field="HPDDSF" condition="(HPDDSF).is('Histrionic Personality with Compulsive Features')"] The Pts appeasing characterology suggests an histrionic personality with dependent and compulsive features, which includes - placating behaviours, moderating tendencies, compromising, refereeing, conceding, self-sacrifice. It seems that approval is his one mission in life - You must like me, you must become my friend. To achieve this goal, he continually compliments, praises, flatters, commends, and make you feel that they would do anything for you - You are so ingenious. You have done a perfect job. You look so beautiful. How can I help you. Whenever he senses indifference, he immediately steps up his activities, positioning his appraisal back toward the positive. In effect, he presents the image of absolute goodwill, someone for whom appreciation becomes a moral imperative. When disagreements do occur, he immediately begins smoothing things over, even when he must sacrifice ground, compromise their own desires, or concede important points. Rather than retaliate against those who cannot be placated, he chooses simply to suffer injuries, painting himself as an innocent victims caught in a cruel world; a martyr who suffer the slings and arrows of outrageous fortune, ever deserving of sympathy and pity. The implication of such a conciliatory lifestyle is the compensation for a substantial void. Beneath his friendly smiles lies the emptiness of the histrionic, the guilt of the compulsive, and the inferiority and helplessness of the dependent. Most feel that they are problem persons who are unloved and inadequate. As such, he becomes a superpleaser, ever alert to any subtle means whereby appreciation and approval might be secured. More developmentally advanced than the basic histrionic, these individuals have internalized condemning parental voices that rain down from on high with criticism and admonishment. Whereas compulsives hyper-conform, these individuals appease their tormentors, conscientiously anticipate their needs, and offer only goodwill and kind gestures in return for anger and hostility. Essentially, they become so nice and good and sweet they could make even a sadistic superego feel guilty.[/conditional] [comment memo="Viviacious | Charming | Bubbly | Flippant | Energetic | Ebullient"] [checkbox name="HPDNF" value="Histrionic Personality with Narcissistic Features"][conditional field="HPDNF" condition="(HPDNF).is('Histrionic Personality with Narcissistic Features')"] The Pts vivacious characterology suggests an histrionic personality with narcissistic features, which includes: vigour, charm, bubbly and brisk manner, spirited, flippant, impulsive, seeks momentary cheerfulness and playful adventures, animated, energetic and ebullient. Pt synthesizes the seductiveness of the histrionic with the energy level typical of hypomania. The result radiates attractiveness, charm, playfulness, verve, and intensity. More than just bubbly or perky, vivacious histrionics are interpersonally cheerful, optimistic, spontaneous, and impulsively expressionistic, often without regard to future consequences. Driven by a need for excitement and stimulation, many are easily infatuated, attaching themselves to one person after another in quick succession. Behaviorally, their movements are quick and animated. They both enter and leave with a flourish. Even though they are only superficial thinkers, their ideas often flow so quickly and easily that others become infected by their excitement. Those who are more normal race around, get things done, start projects, and persuade others to join them with an energy and friendliness that make for a natural salesperson. Others, however, pursue momentary whims without completing much of anything—leaving broken promises, empty wallets, and distraught associates. Not surprisingly, many vivacious histrionics also possess narcissistic traits.[/conditional] [comment memo="Impulsive | Moody | Complaining | Stormy | Turbulent | Impassioned"] [checkbox name="HPDNeF" value="Histrionic Personality with Negativistic Features"][conditional field="HPDNeF" condition="(HPDNeF).is('Histrionic Personality with Negativistic Features')"] The Pts tempetuous characterology suggests an histrionic personality with negativistic features, which includes - impulsivity, moodiness, complaining, sulking, precipitous emotion, stormy, impassioned, periodically inflamed and interpersonal turbulence. The tempestuous variant combines features of the histrionic and negativistic personality. Such individuals are best described as intensely moody and emotionally variable. During better periods, they enact mainly histrionic features, presenting an attractive front, being superficially friendly and sociable, engaging others in conversation, and adding their own free emotional expression in return. Like the theatrical histrionic, they are easily bored, overly dramatic, hyperreactive to external stimulation, and impulsively sensation-seeking. When combined with borderline features, the result is emotional overdrive. Like the borderline, tempestuous histrionics are hypersensitive to criticism, intolerant of frustration, and socially immature—characteristics that almost ensure that the good times won’t last. Most alternate between periods of extreme emotional excitement and impulsive acting-out, followed by fits of anger that transition to depressive-like symptoms of fatigue and sleep and eating pattern changes. Whereas normal persons develop a strong sense of self-identity that wraps and conceals basic drives and moderates emotions, tempestuous histrionics are not only more thinly veneered than the basic histrionic pattern but also somewhat fragmented like the borderline. Consequently, they are much more vulnerable to unmoderated displays of raw and rapidly changing emotions. When tweaked, they lose control, reacting with storm and turbulence to even minor provocations. Deprived of attention, they may search frantically for approval, becoming contentious, dejected, or hopeless when it is not readily forthcoming. Over time, these individuals may become less and less histrionic and more and more disgruntled and critical of others, begrudging others’ good fortune. They may also develop preoccupations with body functioning and health, and dramatically exhibit their illnesses or complain endlessly about ailments to recapture lost attention and support.[/conditional] [comment memo="Underhanded | Scheming | Contriving | Plotting | Egocentric | Guileful"] [checkbox name="HPDASF" value="Histrionic Personality with Antisocial Features"][conditional field="HPDASF" condition="(HPDASF).is('Histrionic Personality with Antisocial Features')"] The Pts disingenuous characterology suggests an histrionic personality with antisocial features, which includes - underhandedness, double dealing, scheming, contriving, plotting, craftiness, false heartedness, egocentricity, insincereity, deceipt, calculating and guileful The disingenuous subtype synthesizes histrionic and antisocial features. A somewhat different picture is created, depending on the relative influence of histrionic and antisocial traits. In the beginning, they make a good first impression and seem sociable and sincere, exhibiting such spontaneity and charm that others quickly lower their defenses. The combination of histrionic and antisocial features, however, makes the disingenuous subtype more manipulative than the basic histrionic pattern and for ends other than simple attention and approval. For some, their histrionic traits serve simply as a convenient method of making contacts and opening doors but overlay and temporarily conceal characteristics fundamental to the antisocial, including a willingness to violate social conventions, break promises and shatter loyalties, behave irresponsibly, and sometimes erupt with anger and physical confrontation. For some, the antisocial influence stops here with traits attributable to simple delinquency. Others, however, combine histrionic and more psychopathic characteristics. These individuals synergize the histrionic’s more adaptive social skills, charm, and ability to read the motives and desires of others with a rather calculated malevolence. Obviously, this variant is more egocentric, more willingly insincere, and probably more conscious of their manipulations than is the basic histrionic pattern. They often seem to enjoy conflict, gaining a degree of gratification or amusement from the excitement and tension thereby produced. Because antisocials usually interpret kindness as weakness, their friendly histrionic traits sometimes make them afraid that others will come to view them in exactly that same way. If they sense this is true, they may avenge this wrong impression by becoming particularly predatory.[/conditional] [comment memo="Affectedness | Posturing | Eye-catching | Stimulate desire | Theatrical | Dramatizing"] [checkbox name="HPDT" value="Histrionic Personality"][conditional field="HPDT" condition="(HPDT).is('Histrionic Personality')"] The Pts theatrical characterology suggests a histrionic personality structure, which includes - affectedness, posturing and posing, being eye catching, concerned with self-appearance, stimulating desire, being overly theatrical and dramatizing. Especially dramatic, romantic, and attention seeking, the theatrical histrionic is the epitome of the basic histrionic pattern. Pt lives as if they are marketting themselves, and essentially live as commodities, marketing themselves as chameleons on social demand, and changing the characteristics they display depending on audience and circumstance. For them, nothing is intrinsic. Instead, the self is subordinated to the requirements of the social economy — transformed, synthesized, fabricated, and packaged to optimize their appeal to the given market niche. Style is not only valued over substance but also valued to the exclusion of substance. As a result, the theatrical histrionic exists largely without depth, as having inner identity limits potential maneuvering. Rather, reading the motives of others and reflecting back to them what is attractive, pleasing, and seductive is their prominent endeavor. Within the theatrical subtype lie several subvarieties. Among women, such histrionics personify the female gender by adorning themselves with bright, sexy clothes and jewelry. Some create a good composition and resemble fashion plates; others, however, look gaudy, accessorizing beyond all sensibility, as if level of attractiveness were directly proportional to the number of earrings and bracelets. Among men, theatrical histrionics include some bodybuilders and many pretty boys, who embody the male sex role by creating a look that suggests superpotency. Somewhat less obvious, but still within the theatrical subtype, are those who dramatically exhibit their intellectual achievements or financial success, perhaps through ostentatious displays of consumer goods. Whether male or female, theatrical histrionics are always mating, at least symbolically. Yvonne is probably not exaggerated enough to qualify for this subtype.[/conditional] [comment memo="Emotionally unstable | High strung | Volatile | Childish | Demanding | hot and cold"] [checkbox name="HPDBPF" value="Histrionic Personality with borderline features"][conditional field="HPDBPF" condition="(HPDBPF).is('Histrionic Personality with borderline features')"] The Pts borderline characterology suggests a histrionic personality structure with emotionally unstable features, which includes - lability, highly strung, volatility, clutching to others, childish hysteria, pouting, demanding, overly attached. Many histrionics possess strong dependency issues. By sexualizing relationships prematurely and pulling powerful others into their orbit, histrionics experience more indulgences and fewer frustrations. Therefore, they have no need to develop the solid sense of identity that begins its formation with what analysts call the reality principle, the realization that life is so intrinsically frustrating that some generalized psychic apparatus, the ego, will be required to deal with it. As such, the life of the histrionic continues to be dominated by a need to be the center of attention, by persistent sensation seeking, and by primitive regressions into fantasy, all of which serve the pleasure principle. In the more primitively organized borderline-histrionic, the expression of these characteristics is even more severe. Given their lack of identity formation, their attachment to significant others is highly dependent and demanding. Most constantly seek reassurance to maintain their stability and vacillate between overcompliance and profound depression when approval is not forthcoming. With no sense of self to buffer or modulate their basic drives, their emotions change quickly, easily, and unpredictably, running the gamut from intense love to intense rage to intense guilt, all of which may be expressed simultaneously. In more pleasant moments, they may behave with a childlike agreeableness or fascination but become sullen or pouty the next. Many complain that they are either unloved or treated unfairly, attitudes that quickly escalate into tantrums when anyone disagrees.[/conditional] [checkbox name="EPD" value="EBULLIENT PERSONALITY FEATURES -- The Counter Depressive Personality"][conditional field="EPD" condition="(EPD).is('EBULLIENT PERSONALITY FEATURES -- The Counter Depressive Personality')"] Pt presents with Ebullient Personality Characterology - Jolly | Exuberant | Scattered | Relentless energy | Intemperate | Truculent | Combative | Tempestuous | Frenetic | Driven | Exciteable | Tireless | Mercurial Themes articulated by the Pt:[/conditional] [checkbox value="flight of ideas|grand plans|fondness for merriment|enthusiasm for the latest thing|people-seeking|silliness|transient infatuations|momentary adventures|responsibility avoiding|hapazard approach to life|empowering ambitions|the universe has a plan|focusses on the positive|denies negativity|lewd jokes and provocative subjects|Melodramas with friends and family"] [comment memo="Clever | Charming | Flipant | Thrill seeking"] [checkbox name="EPHiF" value="Ebullient Personality with Histrionic Features"][conditional field="EPHiF" condition="(EPHiF).is('Ebullient Personality with Histrionic Features')"] In addition to the high level of energy and vigor that typifies ebullient personalities, they tend to be clever, charming, flippant, and capable of weaving fanciful images that intrigue and seduce the naive. Given these latter characteristics, it should not be surprising that these vivacious personalities may also exhibit a variety of confident personality traits. Driven by a need for excitement and stimulation, this energetic and driven vivacious amalgam will often act impulsively, be unable to delay gratification, and evidence a penchant for momentary excitements and fleeting adventures, with minimal regard for later consequences. These individuals are notably thrill-seeking, easily infatuated, and overly, but transiently, attached to one thing or person following another. We might describe these ebullients with the following adjectives: vigorous, bubbly, spirited, brisk, and impulsively expressive. They are restlessly energetic, of good cheer, seeking momentary playful and joyful adventures, without imposing constraints on where and when these are to be pursued. For the most part, vivacious persons tend to be overly upbeat, of a lively and spirited nature, disposed to live life to the fullest in a brisk and vigorous way. They are persons who are distinguished by the animated nature of their movements, by their ill disposition to sit still and relax for any period of time. They always seem to be on the go, gesticulate freely and in a highly expressive manner, enjoy their conversations, and produce their ideas in a quick tempo. They race their physical and psychic engines, Exhibiting vigor in their movements, as in all other aspects of their behaviors and thoughts. For the most part, they are quite cheerful, although inclined to be rather superficial in the topics they discuss. They move from one thing to another, often in a superficially joking manner. Most view things from an optimistic and cheerful perspective; serious and problematic matters tend to be overlooked. Although energized and informed by the presence and contributions of others, this personality is largely driven by his own ideas and beliefs. He is action-oriented and does not like to sit still. Quick to make decisions, he will likely stir things up when events move too slowly or get boring. Lively and fun-loving for the most part, he usually knows where the action can be found and likes to be in the middle of things. Vivacious personalities often lack social dependability, exhibiting a disdain for the effects of their behaviors, as they pursue one restless chase or satisfy one whim after another. There may be a capricious disregard for agreements hastily assumed, and a trail may be left of broken promises and contracts, squandered funds, distraught employers, and so on. Lacking inner substance and self-discipline, tempted by new and exciting stimuli, and skilled in attracting and cheerfully seducing others, such vivacious personalities may travel an erratic course of flagrant irresponsibility and leave in their wake the scattered debris of seductive and once promising hopes. [/conditional] [comment memo="Optimistic | Imaginative | Charismatic | Novel"] [checkbox name="EPAnF" value="Ebullient Personality with Antisocial Features"][conditional field="EPAnF" condition="(EPAnF).is('Ebullient Personality with Antisocial Features')"] Gaining his stimulation from others and having insight into their strengths and weaknesses, the innovative ebullient person is skillful in handling them, especially if his efforts are recognized. His optimism and goodwill are broad-ranging, particularly when applied in conjunction with his fertile imagination and creative impulses. Keenly stimulated to improvise novel ways of performing conventional tasks as well as possessing the spontaneity and energy to start (if not necessarily to complete) them, he takes special pleasure in tackling all challenges and is often quite versatile in meeting them. Full of ideas and rather confident of his own worth, he might be inclined to pursue any curiosity or future possibility. This inclination periodically results in somewhat impulsive decisions and actions. Stirred as well by his keen observational skills and alert scanning of his environment, he is easily stimulated, restless, and high-spirited. He could find himself surrounded by others who look to him for fellowship, guidance, and inspiration. Given his outgoing demeanor and forwardlooking perspective, he could gravitate to the center of a group to serve as its catalyst or as its leader. His charismatic qualities engender his success in leading others to overcome unexpected circumstances or to achieve goals innovatively, but he might not be quite as effective a leader in formal organizations, which limit spontaneity and innovation with their institutional rules and procedures, policies that could eventually test the limits of his patience. Further affecting his efficiency in formal group settings is the seemingly haphazard manner in which he organizes his affairs. Painstaking detail work and extended followthrough are anathema to him. Focusing on the immediate and shifting from one appealing task to the next produce a rather helterskelter quality to his work and relationships. Such an operative style is too desultory to be effective, given the typical structure of most organizations. On the other hand, his lively style might prove helpful in sales or marketing roles. As noted, he has a distinct aversion to routine, quickly becoming bored once he has met an inspiring initial challenge. It should be noted, however, that he is quite effective in the start-up phase of a project, enthusiastically proposing innovative solutions and often inspiring others to join in. Problematic here is that he might inundate himself with a multitude of ideas and solutions. With so many pointing in different directions, he could find it difficult to decide priorities, focus, and proceed. Consequently, his fertile imagination could, in some circumstances, become a hindrance and perhaps result in squandered energies, ill-chosen directions, or unexecuted tasks, as well as in disappointed followers and colleagues. For the most part, those with an innovative ebullient style exhibit an air of general imperturbability, appearing most often as selfpossessed and coolly unimpressionable yet buoyantly optimistic. Possessing a sense of high self-worth, the ebullient innovator acts in a confident and assured manner. Transcending the constraints of conventional thinking and tending toward the creative and imaginative, he possesses sufficient social talent and selfassurance to act quite boldly in advancing his aspirations. Adept in dealing with others, he can be quite persuasive in attracting them to causes he espouses. He also possesses an empowering ambition that drives him to be successful in all he endeavors. His belief that he is special is matched by his expectation that others will view him in a similar fashion and will consequently treat him well. Competitive and astute in his dealings with others, able to clearly visualize his future goals, and able to take full advantage of his strengths and talents, the respondent can effectively marshal these capabilities to achieve what he has set out to accomplish. Believing in himself, he is prepared to work hard for long periods to obtain what he believes he deserves. Willing at times to disregard conventional standards of social conduct and devising plausible reasons to justify behaviors that are lacking in sensitivity, he can sometimes deceive himself as much as those around him. Nonetheless, his boldness and ambition do often make good things happen, benefiting not only himself but also the lives of others. His style is to live in the moment and seek out life’s joys and pleasures, while still being pragmatically resourceful. This means that ideas and beliefs must have practical applications; they should be grounded in concrete phenomena, not in intuitive speculations, and hence should be appraised more or less objectively. Neither cognitively rigid nor formal, the person is open to alternative possibilities and is spontaneous in searching for or exploring new modes of thought. With his easy confidence and relaxed, albeit energetic, social style, he not only is unperturbed by whatever arises but is inclined to seek out a challenge or two. His behavior is marked by a degree of restlessness, and he never has enough time to work on all the projects he conceives. Frequently in center stage, caught up in a flurry of different activities, he will seem, and often may be, somewhat overwhelmed and disorganized, having taken on responsibility for too much at once. Despite this occasional problem, the respondent is a skillful manipulator of events and is endowed with the energy to enjoy life. Further, he keeps focused on results and enjoys negotiating crises by making tough but realistic assessments and efficient implementations. Preferring action to conversation, he has a crisp, matter-offact, and assertive style of problem-solving, moving forward directly and unhesitatingly, and expediting matters without delay. [/conditional] [comment memo="Cheerful | Bouyant | Pleasure Seeking | Entertaining | Bon vivant | Glib | Convivial"] [checkbox name="EPEF" value="Ebullient Personality with Euphoric Features"][conditional field="EPEF" condition="(EPEF).is('Ebullient Personality with Euphoric Features')"] The dominant characteristic of this subtype is their cheerfulness and buoyancy, their desire to enjoy life, to follow the ‘‘pleasure principle,’’ to experience events in a jovial manner, to be carefree and happy-go-lucky. If events and experiences are not immediately gratifying and mirthful, they are ready to pick up and move on to something else that may be. To be in the company of others who are similarly inclined or receptive to them dominates their aspirations. They are social entertainers. Nothing is more wonderful and exulting than to be in the company of people open to their cheerful glibness. They race from one person to another, constantly seeking a jubilant and gleeful response to their entreaties. Social conviviality is their goal. Most cannot be public performers or comedians, of course, but the euphoric exuberant will attempt in his small personal world to engage in clever chit-chat, jokes, shocking commentaries, and outrageous humor. Blithe and frivolous, these entertaining personalities keep their attention focused on the superficial and cheerful aspects of life. Unfortunately, in the rush to maintain a euphoric and animated life, they rarely become fully accomplished in any single realm. To settle down, concentrate, and expend effort is more than they can tolerate. Superficiality and good spirits are all that they desire. They are great entertainers, with ideas moving in a lightning fast, almost frenzy-like fashion, from one topic to another. They cannot focus their attention and concentrate; all sorts of creative ideas and plans are generated to keep those around them in a buoyant and convivial mood. Personal relationships are superficial, however, with minimal affective resonance achieved with others. In their effort to maintain their bustling activity, their interpersonal superficiality and inattentiveness to the interests of others comes to the fore. Caring little for durable relationships, for anything and anyone, means they cannot acquire a genuine degree of warmth and intimacy with others. They are poor conversationalists as a consequence of their failure to reciprocate the affairs and concerns of those they relate to. They continually interrupt others, keep the flow of conversation centered on the primacy of their own wishes, and seek to maintain the tone of repartee upbeat and cheerful. The traits of this subtype reflect the blending of both exuberant and histrionic personality features. [/conditional] [comment memo="Entrepreneurial | Eager | Lively | Optimistic | Irrepresible"] [checkbox name="EPNaF" value="Ebullient Personality with Narcissistic Features"][conditional field="EPNaF" condition="(EPNaF).is('Ebullient Personality with Narcissistic Features')"] Most notable about this subtype is their entrepreneurial spirit, their eagerness, liveliness, vitality, and optimism. They are enthusiastic promoters of ideas and plans. They are passionate and effusive in their pursuit of their goals, evidencing at times an irrepressible spirit that drives them to pursue one implausible venture after another. Some refer to these zealots as masterminds of grand schemes and plans. These arm-waving boosters are able to provide others with a dizzying array of idea-aminute lectures and proposals. They champion numerous amusements, as well as numerous ways of engaging others to pursue and promote them. Their passion and ebullience, however, is short-lived; most peter out as they leap from one passing exciting venture to another. Many naive persons are drawn to these exuberant’s enterprises and gambles because enthusiasm is infectious. But these risky undertakings are not sustainable: exuberants are too readily bored; they lack the ‘‘staying power’’ and consistency necessary to complete projects. Ideas emerge quickly in full form, but not necessarily thoughtfully or sensitive to practicalities. Getting serious or detail-oriented is not their forte. Excited by variety, novelty, and change, their consistency consists of inconsistency. The zealous entrepreneur appears largely to be a blend displaying traits of both the exuberant and narcissistic personalities. The best part of life to these enthusiastic promoters lies in anticipating what might be, not in everyday mundane realities. It may well be that they are too frightened of stopping, of looking inward. Each idea springs anew as they run away from the thought of any finality or closure. When they do work, they do so in spurts, resisting any event or action that may slow them down. Any experience they judge as drudgery, prosaic, or ordinary is avoided like the plague. As noted, they throw themselves into their world with tremendous vitality and ardor. They indulge in anything that may come to mind with such immediacy and fervor that it invariably leads to a constant flow of fresh possibilities, again and again, faster and more. A problem that arises, of course, is that they stuff their minds with transient anticipations, with what they enthusiastically look forward to. As a consequence, they lose touch with what lies presently before them. Their immediate environment fails to take hold and cannot therefore be fully satisfying. They always look to tomorrow, the next event, not that which exists in front of them now. Life is what they want to do or what they must acquire. What they have in hand is never enough; it’s only what may be that can be satisfying, so they believe. [/conditional] [comment memo="Turbulent | Careless | Impetuous | Impulsive | Harebrained | racing from one thing to another"] [checkbox name="EPBoF" value="Ebullient Personality with Borderline Features"][conditional field="EPBoF" condition="(EPBoF).is('Ebullient Personality with Borderline Features')"] As matters deteriorate for the exuberant, they gradually decompensate to the turbulent level of malfunctioning. What we see is a pattern of heedless behavior, scattered thinking, and brash and impetuous actions and moods. They appear desperately impetuous, engaging in careless and unmindful behaviors, acting impulsively and abruptly as they generate irresponsible and harebrained schemes. In their effort to keep functioning while they seek to deny the pressure of an upsurging depression, they race wildly, almost completely out of control. Their actions, thoughts, and moods become erratic and unpredictable; their behaviors and emotions become akin to the manic breakdown of compulsive personalities. Within the space of a few minutes, moods and actions may shift rapidly from one extreme to the other, swinging from jubilance one second to tearful remorse the next. Scattered among these unpredictable shifts may also be seen moments of precipitate hostility. Careless and unmindful of what they say, their behavior becomes increasingly irresponsible. Interspersed among their devil-may-care outlook are previously repressed outbursts of momentary anger and fearful anxiety. One moment they may feel the most joyous and excited of moods, the next they throw themselves into a deep sense of sadness and loneliness. It is during these extremely erratic periods that we may begin to see a full blown manic attack in which their emotions and behaviors are completely out of control. As noted, turbulents race from one impetuous sensibility to another as they seek to defend against the upwelling of their subliminal depression. They dread slowing down and permitting their surging disconsolate feelings from moving into consciousness. At these times their behaviors make them vulnerable to preventable accidents and vexatious relationships. In their reckless push to keep themselves from acknowledging their feelings of dejection and devaluation, they may become excessively demanding, insisting that others do their bidding and satisfy their cravings instantaneously. At this point they have little tolerance for external resistances or any personal discomfort. Needless to say their uncalled for demands and irrational outbursts cause others to react to them with annoyance and displeasure. Unthinking, heedless, with little self control and increasing impatience they become indifferent to how others respond to them. They are unable to stop their ill-considered actions when others confront them or ask for greater self-control and consideration. Their recklessness leads them to extreme social intolerance and self-destructive behaviors. Increasingly dangerous both to themselves and others, they are now incapable of regaining a measure of their emotional stability; their driving energy and thoughtlessness has gotten out of hand. At this stage of their deterioration these turbulents may feel that everything that they have done and tried to do has been a failure. Some come to the conclusion, desperate and irresponsible though it may be, that their best way to handle their sorry plight is to go on the offense, to attack anyone and anything that encroaches on their sense of self-esteem. For that moment or two they aggrandize themselves as a means of enhancing their sense of self. Their fear of being dominated and controlled by others drives them to the outer extremes of manic behavior. They must struggle to keep others at bay and to toughen themselves against pressures that well up within them. [/conditional] [comment memo="Worn out | Drained | Haggard | Weary | Sad"] [checkbox name="EPMeF" value="Ebullient Personality with Melancholic Features"][conditional field="EPMeF" condition="(EPMeF).is('Ebullient Personality with Melancholic Features')"] This personality disordered person represents a state of collapse. The exhausted turbulent appears worn out, drained, consumed, depleted. These persons look weary and haggard in their appearance now that they have finally succumbed to the upsurge to their deeper depressive feelings. Having engaged in an extended bout of wild, desperate, and reckless activities, they find that they have pushed themselves beyond the limits of their psychic and physical endurance. This breakdown indicates that they have been swamped by the sadness they have failed to keep at bay. The exhausted subtype’s psychic collapse may have been precipitated by a sudden physical ailment or some chance misfortune, no less than by the indulgences of an excess of drugs or alcohol. Whatever its origins, this individual no longer has the vigor, the brash, energetic, and irresponsible drive that characterized his earlier behaviors. No longer able to constrain his depressive feelings by vigorous denial, he gives way and permits his previously constrained moods to take over and come into ascendance. Unable to escape into hyperactivity and a busy external life, he no longer possesses the coping ability to limit his upsetting emotions from gaining control. Having squandered his former talents and capabilities, unable to regain his energy and confidence he feels suddenly overwhelmed by a depressive upsurge he can no longer escape. Also, having misspent his former goodwill, and unable to regain his composure and control, his defenses have crumbled, his relationships sundered, and his talents fragmented. He now lies in a depleted and dissolute state, one in which his prior extravagances and profligate behaviors have emptied out, leaving him drained and debauched. Although periods of depression are likely to have occurred in the past, exhausted turbulents no longer have the ability to cope adequately with them. Surging up from their unconscious, these turbulents now feel as if they have been overwhelmed, even swallowed up. It is at this point that the painful elements of their subconscious gain primacy. At a complete loss, they disintegrate into the ‘‘giving up’’ outlook that so often characterizes depression and melancholia. As their psychic world implodes into a depleted and washed out reality, this personality evaporates, is no longer there, having now become a barren shell, a misspent and toilworn emptiness. Some speak of themselves as being dead. No longer assertive or in control, they are unable to keep their guard up and deal with what they now see as the harsh realities of their lives. It is at this stage that we observe the reemergence of the depressive/melancholic qualities that lie beneath the surface of their formerly exuberant and hyperactive lifestyle. [/conditional] [checkbox name="ComPD" value="COMPULSIVE PERSONALITY FEATURES"][conditional field="ComD" condition="(ComPD).is('COMPULSIVE PERSONALITY FEATURES')"] Pt presents with Compulsive Personality Characterology - Efficient | Well ordered | Dutiful | Guilt avoiding | Perfectionistic | Internal high standards | Seeking approval from authority | Selflessly committed to a greater cause | Dogmatic | Moral | Rule following | Beliefs are absolute truth | Struggles with downtime | Conscientious. Themes articulated by the Pt:[/conditional] [checkbox value="I am responsible for myself and others|I have to depend on myself to see that things get done|Everything feels like my responsibility|Others are too casual and not detail focussed enough|Self indulgence is wrong|It is important to do a perfect job on everything|I need order, rules and systems or I feel out of control|Without me, everything will fall apart|Any flaw of performance may lead to a catastrophe|Im guilty of something|It is necessary to stick to the highest standards at all times, or things will fall apart|I hold myself to the highest standards|I need to be in complete control of my emotions|If I don’t perform at the highest level, I have failed|Flaws, defects, or mistakes are intolerable|Details are extremely important|My way of doing things is generally the best way."] [comment memo="Rule-bound | Conscientious | Duty-bound | Earnest | Self-doubting | Meticulous | Submissive"] [checkbox name="ComPDDF" value="Compulsive Personality with Dependent Features"][conditional field="ComPDDF" condition="(ComPDDF).is('Compulsive Personality with Dependent Features')"] The Pts conscientious characterology suggests a compulsive personality structure with dependent features, which includes: being rule-bound, duty-bound, earnest, hardworking, meticulous, painstaking, indecisive, inflexible, self-doubting, dreading errors and mistakes. Pt exhibits a conforming dependency, compliance to rules and authority, and a willing submission to the wishes, values, expectations, and demands of others. Conscientious compulsives see themselves as considerate, thoughtful, and cooperative. They often voice a strong sense of duty, which masks underlying feelings of personal inadequacy. As such, they tend to minimize their accomplishments, underplay their abilities, and grade their success in terms of how well the expectations of others are fulfilled. Though they are usually described as earnest, hardworking, and thorough, these characteristics compensate for deep feelings of self-doubt and hesitation and serve to keep them in the good graces of those they rely on for esteem. You may note from the preceding description that conscientious compulsives exhibit insecurity in a manner similar to the dependent, although they still compensate for feelings of inadequacy much like the typical compulsive. They hold fast to the belief that they will be cared for, valued, and loved in direct proportion to their hard work and monumental accomplishments. This belief structure comes with a significant liability: They fear that failure to perform perfectly will provoke both abandonment and condemnation, which creates considerable inner sensations of tension and guilt. So dreadful is thhought of making mistakes or taking even the smallest risk that they perpetually rework their efforts, never attaining a true sense of satisfaction for a job well done, all the while feeling perennially anxious over their perceived inadequacy to handle any unanticipated hitch. This blend of dependent and compulsive features gives rise to a distinct submissive interpersonal manner with superiors and an air of propriety and restraint with all others. This is in direct conflict with intense contrary feelings that frequently lurk beneath this veneer, and on occasion, these more primitive qualities sneak through their tightly controlled coping skills. Their occasional experience with such security breaches teaches them to hold even tighter to self-control, thereby creating an existence that is overorganized, devoid of spontaneity, and dramatically upset by any deviation in routine. Understand, however, that this is primarily a private battle and is usually masked by a front of equanimity and social agreeableness. Like the other variants, conscientious compulsives do sometimes attach themselves to institutions or religious organizations, both for interpersonal support and as a means of participating vicariously in a social aura of respect or holiness. In general, however, the conscientious variant is the most sublimated of the compulsive subtypes, jettisoning some of the more self-righteous and forceful qualities that produce interpersonal discomfort. This subtype tends to shade much more readily into normality than the other variants described next.[/conditional] [comment memo="Bureacratic | Petty | Intrusive | Officious | Over-identifies with professional role"] [checkbox name="ComPDNF" value="Compulsive Personality with Narcissistic Features"][conditional field="ComPDNF" condition="(ComPDNF).is('Compulsive Personality with Narcissistic Features')"] The Pts bureacratic characterology suggests a compulsive personality structure with narcisisstic features, which includes: feeling empowered in bureacratic organisations, tends to identify with the rules or the job, officious, high-handed, unimaginative, intrusive, nosey, petty-minded, meddlesome, trifling and close-minded. Pt feels secure and grounded when he allies himself with traditional values, established authorities, and formal organizations. Whilst, most other compulsive subtypes feel conflicted, angered, and even oppressed by these influences, although their overt awareness of this conflict is suppressed. Bureaucratic compulsives are somewhat more aware of this conflict than their counterparts, and instead of allowing their feelings to cause even the slightest difficulty, they wholeheartedly embrace the order and structure inherent in recognized institutions, authorities, and social mores. They flourish in organizational settings, feeling comforted, strengthened, and empowered by clearly defined superior and subordinate relationships, definite roles, and known expectations and responsibilities. Once established, they function loyally and dependably. In effect, these individuals use highly developed and formalized external structures to compensate for the internal sense of ambivalence and indecisiveness that plagues the average compulsive pattern. Many fuse their identity with the system as a means of achieving place, purpose, and protection, and this frees them from any anxiety related to making independent decisions. Their superiors know them as trustworthy, diligent, and faithfully committed to the goals and values of the institution, which fortifies their self-esteem and gives them a direction. Be it church, police, union, university, or business, without the organization most would feel lost or aimless in life. Punctual and meticulous, they adhere to the work ethic like worker ants in a colony, appraising their own and others’ tasks with black-and-white efficiency, as done or not done. The status gained by their alliance with their “greater cause” offers these generally rigid and constrained individuals better than a modicum of pride and self-importance. Deeply committed to all of the trifling and inconsequential directives of their beloved institutions, bureaucratic subtypes gain a sense of status by fusing their identity with much larger force and becoming an indispensable part of this important structure. As such, they often share hallmarks with the narcissistic personality, although these more inflated qualities are but skin-deep. Like the conscientious compulsive, the bureaucratic compulsive often shades gently into normality, but individual differences run the spectrum from nearly normal to wholly forceful. At a moderately disordered level, their rigid adherence to policies and rules makes them seem officious, high-handed, close-minded, and petty. At a severely disordered level, they may use their knowledge of the rules, effectiveness with red tape, and ingratiating attitude with superiors to terrorize subordinates or anyone else who crosses their path without paying them the proper dues and respect.[/conditional] [comment memo="Austere | Bigotted | Zealous | Uncompromising | Moral"] [checkbox name="ComPDPaF" value="Compulsive Personality with Paranoid Features"][conditional field="ComPDPaF" condition="(ComPDPaF).is('Compulsive Personality with Paranoid Features')"] The Pts puritanical characterology suggests a compulsive personality structure with paranoid features, which includes: austerity, self-righteousness, bigoted, dogmatic, zealous, uncompromising, indignant, judgemental, grim, moral prudishness, must control and counteract repugnant impulses and fantasies. As originally emphasized by analytic authors and later expanded by object-relations and interpersonal theorists, all compulsives experience a deep ambivalence between obedience and defiance, which they resolve through sublimation, reaction formation, and displacement. Those who sublimate this conflict seem more normal, those who displace their aggression seem more forceful, and those who react strongly against their internal anger become self-righteous. Over the course of development, each person’s defensive operations settle into a defensive style that armors him or her against the world. We might say that the drives and impulses lurking within puritanical compulsives are so strong, yet so strongly reacted against, that these individuals seek the armor of God’s righteousness to purify, transform, and contain them. Most feel the persistent press of irrational and repugnant aggressive and sexual drives and adopt an ascetic and austere lifestyle to prohibit their dark impulses and fantasies. All variants of the compulsive pattern experience a conflict between obedience and defiance on some level, but the puritanical variant experiences this much more intensely than any other. Though sharing aspects of zealous defensiveness and guardedness with the paranoid, the puritanical subtype presents as an exaggeration of the basic compulsive pattern. Their hostility, then, is also greater and more likely to be vented through vicious displacements, which usually identify a common enemy or seek to scapegoat the weak. Dichotomous thinking reinforces these urges: In their mind, the world is composed of the all good and the all bad, us versus them, the justified and the unjust, the saved and the sinners, along with the saints (i.e., the compulsives themselves). Naturally reviled by perceived moral laxity, puritanicals use their wrath as a “vengeful sword” of righteousness bestowed with a sacred mandate to dispel sin and iniquity. Most are pleased to be this instrument through which justice is administered. In fact, puritanicals naturally gravitate toward radical fundamentalism, as the literalism inherent in such beliefs creates a clear picture, not only of who deserves punishment, but who deserves absolute punishment. Thus, injustice is made just and they are free of any residual guilt. Many of these puritanical compulsives secretly enjoy punishing others, as they are strengthened by this judgment of their superego. People respond in very diverse ways to such a personality. A large part of our society admires the seeming combination of strength and purity that such individuals project. Moreover, puritanical compulsives are not limited to religious dogma. Over the course of history, and even in current politics, they have been an influential force in stirring nationalistic fervor. On a smaller scale, they can be found in virtually any institution, large or small, assuming the mantle of righteousness, preaching the transgressions of their associates, and demanding purges. In fact, excessive interpersonal control may be geared toward eliciting behaviors of defiance from others, so that the enemy can be uncloaked. Some succeed in their pursuit, but eventually, most come to view them as harsh, demanding, abrasive, irritating, and prudish. Some are simply exceptionally straitlaced. Here, the function of the straight and narrow path is transparent, intended to contain and civilize drives that would otherwise be almost uncontrollably intense.[/conditional] [comment memo="Miserly | Tight-fisted | Ungiving | Isolative"] [checkbox name="ComPDScF" value="Compulsive Personality with Schizoid Features"][conditional field="ComPDScF" condition="(ComPDScF).is('Compulsive Personality with Schizoid Features')"] The Pts parsimonious characterology suggests a compulsive personality structure with schizoid features, which includes: miserly, niggardly, tight-fisted, ungiving, hoarding, unsharing, fears psychic intrusions into vacant inner world, dreads exposure of personal impropriaties and contrary impulses. For these individuals, miserliness takes on an almost symbolic significance. Ever wary of the possibility of loss, they are selfish and niggardly and keep a tight, self-protective grip on everything they possess, lest it somehow be wrested from them. Here, the concern shifts from identification with authority or organizational codes to the security value of material goods. Having been deprived of so many wishes and desires in childhood, they nurture and protect what little they have, ever suspicious that others might scavenge their few prized possessions. They draw sharp boundaries and behave with an unnecessary stinginess. In effect, their behavior says, “What is mine is mine, and what is yours is yours.” Such individuals were often deprived of wishes and desires. Their basic needs were not necessarily neglected by their parents, but perhaps few if any of their wants were fulfilled in a manner that seemed reasonable to them. Perhaps under the best of intentions, the caregivers attempted to instill a deep sense of duty and self-responsibility by radically avoiding any measure that could potentially spoil the child. Undoubtedly, it is far healthier to allow children to experience a modicum of unfulfilled wishes than it is to indulge them with everything they could ever imagine. However, when this otherwise healthy approach to child rearing is taken to an illogical extreme, an orientation evolves wherein individuals seem to have an almost one-dimensional focus on nurturing and protecting anything earned or achieved. They become self-sufficient to a fault, disallowing anyone who may potentially deprive them of their resources and acting as if any loss in their nest egg could not be replenished. This miserliness also masks a deeper need. By effectively shutting out anyone else from permeating their world of possessions, they are, in effect, guarding against any discovery of the barrenness of their attainments and competencies. Even more important, this is a safeguard shared with other variants of the compulsive personality, in that keeping an air of propriety and privacy staves off any possible unearthing of their dreaded rebellious urges or irrational anger. This cool distancing from others and this protection of monetary and material possessions from external intrusions are qualities shared with the schizoid personality.[/conditional] [comment memo="Bedevilled | Ambivalent | Muddled | Frustrated | Conflicted"] [checkbox name="ComPDNegF" value="Compulsive Personality with Negativistic Features"][conditional field="ComPDNegF" condition="(ComPDNegF).is('Compulsive Personality with Negativistic Features')"] The Pts bedevilled characterology suggests a compulsive personality structure with negativistic features, which includes: unresolved ambivalences, feelings of torment, muddled, indescisive, befuddled, beset by internal conflicts, confusions, frustrations, obsessions and compulsions control contradictory emotions. The bedeviled compulsive is blended with the negativistic personality. For average compulsives, the strategy of self-denial works reasonably well, allowing them to submerge their oppositional desires and put forth a proper and correct front. The bedeviled variety, however, appears on the surface to be maintaining a controlled and austere front but struggles incessantly with a desire to conform to the wishes or agendas of others one minute and the desire to subvert others and assert their own interests the next. When expected to act decisively, they vacillate and procrastinate, feel tormented and confused, become cautious and timid, and use complex rationales to delay making decisions as long as possible. Unable to crystallize their own identity and feeling wave upon wave of ambivalence, they may express their dissatisfaction by becoming exhausted, grumpy, and discontent. Many feel caught between heart and head, between what one part of them sees as reasonable and another part as emotionally satisfying. Perpetually overwhelmed by the conflict between the will and better decisions, the bedeviled variant’s existential experience is that of being caught between a rock and hard place. Painfully aware of their inner impulses, many engage in a form of self-torture, an act of punitive resolution that symbolically undoes that which bedevils them. In this context, the obsessions and compulsions that emerge signify a futile attempt to control that which is illogical, irrational, or even abstract about themselves and their desires. Unfortunately, this is not all that such attempts signify. Generally, the more extreme the obsessions and compulsions, the more the individual’s routine coping skills are failing. Their inner ambivalence is the inability to confront what is upsetting to them, and outward behaviors such as compulsions are an outlet for their contradictory feelings. As individuals become more severely disordered, they may see themselves as driven by ego-alien forces, perhaps demons. Helpless, in their perspective, to escape the clutches of corruption, the more decompensated individuals may come to feel as though they are on the edge of psychic dissolution. [/conditional] [comment memo="BORDERLINE PERSONALITY NOTES -- The core characteristic in this Pts history, is separation anxiety at near psychotic / disproportional levels directed towards the parent, parent figure, attachment figure (e.g. partner), or idealized other such as a therapist. Moreover, unlike Pts on the dependent personality spectrum, the Borderline Pt has a core ambivalence towards the idealized other. In other words, where the Dependent Personality is unambiguous in their need for an idealised other, the Borderline is torn between vaciliating states of compliance and defiance. This Pt is prone to, and equally disassisfied with fantasies of fusion. There is a tendency towards idealization of a 'magical' romantic figures, which leads in turn to a need for total dependence on someone else for a sense of self-worth and self-esteem. However, greater intimacy exaggerates fears of being vulnerable and exposed, leading back to equal and opposite desires for separation. The answer to this paradox, of course, is to never let any relationship become too stable. Here, chaos is not just a pathological outcome, but also an instrumental strategy. When relationships become too normal or things are going too well, contentment must be sabotaged. The primary processes for the Borderline Personality include: Compliance mode -- like the Compulsive Personality, Borderline Pts have an excessive focus on self-control, obedience, and pleasing behaviours to elicit a care-giving or approving response. However, given the instability of the personality architecture, making them unsure of external approval and troubled by surging inner impulses, the Borderline Pt decompensates into a vacillation of marked self-condemnation, protestations of piety and good intentions, and impulsive outbursts of anger, followed by feelings of intense shame and guilt for 'errors' and shortcomings. On the other hand, in defiance mode, like the negativistic personality, the Borderline Pt will rapidly flip to irritable complaining about the shortcomings of the care-giver or idealised other. In their negativistic mode under increasing stress, the Borderline Pt will reach a more intense, unpredictable, and erratic pace, swinging into profound gloom at one time, and irrational negativism and chaotic excitement the next. Put differently, the Borderline Pts intense abivalence, in the absence of a stable idealizing transference towards a parent, or idealized other, creates a vicious circle within which the borderline becomes trapped. Notable in this sequence are: ambivalence between wishing to be seen as 'good' by one's parents, or idealised other, accompanied by a resistance to obeying them. By analogy, this is like saying 'I need you, but I hate that I need you'. On an emotional level, this is experienced as rapidly fluctuating and intensely felt anxiety and depression leading to the need for constant reassurance of love that fails, or is perceived to fail, to be forthcoming; a consequent hypersensitivity to anticipated rejection from others; a growing feeling of personal failure, loneliness, and emptiness; a projected hostile acting out against others, followed by contrition and guilt; self-punitive and self-damaging behaviors such as drug or alcohol addiction; and increased anxiety and depression—and the vicious circle begins anew. The secondary processes are what happens as a result of a 'failure' in the above dynamics. Failing to elicit an approving response, or failing to register an approving response, the Borderline Pt tends to experience extended periods of dejection and disillusionment, interspersed occasionally with brief excursions of euphoria and significantly more frequent episodes of irritability, and self-destructive acts."] [checkbox name="BoPD" value="BORDERLINE PERSONALITY FEATURES - Cycloid Personality"][conditional field="BoPD" condition="(BoPD).is('BORDERLINE PERSONALITY FEATURES - Cycloid Personality')"] Pt presents with Borderline Personality Characterology - Conflicted | Vacilating | Guilt Prone | Guilt avoiding | Interpersonally Sabotaging | Ambivalent about obediance | Ambivalent about defiance | Self condeming | Fatuous | Approval seeking | Emotional. Themes articulated by the Pt:[/conditional] [checkbox value="If people get close to me, they will discover the real me and reject me|Unpleasant feelings will escalate and get out of control.|Any signs of tension in a relationship indicate the relationship has gone bad|I am needy and weak, and hate myself for it|I need saftey, but I dont trust it|Im alone in a malevolent world|I cannot trust other people, but I need to|I have to be on guard at all times and feel guilty about it|People often say one thing and mean something else|A person whom I am close to could be disloyal or unfaithful|Other people will abandon or punish me, especially when I become intimate with them|I am bad or evil and deserve punishment|I have no right to express my opinions/wishes/emotions|Self-assertiveness will alienate me from my caregivers|If I express anger or other unpleasant emotions they will be jeopardizing their relationships.|I am a victim, and have been wronged, others need to feel my pain to understand that"] [comment memo="Pliancy | Submissiveness | Loyalty | Hoplessness | Depressions | Powerlessness"] [checkbox name="BoPDDADF" value="Borderline Personality with Dependent and Avoidant Features"][conditional field="BoPDDADF" condition="(BoPDDADF).is('Borderline Personality with Dependent and Avoidant Features')"] The Pts discouraged characterology suggests a borderline personality structure with avoidant and dependent features, which includes: pliancy, submissiveness, loyalty, whilst at the same time feeling vulnerable and in constant jeopardy, hopelessness, depression, helplessness and powerlessness. The discouraged borderline personality is mixed with the dependent or avoidant patterns. Such individuals pursue a strategy of submissive attachment to just one or two significant prominent personality traits include not only avoidance of competition, loyalty, and humility but also masochistic subordination and a parasitic clinginess. By exclusively relying on a single someone, discouraged borderline personality patients “put all their eggs in one basket.” Always fearing that their lifeline is threatened, their world is chronically destabilized. Consequently, they are ever preoccupied with their lack of security, mainly their own helplessness, self-doubt, and lack of self-sufficiency. To reinforce their relationships, they cling tenaciously to whoever is available, merging their own identity into that of their partner. Given such profound needs, they are easily panicked by a sense of isolation or aloneness and easily feel depressed and powerless. Simple responsibilities seem monumental, everything is a burden, and life is empty and heavy. Should their sense of futility intensify, they may regress to a state of marked depression or infantile dependency, requiring others to tend to them as if they were infants. Other discouraged borderlines mix characteristics of the depressive personality. Such individuals have been taught to be conscientious and proper. They respect authority, tend to be grim and humorless, and expect rewards contingent on compliance and submission. Borderline characteristics begin to develop when the individual senses that this interpersonal pact has been violated too often—that others have selfishly failed to supply promised rewards of affection. Resentful and angry, they no longer believe that conformity will forestall desertion. Instead, they feel coerced into submission and betrayed—emotions that periodically break through normal controls. Because anger is not only inconsistent with their self-image but also alienates or provokes those on whom they depend, intense negative feelings are experienced as dangerous. In response, they may swing to the opposite pole, becoming excessively preoccupied with self-reproach. Self-mutilation and suicidal attempts, symbolic acts of self-desertion, may be used to control their resentment or as punishment for anger.[/conditional] [comment memo="Impatience | Peevish | Restlessness | Stubborn | Sullen | Easily offended | Pessimmistic"] [checkbox name="BoPDNeDF" value="Borderline Personality with Negativistic Features"][conditional field="BoPDNeDF" condition="(BoPDNeDF).is('Borderline Personality with Negativistic Features')"] The Pts peevish characterology suggests a borderline personality structure with negativistic features, which includes: impatience, restlessness, stubborn defiance, sullenness, pessimissm, resentment, easily slighted, and quickly disillusioned. The peevish borderline is mixed with the negativistic personality. When even more dyscontrol is added to the active-ambivalence of the negativist, the result is someone who is even more unpredictable, restless, irritable, impatient, complaining, disgruntled, stubborn, sullen, pessimistic, resentful, and envious of the happiness and success of others. They resent those on whom they depend and hate those to whom they must plead for love. In contrast to other borderline subtypes, most petulants have seldom had their needs satisfied on a regular basis and have never felt secure in their relationships. Stubborn and demanding, they openly register their disappointments. Unable to find comfort with others, they may become increasingly bitter and discontent, caught between two pathological extremes. At times, they express feelings of worthlessness and futility, become highly agitated or deeply depressed, express selfcondemnation, and develop delusions of guilt. At other times, their habitual negativism becomes completely irrational, driving them into rages in which they distort reality, make excessive demands of others, and viciously attack those they see as having trapped them and forced them into intolerable conflicts. Their moods become a way of threatening others that further trouble is coming unless something is done. However, following these wild outbursts, petulants turn their hostility inward and become remorseful, plead for forgiveness, and promise to behave and make up for their transgressions. Alternatively, they may express fatigue and somatic disorders as a means of milking others’ attention while burdening them at the same time. As children, they are likely to have felt mishandled and cheated, perhaps caught in a power struggle between caretakers who used the child as a pawn. For them, affection was never free of conflictful feelings.[/conditional] [comment memo="Capricious | Flighty | Dramatic and Theatrical | Distractable | Seductive | Loss averse | Agitated | Suicidal"] [checkbox name="BoPDHiF" value="Borderline Personality with Histrionic Features"][conditional field="BoPDHiF" condition="(BoPDHiF).is('Borderline Personality with Histrionic Features')"] The Pts impuslive characterology suggests a borderline personality structure with histrionic features which includes: caprisciousness, superficiality, flightyness, distractability, frenetic, seductive, fearing loss, agitation, suicidality. Unless constantly receiving attention, such individuals become increasingly seductive, impulsive, capricious, and irresponsible. Though most borderlines are famous for dysregulation of negative emotions, subjects with histrionic traits become even more behaviorally hyperactive and cognitively scattered, exhibiting a dysregulation of positive affects that includes frenetic gaiety, frantic gregariousness, and irrational and superficial excitement. At times, they lose all sense of propriety and judgment. Individuals with a antisocial traits become even more impulsive and thoughtless, both failing to plan ahead or heed the consequences of their actions as they struggle to free themselves from social constraints. At the borderline level, the strategies of the basic histrionic and antisocial patterns are simply much less successful than before. As such, they are likely to experience many disappointments, to go for extended periods of time without the security they crave, and to succumb to hopelessness and depression. The impulsive borderline is especially likely to have experienced the chaotic family or soap opera environment, which encourages drama, a desire for stimulus variety, and an intolerance of boredom. Many will have felt a sense of security and attachment only when their parents acknowledged some exhibitionistic performance or when their misbehavior was intense enough to stand out against the background noise of chaos and discord. Many were exposed to exhibitionistic parental models and learned to depend on sex-role stereotypic compliments—physical attractiveness for histrionics and manliness for antisocials — as the basis for their self-esteem. In general, they are especially sensitive to external sources of reward and move impulsively and capriciously from one engaging item to the next. Thus oriented to the external world, they fail to develop a solid self-identity that might anchor them during periods of stress. As a consequence, they are always on unsure footing, constantly on edge, never quite sure who will provide the attention and stimulation they desperately require. Periods of brooding, dejection, and hopelessness alternate with simulated euphoria as they shift from acknowledging to denying their condition.[/conditional] [comment memo="Self punishing | Conforming | Deferential | High strung | Moody | Suicidal"] [checkbox name="BoPDMaF" value="Borderline Personality with Masochistic Features"][conditional field="BoPDMaF" condition="(BoPDMaF).is('Borderline Personality with Masochistic Features')"] The Pts self-destructive characterology suggests a borderline personality structure with masochistic features which includes: inward-turning, intropunitively angry, conforming, deferential, high strung and moody, suicidal. All borderlines are at times self-destructive, perhaps to the point of self-mutilation. In the self-destructive borderline subtype, however, self-destruction serves the needs of a comorbid masochistic pattern. Like the peevish borderline, the self-destructive type is unable to find a comfortable niche with others. Unlike the peevish type, selfdestructive borderlines do not become increasingly testy and bitter over time. Instead, their masochistic traits cause them to turn inward, where destructive feelings can be expressed upon the self. In the past, these individuals presented a veneer of sociability and conformity. Underneath, however, were both a desire for independence and a genuine fear of autonomy. As a result, their social propriety cloaked a deeply conflictful submission to the expectations of others. To control these oppositional tendencies, they struggled to present a façade of self-restraint and self-sacrifice. Ever deferential and ingratiating, most have bent over backwards to impress their superiors with their conformity, all the while denying their dependencies and becoming even more conflicted. At times, these antagonisms have given rise to public displays and bitter complaints about being treated unfairly, of expecting to be disillusioned and disapproved by others, and of no longer being appreciated for their diligence, submissiveness, and selfsacrifice. With the persistence of ambivalent feelings, self-destructive borderlines often begin to voice growing distress about a wide range of physical symptoms. As more subtle means of discharging negative feelings prove self-defeating, tension and depression mount beyond tolerable limits. They may accuse others of despising them, seeking to destroy their worth, and plotting to abandon them. Inordinate demands for attention and reassurance may be made. They may threaten to commit suicide and thereby save others the energy of destroying them slowly. The self-destructive and discouraged borderline subtypes perpetuate their pathology by deliberately putting themselves in positions of excessive vulnerability, making themselves so dependent and clingy that others could only become exasperated.[/conditional] [checkbox name="NegPD" value="NEGATIVISTIC PERSONALITY FEATURES"][conditional field="NegPD" condition="(NegPD).is('NEGATIVISTIC PERSONALITY FEATURES')"] Pt presents with Negativistic Personality Characterology - Needy and Independent | Agreeable and resistant | Irritable towards self and others | Resentful towards authority | External high standards | Fault-finding | Passive-aggressive | Contrarian | Indirectly oppositional. Themes articulated by the Pt:[/conditional] [checkbox value="I am self-sufficient, and only accept help reluctantly.|I strive to preserve my self-respect, but do this indirectly|I like to be attached to people but I am unwilling to pay the price of being dominated.|Authority figures tend to be intrusive, demanding, interfering, and controlling.|I have to resist the domination of authorities but at the same time maintain their approval and acceptance. |Being controlled or dominated by others is intolerable.|I have to do things my own way.|Making deadlines, complying with demands, and conforming are direct blows to my pride and self-sufficiency.|If I follow the rules the way people expect, it will inhibit my freedom of action.|It is best not to express my anger directly but to show my displeasure by not conforming.|Other people should respect the rules|What’s best for me is good for others|Rules are arbitrary and stifle me.|Other people are often too demanding.|If I regard people as too bossy, I have a right to disregard their demands."] [comment memo="Fluctuating emotions | Vascillating | Capricious | Indecisive | Irresolute"] [checkbox name="NePDBoF" value="Negativistic Personality with Borderline Features"][conditional field="NePDBoF" condition="(NePDBoF).is('Negativistic Personality with Borderline Features')"] The Pts vacillating characterology suggests a negativistic personality structure with unstable features which includes: fluctuating emotions, struggles to understand ones own capricious nature, wavering on decisions, chronically irresolute. Representing a combination of the negativistic and borderline patterns, the vacillating variant is distinguished by unstable and rapidly fluctuating emotions and attitudes. They may, for example, present themselves as affectionate, predictable, interesting, even charming, but then suddenly become irritable, oppositional, and disagreeable. Or they may appear self-assured, decisive, and competent, only to abruptly regress to a clinging dependency. Or they may be pleased with themselves one moment, only to become angry and depressed the next. Torn by conflict, the thoughts of vacillating negativists seem to flow freely in almost any direction, putting them at the mercy of rapidly changing emotions. Emotions are expressed directly and primitively, untransformed by a cohesive self-structure that might give direction to behavior. Tantrums are common. Unable to fathom the source of such shifts, others find them aversive, if only because their emotional maelstroms are difficult to understand.[/conditional] [comment memo="Discontented | Griping | Cranky | Complaining | Vexed | Moody | White-anting"] [checkbox name="NePDDeF" value="Negativistic Personality with Depressive Features"][conditional field="NePDDeF" condition="(NePDDeF).is('Negativistic Personality with Depressive Features')"] The Pts discontented characterology suggests a negativistic personality structure with depressive or melancholic features which includes: griping, pettiness, testiness, crankiness, embittered, complaining, fretful, vexed, moody, acts friendly but harbours resentment, avoids confontation, white-anting, legitimate but trivial complaining. As a combination of the negativistic and depressive personalities, discontented negativists are the consummate gripers. In contrast to circuitous negativists, who sabotage through covert action or inaction any satisfaction others might receive from accomplishing their goals, the discontented negativist attacks emotionally through annoying complaints, thinly cloaked criticisms, and unsubtle digs. Whereas the abrasive negativist can be brutal, the discontented negativist fights a war of attrition, actually a series of small battles designed to wear down the enemy. Constantly disapproving, they seek some thin rationale by which to be negative and fault-finding. They point out imperfections, pick at old wounds, work others into a state of irritation, and then complain further that their concerns have not been properly addressed. Often, their assertions have some basis in fact but represent trivial concerns in the context of the larger plan. Some represent themselves as persons of goodwill who are exasperated with the problem at hand, perhaps struggling with the inefficiency or ineptitude of those around them, especially those who give the orders. By getting attention for their complaints, some may cultivate the image of being more competent than their managers, whose recognized status and authority they deeply resent.[/conditional] [comment memo="Circuitous | labyrinthine | Procrastinating | Inefficient | Forgetful | Ambiguous | Indirect"] [checkbox name="NePDDepF" value="Negativistic Personality with Dependent Features"][conditional field="NePDDepF" condition="(NePDDepF).is('Negativistic Personality with Dependent Features')"] The Pts circuitous characterology suggests a negativistic personality structure with dependent features which includes: opposition in a round-about way, labyrinthine and ambiguous interpersonal style, procratination, dawdling, forgetfulness, inefficiency, neglectful, stubborn, indirect in venting resentments, subtly resists demands. Pt presents with a combination of the negativistic and dependent personalities. Indirect resistance to the expectations of others is an almost defining feature, especially where such expectations assume compliance and thus value the individual as a means to an end, not as a unique human being. As the name suggests, these persons avenge themselves mainly in roundabout and covert ways that undercut and frustrate anyone who would take them for granted or demand a certain level of performance. Their exact methods vary but include procrastination, dawdling, stubbornness, forgetfulness, and intentional inefficiency. Fearful of expressing resentments directly, the circuitous negativist fulfills obligations with foot-dragging slowness and inconsistent performance. Depending on the prominence of dependent features, feigned incompetence or exhausting requests for help may be used to frustrate others. Given a looming deadline or the need to perform at unusually high levels, somatic complaints may be used passive-aggressively as a means of excusing them from work, thus increasing the level of tension for everyone else.[/conditional] [comment memo="Abrasive | Contentious | Fractious | Caustic | Acrimonious | Derogates"] [checkbox name="NePDSaF" value="Negativistic Personality with Sadistic Features"][conditional field="NePDSaF" condition="(NePDSaF).is('Negativistic Personality with Sadistic Features')"] The Pts abrasive characterology suggests a negativistic personality structure with sadistic features which includes: conflict between ones own agenda and loyalty to others, contentious, intransigent, fractious, quarrelsome, irritable, caustic, debasing, corrosive, acrimonious, contradicts and derogates, little conscience or remorse. Whereas circuitous negativists struggle with their internal resentments, abrasive negativists remain caught in the conflict between their own agenda and a loyalty to others but have become more overtly and intentionally contentious and quarrelsome nonetheless. Such individuals, in fact, feel so torn by conflict that every request or expectation feels like a major burden, an opportunity to incur contempt. Past experience has shown them that even their most conscientious performances are likely to be evaluated with disappointment and derision. Abrasive negativists are so tired and jaded that they have deep doubts about whether life will work out or whether happiness is even possible at all. The abrasive negativist fears that loyalty and the tender emotions are only a sad illusion created to conceal the perverse cruelty of human nature. Many were subjected as children to “damned if you do and damned if you don’t” situations by their attachment figures. As such, minor frictions tend to exacerbate into major confrontations and power struggles. Some take special joy in spotting inconsistencies in the behaviors or ethical standards of anyone who would require something from them. They construct arguments that amplify observed contradictions and shove these squarely in the face of their antagonists, just for the sadistic pleasure of undermining their self-confidence and watching them squirm. Aware of the sadistic power of the superego, many take the moral high ground and dogmatically insist that others are either hypocritical or mentally defective. When pressed, even such indirect oppositionality may give way to contemptuous faultfinding and outright insults. During such periods, anyone who crosses their path may become an object of scorn and derision. Abrasive negativists represent a blend of the negativistic and sadistic personalities.[/conditional] [comment memo="NARCISSISTIC PERSONALITY NOTES -- Given the rarity of NPD, it is overdiagnosed as pathological, even when the individuals personality simply reflects 'normal' independent personality architecture. These individuals naturally think highly of themselves, and their abilities. Sometimes this is reasonable if they have commensurrate talents, and possibly delusional if they do not. Irrespective, they are hardwired to be self-focussed, and whether this represents pathology, is not always straightforward. Given that, here are some characteristics that point towards pathology: - A stunning lack of insight and self-reflective capacity - Gives others superficial labels or pet names quickly. - Assumes leadership in situations where it is not required - Attracted to status symbols - Tends to attract disciples / accoltyes - Grandiosity - overt (exagerates ability) or covert (entertains fantasies of grandeur) - High needs for flattery or recognition - Devalues others - Envious - Hauty - Lacks empathy - Struggles with close mutual relationships - Criticism phobic - Easily bored - Feels empty - Emotionally superficial - Disregards rules - Few if any standards - Has broken many laws (even if they havnt been caught) - Failure phobic - Unaccomodating to others - Presents alternative realities - Positive impression management - Grand plans - Prefer convenience over principles - Laissez-faire superego - Suspcious of morallity"] [checkbox name="NarPD" value="NARCISSISTIC PERSONALITY FEATURES"][conditional field="NarPD" condition="(NarPD).is('NARCISSISTIC PERSONALITY FEATURES')"] Themes articulated by the Pt:[/conditional] [checkbox value="envy|resentments|Underinflation (negative inflation - requiring compensation)|Specialness, being different to others, rejecting commonality with others|rejecting ones shared humanity|Feels entitled to special treatment and privileges|The rules apply to other people|Recognition, praise, and admiration seeking|If others dont respect my status, they should be punished|Other people should satisfy my needs|Other people should recognize how special I am|Its intolerable if Im not accorded my due respect or don’t get what I’m entitled to|Other people don’t deserve the admiration or riches they get|People have no right to criticize me|No ones needs should interfere with my own|Since I am so talented, people should go out of their way to promote my career|Only people as brilliant as I am understand me|I have a special destiny."] [comment memo="Unprincipled | Contentious | Quarrelsome | Derogates | Lack of remorse"] [checkbox name="NarPDAnF" value="Narcissistic Personality with Antisocial Features"][conditional field="NarPDAnF" condition="(NarPDAnF).is('Narcissistic Personality with Antisocial Features')"] - The Pts unprincipled characterology suggests a narcissistic personality structure with antisocial features which includes: conflicted between ones own agenda and loyalty to others, contentious, intransigent, fractious, quarrelsome, irritable, caustic, debasing, corrosive, acrimonious, contradicts and derogates, little conscience or remorse. Pt combines the self-confidence of the narcissist with the recurrent aberrant behaviour of antisocial personality patterns. Many of these individuals achieve success in society by exploiting legal boundaries to the verge of unlawfulness. Others may inhabit drug rehabilitation programs, centers for youth offenders, and jails and prisons. Still others are opportunists and con men, who take advantage of others for personal gain. Most people who demonstrate a pattern combining these styles are vindictive and contemptuous of their victims. Whereas many narcissists have normal superego development, unprincipled narcissists are skilled in the ways of social influence but have few internalized moral prohibitions. They are experienced by others as unscrupulous, amoral, and deceptive. More than merely disloyal and exploitive, these narcissists show a flagrant indifference to the welfare of others, a willingness to risk harm, and fearlessness in the face of threats and punitive action. Vengeful gratification is often obtained by humiliating and dominating others. Joy is obtained by gaining the trust of others and then outwitting or swindling them. Their attitude is that those who can be taken advantage of deserve it. Because they are focused on their own self-interest, unprincipled narcissists are indifferent to the truth. If confronted, they are likely to display an attitude of justified innocence, denying their behavior through a veneer of politeness and civility. If obviously guilty, they are likely to display an attitude of nonchalance or cool strength, as if the victim were to blame for not having caught on sooner. To them, achievement deficits and social irresponsibility are justified by expansive fantasies and frank lies. Those who display more antisocial traits may put up a tough, arrogant, and fearless front, acting out their malicious tendencies and producing frequent family difficulties and occasional legal entanglements. Relationships survive only as long as the narcissist has something to gain. So strong is their basic self-centeredness and desire to exploit others that people may be dropped from their lives with complete indifference to the anguish they might experience or how their lives will be affected. In many ways, the unprincipled narcissist is similar to the disingenuous histrionic. The unprincipled narcissist preys on the weak and vulnerable, enjoying their dismay and anger. In contrast, the disingenuous histrionic seeks to hold the respect and affection of those they dismiss in their pursuit of love and admiration.[/conditional] [comment memo="Elitist | Entitled | Upwardly mobile | Status seeking | Self-assured"] [checkbox name="NarPDElnF" value="Narcissistic Personality with Elitist Features"][conditional field="NarPDElnF" condition="(NarPDElnF).is('Narcissistic Personality with Elitist Features')"] - The Pts elitist characterology suggests a narcissistic personality structure which includes: feelings of privilge and enitlement by virtue of special status and pseudo acheivements, facade bears little resemblence to reality, seeks a favoured position in organisational settings, upwardly mobile, positions self near people of high status. The elitist typology is somewhat reminiscent of the phallicnarcissist character: self-assured, arrogant, energetic, impressive in bearing and ill-suited to subordinate positions among the rank and file. Pt tends to construct a false façade, but one that amplifies an already superior self-image, not one that compensates for deep feelings of inferiority. Theirs is a fear, not of being inadequate, but of being ordinary. The phallic-narcissists, are often found among military men, pilots, and athletes. Real-world historical figures Napoleon and Mussolini serve as examples of the classic character. In today’s Western society, we might add to this list many modern-day lawyers, surgeons, entrepreneurs, and other professions that naturally resonate with a swollen, aggressive courage regarded as the cardinal trait of the phallic-narcissist. When carried to the logical extreme, such individuals fancy themselves as demigods who stand as a race apart from ordinary human beings, competing against one another for victory on the world stage with only a handful of worthy competitors. Many hold the common person in such contempt that they may be said to possess traits of the sadistic personality as well. However, the concept of the elitist narcissist is somewhat broader than Reich’s phallic-narcissist. Whereas elitist narcissists revel in displays of power, the exhibitionism of raw self-assertion may also be focused on intellectual ability or the privilege of accumulated wealth; there are many ways to be swollen with aggressive confidence. Such individuals attend the most prestigious schools and academies, join exclusive fraternities, and associate only with members of their own social class. Moreover, elitists are known to flaunt symbols of their status and achievement. Most idolize recognition and engage heavily in self-promotion. In whatever domain of activity interests them, they advertise themselves, brag about their achievements (whether substantive or fraudulent), and make everything they have done appear wonderful and impressive. Unrivaled in the pursuit of becoming “Number 1,” many elitists actively create comparisons between themselves and others, turning personal relationships into public competitions and contests. By making excessive claims about themselves, elitist narcissists expose a great divide between their actual selves and their self-presentation. Many other narcissistic personalities recognize such disparities in themselves, but elitists are absolute in their belief of their grandeur. Rather than backing off, withdrawing, or feeling shamed when responded to with indifference, elitists accelerate their efforts all the more, acting increasingly and somewhat erratically to exhibit deeds and awards worthy of high esteem. They may present grandiose illusions about their powers and future status, amplify their limited accomplishments, and compete foolishly against others who have already eclipsed them in reality. Through such self-protective behaviors, elitists frequently alienate those around them, depriving themselves of the admiration and recognition they so desperately require, thus contributing further to their own troubles.[/conditional] [comment memo="Seductive | Enticing | Body obsessed | Glib | Intimacy phobic | Bewitching | Mythomania"] [checkbox name="NarPDHiF" value="Narcissistic Personality with Histrionic Features"][conditional field="NarPDHiF" condition="(NarPDHiF).is('Narcissistic Personality with Histrionic Features')"] - The Pts attention-seeking characterology suggests a narcissistic personality with histrionic features which includes: proccupations with seduction, sexuality, enticement, body image, identity, glibness, intimacy phobic, hedonistim, bewitching and inveigling others, pathological lying, swindling. Attention-seeking narcissists, who represent a blend of the core narcissistic temperament with traits of the histrionic, are often defined by the game of seduction they play with others, particularly the object of their affection. Their skill lies in enticing and tempting the emotionally needy and naïve, while fulfilling their own hedonistic desires and sexual appetites as they deem necessary. Although their game plan usually implies the possibility of an exclusive relationship, they are not inclined toward genuine intimacy, instead choosing to romance a number of potential conquests simultaneously. Some are sexual athletes whose designs call simply for sexual exploitation. They may seem to desire the warm affection of a genuine relationship, but when they find it, they usually feel restless and unsatisfied. Repeated demonstrations of sexual prowess often become an obsession, with “victory” only reinforcing their sense of narcissistic power. Having won others over, they quickly devalue their lovers and feel the need to continue their game elsewhere. For the most part, their partners simply provide a warm body that they can temporarily exploit before boredom overtakes them. As such, histrionic narcissists leave behind them a trail of sexual excesses and intricate lies as they maneuver their way from one pathological relationship to another. Confrontation, criticism, and punishment are unlikely to make them change their ways. Narcissists quickly dismiss such carping as the product of jealous inferiors. More than most, the histrionic variety is likely to exhibit substantial body narcissism, attending scrupulously to physical appearance, clothes, and other external attributes.[/conditional] [comment memo="Feelings of inferiority | Low self-esteem | Secretly feels exceptional | Claims status without achievement | Seeks trophies and symbols | Embittered"] [checkbox name="NarPDNegF" value="Narcissistic Personality with Negativistic or Avoidant Features -- The Fragile Narcissist"][conditional field="NarPDNegF" condition="(NarPDNegF).is('Narcissistic Personality with Negativistic or Avoidant Features -- The Fragile Narcissist')"] - The Pts fragile and sensitive characterology suggests a narcissistic personality with negativistic or avoidant features which includes: struggles with feelings of inferiority and low self-esteem, creates illusions of superiority; feeling exceptional, admirable and noteworthy without requisite accomplishments, seeks self-enhancement with trophies and symbols. The fragile captures the psychoanalytic understanding of the narcissistic personality. The early experiences of fragile narcissists are not too dissimilar to those of the avoidant and negativistic personalities. All have suffered “wounds” early in life. Rather than collapse under the weight of inferiority and retreat from public view, like the avoidant, or vacillate between loyalty and anger, like the negativist, however, the fragile narcissist develops an illusion of superiority. Life thus becomes a search to fulfill aspirations of status, recognition, and prestige. Every small certificate and plaque the individual has ever received may be displayed on the office wall, for example. At other times, they may bore others while they present a complete biography of their most minuscule successes and achievements. Like avoidant personalities, fragile narcissists are exceedingly sensitive to the reactions of others, noting every critical judgment and feeling slighted by every sign of disapproval. Unlike avoidants, however, they seek to conceal their deep sense of deficiency from others and from themselves by creating a façade of superiority. Though they often have a degree of insight into their functioning, they nevertheless indulge themselves in grandiose fantasies of personal glory and achievement. Some procrastinate in doing anything effective in the real world for fear of evaluation. Instead of living their own lives, they often pursue the leading role in a false and imaginary theater unrelated to the real world. When threatened with reality, they may defend themselves by becoming more and more arrogant and dismissive until the offending stimulus withdraws. If reality overturns their illusion completely, compensating narcissists may retreat more and more into an imaginary world of others who recognize their supposed accomplishments.[/conditional] [checkbox name="ParaPD" value="PARANOID PERSONALITY FEATURES"][conditional field="ParaPD" condition="(ParaPD).is('PARANOID PERSONALITY FEATURES')"] Pt presents with Paranoid Personality Characterology - Absolute self-determination | Guarded | Sadistic | Acusatory | Black-and-white thinker | Autonomous | Conspiratorial | Suspicious | Grudge bearing | Unforgiving | Sceptical | Hostile | Loyalty testing Themes articulated by the Pt:[/conditional] [checkbox value="I cannot trust other people|Other people have hidden motives|Others will try to use me or manipulate me if I don’t watch out|I have to be on guard at all times|It isn’t safe to confide in other people|If people act friendly, others may be trying to use or exploit me|People will take advantage of me if I give them the chance|For the most part, other people are unfriendly|Other people will deliberately try to demean me|Oftentimes people deliberately want to annoy me|I will be in serious trouble if I let other people think they can get away with mistreating me|If other people find out things about me, they will use them against me|People often say one thing and mean something else|A person whom I am close to could be disloyal or unfaithful"] [comment memo="Self-assertive | Unyeilding | Steely | Peevish | Legalistic | Cranky"] [checkbox name="ParaPDComF" value="Paranoid Personality with Compulsive Features"][conditional field="ParaPDComF" condition="(ParaPDComF).is('Paranoid Personality with Compulsive Features')"] - The Pts obdurate characterology suggests a paranoid personality with compulsive features which includes: self-assertiveness, unyeilding, stubborn, steely, implacable, unrelenting, dyspeptic, peevish, crankiness. Legalistic and self-righteous, happy to discharge feelings of hostility. Obdurate paranoids combine aspects of the paranoid and compulsive personalities, but like all paranoid patterns, they are more unstable and pathological than their compulsive counterparts. Like the compulsive, they are rigid, perfectionistic, grim, humorless, tense, overcontrolled, small-minded, peevish, legalistic, and self-righteous. However, whereas compulsives temper their angst with the belief that success and happiness can be achieved by conforming to the dictates of authority, obdurate paranoids renounce this dependency, taking on a posture of unabashed self-assertion. They actively rebel against any and all external constraints in a maladaptive effort to regain their sense of perceived control and overturn injustices previously doled out on them. While they do continue to seek clarity from imposed rules and regulations, they are now the imposers of a system that is used to attack others, usually through either legal action or the setting of impossible rules that cannot realistically be followed. Those in this paranoid personality’s wake are despised for their weakness, their sloppiness and lack of regard for disciplined behavior, their failure to live an organized life, and their hypocrisy. Despite these assertions of nonconformity and dominance, however, obdurate paranoids are not likely to eschew deep-seated feelings of guilt and fear of retribution. Further, they may appear to function normally much of the time but possess tightly compartmentalized persecutory delusions. These tendencies go largely unnoticed, but the individual’s hypersensitive antennae are perpetually in alert mode, noticing any unusual twitch, remark, or facial expression emanating from nearby others. It is not unusual for this paranoid pattern to project their anger onto others—thereby creating the perception of hostile intent from innocuous or absent signals. In fact, what we now think of as “classical paranoia,” that is, compartmentalized beliefs separate and apart from a patient’s usual thought process, usually emanates from those of the obdurate variant because of their tightly controlled, segmented belief structure: When a sensitive nerve is touched, their otherwise normal functioning is impaired and the hidden beliefs become manifest.[/conditional] [comment memo="Grandiose paranoid conspiracies | Pretentious | Contempt | Hyper-sensitive | Fantasy prone"] [checkbox name="ParaPDNarF" value="Paranoid Personality with Narcissistic Features"][conditional field="ParaPDNarF" condition="(ParaPDNarF).is('Paranoid Personality with Narcissistic Features')"] - The Pts fanatical characterology suggests a paranoid personality with narcissistic features which includes: grandiose delusions that are irrational and flimsy; pretentious, supercilious contempt and arrogance towards others, sensitive to self-esteem injury, extravagant claims and fantasies. The fanatic paranoid pattern often resembles its less troubled cousin, the narcissistic personality, as this variant is an interweaving of both paranoid and narcissistic traits. Like the narcissist, the fanatic variant of the paranoid pattern comes across as arrogant, pretentious, and expansive and maintains an air of contempt toward others. A major difference is that narcissists often achieve some success, whereas fanatic paranoids have run hard into reality, their narcissism profoundly wounded. Thus fallen from grace, their self-image of perfection shattered, fanatic paranoids seek to reestablish lost pride through extravagant claims and intricate fantasies. By endowing themselves with illusory powers, they become superheroes or demigods, ready to prevail against an evil universe. Eventually, delusions of grandeur become their primary coping mechanism. By assuming a grandiose identity, fanatic paranoids offset the collapse of self-esteem produced by objective reality. They may present themselves as a holy saint, inspired leader, or talented genius. Elaborate schemes may be devised by which to deliver the world from sin, lead the planet to world peace, solve long-standing scientific problems, or create utopian societies. Often, their plans are sufficiently detailed to draw at least passing interest. When their ideas are eventually dismissed by others, they are likely to attribute interference to intangible powers, perhaps secret government agencies that have conspired to preserve the status quo. Projection, righteous indignation, and a sense of omnipotence combine to create a defensive armor in this subtype. Developmentally, fanatic paranoids are similar to fragile narcissists. Overindulged and unrestrained by their parents, their imagination of what they might become in life was given free reign and encouraged by caretakers, perhaps as a means of compensating for poor family status. Once beyond the protective confines of the household, however, their image of superiority was quickly and unmercifully destroyed by the outside world. Completely defeated, saddled with a crushed sensed of self-worth, and unwilling to face reality, they retreat deeper inside their private world of fantasy, creating a compensatory universe in which they can assume their former station, fulfill previous ambitions, and salvage their existence.[/conditional] [comment memo="Querulous | Contentious | Fractious | Faultfinding | Jealous | Sullen | Unaccomodating"] [checkbox name="ParaPDNegF" value="Paranoid Personality with Negativistic Features"][conditional field="ParaPDNegF" condition="(ParaPDNegF).is('Paranoid Personality with Negativistic Features')"] - The Pts querulous characterology suggests a paranoid personality with negativistic features which includes: contentious, caviling, fractious, argumentative, faultfinding, unaccomodating, resentful, choleric, jealous, peevish, sullen, endless interpersonal wrangles, whiny, waspish, snappish. The querulous paranoid combines aspects of the paranoid with negativistic patterns, with the latter contributing characteristics such as discontentment, pessimism, stubbornness, vacillation, and vengefulness. When combined with paranoid projection, these traits are amplified into overt hostility and forthright delusions. This result manifests in tones of faultfinding, sullenness, resentfulness, contentiousness, jealousy, and insistence on being forever wronged or cheated. It is rare to find these individuals insustained, healthy relationships. Instead, these persons tend to give up their quests for affection and move to a contrived stance of autonomy and self-determination, renouncing their social needs yet harboring a cloaked sense of dejection. While they state their newfound independence with vengeful fury, the querulous variant remains deeply troubled by interpersonal discontentedness and feelings of indecisiveness, with hidden feelings vacillating between desiring the company of others and feeling repulsed by them. As envy mounts, they often complain that the achievements of others reflect unfair advantages or preferential treatment. Grumbling turns to anger and spite as their fantasies of being taken advantage of accrete ever more injustices. Legal action against those who have wronged them is common, as are erotic delusions because the querulous paranoid does still seek affection even while refusing it. This is done via the intrapsychic projection mechanism, whereby the individual comes to believe that the feelings of the self are actually emanating from others. Thus, by projecting their own desires onto others, it becomes “them” who make lewd remarks or otherwise suggest sexual intentions. Accusations of infidelity, deceit, and betrayal are often made against innocent relatives and friends, a further synthesis of the negativistic and paranoid patterns.[/conditional] [comment memo="Reclusive | Hermetical | Hypervigilant | Self-sequestering"] [checkbox name="ParaPDAvF" value="Paranoid Personality with Avoidant Features"][conditional field="ParaPDAvF" condition="(ParaPDAvF).is('Paranoid Personality with Avoidant Features')"] - The Pts insular characterology suggests a paranoid personality with avoidant features which includes: reclusiveness, self-sequestered, hermetical, shutting oneself away from imagined omnipresent threats of destruction, hypervigilance and defense against imagined dangers. The insular paranoid combines aspects of the paranoid and avoidant personalities. Such individuals are often moody, apprehensive, and hypersensitive to criticism, especially where their worth and achievements are concerned. Extremely vulnerable, many insular paranoids seek solace in self-focused ways. For example, they may engage in abstruse intellectual activities to enhance their self-esteem or indulge in drugs and alcohol to calm their fears. Especially fearful of shame and humiliation, insular paranoids seek to defend themselves against both real and imagined dangers. More than most, they seek to protect themselves from a world both threatening and destructive. As such, they may isolate themselves for long periods of time, a means of keeping the inevitable judgments of others out of their lives. Insular paranoids also have an unusually strong fear of being controlled. They not only seek to prevent external influence but also desire to rely solely on their own conclusions and beliefs. Unwilling to check their thoughts against consensual reality, they grow more and more out of touch with the surrounding world, eventually losing the ability to distinguish fantasy from reality. Fears of shame and humiliation, an important component of both the paranoid and avoidant patterns, easily inflate to full-blown conspiracies. Eventually, their thoughts may become so painful and terrifying that they begin intentionally to interrupt the continuity and focus of their perceptions, distracting themselves from their own thoughts. By deserting themselves, their inner world becomes a chaotic mélange of distorted, incidental, and unconnected notions, the threshold of a decompensated paranoid state.[/conditional] [comment memo="Beligerent | Cantankerous | Intimidating | Callous | Persecutory Delusions"] [checkbox name="ParaPDSadF" value="Paranoid Personality with Sadistic Features"][conditional field="ParaPDSadF" condition="(ParaPDSadF).is('Paranoid Personality with Sadistic Features')"] - The Pts malignant characterology suggests a paranoid personality with sadistic features which includes: beligerence, cantakerous, intimidating, vengeful, callous, tyrantical, fantasies of hostility, projects venemous intent onto others, persecutory delusions. Malignant paranoids combine aspects of the paranoid and sadistic personalities. Such individuals have built expectations that they will be on the receiving end of others’ aggressions. Highly sensitive to power issues, their strategy is to dominate you before you can dominate them. Intimidating and belligerent, they possess a ruthless desire to avenge past wrongs and triumph over others. Even when they are alone, the long list of perceived wrongs done to them constantly rises into awareness, thus keeping a potential for aggression close to the surface. However, many have found that their actual efforts at abusing and terrorizing others routinely backfire, which leads them to seek retribution more through fantasy than action. These setbacks are wrought by their own hand, as their chip-on-the-shoulder attitude toward others provokes abundant antagonism. As they become more isolated, left to ruminate over this self-created perpetual cycle of interpersonal hostility, fanatic paranoids begin to cogitate on the perceived malicious nature of their hostile environment, complete with the venomous individuals who inhabit it. Via the intrapsychic mechanism of projection, they begin to attribute their own acrimony to others, ascribing to them all of the enmity they feel within themselves. As the line between objective antagonism and imagined hostility grows thin, the belief that others are intentionally persecuting them may take on almost delusional proportions. The need to protect their autonomy against any and all outside influence is a defining feature of this variant because nothing is so valuable and so vulnerable to them as their sense of self-worth. This is particularly evident in the content of their persecutory delusions. The malevolence they perceive emanating from others is neither casual nor random but designed to intimidate, offend, undermine their self-esteem, control their thoughts, and weaken their will. They are ever alert against their darkest fears: Others will make them soft and yielding, forced to submit to authority, or worse, tricked into surrendering their self-determination.[/conditional] [checkbox name="AntPD" value="ANTISOCIAL PERSONALITY FEATURES"][conditional field="AntPD" condition="(AntPD).is('ANTISOCIAL PERSONALITY FEATURES')"] Pt presents with Antisocial Characterology - Disregards the rights of others | Unlawful | Deceitful | Impulsive | Aggressive | Reckless | Irresponsible | Callous Themes articulated by the Pt:[/conditional] [checkbox value="I have to look out for myself|Force or cunning is the best way to get things done|We live in a jungle and the strong person is the one who survives|People will get at me if I dont get them first|It is not important to keep promises or honour debts|Lying and cheating are OK as long as you dont get caught|I have been unfairly treated and am entitled to get my fair share by whatever means I can|Other people are weak and deserve to be taken|If I don’t push other people, I will get pushed around|I should do whatever I can get away with|What others think of me doesnt really matter| If I want something, I should do whatever is necessary to get it|I can get away with things so I dont need to worry about bad consequences|If people cant take care of themselves, thats their problem"] [comment memo="Feels Jinxed | Gypsy-like | Vagrancy | Impulsive | Misfit | Petty crime | Itinerant | Roaming | Drop-out"] [checkbox name="AntPDSchF" value="Antisocial Personality with Schizoid Features"][conditional field="AntPDSchF" condition="(AntPDSchF).is('Antisocial Personality with Schizoid Features')"] - The Pts nomadic characterology suggests a antisocial personality with schizoid or avoidant features which includes: feeling jinxed, ill-fated, doomed and cast-aside; peripheral, drifter, gypsy-like roaming, vagrancy, drop-out, misfit, itinerant, vagabond, tramp, wandering, impulsivity. Although the most widely held impression is that antisocials are incorrigible criminals who undermine the values of the surrounding culture, some seek simply to run away from a society in which they feel unwanted, cast aside, or abandoned. Although most antisocials react antagonistically to social rejection, these individuals drift along at the margins of society, scavenging whatever slim resources they come across. The nomadic variant combines antisocial with schizoid and/or avoidant characteristics. Most see themselves as jinxed or doomed and desire only to exist at the edge of a world that would almost certainly reject them. Mired in self-pity, they drop out of society to become gypsy-like roamers, vagabonds, or wanderers. With little regard for their personal safety or comfort, they may drift from one setting to another as homeless persons involved in prostitution and substance abuse. Adopted children who feel uneasy about their place in the world sometimes follow the path of the nomadic antisocial, wandering from place to place in an apparently symbolic search for their true home or natural parents. Their sense of “being no place” signifies alienation from self and others. For this reason, nomadics often appear vaguely disconnected from reality and lack any clear sense of self-identity. Compared to other variants, nomadic antisocials often seem relatively harmless because of their attitude of indifference and disengagement. Some are indeed vacant and fearful, but others are deeply angry and resentful. As a consequence of alcohol or substance abuse, they may act out impulsively, discharging their frustrations in brutal assaults or sexual attacks on those weaker than themselves.[/conditional] [comment memo="Malevolent| Belligerence | Rancorous | Malignant | Vicious | Brutal | Resentful | Truculent | Fearless | Guiltless"] [checkbox name="AntPDSadF" value="Antisocial Personality with Sadistic Features"][conditional field="AntPDSadF" condition="(AntPDSadF).is('Antisocial Personality with Sadistic Features')"] The Pts malevolent characterology suggests a antisocial personality with sadistic or paranoid features which includes: belligerence, rancorous, vicious, malignant, brutal, resentful; anticipates betrayal and punishment, desires revenge, truculent, callous, fearless, guiltless. As a blend of the antisocial and paranoid or sadistic personalities, malevolent antisocials are often seen as the least attractive antisocials. Belligerent, rancorous, vicious, malignant, brutal, callous, vengeful, and vindictive, they perform actions charged with a hateful and destructive defiance of conventional social life. Like the paranoid, they anticipate betrayal and punishment. Rather than merely issue verbal threats, however, they seek to secure their boundaries with a cold-blooded ruthlessness that avenges every mistreatment they believe others have inflicted on them in the past. For them, tender emotions are a sign of weakness. They interpret the goodwill and kindness of others as hiding a deceptive ploy for which they must always be on their guard. Where sadistic traits are prominent, they may display a chip-on-the-shoulder attitude and a willingness to confirm their strong self-image by victimizing those too weak to retaliate or those whose terror might prove particularly entertaining. When confronted with displays of strength, malevolents are experts at the art of posturing and enjoy pressuring their opponents until they cower and withdraw. Most make few concessions and instead escalate confrontations as far as necessary, backing down only when clearly outgunned. [/conditional] [comment memo="Covetous| Feels denied | Begrudging | Envious | Retribution seeking | Greedy"] [checkbox name="AntPDCovF" value="Antisocial Personality with Covetous Features"][conditional field="AntPDCovF" condition="(AntPDCovF).is('Antisocial Personality with Covetous Features')"] - The Pts covetous characterology suggests a antisocial personality which includes: feeling intentionally denied and deprived, rapacious, begrudging, discontentedly yearning, envious, seeking retribution, avariously greedy, gains pleasure in taking more than owning. The covetous character is a prototypical antisocial personality organisation. Here, aggrandizement, the desire to possess and dominate, is seen in a distilled form. These individuals feel that life has not given them “their due”; they have been deprived of their rightful amount of love, support, or material reward; and others have received more than their share. Jealous of those who have received the bounty of a good life, they are driven by an envious desire for retribution to take what destiny has refused them. Whether through deceit or destruction, their goal is compensation for the emptiness of life, rationalized by the assertion that they alone can restore the imbalance fated to them. Seething with anger and resentment, their greatest pleasure lies in taking control of the property and possessions of others. Some are overtly criminal. Many possess an enormous drive for revenge, manipulating others like pawns in a power game. Regardless of their success, however, covetous antisocials usually remain insecure about their power and status, never feeling that they’ve been compensated for life’s impoverishments. Ever jealous and envious, pushy and greedy, they may make ostentatious or wasteful displays of materialism and conspicuous consumption such as buying exotic cars, mansions, and elaborate jewelry as a means of exhibiting their power and achievements to others. Most feel a deep sense of emptiness, juxtaposed with vague images of how different life might have been had opportunity blessed them, as it has so many others. Some are simple thieves, while others become manipulative entrepreneurs who exploit people as objects to satisfy their desires. Although they have little compassion for or guilt about the effects of their behavior, they never feel that they have acquired quite enough, never achieve a sense of contentment, and feel unfulfilled regardless of their successes, remaining forever dissatisfied and insatiable.[/conditional] [comment memo="Dauntless| Venturesome | Intrepid | Audacious | Daring Reckless | Heedless | Impulsive"] [checkbox name="AntPDHistF" value="Antisocial Personality with Histrionic Features"][conditional field="AntPDHistF" condition="(AntPDHistF).is('Antisocial Personality with Histrionic Features')"] - The Pts risk-taking characterology suggests a antisocial personality with histrionic features which includes: dauntless, venturesome, intrpid, bold, audacious, daring, reckless, foolhardy, impulsive, heedless, pursuing perilous adventures. Minor risk taking within a controlled environment provides a normal outlet for excitement and sensation seeking; many people love a roller coaster, for example. However, there are individuals for whom risk taking is intended to impress others with a front of courageous indifference to potentially painful consequences. Risk-taking antisocials, who combine antisocial and histrionic traits, wish others to see them as unaffected by what almost anyone else would surely experience as dangerous or frightening. While others shrink in fear, they are unfazed by the possibility of gambling with death or serious injury. Risk is proactively sought as its own reward, a means of feeling stimulated and alive, not a means of material gain. Although their pretense is being dauntless, intrepid, and bold, their hyperactive search for hazardous challenges is seen by normals as foolhardy, if not stupid. In effect, they are thrill seekers infatuated by the opportunity to test their mettle by performing for the attention, applause, and amazement of an audience. Otherwise, they would simply feel trapped by the responsibility and boredom of everyday life. The most important factors making them antisocial is the irresponsibility of their actions and their failure to consider the consequences for their own life, or the lives of others, as they pursue ever more daring challenges.[/conditional] [comment memo="Unassailable| Invincible | Indominable | Formidble | Intransigent | Overeacts to slights"] [checkbox name="AntPDNarcF" value="Antisocial Personality with Narcissistic Features"][conditional field="AntPDNarcF" condition="(AntPDNarcF).is('Antisocial Personality with Narcissistic Features')"] - The Pts unassailable characterology suggests a antisocial personality with narcissistic features which includes a need to thought of as unflawed, unbreakable, invincible, indominable, formidable, inviolable, intransigent when status is questioned, over-reacts to slights. Not all antisocials covet material possessions or power. Those who share traits with the narcissistic personality are motivated by the desire to defend and extend a reputation of bravery and toughness. Antisocial acts are designed to ensure that others notice them and accord them the respect that they deserve. As such, they are perpetually on guard against the possibility of belittlement. Society should know that the reputationdefending antisocial is someone significant, not to be easily dismissed, treated with indifference, taken lightly, or pushed around. Whenever their status or ability is slighted, they may erupt with ferocious intensity, posturing, and threatening until their rivals back down. Some reputation-defending antisocials are loners, some are involved in adolescent gang activities, and still others simply seek to impress peers with aggressive acts of leadership or violence that secure their status as the alpha male, the dominant member of the pack. Being tough and assertive is essentially a defensive act intended to prove their strength and guarantee a reputation of indomitable courage.[/conditional] [checkbox name="AvoPD" value="AVOIDANT PERSONALITY FEATURES"][conditional field="AvoPD" condition="(AvoPD).is('AVOIDANT PERSONALITY FEATURES')"] Pt presents with Avoidant Characterology - Social inhibition | Negative self-evalution | Fears rejection | Avoids interpersonal contact | Shame prone | Fear of ridicule | Feels inadequate | Feels unappealing Themes articulated by the Pt:[/conditional] [checkbox value="Social ineptitude|Others are watching and scrutinizing me|A presumption that others are going to be critical, rejecting or demeaning|Unpleasant feelings cant be tolerated|If people get close they will reject me|Im inferior to others|I cant be the centre of attention|Unpleasant feelings will escalate without end|All criticism of me is valid|Inaction is better than trying and failing|If I avoid thinking about a problem it will go away|Relationship tension indicates a catastrophe is imanent"] [comment memo="General apprehensiveness | Many qualms | Disquietude symbolized by repugnant and specific dreadful object or circumstances"] [checkbox name="AvPDDeF" value="Avoidant Personality with Dependent Features"][conditional field="AvPDDeF" condition="(AvPDDeF).is('Avoidant Personality with Dependent Features')"] - Pts phobic characterology suggests an avoidant personality with dependent features - over-relying on displacement defenses. Like the avoidant, dependent personalities desire close personal relationships; unlike the avoidant’s basic sense of mistrust, however, dependents invest their trust (and much of their sense of self) in a significant other and relentlessly dread the potential loss of that relationship. Phobic avoidants combine features of these two personalities. Trapped between desire and the possibility of abandonment, phobic avoidants find a symbolic substitute onto which to project or displace their fear and anger. A free-floating and barely tolerable sense of anxiety or dread is thus concretized and shifted away from its true object: It’s not the boyfriend or girlfriend, but the dog next door that is to be feared. By fleeing the phobic object or situation, such individuals seek to free themselves by symbolically leaving fear behind. Such phobias express the avoidant’s fear of personal rejection, humiliation, and shame. For many phobic avoidants, the expression of fear in the presence of the phobic object also represents a cry for compassion, a desire to make instrumental use of fear as a means of disarming rejection and abandonment threats by eliciting support from otherwise unsupportive persons. Thus, phobic avoidants may successfully distance themselves from anxiety-producing situations, while also soliciting a degree of tolerance from others: You can’t really hate her for not wanting to take the job at the dam; she has a fear of drowning. Unfortunately, such attempts often backfire, for the phobia itself may elicit mockery. Our case study, Allison, does not seem to fit this pattern, either. Note that while she does experience similar acute symptomology, hers are clearly panic attacks that relate directly to her interpersonal world, rather than displaced phobic reactions to inanimate “replacement” objects. She is not attempting to make her worries tangible and concrete as a phobic avoidant may do in projecting fears onto a dreaded stimuli. She is also not attempting to elicit support by her panic attacks; quite the contrary, these are an instrumental method of escape. Note, too, that many personalities experience phobic syndromes. Some exhibit dramatic displays; others, being more constrained, show a motor restlessness and worry about being exposed as weak and inadequate. Irritable personalities seem always on edge, even when the phobic object is not present; avoidants hide their fears under a quiet public reserve.[/conditional] [comment memo="Creates unwinable binds for others | Subtly implies others have wronged him | Seeks affection in a round-about manner"] [checkbox name="AvPDNeF" value="Avoidant Personality with Negativistic Features"][conditional field="AvPDNeF" condition="(AvPDNeF).is('Avoidant Personality with Negativistic Features')"] - Pts conflicted characterology suggests an avoidant personality with negativistic features: He presents with not only with the withdrawal tendencies of the avoidant personality but expressed in a manner akin to the negativist’s penchant for “interpersonal guerilla warfare.” That is, a tendency to creating unwinable binds for others. He attacks others for failing to recognize his needs for affection, but then accuses those who offer nurturance of seeking to compromise his independence. Unfortuantely this tends to create a perception of petulant sulking when needs for closeness are not met. Predisposed to anticipate the disappointments and fears of facing others openly, the Pt is known to strike out indirectly by obstructing the actions of friends and misrepresenting their wishes. He reports feeling misunderstood, unappreciated, and demeaned by friends, family and colleagues, and struggles with mood lability more than most avoidants. During periods when stresses are minimal, he may deny past resentments and portrays an image of general contentment. However, under slight pressures, his calm surface quickly gives way to impulsive hostility. Unable to orient emotions and thoughts logically, he may at times become lost in personal irrelevancies and autistic asides, further alienating them from others. Relating to the Pt is an arduous process, requiring far more patience than most people are likely to offer. I fell this unconsciously fulfills the avoidant’s circular struggle; it vilifies others and discourages their closeness (keeping them safe from harm), yet ensures the avoidant’s unwanted isolation.[/conditional] [comment memo="Wary | Suspicious | Timorous | Thin Skinned | Petulant | Prickly"] [checkbox name="AvPDPaF" value="Avoidant Personality with Paranoid Features"][conditional field="AvPDPaF" condition="(AvPDPaF).is('Avoidant Personality with Paranoid Features')"] - Pts hypersensitive characterology suggests an avoidant personality with paranoid features: intensely wary and suspicious, timorous, thin skinned, petulant and prickly. The Pts personality architecture incorporates features of paranoid personality, but exhibits greater reality contact. Whereas persons with paranoid personality disorder are generally autonomous to a fault and cannot acknowledge any personal vulnerabilities, even to themselves, this Pt is well aware of his own shortcomings but attributes them as much to the maneuverings of others as to himself. Pt presents as high-strung and prickly, vigilant to signs of rejection and abuse, and excessively wary of the motives of others. Moreover, his pervasive apprehensiveness is often accompanied by intense and labile moods that feature prolonged periods of edginess and self-deprecation. The Pt strongly expects that others will be rejecting and disparaging but alternates between the profound gloom that often accompanies the basic avoidant pattern and the irrational projection of the paranoid. Either way, his usual strategy is a protective withdrawal that maintains a safe distance from all emotional involvement. With a tendency to retreat defensively, the Pt has become increasingly remote from others and from needed sources of support, reporting an admixture of guilt, and contrition, as well as feeling misunderstood, unappreciated, and demeaned by others. The paranoid characterology means the Pt finds it difficult to contain his anger toward anyone who has been unsupportive, critical, or disapproving. Under duress, the Pt exhibits more severe paranoid features and expresses a believe that his woes are the product of covert actions by others to undermine him or make him inhibit himself. The paranoid architecture makes it easy for the Pt believe that others are the cause of his inadequacy, an external attribution, than to believe that he is naturally inadequate, an internal attribution. Where the former shifts the blame and perhaps allows a remedy; the latter leads only to resignation.[/conditional] [comment memo="Thought blocking | Low moods | Casting away untenable thoughts | Fantasy prone | Self-neglect"] [checkbox name="AvPDDeF" value="Avoidant Personality with Depressive Features"][conditional field="AvPDDeF" condition="(AvPDDeF).is('Avoidant Personality with Depressive Features')"] - Pts self-devaluing characterology suggests an avoidant personality with depressive features, which includes thought blocking, framenting self-awareness, casting away untenable thoughts. This pt combines the social retreating of the avoidant with the ruminative (cognitive) self-devaluation of the depressive personality. The Pt immerses himself in a surrogate fantasy existence to avoid the discomfort of having to relate to others. He is not, however, unaware of his use of these tactics, and this makes him painfully aware of his perceived inadequacies. Under duress, I note the Pts rich inner fantasies are less effective, and his thoughts center more and more on the misery of his life and the anguish of his past experiences. In other words, his waking dreams are displaced by painful ruminations. Thus totally interiorized, the feelings that motivated his initial withdrawal reverberate unremittingly. More and more, he cannot tolerate being himself and seeks to completely withdraw from his own conscious awareness, an existential abnegation of selfhood. Some become increasingly neglectful psychologically and physically, even to the point of neglecting basic hygiene. Pts like this, often plunge into despair and are driven toward suicide, abandoning life as a means of ridding themselves of inner anguish and horror of their own identities. Others regress into a state of emotional numbness in which they are completely disconnected from themselves. In particularly severe cases, the structure of consciousness itself may split or fragment, leaving a regressive disorganization reminiscent of the schizotypal personality. As this process proceeds, self-devaluing avoidants become outside spectators, observing from without the drama of their frightening transformation.[/conditional] [checkbox name="StplPD" value="SCHIZOTYPAL PERSONALITY FEATURES"][conditional field="StplPD" condition="(StplPD).is('SCHIZOTYPAL PERSONALITY FEATURES')"] Pt presents with Schizotypal Characterology - Marked social deficits | Discomfort with close relationships | Cognitive distortions | Ideas of reference | Magical thinking | Suspicious | Eccentric | Lack of friends Themes articulated by the Pt:[/conditional] [checkbox value="Quirky and unusual interpretations of ordinary phenomenon|Focus on the tangential at the expense of the salient|Attributing unusual and special significance to peripheral and incidental events|A fundamental lack of social comprehension and logic|Idiosyncratic interpretations about others|Perplexity about normal human interactions|Unusual theory of mind|Magical thinking, bodily illusions, odd beliefs, peculiar suspicions, and cognitive blurring that interpenetrates reality with fantasy|Superstitions, referential ideas, and illusions|See self as alienated from the world|Sees self as forlorn and estranged|Ruminations about life’s emptiness and meaninglessness|Sees self more dead than alive, insubstantial, foreign, and disembodied|Gets lost in personal irrelevancies and in tangential asides that seem vague, digressive, and with no pertinence to the topic at hand|Ideas of reference in which the patient believes that unrelated events are related to him or her|Vague paranoid ideation|Magical thinking|Pseudo hallucinations (a dead relative is present or people in the shadows)|Emotional reasoning|Personalization (over-responsiblity)"] [comment memo="Insipid | Disengaging from others | Disembodied self | Body and mind sundered | Dissociated"] [checkbox name="StplPDDeF" value="Schizotypal Personality with Dependent Features"][conditional field="StplPDDeF" condition="(StplPDDeF).is('Schizotypal Personality with Dependent Features')"] - Pts insipid characterology suggests an schizotypal personality with dependent and depressive features, which includes: disengaging from others and self, self is disembodied or distant object, body and mind sundered, cleaved, dissociated, disjoined, eliminated. The insipid schizotypals represent a structural exaggeration of the passive-detached pattern. Like the schizoid, they are notably insensitive to feelings, seem indifferent to the external world, and appear drab, unmotivated, apathetic, inexpressive, sluggish, and joyless. Insipid schizotypals, however, exaggerate even this. Being detached, they have no connection to the external world. Being passive, they generate nothing inside themselves that might give substance to their identity. Instead, they exist with form but no content. Some experience their mind and body as separate or decoupled. Others experience occasional existential crises—episodes of terror during which they feel hollow, dead, or nonexistent—and may grasp at anything to confirm their existence and avoid nothingness. Others see themselves as automatons without meaning or purpose. Their consciousness may seem to float, unconnected to the physical world, and lost in some dimension between being and nonbeing. Cognitive processes seem obscure, vague, and tangential. Symptoms of depersonalization are common. Social communications are responded to minimally or with inappropriate affect or peculiar ideas or in a circumstantial and confused manner. Speech is monotonous, listless, or even inaudible. In some cases, depressive and dependent features may also be present. Developmentally, insipid schizotypals are likely to have had family atmospheres of excessive indifference, impassivity, or formality. The family provides an important model for lifelong patterns of social reticence, interpersonal insensitivity, and discomfort with personal affection and closeness. Styles of fragmented and amorphous communication, complicated by disjointed, vague, confusing, and pointless interactions, are probably also a factor, leading to unfocused and irrelevant interpersonal relations. Given emotional deficits that flatten otherwise rich experiences and cognitive obscurities that further blur important distinctions, the opportunity for having satisfying interpersonal experiences is lost. Unable to communicate with either affect or clarity, they likely were shunned, overlooked, and invited to share few of the more interesting experiences to which others were drawn. Failing to interchange ideas and feelings with others, they remain fixed and undeveloped, continuing, therefore, in their disjointed, amorphous, and affectless state. Restricted in their social experiences, they acquire few social skills, find it increasingly difficult to relate socially, and perpetuate a vicious circle that fosters their isolation and accentuates their social inadequacies and cognitive deficiencies.[/conditional] [comment memo="Timorous | Wary | Aprehensive | Suspicious | Guarded | thought blocking | reversing and disqualifying thoughts"] [checkbox name="StplPDAvNegF" value="Schizotypal Personality with Avoidant and Negativistic Features"][conditional field="StplPDAvNegF" condition="(StplPDAvNegF).is('Schizotypal Personality with Avoidant and Negativistic Features')"] - Pts timorous characterology suggests an schizotypal personality with avoidant and negativistic features, which includes: wary apprehension of others, watchfulness, suspicion, guardedness, shrinking, hyper-sensitivity, alienated from self and others, thought blocking, reversing and disqualifying own thoughts. Timorous schizotypals represent a structural exaggeration of the active-detached pattern. Like the avoidant, they are restrained, isolated, apprehensive, guarded, and socially shrinking. In contrast to the insipid variant, apathy and indifference are used protectively to damp down their sensitivities, feelings, and desires. Some develop exaggerations of avoidant scanning and hypervigilance, becoming drawn to strange signs and omens through which protective guidance can be obtained and malicious events controlled or averted. They may focus on irrelevant details or those that would escape the ordinary person and develop superstitious behaviors or rituals. Many devalue the self so completely that they deliberately confuse their own cognitive processes as a means of avoiding what is presumably rational and objective. Others turn the fantasy life cultivated by some avoidants into perceptions that are normally beyond the five senses. In effect, they create a new inner world populated by magical fantasies, illusions, telepathic relationships, and other odd thoughts that provide them with an existence more significant and rewarding than that found in reality. Others seek to jettison the self completely, voiding their identity and following a path similar to that of their insipid counterparts. Timorous schizotypals are excessively apprehensive, particularly in social encounters, exhibiting agitation and an anxious watchfulness. Most exhibit a distrust of others and a suspiciousness about their motives that rarely recede despite growing familiarity. Developmentally, timorous schizotypals were likely exposed to belittlement, rejection, and humiliation. As a result, they have low self-esteem, feelings of incompetence, and a marked distrust of others. As a result of such harsh treatment, they protectively keep their distance from others, wall off from society, and insulate their feelings. Eventually, they avoid interacting with others at all, fearing that any amount of contact might lead to some negative appraisal. So convinced are they of their lack of worth that many come to denigrate themselves. Of the two subtypes, Neal more closely resembles the timorous schizotypal.[/conditional] [checkbox name="SchiPD" value="SCHIZOID PERSONALITY FEATURES"][conditional field="SchiPD" condition="(SchiPD).is('SCHIZOID PERSONALITY FEATURES')"] Pt presents with Schizoid Characterology - Restrictied emotional expression | Prefers solitary activities | Low interest in intimacy | Anhedonic | Does not desire close relationships | Indifferent to praise or criticism | Emotional detachment Themes articulated by the Pt:[/conditional] [checkbox value="It doesn’t matter what other people think of me|It is important for me to be free and independent of others|I enjoy doing things more by myself than with other people|In many situations, I am better off to be left alone|I am not influenced by others in what I decide to do|Intimate relations with other people are not important to me|I set my own standards and goals for myself|My privacy is much more important to me than closeness to people|What other people think doesn’t matter to me|I can manage things on my own without anybody’s help|It’s better to be alone than to feel stuck with other people|I shouldn’t confide in others|I can use other people for my own purposes as long as I don’t get involved|Relationships are messy and interfere with freedom"] [comment memo="Distant | Removed | Inaccessible | Solitary | Isolated | Homeless | Secluded |Aimless drifting"] [checkbox name="SchiPDAvSchizF" value="Schizoid Personality with Avoidant and Schizotypal Features"][conditional field="SchiPDAvSchizF" condition="(SchiPDAvSchizF).is('Schizoid Personality with Avoidant and Schizotypal Features')"] - Pts remote characterology suggests an schizoid personality with avoidant or schizotypal features, which includes: distant and removed, inaccessible, solitary, isolated, homeless, disconnected, secluded, aimlessly drifting, peripherally occupied. Although more characteristic of the avoidant personality development, children subjected to intense hostility and rejection very early in life may protectively withdraw so completely that their native capacity for feeling and relating to others becomes permanently reduced. Here, youngsters otherwise capable of normal interpersonal adjustment learn that such desires and emotions yield only anguish and disillusionment. Unlike the basic schizoid, some capacity for feeling and relating remains with the remote schizoid, but the wish for affective bonding has been so completely repressed that it no longer enters conscious awareness. Remote schizoids who are more severely impaired may also possess features of the schizotypal personality. Such individuals are often seen among the homeless, the chronically institutionalized, and the residents of halfway houses. Whereas the basic schizoid is aloof and insensitive to emotional experience, remote schizoids may express a measure of social anxiety as well as frequent behavioral eccentricities, autistic thinking, and depersonalization. At best, their low self-esteem and deficits in social competence allow them only a peripheral, but dependent, role in interpersonal and familial relationships. Most seek solitude and go through life as detached observers closed off from sources of growth and gratification. Some earn a marginal livelihood in low-status jobs, but most follow a meaningless, ineffectual, and idle pattern, drifting aimlessly on the periphery of social life. Many are totally dependent on public support.[/conditional] [comment memo="Inert | Deficient activation | Phlegmatic | Lethargic | Weary | Exhausted | Enfeebled"] [checkbox name="SchiPDMelF" value="Schizoid Personality with Melancholic Features"][conditional field="SchiPDMelF" condition="(SchiPDMelF).is('Schizoid Personality with Melancholic Features')"] - Pts languid characterology suggests an schizoid personality with depressive or melancholic features, which includes: inertia, deficient activation level, phlegmatic, lethargic, weary, leaden, lackadaisical, exhausted, enfeebled. A combination of the schizoid and melancholic personalities, the languid schizoid is marked by a slow personal tempo, low activation level, and the absence of vigorous and energetic action. Easily fatigued, with only weak motoric expressiveness, languids seem either too comfortable or too lazy; they are unable to rouse themselves to meet their responsibilities, pursue the simplest pleasures, or behave with spontaneity. Interpersonally, they have a quiet, colorless, and vaguely dependent way of relating, hybridizing the introversion of the schizoid with the lethargy characteristic of the depressive personality. As such, they rarely take the initiative, seem broadly anhedonic and cognitively detached, or vaguely ruminative. Such individuals have few interests, preferring a simple, repetitive, and dependent lifestyle. Unlike the affectless schizoid, described later, languids are not necessarily emotionally void. They do suffer the same type of profound angst often seen in depressives, yet their lack of vitality ensures that their sentiments are rarely expressed strongly.[/conditional] [comment memo="Inert | Deficient activation | Phlegmatic | Lethargic | Weary | Exhausted | Enfeebled"] [checkbox name="SchiPDMelF" value="Schizoid Personality with Melancholic Features"][conditional field="SchiPDMelF" condition="(SchiPDMelF).is('Schizoid Personality with Melancholic Features')"] - Pts affectless characterology suggests an schizoid personality with compulsive features, which includes: passionless, unresponsive, unaffectionate, chilly, uncaring, unstirred, spiritless, lackluster, unexcitable, unpeterbed, cold, emotionally constricted. The isolated, emotionally detached, and solemn characteristics of the affectless schizoid suggest constitutional factors, perhaps some abnormality of the neurological systems that support empathy, warmth, and sensitivity in human relationships. Although this might seem to suggest schizotypal features, the schizotypal exhibits a defect in the ability to understand the meaning of human communication. In contrast, the affectless variant combines the apathy of the schizoid with the emotional constriction and formality of the compulsive, effectively eliminating all emotional expression. Like compulsives, they find structured settings comfortable and are more likely to be effective in adult roles than the basic schizoid pattern. But like schizoids, they express the basic conflict of the compulsive, autonomy versus obedience, only weakly if at all.[/conditional] [comment memo="Inert | Deficient activation | Phlegmatic | Lethargic | Weary | Exhausted | Enfeebled"] [checkbox name="SchiPDSchizotyF" value="Schizoid Personality with Schizotypal Features"][conditional field="SchiPDSchizotyF" condition="(SchiPDSchizotyF).is('Schizoid Personality with Schizotypal Features')"] - Pts depersonalised characterology suggests an schizoid personality with schizotypal features, which includes: disengaging from others and self, self is disembodied or distant object, body and mind sundered, cleaved, dissociated, disjoined, eliminated. Often observed simply staring off into space, depersonalized schizoids seem dreamy and distant, as if they were contemplating some peaceful vision that draws them more and more away from the everyday existence of the mundane world. Like all schizoids, they are extremely inattentive and disengaged from the affairs of life. More than most, however, depersonalized schizoids have deteriorated into obliviousness. Although they appear preoccupied internally with something substantive, they are in fact preoccupied with nothing at all. Rather, their detachment takes a peculiar, schizotypal-like form: These schizoids feel like disembodied observers viewing themselves from the outside, detached not only from the real world but also from their own thoughts and feelings, from their imagination and fantasies, and from their own corporeal bodies, as well. Focused neither internally nor externally, they possess an ethereal attitude and only a residual physical presence. Whereas the basic schizoid pattern is best described as cognitively vacant, depersonalized schizoids seem cognitively absent.[/conditional] RISK ASSESSMENT Suicide Risk Report for [text name="Name"] Assessment date and time: [text name="date"] -- SUICIDE RISK SUMMARY -- Risk State (risk compared to Pts usual baseline): [checkbox value="higher than|similar to|lower than"] the Pts usual baseline of risk. Risk Status (risk relative to a specified subpopulation): [checkbox value="higher than|similar to|lower than"] the general population, and [checkbox value="higher than|similar to|lower than"] other Pts in the current service setting. Foreseeable changes in risk: [textarea default=""] Available resources immediately accessible to the Pt: [textarea default="Help line numbers, Acute Care Team, PRN meds, Friends, Family, Counsellor, Community Mental Health Clinician, Disability Support Worker, NGO Caseworker"] -- PATIENT REPORT -- Pt confirmed having [checkbox name="freq" value="no suicidal thoughts.|suicidal thoughts"][conditional field="freq" condition="(freq).is('suicidal thoughts')"] [checkbox value="every now and then|every other day|every day"], and rated these thoughts as [checkbox value="mild|moderate|severe"] in their intensity. When asked about having suicide plans, the patient reported: [checkbox value="no current plans|vague plans|having a definite plan|they are unwilling to discuss it"]. When further asked about how close have they been to acting on these thoughts in the past, the patient reported [checkbox value="not close at all|very close|they did indeed attempt suicide|they do not wish to discuss it"]. When asked how certain they feel about acting on these thoughts in the future, the patient reported [checkbox value="it's unlikely|they weren't sure|they were absolutely certain|they did not wish to discuss it"] Finally, when I asked about having access to the means to suicide, the patient reported [checkbox value="no|yes possibly|yes absolutely"][/conditional] [checkbox name="stat" value="-- ENDURING RISK FACTORS --"][conditional field="stat" condition="(stat).is('-- ENDURING RISK FACTORS --')"] Strengths and Protective Factors [checkbox value="treatment responsiveness|connectedness to individuals, family, community, and social institutions|problem-solving skills|coping skills|ability to adapt to change|they sense of purpose or meaning in life Cultural, religious, or personal beliefs that discourage self-injury|good social skills|ability to manage feelings of anger|good health|access to mental and physical health care|healthy fear of risky behaviours and pain|hope for the future and optimism|sobriety|medical compliance|a sense of the importance of health and wellness|impulse control|they strong sense of self-worth or self-esteem|a sense of personal control or determination|access to a variety of clinical interventions and support for seeking help|resiliency|expressed reasons for living|being married|being a parent|strong relationships, particularly with family members|opportunities to participate in and contribute to school or community projects and activities|living in a reasonably safe and stable environment|having restricted access to lethal means|sense of responsibility and duty to others|being a pet owner"] Long-term Risk Factors [checkbox value="Hx of denying the need for service contact|Hx of avoiding service contact|Dx of eating disorder|Dx neurological disorder|persistent psychotic illness|non-responsiveness to pharmacological treatment|non-responsiveness to psycho-social interventions|chronic stressors|Hx of psychiatric illness|long-standing fascination with death|social isolation|romantises death and dying|Hx of discrimination|a background of childhood adversity|having a family history of suicide|a disruptive and unsupportive family background|Dx of PTSD|combat veteran|background of being a first responder|Hx of relationship conflicts|divorced|complex family dynamics|unsupportive family|demographic - male - single age 35-64|substance misuse|absolutistic thinking|tunnel vision|perfectionism|sexual orientation rejected by family|guns in the home|access to abundant medications|chronic medical illness|chronic pain"] Impulsivity/Self Control [checkbox value="Hx of impulsive behaviour|problem-solving difficulties|unstable personality structure|Hx of substance abuse|low threshold for boredom|Hx of provocative behaviours|Dx with ABI|Dx with intellectual disability|Dx with developmental delay|Pt struggles with decision-making|Hx of sensation seeking behaviours|Pt struggles to delay gratification|Pt struggles to self-regulate emotions|low threshold for emotional arousal|Pt struggles to maintain goal focus|external locus of control|Hx of reckless self-endangerment|Pt struggles to inhibit aggression|limited capacity for self-soothing|low expecations for positive future|Dx with ADHD|Pt remains pre-occupied with suicide"] Past Suicidal Behaviour [checkbox value="history of self-harm|history of previous suicide attempts|previous hospitalization for suicidality|previous hospitalization for self-harm"][/conditional] [checkbox name="Dyna" value="-- DYNAMIC RISK FACTORS --"][conditional field="Dyna" condition="(Dyna).is('-- DYNAMIC RISK FACTORS --')"] Recent/present suicide ideation or behaviour [checkbox value="current suicidal ideation|has a suicide plan|suicide plan has high lethality|preparation behahiours|vocalising threat to suicide|rehearsal behaviours|access to lethal means|recent suicide attempt|Pt regrets not dying|mood lability|persistent agitation|tearful|guarded|withdrawal from services|increased impulsivity|increased recklessness|increased anger|seeking revenge|recent violent behaviours|final act behaviours"] Stressors / precipitants [checkbox value="financial loss|poor health|pending incarceration|detention|stressful loss|rejection|sense of being a burden|feeling alone|feeling isolated|suicide contagion in community|feeling trapped|recent humiliation|recent assualt|social rejection|anniversary of loss|suicide command hallucinations|argument with intimate|relationship conflict|loss of status|loss of self-esteem|loss of purpose and meaning|loss of social support|recent loss of job|suicide of an intimate"] [textarea default=""] Symptoms, suffering and recent changes [checkbox value="increased depressive symptoms|reports inner torment|persistent negative thoughts about self|reports self-hatred|social media posts about suicide|persistent crying|final act behaviours|mental illness Sx|unremitting pain|recent discharge from MHIPU|feeling trapped|increased substance abuse|persistent self-devaluation|no reasons for living|stalking|comorbid MH concerns|increasing impulsivity|being victimised|pending unemployment|increasing financial pressures|persistent nightmares|increasing financial pressure|recklessness|feeling out of control|feeling intolerably alone|withdrawal|feeling anger|icreased anxiety|panic|fear|agitation|hopelesness|pending legal issues|negative appraisals of self|insomnia|intense jealousy over ex|low expectation for recovery|pending criminal charges|declining health|feelings of shame|change in sleep patterns|change in appetite|access to lethal means|unmet needs|feelings of anger"] [textarea default=""][/conditional] -- RESPONSE -- [checkbox value="No action taken|provided brief supportive counselling|actively listened and validated Pt concerns|referred Pt to suicide prevention service|hospitalization recommended|immediate assessment with MH professional recommended|discussed Pt with supervisor|discussed Pt with MDT|supported Pt to remove lethal means|arranged monitoring by supportive person|informed family of risk|advised primary health provider of risk|recommended Pt seek treatment of MH Sx|recommended D&A treatment service|recommended counselling|helped Pt improve coping strategies|challenged Pts negative beliefs|emphasized behavioural control|encouranged behavioural activation to enhance mood|recommended pleasant activities|recommended to call 000 or present to ED after hours if needed|recommended Pt to call Acute Care Team after hours or Community Mental Health outpatients during business hours if Sx worsen|recommended use of PRN medications|alerted supportive individuals|recommended increasing psychosocial supports|encouraged reality-testing with family, friends or professionals|provided interruption strategies for troubling thoughts|after hours numbers provided|written safety plan provided"] [checkbox name="Safe" value="-- SAFETY PLAN --"][conditional field="Safe" condition="(Safe).is('-- SAFETY PLAN --')"] Encouraged Pt to make the environment safe by suggesting: - remove or secure harmful items - going to another location until the urges have passed - getting another person involved to help Warning signs (thoughts, images, mood, situation, behaviour) that a crisis may be developing: [textarea default=""] People who can provide distraction [textarea default=""] People to ask for help [textarea default=""] [textarea default=""][/conditional] VIOLENCE RISK ASSESSMENT The patients violence risk state is [checkbox value="higher than|similar to|lower than"] their usual baseline of risk. The patients violence risk status is [checkbox value="higher than|similar to|lower than"] the general population, and [checkbox value="higher than|similar to|lower than"] other patients in our service setting. Foreseeable changes in violence risk: [textarea default="Nil"] Documented incidents of violence: [textarea default="Nil. Yes."] Resources available to the Pt: [textarea default="Help line numbers, Acute Care Team, PRN meds, Friends, Family, Counsellor, Community Mental Health Clinician, Disability Support Worker, NGO Caseworker, Distraction strategies"] When asked, the patient [checkbox name="vicon" value="denied any current violent ideation or actions|disclosed current thoughts about violence|disclosed plans and / or intent to carry out acts of violence|admitted to recently committing an act of violence"][conditional field="vicon" condition="(vicon).is('disclosed current thoughts about violence')||(vicon).is('disclosed plans and / or intent to carry out acts of violence')||(vicon).is('admitted to recently committing an act of violence')"], because the patient felt: [checkbox value="current circumstances are unfair|mentally confused|tormented by thoughts|paranoid|righteous|outraged|not listened to|disrespected|impinged upon by others|current circumstances are out of their control|bullied|disrespected|wronged|the need for revenge|afraid for their safety|threatened|they have lost something of value|victimized by recent violence|excited by violence|their routine was disturbed|the need to assert toughness|forced to commit violence by peers|affected by substances|controlled by the behaviour of others."][textarea default=""][/conditional]. [checkbox name="violence" value="Known risk factors:"] [conditional field="violence" condition="(violence).is('Known risk factors:')"] [checkbox value="nil|documented violence towards others|Dx of conduct disorder|Dx of ASPD|Dx of ASD|attention deficits|hyperactivity|learning difficulties|an ABI|developmental delay|episodes of mania|poor theory of mind|impulse control difficulties|low frustration tolerance|low threshold for emotional reactivity|a history of early aggressive behaviour|low empathy|psychopathic traits|perspective-taking deficits|poor moral reasoning|drugs and/or alcohol misuse|intellectual difficulties|depression|poor behavioural control|excited by violence|fire-setting behaviours|deficits in social cognitions|sadistic traits|cruelty to animals|deficits in information-processing|documented incidents of dishonesty|attributes hostile intent to others|maternal alcohol abuse|is shame prone|paranoia|self-esteem is linked to violence|feels intense emotional distress|a psychotic illness|a history of treatment for emotional problems|antisocial beliefs and attitudes|an exposure to violence and conflict in the family|gang membership"][textarea default=""][/conditional]. [checkbox name="famfac" value="No known familial risk factors.|Familial risk factors:"] [conditional field="famfac" condition="(famfac).is('Familial risk factors:')"] [checkbox value="authoritarian childrearing attitudes|harsh, lax or inconsistent disciplinary practices|low parental involvement|low emotional attachment to parents or caregivers|low parental education|low parental income|parental substance abuse|parental criminality|poor family functioning|poor monitoring and supervision of children"][textarea default=""][/conditional]. [checkbox name="peerfac" value="No known peer risk factors.|Peer risk factors:"][conditional field="peerfac" condition="(peerfac).is('Peer risk factors:')"] [checkbox value="association with delinquent peers|involvement in gangs|feels socially rejected by peers|lacks involvement in conventional activities|academic underperformance|low commitment to education|school failure"][textarea default=""][/conditional]. [checkbox name="comfac" value="No known community risk factors.|Community risk factors:"][conditional field="comfac" condition="(comfac).is('Community risk factors:')"] [checkbox value="diminished economic opportunities|living in an area with a high concentration of underprivileged residents|has high levels of transiency|experiences high levels of family disruption|has low community participation|lives in a socially disorganised neighbourhood"][textarea default=""][/conditional]. [checkbox name="protfac" value="Protective factors:"][conditional field="protfac" condition="(protfac).is('Protective factors:')"] [checkbox value="an intolerant attitude towards deviant behaviour|a high IQ|good academic grades|a positive social orientation|highly developed social skills|plans ahead|realistic expectations for the future|religious|connected to family|connected to non-violent peers|fears violence and aggression|discusses problems with others|perceives parental disapproval for aggression|shares activities with family|supportive spouse|involved in pro-social activities|has positive role models|has affective relationships which are strong, close and prosocially oriented|is commited to education|is commited to work|has high needs for achievement|non-deviant peers|peer group rejects antisocial behaviour|involvement in pro-social activities|early exposure to positive parenting practices"][textarea default=""][/conditional]. [textarea cols=90 rows=20 default="No additional information about violence risk known"]. PSYCHIATRIC HISTORY [text default="The patient"] [checkbox name="Prev" value="denied any past psychiatric concerns.|identified previous psychiatric concerns:"] [conditional field="Prev" condition="(Prev).is('identified previous psychiatric concerns:')"] [checkbox value="a neurodevelopmental disorder|a schizophrenia spectrum disorder|a bipolar disorder|a depressive disorder|an anxiety disorder|an obsessive-compulsive disorder|a trauma and stress related disorder|a dissociative disorder|a somatic complaint disorder|a feeding and eating disorder|an elimination disorder|a sleep-wake disorder|a sexual dysfunction|a conduct disorder|a substance abuse disorder|a neuro-cognitive disorder|a personality disorder|a paraphilic disorder"].[/conditional] MEDICAL HISTORY [text default="The patient"] reported [checkbox name="medi" value="no significant medical history.|a history of medical concerns that include:"][conditional field="medi" condition="(medi).is('a history of medical concerns that include:')"] [checkbox value ="blood problems|a diagnosis of cancer|cardiovascular problems|a congential disorder|ear problems|eye problems|infectious disease issues|issues with their immune system|significant injuries|metabolic and endocrine issues|muscular-skeletal problems|neurological problems|gastrointestinal problems|renal and urogenital problems reported|reproductive health problems|respiratory problems|dermatological problems|a history of multiple medical problems|a medical problem that still remains undiagnosed and requires further investigation"][textarea cols=50 rows=20 default="details"].[/conditional] SURGICAL HISTORY [textarea cols=80 rows=20 default="No surgical history reported."] ALLERGIES [checkbox value="No known allergies"] [checkbox name="All" value="Known allergies:"][conditional field="All" condition="(All).is('Known allergies:')"] [textarea cols=60 rows=5 default=""][/conditional] MEDICATION LIST [checkbox value="No known medications."] [checkbox name="Med1" value="Medication:"][conditional field="Med1" condition="(Med1).is('Medication:')"][textarea cols=50 rows=1 default=""] [textarea cols=40 rows=1 default="Dose:"] [textarea cols=40 rows=1 default="Frequency:"] [textarea cols=40 rows=1 default="Prescriber:"] [textarea cols=50 rows=1 default="Reason:"][/conditional] [checkbox name="Med2" value="Medication:"][conditional field="Med2" condition="(Med2).is('Medication:')"][textarea cols=50 rows=1 default=""] [textarea cols=40 rows=1 default="Dose:"] [textarea cols=40 rows=1 default="Frequency:"] [textarea cols=40 rows=1 default="Prescriber:"] [textarea cols=50 rows=1 default="Reason:"][/conditional] [checkbox name="Med3" value="Medication:"][conditional field="Med3" condition="(Med3).is('Medication:')"][textarea cols=50 rows=1 default=""] [textarea cols=40 rows=1 default="Dose:"] [textarea cols=40 rows=1 default="Frequency:"] [textarea cols=40 rows=1 default="Prescriber:"] [textarea cols=50 rows=1 default="Reason:"][/conditional] [checkbox name="Med4" value="Medication:"][conditional field="Med4" condition="(Med4).is('Medication:')"][textarea cols=50 rows=1 default=""] [textarea cols=40 rows=1 default="Dose:"] [textarea cols=40 rows=1 default="Frequency:"] [textarea cols=40 rows=1 default="Prescriber:"] [textarea cols=50 rows=1 default="Reason:"][/conditional] [checkbox name="Med5" value="Medication:"][conditional field="Med5" condition="(Med5).is('Medication:')"][textarea cols=50 rows=1 default=""] [textarea cols=40 rows=1 default="Dose:"] [textarea cols=40 rows=1 default="Frequency:"] [textarea cols=40 rows=1 default="Prescriber:"] [textarea cols=50 rows=1 default="Reason:"][/conditional] [checkbox name="Med6" value="Medication:"][conditional field="Med6" condition="(Med6).is('Medication:')"][textarea cols=50 rows=1 default=""] [textarea cols=40 rows=1 default="Dose:"] [textarea cols=40 rows=1 default="Frequency:"] [textarea cols=40 rows=1 default="Prescriber:"] [textarea cols=50 rows=1 default="Reason:"][/conditional] DRUG & ALCOHOL ASSESSMENT [checkbox value="Current drug & alcohol use denied when asked."] [checkbox name="Alc1" value="Alcohol."][conditional field="Alc1" condition="(Alc1).is('Alcohol.')"] Method of use: [select value="oral|inhaled|intravenous|intranasal"] [textarea cols=50 rows=1 default="Quantity:"] [textarea cols=50 rows=1 default="Frequency:"] [textarea cols=50 rows=1 default="Time period of use:"][/conditional] [checkbox name="Caf1" value="Caffeine."][conditional field="Caf1" condition="(Caf1).is('Caffeine.')"] Method of use: [select value="oral|inhaled|intravenous|intranasal"] [textarea cols=50 rows=1 default="Quantity:"] [textarea cols=50 rows=1 default="Frequency:"] [textarea cols=50 rows=1 default="Time period of use:"][/conditional] [checkbox name="Nic1" value="Nicotine."][conditional field="Nic1" condition="(Nic1).is('Nicotine.')"] Method of use: [select value="oral|inhaled|intravenous|intranasal"] [textarea cols=50 rows=1 default="Quantity:"] [textarea cols=50 rows=1 default="Frequency:"] [textarea cols=50 rows=1 default="Time period of use:"][/conditional] [checkbox name="Her1" value="Heroin."][conditional field="Her1" condition="(Her1).is('Heroin.')"] Method of use: [select value="oral|inhaled|intravenous|intranasal"] [textarea cols=50 rows=1 default="Quantity:"] [textarea cols=50 rows=1 default="Frequency:"] [textarea cols=50 rows=1 default="Time period of use:"][/conditional] [checkbox name="Opi1" value="Opiates."][conditional field="Opi1" condition="(Opi1).is('Opiates.')"] Method of use: [select value="oral|inhaled|intravenous|intranasal"] [textarea cols=50 rows=1 default="Quantity:"] [textarea cols=50 rows=1 default="Frequency:"] [textarea cols=50 rows=1 default="Time period of use:"][/conditional] [checkbox name="Thc1" value="THC."][conditional field="Thc1" condition="(Thc1).is('THC.')"] Method of use: [select value="oral|inhaled|intravenous|intranasal"] [textarea cols=50 rows=1 default="Quantity:"] [textarea cols=50 rows=1 default="Frequency:"] [textarea cols=50 rows=1 default="Time period of use:"][/conditional] [checkbox name="Coc1" value="Cocaine."][conditional field="Coc1" condition="(Coc1).is('Cocaine.')"] Method of use: [select value="oral|inhaled|intravenous|intranasal"] [textarea cols=50 rows=1 default="Quantity:"] [textarea cols=50 rows=1 default="Frequency:"] [textarea cols=50 rows=1 default="Time period of use:"][/conditional] [checkbox name="Met1" value="Methamphetamine."][conditional field="Met1" condition="(Met1).is('Methamphetamine.')"] Method of use: [select value="oral|inhaled|intravenous|intranasal"] [textarea cols=50 rows=1 default="Quantity:"] [textarea cols=50 rows=1 default="Frequency:"] [textarea cols=50 rows=1 default="Time period of use:"][/conditional] [checkbox name="Ice1" value="ICE."][conditional field="Ice1" condition="(Ice1).is('ICE.')"] Method of use: [select value="oral|inhaled|intravenous|intranasal"] [textarea cols=50 rows=1 default="Quantity:"] [textarea cols=50 rows=1 default="Frequency:"] [textarea cols=50 rows=1 default="Time period of use:"][/conditional] [checkbox name="Inh1" value="Inhalants."][conditional field="Inh1" condition="(Inh1).is('Inhalants.')"] Method of use: [select value="oral|inhaled|intravenous|intranasal"] [textarea cols=50 rows=1 default="Quantity:"] [textarea cols=50 rows=1 default="Frequency:"] [textarea cols=50 rows=1 default="Time period of use:"][/conditional] [checkbox name="Sti1" value="Stimulants."][conditional field="Sti1" condition="(Sti1).is('Stimulants.')"] Method of use: [select value="oral|inhaled|intravenous|intranasal"] [textarea cols=50 rows=1 default="Quantity:"] [textarea cols=50 rows=1 default="Frequency:"] [textarea cols=50 rows=1 default="Time period of use:"][/conditional] [checkbox name="Hal1" value="Hallucinogens."][conditional field="Hal1" condition="(Hal1).is('Hallucinogens.')"] Method of use: [select value="oral|inhaled|intravenous|intranasal"] [textarea cols=50 rows=1 default="Quantity:"] [textarea cols=50 rows=1 default="Frequency:"] [textarea cols=50 rows=1 default="Time period of use:"][/conditional] [checkbox name="Oth1" value="Other."][conditional field="Oth1" condition="(Oth1).is('Other.')"] [textarea cols=50 rows=1 default="Name of substance:"] Method of use: [select value="oral|inhaled|intravenous|intranasal"] [textarea cols=50 rows=1 default="Quantity:"] [textarea cols=50 rows=1 default="Frequency:"] [textarea cols=50 rows=1 default="Time period of use:"][/conditional] -- Historical substance use -- [checkbox value="Historical drug & alcohol use denied when asked."] [checkbox name="Alc2" value="Alcohol."][conditional field="Alc2" condition="(Alc2).is('Alcohol.')"] Method of use: [select value="oral|inhaled|intravenous|intranasal"] [textarea cols=50 rows=1 default="Quantity:"] [textarea cols=50 rows=1 default="Frequency:"] [textarea cols=50 rows=1 default="Time period of use:"][/conditional] [checkbox name="Caf2" value="Caffeine."][conditional field="Caf2" condition="(Caf2).is('Caffeine.')"] Method of use: [select value="oral|inhaled|intravenous|intranasal"] [textarea cols=50 rows=1 default="Quantity:"] [textarea cols=50 rows=1 default="Frequency:"] [textarea cols=50 rows=1 default="Time period of use:"][/conditional] [checkbox name="Nic2" value="Nicotine."][conditional field="Nic2" condition="(Nic2).is('Nicotine.')"] Method of use: [select value="oral|inhaled|intravenous|intranasal"] [textarea cols=50 rows=1 default="Quantity:"] [textarea cols=50 rows=1 default="Frequency:"] [textarea cols=50 rows=1 default="Time period of use:"][/conditional] [checkbox name="Her2" value="Heroin."][conditional field="Her2" condition="(Her2).is('Heroin.')"] Method of use: [select value="oral|inhaled|intravenous|intranasal"] [textarea cols=50 rows=1 default="Quantity:"] [textarea cols=50 rows=1 default="Frequency:"] [textarea cols=50 rows=1 default="Time period of use:"][/conditional] [checkbox name="Opi2" value="Opiates."][conditional field="Opi2" condition="(Opi2).is('Opiates.')"] Method of use: [select value="oral|inhaled|intravenous|intranasal"] [textarea cols=50 rows=1 default="Quantity:"] [textarea cols=50 rows=1 default="Frequency:"] [textarea cols=50 rows=1 default="Time period of use:"][/conditional] [checkbox name="Thc2" value="THC."][conditional field="Thc2" condition="(Thc2).is('THC.')"] Method of use: [select value="oral|inhaled|intravenous|intranasal"] [textarea cols=50 rows=1 default="Quantity:"] [textarea cols=50 rows=1 default="Frequency:"] [textarea cols=50 rows=1 default="Time period of use:"][/conditional] [checkbox name="Coc2" value="Cocaine."][conditional field="Coc2" condition="(Coc2).is('Cocaine.')"] Method of use: [select value="oral|inhaled|intravenous|intranasal"] [textarea cols=50 rows=1 default="Quantity:"] [textarea cols=50 rows=1 default="Frequency:"] [textarea cols=50 rows=1 default="Time period of use:"][/conditional] [checkbox name="Met2" value="Methamphetamine."][conditional field="Met2" condition="(Met2).is('Methamphetamine.')"] Method of use: [select value="oral|inhaled|intravenous|intranasal"] [textarea cols=50 rows=1 default="Quantity:"] [textarea cols=50 rows=1 default="Frequency:"] [textarea cols=50 rows=1 default="Time period of use:"][/conditional] [checkbox name="Ice2" value="ICE."][conditional field="Ice2" condition="(Ice2).is('ICE.')"] Method of use: [select value="oral|inhaled|intravenous|intranasal"] [textarea cols=50 rows=1 default="Quantity:"] [textarea cols=50 rows=1 default="Frequency:"] [textarea cols=50 rows=1 default="Time period of use:"][/conditional] [checkbox name="Inh2" value="Inhalants."][conditional field="Inh2" condition="(Inh2).is('Inhalants.')"] Method of use: [select value="oral|inhaled|intravenous|intranasal"] [textarea cols=50 rows=1 default="Quantity:"] [textarea cols=50 rows=1 default="Frequency:"] [textarea cols=50 rows=1 default="Time period of use:"][/conditional] [checkbox name="Sti2" value="Stimulants."][conditional field="Sti2" condition="(Sti2).is('Stimulants.')"] Method of use: [select value="oral|inhaled|intravenous|intranasal"] [textarea cols=50 rows=1 default="Quantity:"] [textarea cols=50 rows=1 default="Frequency:"] [textarea cols=50 rows=1 default="Time period of use:"][/conditional] [checkbox name="Hal2" value="Hallucinogens."][conditional field="Hal2" condition="(Hal2).is('Hallucinogens.')"] Method of use: [select value="oral|inhaled|intravenous|intranasal"] [textarea cols=50 rows=1 default="Quantity:"] [textarea cols=50 rows=1 default="Frequency:"] [textarea cols=50 rows=1 default="Time period of use:"][/conditional] [checkbox name="Oth2" value="Other."][conditional field="Oth2" condition="(Oth2).is('Other.')"] Method of use: [select value="oral|inhaled|intravenous|intranasal"] [textarea cols=50 rows=1 default="Quantity:"] [textarea cols=50 rows=1 default="Frequency:"] [textarea cols=50 rows=1 default="Time period of use:"][/conditional] SUICIDE RISK [checkbox name="Suri1" value="There are suicide risk concerns for this patient.|There were no current suicide risk concerns identified for this patient."][conditional field="Suri1" condition="(Suri1).is('There are suicide risk concerns for this patient.')"] [textarea cols=50 rows=10 default="Previous suicide attempt denied / reported:"] [textarea cols=50 rows=10 default="Current suicide plan denied / reported: Lethality of this suicide plan rated as high / low / uncertain"] [textarea cols=50 rows=10 default="Means to suicide denied / reported:"] [textarea cols=50 rows=10 default="Intention to suicide denied / reported:"][/conditional]. HOMICIDAL RISK [checkbox name="Homi1" value="There were violence risk concerns identified for this patient.|There were no violence risk concerns identified for this patient."][conditional field="Homi1" condition="(Homi1).is('There were violence risk concerns identified for this patient.')"] [textarea cols=50 rows=10 default="Thoughts of harming others were not identified. / identified:"]. [textarea cols=50 rows=10 default="There was no identified target for these thoughts. / an identified target for these thoughts:"]. [checkbox value="The patient is able to manage these thoughts without acting on them|The patient is unable to manage these thoughts."] [textarea cols=50 rows=10 default="The patient has no current plan to act on these thoughts of violence. / has a current plan to act on these thoughts:"]. [textarea cols=50 rows=10 default="The patient has no identified means to carry out plans of violence. / the means to carry out an act of violence:"] [checkbox value="The patient intends to act on these thoughts|The patient does not intend to act on these thoughts."] [checkbox value="Lethality of plan rated as: high|Lethality of plan rated as: low|I was unable to estimate lethality of the plan"][/conditional]. HIGH RISK BEHAVIOURS [checkbox name="hrb1" value="There were no high risk behaviour concerns identified for this patient.|There were high risk behaviour concerns identified for this patient,"][conditional field="hrb1" condition="(hrb1).is('There were high risk behaviour concerns identified for this patient,')"] in particular: [checkbox value="cutting|anorexia|bullimia|head banging|self injurious behaviours"] [textarea cols=50 rows=10 default="other"].[/conditional] ABUSE ASSESSMENT [checkbox name="Abu1" value="The patient denied being hit, kicked, or physically hurt by another person in the last year.|The patient reported being physically abused within the last year:"][conditional field="Abu1" condition="(Abu1).is('The patient reported being physically abused within the last year:')"] [textarea cols=50 rows=10 default=""].[/conditional] [checkbox name="Pabu1" value="The patient denied being in a relationship with someone who threatens or physically harms them.|The patient reported being in a relationship with someone who threatens or physically harms them:"][conditional field="Pabu1" condition="(Pabu1).is('The patient reported being in a relationship with someone who threatens or physically harms them:')"] [textarea cols=50 rows=10 default=""].[/conditional] [checkbox name="Fabu1" value="The patient denied being forced to have sexual contact that they were not comfortable with.|The patient reported being forced to have sexual contact that they were not comfortable with:"][conditional field="Fabu1" condition="(Fabu1).is('The patient reported being forced to have sexual contact that they were not comfortable with:')"] [textarea cols=50 rows=10 default=""].[/conditional] [checkbox name="Habu1" value="The patient denied ever being abused.|The patient reported a history of being abused:"][conditional field="Habu1" condition="(Habu1).is('The patient reported a history of being abused:')"] [textarea cols=50 rows=20 default="who / when / how"].[/conditional] FAMILY / SOCIAL HISTORY The patient was born in [text default=""], and was raised [text default="there too."] [checkbox name="Sib1" value="The patient reported having no siblings.|The patient reported having siblings:"][conditional field="Sib1" condition="(Sib1).is('The patient reported having siblings:')"] [select value="no|1|2|3|4|5|6|7|8"] brothers, and [select value="no|1|2|3|4|5|6|7|8"] sisters. In terms of birth order, the patient was [select value="1st|2nd|3rd|4th|5th|6th|7th|8th"] of [select value="1|2|3|4|5|6|7|8"] children.[/conditional] The patient reported primarily being raised by [textarea cols=50 rows=1""] Marriages or significant relationships: [textarea cols=50 rows=1""] Number of children: [textarea cols=50 rows=1""] Current living situation: [textarea cols=50 rows=3""] Military history/type of discharge: [textarea cols=50 rows=1"N/A"] Supports/social network: [textarea cols=50 rows=5""] PSYCHOSOCIAL AND SOCIOECONOMIC FACTORS I asked the patient about psychosocial and socioeconomic factors that may have impacted on their development and current functioning: [checkbox name="Q1" value="There were difficulties related to education and literacy"][conditional field="Q1" condition="(Q1).is('There were difficulties related to education and literacy')"], in particular: [checkbox name="education" value="Z55.0 Illiteracy and low-level literacy|Z55.1 Schooling unavailable and unattainable|Z55.2 Failed examinations|Z55.3 Underachievement in school|Z55.4 Educational maladjustment and discord with teachers and classmates|Z55.8 Other problems related to education and literacy|Z55.9 Problem related to education and literacy, unspecified"][textarea cols=80 rows=5 default=". No further details provided by the patient."][/conditional] [checkbox name="Q2" value="There were difficulties related to employment"][conditional field="Q2" condition="(Q2).is('There were difficulties related to employment')"], in particular: [checkbox name="employment" value="Z56.0 Unemployment, unspecified|Z56.1 Change of job|Z56.2 Threat of job loss|Z56.3 Stressful work schedule|Z56.4 Discord with boss and workmates|Z56.5 Difficult conditions at work|Z56.6 Other physical and mental strain related to work|Z56.7 Other and unspecified problems related to employment"][textarea cols=80 rows=5 default=". No further details provided by the patient."][/conditional] [checkbox name="Q3" value="There were difficulties related to hazzardous work conditions"] [conditional field="Q3" condition="(Q3).is('There were difficulties related to hazzardous work conditions')"], in particular: [checkbox name="hazwork" value="Z57.0 Occupational exposure to noise|Z57.1 Occupational exposure to radiation|Z57.2 Occupational exposure to dust|Z57.3 Occupational exposure to other air contaminants|Z57.4 Occupational exposure to toxic agents in agriculture|Z57.5 Occupational exposure to toxic agents in other industries|Z57.6 Occupational exposure to extreme temperature|Z57.7 Occupational exposure to vibration|Z57.8 Occupational exposure to other risk-factors|Z57.9 Occupational exposure to unspecified risk-factor"][textarea cols=80 rows=5 default=". No further details provided by the patient."][/conditional] [checkbox name="Q4" value="There were difficulties related to environmental toxins"][conditional field="Q4" condition="(Q4).is('There were difficulties related to environmental toxins')"], in particular: [checkbox name="envitox" value="Z58.0 Exposure to noise|Z58.1 Exposure to air pollution|Z58.2 Exposure to water pollution|Z58.3 Exposure to soil pollution|Z58.4 Exposure to radiation|Z58.5 Exposure to other pollution|Z58.6 Inadequate drinking-water supply|Z58.7 Exposure to tobacco smoke|Z58.8 Other problems related to physical environment|Z58.9 Problem related to physical environment, unspecified"][textarea cols=80 rows=5 default=". No further details provided by the patient."][/conditional] [checkbox name="Q5" value="There were difficulties related to housing and economic circumstances"][conditional field="Q5" condition="(Q5).is('There were difficulties related to housing and economic circumstances')"], in particular: [checkbox value="Z59.0 Homelessness|Z59.1 Inadequate housing|Z59.2 Discord with neighbours, lodgers and landlord|Z59.3 Problems related to living in residential institution|Z59.4 Lack of adequate food|Z59.5 Extreme poverty|Z59.6 Low income|Z59.7 Insufficient social insurance and welfare support|Z59.8 Other problems related to housing and economic circumstances|Z59.9 Problem related to housing and economic circumstances, unspecified"][textarea cols=80 rows=5 default=". No further details provided by the patient."][/conditional] [checkbox name="Q7" value="There were difficulties related to the social environment"][conditional field="Q7" condition="(Q7).is('There were difficulties related to the social environment')"], in particular: [checkbox value="Problems of adjustment to life-cycle transitions|Z60.1 Atypical parenting situation|Z60.2 Living alone|Z60.3 Acculturation difficulty|Z60.4 Social exclusion and rejection|Z60.5 Target of perceived adverse discrimination and persecution|Z60.8 Other problems related to social environment|Z60.9 Problem related to social environment, unspecified"][textarea cols=80 rows=5 default=". No further details provided by the patient."][/conditional] [checkbox name="Q9" value="There were difficulties related to negative life events in childhood (not maltreatment)"][conditional field="Q9" condition="(Q9).is('There were difficulties related to negative life events in childhood (not maltreatment)')"], in particular: [checkbox value="Z61.0 Loss of love relationship in childhood|Z61.1 Removal from home in childhood|Z61.2 Altered pattern of family relationships in childhood|Z61.3 Events resulting in loss of self-esteem in childhood|Z61.4 Problems related to alleged sexual abuse of child by person within primary support group|Z61.5 Problems related to alleged sexual abuse of child by person outside primary support group|Z61.6 Problems related to alleged physical abuse of child|Z61.7 Personal frightening experience in childhood|Z61.8 Other negative life events in childhood|Z61.9 Negative life event in childhood, unspecified|Z62 Other problems related to upbringing (not maltreatment)"][textarea cols=80 rows=5 default=". No further details provided by the patient."][/conditional] [checkbox name="Q10" value="There were other problems related to upbringing"][conditional field="Q10" condition="(Q10).is('There were other problems related to upbringing')"], in particular: [checkbox value="Z62.0 Inadequate parental supervision and control|Z62.1 Parental overprotection|Z62.2 Institutional upbringing|Z62.3 Hostility towards and scapegoating of child|Z62.4 Emotional neglect of child|Z62.5 Other problems related to neglect in upbringing|Z62.6 Inappropriate parental pressure and other abnormal qualities of upbringing|Z62.8 Other specified problems related to upbringing|Z62.9 Problem related to upbringing, unspecified"][textarea cols=80 rows=5 default=". No further details provided by the patient."][/conditional] [checkbox name="Q11" value="There were other problems related to primary support group (not maltreatment)"][conditional field="Q11" condition="(Q11).is('There were other problems related to primary support group (not maltreatment)')"], in particular: [checkbox value="Z63.0 Problems in relationship with spouse or partner|Z63.1 Problems in relationship with parents and in-laws|Z63.2 Inadequate family support|Z63.3 Absence of family member|Z63.4 Disappearance and death of family member|Z63.6 Dependent relative needing care at home|Z63.7 Other stressful life events affecting family and household|Z63.8 Other specified problems related to primary support group|Z63.9 Problem related to primary support group, unspecified"][textarea cols=80 rows=5 default=". No further details provided by the patient."][/conditional] [checkbox name="Q12" value="There were problems related to certain psychosocial circumstances"][conditional field="Q12" condition="(Q12).is('There were problems related to certain psychosocial circumstances')"], in particular: [checkbox value="Z64.0 Problems related to unwanted pregnancy|Z64.1 Problems related to multiparity|Z64.2 Seeking and accepting physical, nutritional and chemical interventions known to be hazardous and harmful|Z64.3 Seeking and accepting behavioural and psychological interventions known to be hazardous and harmful|Z64.4 Discord with counselors"][textarea cols=80 rows=5 default=". No further details provided by the patient."][/conditional] [checkbox name="Q13" value="There were problems related to other psychosocial circumstances"][conditional field="Q13" condition="(Q13).is('There were problems related to other psychosocial circumstances')"], in particular: [checkbox value="Z65 Problems related to other psychosocial circumstances (legal and military)|Z65.0 Conviction in civil and criminal proceedings without imprisonment|Z65.1 Imprisonment and other incarceration|Z65.2 Problems related to release from prison|Z65.3 Problems related to other legal circumstances|Z65.4 Victim of crime and terrorism|Z65.5 Exposure to disaster, war and other hostilities|Z65.8 Other specified problems related to psychosocial circumstances|Z65.9 Problem related to unspecified psychosocial circumstances"][textarea cols=80 rows=5 default=". No further details provided by the patient."][/conditional] FAMILY HISTORY OF MENTAL ILLNESS [checkbox name="Famill" value="The patient denied a family history of mental illness.|The patient reported the family has a history of mental illness --"][conditional field="Famill" condition="(Famill).is('The patient reported the family has a history of mental illness --')"] [textarea cols=30 rows=1 default="Relative"]: [textarea cols=50 rows=1 default="Illness"]. [textarea cols=30 rows=1 default="Relative"]: [textarea cols=50 rows=1 default="Illness"]. [textarea cols=30 rows=1 default="Relative"]: [textarea cols=50 rows=1 default="Illness"]. [textarea cols=30 rows=1 default="Relative"]: [textarea cols=50 rows=1 default="Illness"]. [textarea cols=30 rows=1 default="Relative"]: [textarea cols=50 rows=1 default="Illness"]. [textarea cols=30 rows=1 default="Relative"]: [textarea cols=50 rows=1 default="Illness"]. [textarea cols=30 rows=1 default="Relative"]: [textarea cols=50 rows=1 default="Illness"]. [textarea cols=30 rows=1 default="Relative"]: [textarea cols=50 rows=1 default="Illness"].[/conditional] EMPLOYMENT [checkbox name="Emplo" value="The patient reported that they are currently unemployed.|The patient reported that they have never had a job.|The patient reported that they are currently employed at XXXXX, as a XXXXX"][conditional field="Emplo" condition="(Emplo).is('The patient reported that they are currently employed at XXXXX, as a XXXXX')"] [checkbox value="This job is full-time|This job is part-time|This job is casual|it is satisfying work|it is unsatisfying work|on a short-term basis|on a long-term basis|with supportive co-workers|with unsupportive co-workers|working alone|and they perform well at this job|and they do not perform well at this job"]. The patient further reported that [select value="she has never been fired from a job.|she has been fired from a job: XXXXXX due to XXXXXXX"]. In the last 5 years, the patient has had XX jobs."][textarea cols=80 rows=5 default=". No further details provided by the patient."][/conditional] EDUCATION [text default="The patient's"] highest educational grade was [select value="high school|a tertiary level TAFE course|a trade apprenticeship|an undergraduate degree|a postgraduate degree"]. She described herself as an [select value="average|above average|below average"] student. Discipline issues were [select value="denied|an infrequent occurance|a frequent occurrence"]. CURRENT LEGAL STATUS [text default="The patient"] [checkbox name="legal" value="reported never having legal issues|reported having legal issues"][conditional field="legal" condition="(legal).is('reported having legal issues')"], in particular: [checkbox value="is currently on parole|is on probation|has charges pending|has been in prison|a civil matter|being a victim of crime|she is on a CTO|she is on an ITO|she has a guardian|she is on an AVO|she is on a DVO"]. [textarea cols=80 rows=5 default=". No further details provided by the patient."][/conditional] DEVELOPMENTAL HISTORY The patient described their childhood as [select value="uneventful|traumatic|painful"]. Their birth was reportedly [checkbox value="planned|unplanned|wanted by both parents|unwanted by either parent|unwanted by mother|unwanted by father"]. [checkbox name="child1" value="Childhood was reported to be otherwise unremarkable.|Childhood difficulties were identified:"][conditional field="child1" condition="(child1).is('Childhood difficulties were identified:')"][checkbox value="an exposure to toxins during pregnancy|fussy eating|sleep difficulties|serious illness|speech delays|learning difficulties|poor adaptability to novel situations|shyness|clingyness|aggression"].[/conditional] [text default="The patient's"] childhood temperament was [select value="easy going|difficult|slow to warm"]. Mum's parenting style was described as [select value="passive|assertive|demanding|aggressive|unremarkable|absent"] and dad's parenting was [select value="passive|assertive|demanding|aggressive|unremarkable|absent"]. [text default="The patient"] had [select value="few|many"] friends, and [select value="did not make|made"] friends easily. [textarea cols=80 rows=5 default="The patient was particularly interested in HOBBIES"] When asked to report on traumatic events in their childhood, [text default="the patient"] [checkbox name="traum" value="denied anything of note.|experienced:"][conditional field="traum" condition="(traum).is('experienced:')"][checkbox value="a natural disaster|a serious fire|an explosion|a transport accident|a serious accident|exposure to toxins|physical assault|asssault with a weapon|sexual assault|CSA|unwanted sexual advances|armed combat|captivity|life-threatening illness|severe human suffering|violent death"]. [textarea cols=80 rows=5 default=". No further details provided by the patient."][/conditional] The patient's sexual orientation [select value="was not disclosed|was not requested|is heterosexual|is homosexual|is bisexual|OTHER."] SPIRITUALITY The patient's religious background [select value="was not disclosed|is Church of England|is Catholic|is Sikh|is Mormon|is Jehovas Witness|is Muslim|is Buddhist|is Christian|is Jewish|is OTHER"]. The patient [checkbox name="relig" value="does not attend any regular religious service|attends regular religious service"][conditional field="relig" condition="(relig).is('attends regular religious service')"] [textarea cols=50 rows=5 default="Where?"][/conditional] CULTURAL ASSESSMENT The patient [checkbox name="cult" value="denied issues that affect their cultural / religious background|reported on issues that affect their cultural / religious background"][conditional field="cult" condition="(cult).is('reported on issues that affect their cultural / religious background')"] [textarea cols=80 rows=10 default=""][/conditional] FINANCIAL ASSESSMENT The patient's financial situation [checkbox name="finsit" value="was not assessed.|is noteworthy in terms of:"][conditional field="finsit" condition="(finsit).is('is noteworthy in terms of:')"] [checkbox value="their having a financial management order|their having a trustee from the T&G service|there is a power of attorney|the stress it puts the patient under"][textarea cols=80 rows=10 default=""][/conditional] COPING SKILLS When asked about healthy coping strategies, the patient identified: [checkbox value="meditation|relaxation|self-care|physical activity|connecting with friends|having a good sense of humour|engaging in hobbies|spirituality|spending time with family|working|meaningful activities|pets|sleep hygiene|nutrition"] [textarea cols=40 rows=5 default="nothing of note"] When asked about unhealthy coping strategies, the patient identified: [checkbox value="drug use|alcohol use|self-harm|ignoring the problem|sedatives|stimulants|over-work|avoiding the problem|denial|over-sleeping"] [textarea cols=40 rows=5 default="Nothing of note"] INTERESTS AND ABLITIES [textarea cols=40 rows=5 default="The patient could not identifiy any interests or hobbies"]. [textarea cols=40 rows=5 default="They were unable to describe being good at anything in particular"]. [textarea cols=40 rows=5 default="When asked what gives them pleasure, they were unable to describe anything of note"]. MENTAL STATUS ASSESSMENT Patient appears to be [select value="stated age|younger than stated age|older than stated age|"][textarea rows="1"]. [select value="well groomed|unkempt|"], [select value="appropriately dressed|inappropriately dressed|"][textarea rows="1"], with [select value="normal posture|slumped posture|rigid posture|"][textarea rows="3"]. behavior is [select value="calm|restless|agitated|irritable|anxious|impulsive|"][textarea rows="1"], and [select value="interactive|inattentive|withdrawn|"][textarea rows="1"][select value=" with good eye-contact| with intermittent eye-contact| with avoidant eye-contact"][textarea rows="2"]. [select value=" presents as [select value="alert and oriented to |disoriented to |"][select value="person, place, and time|"][textarea rows="1"]. [select value="Recent and remote memory are intact|Recent memory is intact, although issues with remote memory include |Remote memory is intact, although issues with recent memory include |Issues with recent and remote memory are noted to be |"][textarea memo="additional information about memory" rows="3"]. [select value="Attention span and concentration are adequate|Difficulty with attention span and concentration are evidenced as "][textarea rows="2"]. Their language skills are [select value="adequate, |limited, |difficult to assess due to the degree of symptomatic presentation|"][select value="and consistent with education|and inconsistent with education|"][textarea rows="1"]. fund of knowledge is [select value="appropriate for stated age and education level|inappropriate for stated age and education level|difficult to assess due to symptomatic presentation|"][textarea rows="2"]. [select value="capable of abstraction| displays difficulty with abstraction|Assessment of abstraction ability difficult due to symptomatic presentation"][textarea rows="1"]. Gait [select value="normal|abnormal|unsteady|shuffling|spastic|"][textarea rows="1"]. Speech is [select value="a regular rate and rhythm|rapid|slow|"][textarea rows="1"][select value=", spontaneous|, appears prepared|"][select value=", fluid, slurred|, monotone|, pressured|, laconic|"][select value=", normal volume|, quiet|, loud|"][textarea rows="2". Vocabulary is [select value="adequate|large|limited|difficult to assess due to symptomatic presentation|"][textarea rows="1"]. Thought processing and content is [select value="adequate, |delayed, |"][select value="logical, |illogical, |"][select value="reality based|"][checkbox name="thoughts" memo="additional descriptors" value=""][conditional field="thoughts" condition="(thoughts).is('')"][checkbox value="disorganized|circumstantial|tangential|flight of ideas|loose association|perseveration|thought blocking|ideas of reference|grandiose|paranoid|persecutory|religious|somatic|self accusatory"][/conditional][textarea rows="2"]. [select value="No evidence of hallucinations or delusions|Hallucinations/delusions characterized as "][textarea rows="2"]. [select value="No evidence of preoccupation with violence|They have a reoccupation with violence as evidenced by |"][textarea rows="2"]. [select value="They deny suicidal ideation|They report positive for suicidal ideation without intent|They report positive for suicidal ideation with intent |"][textarea rows="2"]. [select value="denies homicidal ideation|They affirm homicidal ideation toward |"][textarea rows="1"]. judgment is [select value="good|fair|poor|impaired|"][textarea rows="1"]. insight concerning psychiatric condition is [select value="good|fair|poor|impaired|"][textarea rows="1"]. FUNCTIONAL ABILITY The patient identified the following areas of functional difficulty: [checkbox name="acaperf" value="Academic;"][conditional field="acaperf" condition="(acaperf).is('Academic;')"] in particular, the patient [checkbox value="frequently fails tests|struggles to keep up with peers|complains that the subject matter is too difficult|asserts that extracurricular activities are interfering with academic performance|lacks order and system in study|is disorganized and careless|lacks neatness|is rarely/never prepared|does not seek help when appropriate|copies from peers|engages in cheating/plagiarism|has poor attendance"] [textarea cols=80 rows=5 default=""][/conditional] [checkbox name="sofac" value="Social;"][conditional field="sofac" condition="(sofac).is('Social;')"] in particular, the patient [checkbox value="is a loner|relates poorly to others|tends to isolate|does not fit in|feels excluded by others|is easily influenced and highly suggestible|engages in risky activities with peers|verbally criticizes peers|verbally criticizes caregivers|starts conflict without provocation|bullies and attempts to control others|does not respect rights and property of others|does not participate in group activities|interacts inappropriately with peers|is sexually inappropriate|is noncompliant with reasonable requests|frequently resists and disobeys authority|refuses to complete work assignments|does not follow rules and procedures|is socically disruptive|engages in attention seeking behaviours|is overly demanding of attention from others|has frequent tantrums in groups|frequently acts the clown|plays pranks on others|is overly dependent on others|timid/shy/dependent/anxiety-prone|is not accepted by others||does not sustain friendships|is an object of scorn/ridicule|is scapegoated/picked on|does not defend self when attacked|ostracized|social isolation|social withdrawal"] [textarea cols=80 rows=5 default=""][/conditional] [checkbox name="conduct" value="Conduct;"][conditional field="conduct" condition="(conduct).is('Conduct;')"] in particular, the patient [checkbox value="is verbally aggressive|frequently interrupts|starts fights|purposely agitates/disturbs/disrupts others|bullies and intimidates|frequently teases|attempts to manipulate|is overactive|is frequently inappropriate|cannot sit still and is generally restless|has numerous disciplinary offences|is malicious|is cold and calculating|lacks empathy and warmth|is cruel and punitive|has little respect for authority|is generally considered a troublemaker|is aggressive and generally violent|is destructive of own/others property|initiates physical fights|hits caregivers|is antagonistic|is frequently disobedient|is negativistic|is oppositional|is arguementative|talks back/mouthy|is defiant of authority|lies in regard to chores/homework/ house rules|complies only when threatened|is stubborn|is immature|demonstrates poor judgment|does not take responsibility for mistakes|does not own their behavior or consequences|demonstrates mutism|is prejudiced|is bigoted|insults others|vandalises|engages in hate crimes|lacks respect for authority|dares and provokes others|acts out|uses obscenities|has temper tantrums|falls to floor and tantrums|bangs head|has breath holding episodes|throws objects|screams|weeps|is generally destructive"]. [textarea cols=80 rows=5 default=""][/conditional] [checkbox name="cogfac" value="Cognitive;"][conditional field="cogfac" condition="(cogfac).is('Cognitive;')"] in particular, the patient[checkbox value="is highly distractible|is hyperactive|is inattentive|handles novel situations poorly|lacks foresight|has low frustration tolerance|is easily confused|is unable to understand tasks|frequently daydreams|has poor concentration|is averse to change|is excessively concrete|has an inflexible and rigid thinking style|has unusual and extreme beliefs|appears intellectually delayed|is often confused and unable to accept guidance"]. [textarea cols=80 rows=5 default=""][/conditional] [checkbox name="motdif" value="Motivational;"][conditional field="motdif" condition="(motdif).is('Motivational;')"] in particular, the patient [checkbox name="motdif" value="does not try hard with difficult tasks|generally makes little effort|is content to coast along|has the ability to do better work but lacks interest|generally shows no interest in the subject matter|does not persevere with most tasks|always needs great encouragement to complete work|gives up at first sign of difficulty|has low frustration tolerance|does not seem to pay attention|frequently daydreams|always seems preoccupied|is slow to respond|does not complete work assignments|does not make up for lost time|turns in assignments late|is careless with work|does not spend enough time on important tasks|copies from others|comes to class without necessary work materials|is frequently forgetful|misses excessive days|is known for frequent absenteeism|is always tardy|cuts classes|avoids work|is frequently truant|avoids school|refuses to attend school|refuses to attend work"] [textarea cols=80 rows=5 default=""][/conditional] [checkbox name="becon" value="Behavioural;"][conditional field="becon" condition="(becon).is('Behavioural Concerns')"] in particular, the patient [checkbox value="engages in alcohol/drug/substance abuse|has encopresis|has enuresis|engages in fire setting|engages in hypochondriasis|is frequently overactive and restless|engages in self injurious behaviour|hits others|bites others|engages in head banging|has a sexual preoccupation|engages in public masturbation|demonstrates inappropriate sexual behaviors|is frequently obscene|swears|makes sexualized gestures and remarks|exhibits genitals/disrobes/public nudity|wears provocative clothing|demonstrates molestation concerns|threatens others|touches others|fondles/rubs against others|engages in battery|has had forced sexual intercourse|is assaultative|has raped|threatens others|is slow moving|is slow to respond|lethargy|hypoactive|restless|fidgets|out of seat|impulsive|hyperactive/overactive|speech difficulties|thumb sucking|rocking|stereotyped movements|tics|noise or word productions|violence/aggression"] [textarea cols=80 rows=5 default=""][/conditional] [checkbox name="afcon" value="Affect;"][conditional field="afcon" condition="(afcon).is('Affect;')"] in particular, the patient experiences [checkbox value="anxiety|fears|phobias|nervous habits|avoidance of particular certain things/actions/situations|anger|irritability|outbursts/rage/tantrums/meltdowns|tearfulness|sulking|whines|hurt feelings|low moods|feelings of flatness|joyless|depressed|sad|unhappy|cries|feels hurt|has low energy|is easy fatigued|apathy|withdrawn|ashamed|guilty|suicidal|has limited range of emotions|expresses only high-intensity feelings|emotionally overactive|histrionic|dramatizes|plays the victim"] [textarea cols=80 rows=5 default="and other affect difficulties"][/conditional] FACTORS IMPACTING ON RECOVERY [checkbox name="impac" value="There were no factors identified impacting on the patients recovery|The following factors are likely to impact on the patients recovery:"] [conditional field="impac" condition="(impac).is('The following factors are likely to impact on the patients recovery:')"] [checkbox value="precontemplative stage of motivation|denies the mental health diagnosis|personality factors|coping skills deficits|is difficult to form rapport with|has unrealistic expectations for recovery|has unrealistic expectations for mental health services|poor adjustment to mental health concerns|unpleasant side effects from medication|poor compliance with medication|is unreliable with scheduled appointments|routinely fails to respond to service contact requests|avoids service contact|is not hopefully about the future|does not desire change|is unwilling to play an active role in recovery|identifies with the sick role|has poor executive control|does not derive much benefit from their treatment|is socially isolated|lacks family support|continues to abuse substances|feels stigmatized by their mental health diagnosis|engages in splitting behaviours|is negative towards this mental health services|shy and inhibited temperament|overwhelmed by symptoms associated with mental health diagnosis|poor cohesion between services supporting patient|complicated by medical problems|a history of childhood adversity|complicated by multiple co-occurring mental health concerns|executive function difficulties|intellectual difficulties|tends to exaggerate concerns|receives secondary gains from current mental health status and functioning|has poor rapport with the author"] [textarea cols=80 rows=5 default=""][/conditional] FACTORS PROMOTING RECOVERY [checkbox name="prosu" value="There were no factors identified which promote mental health recovery|There were factors identified that will likely promote mental health recovery"][conditional field="prosu" condition="(prosu).is('There were factors identified that will likely promote mental health recovery')"] which include: [checkbox value="treatment responsiveness|connectedness to individuals, family, community, and social institutions|problem-solving skills|coping skills|ability to adapt to change|sense of purpose or meaning in life Cultural, religious, or personal beliefs that discourage self-injury|good social skills|ability to manage feelings of anger|good health|access to mental and physical health care|healthy fear of risky behaviours and pain|hope for the future and optimism|sobriety|medical compliance|sense of the importance of health and wellness|impulse control|strong sense of self-worth or self-esteem|sense of personal control or determination|access to a variety of clinical interventions|help seeking behaviours|resiliency|expressed reasons for living|being married|being a parent|strong relationships, particularly with family members|opportunities to participate in and contribute to school or community projects and activities|living in a reasonably safe and stable environment|sense of responsibility and duty to others|being a pet owner|intolerant attitude towards deviant behaviour|above average intelligence|having good academic grades|having a positive social orientation|having highly developed social skills|having the ability to plan ahead|having realistic expectations for the future|being religious|being connected to family|being connected to supportive adults outside their immediate family|ability to discuss problems with others|sharing activities with friends and family|having the consistent presence of a parent|involvement in pro-social activities|having positive role models|having affective relationships which are strong, close and prosocially oriented|being committed to learning and self improvement|being committed to work|having high needs for achievement|having non-deviant peers|having peer groups that do not condone antisocial behaviour|involvement in pro-social activities|exposure to positive parenting practices"][/conditional]. OTHER AREAS OF FUNCTIONAL CONCERN (WHODAS 2.0) [checkbox name="comms" value="Understanding and Communicating"][conditional field="comms" condition="(comms).is('Understanding and Communicating')"], in particular: [checkbox value="concentrating|remembering|solving every day problems|learning a new task|understanding verbal communication|initiating and maintaining a conversation"][/conditional]. [checkbox name="gar" value="Getting around"][conditional field="gar" condition="(gar).is('Getting around')"], in particular: [checkbox value="standing for longer than 30 minutes|standing up|moving around the home|getting out of the home|walking distances greater than 1km"][/conditional]. [checkbox name="selc" value="Self-care"][conditional field="selc" condition="(selc).is('Self-care')"], in particular: [checkbox value="washing the whole body|getting dressed|eating|being alone for a few days"][/conditional]. [checkbox name="lifea" value="Life activities"][conditional field="lifea" condition="(lifea).is('Life activities')"], in particular: [checkbox value="managing a household|doing house hold tasks well|completing housework|completing housework in a timely manner|attending work|attending school|completing work tasks adequately|completing school tasks adequately|getting all work done|getting all work done in a timely manner"][/conditional]. [checkbox name="partin" value="Participation in society"][conditional field="partin" condition="(partin).is('Participation in society')"], in particular: [checkbox value="problems joining in community activities|problems because of barriers in the world|problems living with dignity due to the attitudes of others|time spend managing a health condition|Emotional impact of a health condition|impact of a health condition on finances|impact of health condition on family|problems doing things autonomously for relaxation or pleasure"][/conditional].
There are 916 form elements.