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180 STANDARD TERMS AND STATEMENTS FOR REPORTS ABNORMAL Sy MPTOMSCircumstances of Occurrence Hypnagogic, hypnopompic, with delirium, in substance withdrawal, flashbacks, spontaneously, unbidden, cultural/situational/external stimuli influence the hallucinatory experience, hav-ing an undiscoverable relationship to circumstances. Comparison of Organically and Psychogenically Based Hallucinations Organically based Psychologically based Sharply demarcated in time. Fleeting and transient. Vivid and well formed. Vague, shadowy, misty. Polychromic and/or polysonic. Usually in shades of gray. Hypermobility (e. g., bugs creep). Usually static. Accompanied by terror, apprehension. Other emotions. Perseverative quality. Changeable. Patient acts as though he/she really sees/ hears/feels. Patient has an idea that he/she sees, feels, etc., but then does not act consistently. May be associated with his/her psychodynamics. Summary Statements Hallucinations are denied by the patient, but she/he seems to be responding to internal/unseen stimuli. They involve small/moderate/great distortion of consensual reality. The hallucinations are suspected/undoubted/denied. Hyperactivity See Section 12. 3, “Attention-Deficit/Hyperactivity Disorder. ” Identity See Section 9. 3, “Self-Image/Self-Esteem. ” 12. 18. Illusions See Section 3. 16, “Illusions,” for questions. Sense deceptions, deceptive sensations, visual/auditory/tactile distortions, speeded-up or slowed passage of time, macropsia, micropsia, Lilliputianism, gigantism. Intermittent Explosive Disorder See Section 12. 19, below. 12. 19. Impulse-Control Disorders See Sections 3. 17, “Impulse Control,” and 3. 31, “Violence,” for questions. For descriptors, see also Sections 10. 2, “Anger,” 12. 40, “Suicide,” 13. 6, “Aggressive Personality,” 13. 7, “Antisocial Personality,” 13. 8, “Authoritarian Personality,” and 13. 23, “Sadistic Personality. ”
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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12. Abnormal Signs, Symptoms, and Syndromes 181ABNORMAL Sy MPTOMSTypes of Impulse-Control Disorders Impulse-control disorders as described here include, but go beyond, those covered in the Impulse- Control Disorders Not Otherwise Classified section of DSM-IV-TR. Those discussed here include the following: Intermittent Explosive Disorder (ICD-9-CM and DSM-IV-TR code, 312. 34). Kleptomania (ICD-9-CM and DSM-IV-TR code, 312. 32). Pathological Gambling (ICD-9-CM and DSM-IV-TR code, 312. 31). (See Section 12. 16, “Gambling. ”) Pyromania (firesetting) (ICD-9-CM and DSM-IV-TR code, 312. 33). Self-damaging/self-mutilating behaviors. (See Section 12. 33, “Self-Injurious Behavior. ”) Sexual impulsivity, “nymphomania,” “satyriasis,” “sexual addiction. ” (See Section 12. 35, “Sexual Impulsivity/'Addiction'/'Compulsion' ”). Trichotillomania (DSM-IV-TR code, 312. 39; same code in ICD-9-CM, but classified under Disor-ders of impulse control, not elsewhere classified: Other). Degree of Control (↔ by degree) overcontrolled patient volatile impulsive violent armored tolerant loses temper may attack explosive inhibited controlled “short fuse” “blows his/ aggressive denied thoughtful low frustration her top” combative overcautious deliberate tolerance impetuous assaultive rigid quicksilver hot-headed dangerous staid cool-headed quick-tempered flares up restrained “flies off the lashes out self-possessed handle” abrupt “gets riled up” precipitouseasily offended unpredictableexcitable incontinent irritable reckless easily irritated outbursts leaves situationhastyrash What Person Fears Doing Embarrassing self, losing control, “wetting pants”/losing bladder control, fainting, harming self or others, homicidal ideation, unable to resist impulses to commit delinquent or illegal acts. Reason's Influence Acts without weighing alternatives/with little hesitation, unreflective, acts without examina-tion, unmediated, “acts on spur of the moment,” easily agitated, off-handed/ill-considered actions, self-centered actions, seeks immediate gratification of urges, heedless, willful, lim-ited intellectual control over expression of impulses, poor planning. Antisocial Behavior See also Section 13. 7, “Antisocial Personality. ” Obstructiveness, irresponsibility, cheating, lying, stealing, crimes, arrests, fighting, forceful aggression. Insight See Section 11. 9, “Insight,” for descriptors.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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182 STANDARD TERMS AND STATEMENTS FOR REPORTS ABNORMAL Sy MPTOMSLate Luteal Phase Dysphoric Disorder See Section 12. 28, “P re Menstrual Dysphoric Disorder. ” 12. 20. Malingering See also Section 13. 16, “Hypochondriacal Personality. ” The relevant ICD-9-CM and DSM-IV-TR code is V65. 2; ICD-9-CM uses the label Person feigning ill-ness instead of Malingering. According to Rogers (2008), this condition is not rare, not easy to detect, and not a global response style; is not significantly correlated with psychopathy or criminality, or with the presence of other valid psychiatric symptoms; and is not easily detected on psychological testing. Some criteria for suspicion of malingering of mental disorders include the following: 1. Highly atypical symptom presentation (rare, blatant, absurd, contradictory, indiscriminate, rapidly changing). Rogers (1984) offers these: Client recounts symptoms of extreme severity, endorses a large number of symptoms, describes symptoms inconsistent with clinical formu-lations and diagnostic impressions, exhibits a “heightened” recall of psychological stressors. 2. Noncorroboration of this presentation by interviews with collaterals, or by psychological or medical tests. 3. Exclusion of patients with diagnoses of borderline personality or factitious motivations. Adams (1991) adds the following as markers of possible malingering: 4. Patient's being directly referred by an attorney. 5. Marked discrepancy between claimed disability and objective findings. 6. Lack of cooperation with either evaluation or recommendations. 7. Antisocial personality disorder or traits. Other aspects include identifiable incentives for malingering; poor cooperation with diagnosis or treatment, despite assertions of wanting to find a cause or to return to work; invariable relapse after improvement; self-induced worsening of condition; resistance to communications with prior treaters; overly dramatic or exaggerated symptom presentation; and logical inconsistencies between statements or between statements and behaviors. Be aware that the security of many psychological tests has been breached by publicly available Internet sites (Ruiz et al., 2002), and do not rely solely on the results of such tests in making any diagnosis. Ken Pope, Ph D, has generously collected the literature on pub-lished tests of malingering and similar research on his website (www. kspope. com/assess/malinger. php). The following criteria for differential diagnosis of symptoms presenting as physical illness are sug-gested by Hyler and Spitzer (1978); the footnotes have been added. Diagnosis Can a known physical mechanism explain the symptom?Are the symp-toms linked to psychological causes?Is the symptom under voluntary/conscious control?Is there an obvious goal? Conversion Never Always Never Sometimes Malingering Sometimes Sometimes Always Always* Psychosomatic disorders Always Always Never Sometimes Factitious disorders Sometimes Always** Always Never (other than medical attention)*** Undiagnosed physical illness Sometimes Sometimes Never Never *Such as money, obtaining drugs, avoiding responsibility and prosecution, controlling others. **Symptom amplification for unconscious needs. ***Or being seen as ill or injured and assuming the role of patient.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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12. Abnormal Signs, Symptoms, and Syndromes 183ABNORMAL Sy MPTOMSTerms for similar presentations: Simulation, exaggeration, symptom amplification, magnification of pain and disability, overevaluation, functional overlay, supratectorial factors, conscious embellish-ment. Munchausen Syndrome The relevant ICD-9-CM code is 301. 51, Chronic factitious illness with physical symptoms (classified as a form of Histrionic personality disorder). Munchausen syndrome is described in DSM-IV-TR as a variant of Factitious Disorder (300. 16 or 300. 19), in which the patient mimics symptoms of disease or induces medical illness for some psychological gain. It should therefore be distinguished from malingering. The name comes from Baron Karl Friedrich Hieronymus von Munchausen, a German nobleman who lived in the 18th century and told fantastic stories. Identifying features: Peregrination: Moving from one caregiver to another. Use of aliases. Pseudologia fantastica: Telling extravagant and fantastic falsehoods about one's self and experi-ences. An initial story that is quite plausible but not consistent upon probing. Creation of one or more medical illnesses by self-infection, modifying lab test procedures or results, interfering with wound healing, etc. Strong denial of any falsehood if the client is confronted. Unconscious motivations. Done only during periods of great stress. Treatment requires these difficult steps: Keeping the client from moving on to other treaters when discovered, confronting him/her, and overcoming the resistance. Marc Feldman, MD, has a rich website (www. munchausen. com). Mania See Section 10. 9, “Mania,” for descriptors. Mild Traumatic Brain Injury See Section 12. 26, “Post Concussive Syndrome. ” Multiple Personality See Section 13. 14, “Dissociative Identity Disorder,” for descriptors. 12. 21. Obsessions See Section 3. 19, “Obsessions,” for questions. See also Sections 13. 20, “Obsessive Personality,” 3. 9, “Compulsions,” 12. 8, “Compulsions,” and 11. 19, “Stream of Thought. ” The relevant ICD-9-CM and DSM-IV-TR code is 300. 3, Obsessive-Compulsive Disorder(s) (ICD-9-CM uses the plural). Monomania, monothematic thought trains, repetitive themes, egomania, megalomania, over-valued ideas (e. g., dysmorphophobia). Contamination/cleaning: Touching or being touched, bodily excretions, germs, clothing, dirt/ trash/contaminants, animals, resulting illness of self or other. Sexual: Erotomania, children/incest, homosexuality in heterosexuals, aggressive sexuality, “per-versities. ” Religious: Sacrilege, blasphemy, morality, right/wrong, scrupulosity, guilt. Somatic: Illness or disease, body parts, somatic “symptoms. ”Other: Colors, sounds, music, names, titles, numbers, phrases, memories, unpleasant images, impulses to hurt/blurt/harm/steal/cause disaster, not saying certain things, not losing things, needing to remember, etc.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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184 STANDARD TERMS AND STATEMENTS FOR REPORTS ABNORMAL Sy MPTOMS12. 22. Oppositional Defiant Disorder See also Sections 10. 2, “Anger,” 12. 9, “Conduct Disorder,” 12. 19, “Impulse-Control Disorders,” and 13. 7, “Antisocial Personality. ” The relevant ICD-9-CM and DSM-IV-TR code is 313. 81, Oppositional Defiant Disorder. Persistently resists others' ways of doing things, independent, stubborn, noncompliant. Argumentativeness, talks back, “sasses,” insubordinate, challenges, disputes. Irritability, resentfulness, negativism, provokes others, mean, spiteful, rude, temper outbursts or tantrums, obstructive. Always places blame on others/denies all responsibility. 12. 23. Pain Disorder/Chronic Pain Syndrome See Section 3. 21, “Pain, Chronic,” for questions. The relevant ICD-9-CM codes are 307. 8, Pain disorders related to psychological factors; 307. 80, Psy-chogenic pain, site unspecified; 307. 89, Pain disorders related to psychological factors; Other. The relevant DSM-IV-TR codes are 307. 80, Pain Disorder Associated with Psychological Factors; 307. 89, Pain Disorder Associated with Both Psychological Factors and a General Medical Condi-tion. A useful mnemonic for taking a pain history is SOCRATES: S ite; Onset; Character; Radiation (spreading to other area); A lleviating factors/ Associated symptoms; Timing (duration, frequency); Exacerbating factors; and Severity, or, alternatively, Signs and S ymptoms. Pain Behaviors Groans, flinches, winces, grimaces, grits teeth, lengthy/loud sighs. Slow and careful movements/body placements, assumes/maintains odd positions, needs to shift position/stand/walk/stretch frequently. Takes multiple/ineffective medications. Increased resting (“down”/“horizontal”/bed) time and decreased active (“up/vertical”) time, appears fatigued, decreased sleep effectiveness. Decreased or absent sexual activity/duration/frequency/interest. Interference with appetite, and associated weight change. Lessened concentration. Mood Restricted range and intensity of expression. Irritability, “cranky,” anger, threatening, low frustration tolerance. Depressed, demoralized, pessimistic, critical, expressions of hopelessness re: change/improve-ment/return to work, intermittent depressions as reaction to pain's exacerbation. Grieving over losses: Health, autonomy, ability to travel freely/earn a living/care for family, etc. Thought Content Preoccupied with losses/forced accommodations/new roles/somatic sensations/treatments/ pains/symptoms/health status and its implications, focus on small signs of progress. May create illusory correlations of pain/limitations/depression/symptoms with progress/ change/bodily processes. Ruminations concerning “Why me?”/causation/revenge/financial concerns.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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12. Abnormal Signs, Symptoms, and Syndromes 185ABNORMAL Sy MPTOMSFeels “like a cripple,” “worthless,” helpless, optimistically reports “learning to live with it/the pain” but without change, loss of self-esteem because of loss of old roles. Desperate for the situation to change but doubting the effectiveness of any intervention. Inward focus on physical self that is not hypochondriacal but a reaction to chronic pain. Suicidal ideation in the form of passive death wishes. Has a sense of entitlement, focuses on the unfairness of the situation. Feels/believes self harassed/unappreciated by current or former employer(s) or by Workers' Compensation boards/insurance companies/Social Security Disability, resentful of unfair way treated by helpgivers/insurance carriers. Reports being “sick and tired” of pursuing insurance claims/being medically evaluated/filling out forms/“jumping through hoops” to obtain only what is rightly his/hers. Social Aspects Decreased social activities, withdrawal/isolation, decreased/absent recreation. Adopts role of “patient”: Dependency, passivity, helplessness, avoidance/displacement of responsibility, medical/biological model of pain and recovery, seeks a “miracle cure” vs. accepts limitations and “tries another way,” etc. Wants to be believed more than relieved, concerned that her/his symptoms be accepted as authentic. 12. 24. Paranoia See Section 3. 22, “Paranoia,” for questions; see also Sections 12. 10, “Delusions,” and 13. 21, “Paranoid Personality. ” The relevant ICD-9-CM and DSM-IV-TR codes are 295. 30, Schizophrenia, Paranoid Type; 297. 1, Delusional Disorder; and 301. 0, Paranoid Personality Disorder. The following groupings are sequenced by degree ( ↔) of increasing paranoia: Not paranoid, denies any special powers or missions, feels that she/he is quite well treated by individuals and the community. Believes self to be exceedingly virtuous, denies that he/she distrusts others, persistently naive about other's motives, believes self to be especially sensitive, overvalues own subjec-tive knowledge. Alert watchfulness, demonstrations of suspiciousness, distrust, belief that everything is not as it should be, paranoid trends, persecutory ideas, reports inappropriate sus-piciousness, feels scrutinized, systematized delusions, protective thinking (selective attention to confirm suspicions and blaming of others for own failures), paranoid illu-mination (“Now everything makes sense”). Pervasive suspiciousness about everyone/everyone's actions, expects people to seek retribution, views people as vindictive, sees self as victim of others/enemies/ven-detta, partially supported delusions, likely story of persecution/evidence of persecu-tion, on guard, hyperalert, vigilant, wary, spied on, plotted against, attempts made to harm, attacks, attacks foiled, demonstrates Cameron's (Cameron & Rychlak, 1968) “pseudocommunity” of all those united in a plot against him/her. 12. 25. Phobias See Section 3. 23, “Phobias,” for questions, and Section 10. 3, “Anxiety/Fear,” for descriptors. The relevant ICD-9-CM codes are 300. 21, Agoraphobia with panic disorder; 300. 22, Agoraphobia with-out mention of panic attacks; 300. 23, Social phobia; and 300. 29, Other isolated or specific phobias.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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186 STANDARD TERMS AND STATEMENTS FOR REPORTS ABNORMAL Sy MPTOMSThe relevant DSM-IV-TR codes are 300. 29, Specific Phobia; 300. 23, Social Phobia; 300. 22, Agora-phobia Without History of Panic Disorder; and 300. 21, Panic Disorder with Agoraphobia. Phobias involve persistent, recognized-as- unrealistic fears; high levels of circumscribed anxiety; and avoidance of the anxiety- arousing situations/animals/social settings/persons. Types of phobias include traumatically learned phobia, animal phobias, “school phobia,” social phobia, agoraphobia, acrophobia, algophobia, claustrophobia, xenophobia, and zoophobia. About 375 named phobias are listed in an appendix to the Blakiston's Gould Medical Dictionary (1972). “Homophobia” is more likely a part of a personality disorder. (See Sections 13. 8, “Authoritarian Per-sonality,” and 13. 21, “Paranoid Personality. ”) 12. 26. Post Concussive Syndrome The relevant ICD-9-CM code is 310. 2 Postconcussion syndrome. Related diagnoses for these condi-tions are found under 310. x. Postconcussional Disorder is listed in DSM-IV-TR as a disgnosis for further study. PCS is a set of physical, affective, cognitive, and interpersonal symptoms due to an interaction between mild Traumatic Brain Injury and stress or environmental demands. Mild TBI, also called “minor head injury” or “concussion,” results from blows to the head and may be transient or per-manent and cumulative. Symptoms may begin immediately after the trauma or may be delayed up to 10 days or so. Jackson et al. (2002) suggest that three or more of the following are needed for a diagnosis of PCS: easy distraction; trouble concentrating, remembering, paying attention to more than one thing, doing more than one thing at a time, or attending in a distracting environment; forgetting appoint-ments; headaches; difficulty finding the right words; losing things; dizziness; trouble following directions; and increasing difficulty with work. Sensitivity to light and/or noise, loss of hearing, stress intolerance, and/or alcohol intolerance may also be seen. The suggested DSM-IV-TR criteria for Postconcussional Disorder include the following: Loss of consciousness (for more than 5 minutes after the head injury). Amnesia (for more than 12 hours after the injury). Onset or worsening of seizures (within 6 months of the injury). Deficits in memory or attention (concentration, shifting the focus of attention). Three or more of the following if they persist for at least 3 months after the injury: easy fatigue, sleep disorder, headaches, dizziness, irritability or aggression, anxiety, depression or affec-tive lability, lack of spontaneity, changes in social or sexual behavior. 12. 27. Post Traumatic Stress Disorder The relevant ICD-9-CM and DSM-IV-TR code is 309. 81. Components and Symptom Clusters for Evaluation Affective Symptoms Emotional numbing, deadening, lack of emotional responsiveness to usual experiences, estrangement, detachment.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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12. Abnormal Signs, Symptoms, and Syndromes 187ABNORMAL Sy MPTOMSCognitive Symptoms Decreased concentration and memory functioning. “Flashbacks,” reexperiencing/reliving of the traumatic situation, intrusive memories. Foreshortened future, believes will not have a family/career/normal lifespan. Behavioral Symptoms Avoidance of stimuli similar to or elements of the original traumatic situation because these cause experiences of recall. Worsening of symptoms when in situations like the original. Symptoms of increased arousal, such as easy startling, hypervigilance, and sleep disturbance. Impulsive behaviors. Social Symptoms Fear of intimacy, general alienation, family discord. Intolerance of authority. “Survivor guilt,” integrity problems (feelings of betrayal, responsibility for acts of omission/ commission, personalized responsibility and guilt). Considerations for Veterans ICD-9-CM offers V codes (V61. 01 and V61. 02) about the effects of military deployment on a soldier and family. Stressors/traumatic events could include receiving incoming fire, receiving sniper fire, having a unit on patrol ambushed, having a unit engage in a firefight, bomb blasts, etc. Integrity problems may include feeling betrayed by the government or by how the war was fought. Recent approaches to trauma include emphasizing the normality of guilt resulting from killing or other war acts, as well as fear of the dangers of combat. Consideration should be given to Gulf War syndrome, com-bination of medical and psychological disorders. Veterans of the Iraq/Afghanistan wars are likely to be older, married, and/or parents. A very complete review of Gulf War syndrome is available (www. pbs. org/wgbh/pages/frontline/shows/ syndrome ). The National Center for PTSD (www. ncptsd. va. gov ) offers superb resources for care pro-viders and researchers on PTSD assessment and treatment. key Features of PTSD Pies (1993) offers the TRAUMA acronym as a way of summarizing PTSD's key features: Trauma or actual harm outside normal range. Recurrent disturbing dreams, recollections. Avoidance of troubling memories, Amnesia for key events of trauma. Unwanted images, “flashbacks. ”Markedly diminished interest. Autonomic overactivity, Anger outbursts. Related Conditions Acute Stress Disorder has similar but fewer symptoms, which last from 2 days to 4 weeks. Complicated PTSD is more likely with prolonged or repeated exposure and with escalating trauma, and is likely to involve the following symptoms (Courtois, 2004):
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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188 STANDARD TERMS AND STATEMENTS FOR REPORTS ABNORMAL Sy MPTOMSProblems with the regulation of affective impulses. Disturbances in attention and consciousness. Altered self-perception. Altered perception of the perpetrator. Changes in relationships with others. Shifts in systems of meaning. Somatization and/or medical problems. Related symptoms of C-PTSD include these: Emotions of helplessness, shame, guilt. Emotional dyscontrol resulting in suicidal ideation, rages, passive-aggressive behaviors. Making huge life changes. Loss of faith. Amnesia for the trauma, derealization/depersonalization, other dissociative symptoms. Preoccupation with revenge. Attributing omnipotence to the perpetrator. 12. 28. Pre Menstrual Dysphoric Disorder DSM-IV-TR offers PMDD as a diagnosis for further study. Be careful in using this diagnosis, as its rationale has mixed research support and is obviously pejorative and gender-specific. PMDD is a more severe form of P re Menstrual Syndrome. Disabling symptoms of PMS, occurring in the week or two before menses, are summarized below. The somatic symptoms are usually much less severe than the psychological ones. Vegetative Aspects Appetite/eating changes, anorexia, craves specific foods. Sleep changes/hypersomnia/hyposomnia/insomnia, lethargy/fatigue, stays in bed/naps. Affective Aspects Depression, hopelessness, despair, out-of-control self-deprecation. Mood swings, feeling overwhelmed/stressed, sadness, suicidal ideation, crying. Anxiety, tension, “on edge,” restlessness, persistent anger/irritability, lability. Decreased interest in activities. In some cases, affectionate, need for closeness. Excitement, well-being, burst of energy/activity. Pains Cramps, headache, mastalgia, joint/muscle pain, general aches and pain, muscle stiffness, back-ache. Autonomic Nervous System Aspects Nausea/vomiting, palpitations, sweating/cold sweats, “hot flashes/flushes,” dizziness, fuzzy vision, numbness/tingling, heart pounding, chest pain, ringing in ears, feeling of suffocation. Fluid Balance Weight gain, “bloating,” edema, breast tenderness/swelling.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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12. Abnormal Signs, Symptoms, and Syndromes 189ABNORMAL Sy MPTOMSCognitive Aspects Lessened concentration/distractibility, forgetfulness, confusion, lowered judgment, indecision. Decreased efficiency, lowered school or work performance, accidents, motor incoordination, decreased orderliness. Impulsivity. Interpersonal Aspects Irritability, increased conflicts, distrust, oversensitivity to rejection, isolation, avoidance, loneliness. 12. 29. Rape Trauma Syndrome The following is largely based on Burgess and Holmstrom (1974), who first described RTS as occur-ring in three stages. The Acute Phase This occurs within days or weeks. Response Patterns Expressed: Agitated, crying, anxiety. Controlled: Without emotion, “nothing really happened. ” Shock/disbelief: Disorientation, poor concentration, difficulty making decisions or doing ADLs, possible poor recall of the assault. Cognitive Changes Less alert, poor memory, disorganized thoughts, confused, bewildered. Self-blame. Somatic Reactions Gynecological trauma (bruising, bleeding, etc. ). Headaches, fatigue, sleep changes, nightmares. Startle overreactions. Gastrointestinal: Nausea, vomiting, stomach pains, appetite changes, inner tremor. Genitourinary: Discharge, itching, burning, pain, rectal pain/bleeding. Affective Reactions Anger, anxiety, tension, restlessness. Numbing, paralyzing anxiety, crying. Fears of death, dying, attack. Humiliation, embarrassment. Lifestyle Changes Changing residence, taking trips, visiting family/friends for support. Changing phone number. Disruption of routines. Obsessive cleansing. Oversensitivity to others' reactions.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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190 STANDARD TERMS AND STATEMENTS FOR REPORTS ABNORMAL Sy MPTOMSNot all survivors show their emotions outwardly. Some may appear calm and unaffected by the assault, and their reactions may blend into the next phase. The Outward Adjustment-Inner Turmoil Phase The victim may appear to have resumed previous life patterns, but experiences intense internal turmoil and symptoms. Symptoms Anxiety, helplessness, fears, depression, mood swings, sleep disturbances, flashbacks, dissocia-tion, panic attacks, etc. Coping Mechanisms Family and friend support. Substance abuse. Minimization: “Everything is fine,” refusal to discuss it. Dramatization: Continual talking about the assault. Explanation: Trying to understand what happened. Flight to a new home or city. Changes in appearance. Cognitive and Behavioral Changes Loss of sense of personal security, constriction of activities. Avoidance of new relationships. Disturbed sexual relationships— flashbacks, avoidance, hypersexuality for control. Somatic Reactions Tension headaches, fatigue, soreness or localized pain in the chest/throat/arms/legs. Symptoms related to the body area assaulted (e. g., mouth and throat complaints after oral rape). Nausea/vomiting, developing Anorexia Nervosa and/or Bulimia Nervosa. Phobias Specific to the Rape's Circumstances (Traumatophobia) Being in crowds, being approached from the rear or side, being left alone anywhere, leaving the house. Men in general. Characteristics of the assailant (e. g., mustache, curly hair, the smell of alcohol or cigarettes, type of clothing or car). Suspicions, paranoid feelings about strangers. The Resolution/Reorganization/Renormalization Phase Insight into own adjustment, ending of denial, giving up coping mechanisms that are no longer needed and/or are harmful. The rape is no longer central to the victim's life. Guilt, shame, and self-blame come to an end. 12. 30. Reactive Attachment Disorder The DSM-IV-TR code is 313. 89, Reactive Attachment Disorder of Infancy or Early Childhood. The code is the same in ICD-9-CM, but the disorder is classified under Other or Mixed emotional distur-bances of childhood or adolescence: Other.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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12. Abnormal Signs, Symptoms, and Syndromes 191ABNORMAL Sy MPTOMSCardinal Features Severely inappropriate social relating by a child in either of two forms: The disinhibited form, with indiscriminate familiarity and excessive efforts to get comfort or affection from any available adult (including strangers), or peers if the child is older. The inhibited form, showing failure or great reluctance to initiate or accept comfort and affection, even from familiar adults, especially when distressed. Other Features No identifiable, preferred attachment figure. Poor relating to peers. Aggression toward self and others. Misery. Growth failure (in some cases of the inhibited form only). Onset before 5 years of age (Infants to 18-24 months may show nonorganic failure to thrive and abnormal responsiveness to stimuli. ) A history of significant neglect and possible abuse. Some normal social relating with appropriately responsive, nondeviant adults (disinhibited form only). 12. 31. Schizophrenia See also Sections 11. 19, “Stream of Thought,” 12. 10, “Delusions,” and 12. 17, “Hallucinations. ” The relevant ICD-9-CM and DSM-IV-TR codes are as follows: 295. 10, Schizophrenia, Disorganized Type; 295. 20, Schizophrenia, Catatonic Type; 295. 30, Schizophrenia, Paranoid Type; 295. 60, Schizo-phrenia, Residual Type; 295. 90, Schizophrenia, Undifferentiated Type (DSM-IV-TR) or Unspecified type (ICD-9-CM). “Schizophrenia” is so called because it is a split between thoughts and feelings. Note that it does not mean “split personality. ” It includes what Eugen Bleuler (1911/1968) referred to as the “four A's”: disorders of Association, Affect, Ambivalence, and A utism. Schneiderian or First-Rank Symptoms The following list is based on Schneider (1959). Primary delusional perception (a common perception that takes on special significance and is elaborated in a delusional way). Passive reception of a somatic sensation imposed from an outside agency. Thought diffusion, broadcasting, thought insertion, withdrawal, or interference. Clouding of consciousness. “Made” (externally directed) impulses (delusions of somatic passivity). “Made” volitional acts. “Made” feelings or sensations. Voices arguing with the client in the third person, calling his/her name. Voices making a continuous commentary on the subject's actions. Audible thoughts: Speaking the client's thoughts aloud { é c h o d e p e n s é e s }. Note: ü These symptoms have not been found to be pathognomonic to (unique to, confirming the diagnosis of) schizophrenia, although they are more common in it and rarer in other conditions.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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192 STANDARD TERMS AND STATEMENTS FOR REPORTS ABNORMAL Sy MPTOMSPositive versus Negative Symptom Patterns Factor Type I: Positive subtype (behaviors not usually found in normal persons)Type II: Negative subtype (absence of behaviors usually found in normal persons) Diagnosis Paranoid, Undifferentiated, Dis- organized, Catatonic, Residual. “Simple. ” Symptoms Positive: Behavioral excesses. Hallucinations, delusions (q. v. ). Thought disorder, incoherence. Bizarre or disorganized behavior. Negative: Behavioral deficits. Alogia: Poverty of speech and thought processes, vagueness, blocking, great latency. Flattened affect, anhedonia. Asociality, withdrawal. Avolition, apathy. Attentional impairment. Psychomotor retardation, monotone. Thought disorder. Brain abnormalities Overactivity of dopamine in limbic system; normal CT scans. Underactivity of dopamine in frontal cortex. Enlarged ventricles. Intellectual impairment Minimal. Significant. Premorbid functioning Better. Worse. Onset Acute. Insidious. Gender More women. More men. Course Episodic, exacerbations, and remissions. Chronic. Response to treatment Favorable response to older neuroleptics. Poor response to older neuroleptics. Prognosis More likely to return to pre- vious level of functioning. Less likely to return to previous level of functioning. Social functioning Normal social functioning between remissions and exacerbations. Poor social functioning in social, vocational, educational, relationship areas. Note: ü A factor analysis of symptoms suggests five types (not just two): (1) positive/psychotic symptoms/disorganized thoughts, (2) negative symptoms (as described above), (3) excited/acti-vation/motor symptoms, (4) dysphoric mood/anxiety-depression, and (5) autistic preoccupa-tion (White et al., 1997). Schneiderian Symptoms See Section 12. 31, “Schizophrenia,” for descriptors. 12. 32. School Refusal/Avoidance/“Phobia” School refusal is not truly a “phobia,” as it may not be a fear and avoidance of school, but a fear of the consequences of absence from the home. Summary Statements Child is fearful of leaving home because of fears that he/she must guard against some danger to the caregiver/death of parent/abandonment by parent/own failure to fulfill obligations/ separation anxiety.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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12. Abnormal Signs, Symptoms, and Syndromes 193ABNORMAL Sy MPTOMSChild wishes to avoid school because of bullying/harassment/abuse/scapegoating/threats/exclu-sion from cliques/poor social skills/inappropriate disciplinary methods/shaming/demands beyond child's abilities/very poor teaching methods. Compeled attendance caused rifts between the parents and the child/further loss of self- confidence/more abuse/panics/increased symptoms of depression/psychosomatic symp-toms, because it was implemented without examination of the child's experiences in school/best setting to meet the child's educational needs/family issues. Seasonal Affective Disorder See Section 10. 11, “Seasonal Affective Disorder,” for descriptors. 12. 33. Self-Injurious Behavior SIB is “the deliberate, direct destruction or alteration of body tissue without conscious suicidal intent, but resulting in injury severe enough for tissue damage (e. g., scarring) to occur” (Gratz, 2003, p. 193). Klonsky and Glenn (2009, p. 147) add “for purposes not socially sanctioned. ” SIB includes skin cutting, carving, burning, severe scratching, needle sticking, and interference with wound heal-ing. It excludes decorative tattooing, scarification, piercing, and insertion of objects into the body. Another common term for SIB is Non Suicidal Self-Injury. SIB or NSSI is seen in many diagnoses, and so does not imply the presence of any particular disorder or even any disorder; it is equally com-mon in both sexes (Klonsky & Glenn, 2009). The terms “self-abusive,” “-harming,” “-mutilation,” “-violence,” “-destructive,” and “masoch- ü istic” embody assumptions about the motives and goals (e. g., self-hate, suicide) of the activity, but most often these assumptions are inaccurate. SIB is mainly used to manage overwhelmingly intense emotions because of emotion regulation skills that are not well developed. Gratz (2003), after a thorough review of the literature, has identified these possible functions: “(1) to relieve anxiety; (2) to release anger; (3) to relieve unpleasant thoughts and feelings; (4) to release ten-sion; (5) to relieve feelings of guilt, loneliness, alienation, self-hatred, and depression; (6) to externalize and concretize emotional pain; (7) to provide an escape from emotional pain; (8) to provide a sense of security; (9) to provide a sense of control; (10) to self-punish; (11) to set bound-aries with others; (12) to terminate depersonalization and derealization; (13) to end flashbacks; and (14) to stop racing thoughts” (p. 199). Clients may be inarticulate about these motives. Clients often report experiencing aspects of dissociation during SIB. These may include deperson-alization, poor recall, distance from one's body, confusion about who did what, anesthesia, or the perception that it is happening to an alter (see Section 13. 14, “D issociative Identity D isorder”). After sufficient rapport is established, inquire about behaviors (frequency, location, and cutting implements); antecedent situations (social aspects, thoughts, and then feelings); consequences, and, last, motives and expectations. Risk factors include childhood sexual and physical abuse, neglect, separation and loss, and inse-cure attachment. 12. 34. Sexual Abuse, Child See Section 3. 4, “Abuse (Sexual) of Child or Adult,” for questions. The relevant DSM-IV-TR code is V61. 21, Sexual Abuse of Child, or 995. 53 if the focus of clinical attention is on the victim. The same code numbers are used in ICD-9-CM, but V61. 21 signifies Counseling for victim of child abuse, and it is used with 995. 53, Child sexual abuse.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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194 STANDARD TERMS AND STATEMENTS FOR REPORTS ABNORMAL Sy MPTOMSAlmost all of the phenomena listed below occur fairly often in nonabused children. Be extremely judicious in interviewing, hypothesizing, and making statements. Operating in this area requires specialty training. Physical Aspects Genital or anal area pain/swelling/itching/bleeding, bruises, torn/stained/bloody underwear, frequent urinary tract infections, painful urination, vaginal or penile discharge, symptoms of Sexually Transmitted Diseases, pregnancy. Behavioral Aspects Unexplained changes in eating habits, sleeping habits (nightmares and insomnia), difficulties in sitting or walking, inappropriate/public or unusual masturbation, indiscriminate hug-ging/kissing/seductive behaviors with children and adults. Affective Aspects Excessive, and especially sudden, fearfulness about particular persons or places. Social Aspects At home/play: Clinging, withdrawal, regression, poor peer relations. At school: Refusal to attend, absences, drop in grades, refusal to attend or participate in physi-cal education, arriving early or leaving late. Cognitive Aspects Premature knowledge of sexual behaviors, changes in fantasy play to themes of sexuality or harm. Sexual or physical abuse of a child must be reported according to your state's rules, which you ü must know. If in doubt, call and ask a “hypothetical” question. 12. 35. Sexual Impulsivity/“Addiction”/“Compulsion” At this writing, no criteria for sexual addiction have been accepted by the American Psychiatric Association. However, criteria have been generated by drawing analogies with substance depen-dence (Goodman, 2005). In general, sexual addiction is a pattern of sexual behavior without reliable control that leads to significant impairment or distress. “Significantly, no form of sexual behavior in itself constitutes sexual addiction. Whether a pattern of sexual behavior qualifies as sexual addiction is determined not by the type of behavior, its object, its frequency, or its social acceptability, but by how the behav-ior relates to and affects a person's life” (Goodman, 2009). Symptoms Pornography/erotica dependence. Compulsive masturbation. Protracted promiscuity.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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12. Abnormal Signs, Symptoms, and Syndromes 195ABNORMAL Sy MPTOMS12. 36. Side Effects of Psychotropic Medications/Adverse Drug Reactions Common Side Effects Anticholinergic effects: Dry mouth, blurred vision, constipation, urinary retention. Extrapyramidal effects (caused by dopamine blockade in basal ganglia): Parkinson-like effects: Reduced accessory movements, cogwheel rigidity, shuffling gait, rest-ing tremor, mask-like facies (not flat affect), “woodenness,” hypomimia, brady kinesia. Dystonias: Spasms in neck (torticollis), oculogyric crises, etc. (See “Acute Dystonic Reaction,” below. ) Involuntary movements: Lip smacking, tongue rolling/thrusting, jaw clenching, drooling, tics/jerky movements, writhing. Akathisia (uncomfortable sense of inner restlessness). Tardive dyskinesia (See “Tardive Dyskinesia,” below. ) Autonomic effects: Orthostatic hypotension (which can cause dizziness and imbalance). Sedation: Drowsiness, excessive or daytime sedation, oversleeping, insomnia, nightmares. (See Section 12. 37, “Sleep Disturbances. ”) Also, lethargy, easy fatigue, weakness, anergia. Cognitive effects: Impaired concentration or reaction time, memory impairment, confusional states. Sexual effects: Decreased libido/desire, difficulty getting or sustaining an erection/lubrication, anorgasmia, irregular menstruation. Other effects: Weight gain, reduction of seizure threshold, liver problems, photosensitivity, pal-lor/flushing, impaired temperature regulation and risk of heatstroke, blurred vision, cardiac rhythm changes, itching/uticaria. The following are also side effects of psychotropic medications, but there are idiosyncratic side effects and illusory correlations as well, so attend carefully to what the client reports. Neuroleptic Malignant Syndrome The ICD-9-CM and DSM-IV-TR code is 333. 92. NMS is a potentially life- threatening but rare reaction to just about any neuroleptic medication (it affects 1% or fewer of those taking such drugs). Pelonero et al. (1998) provide a comprehensive review on diagnosis and treatment. Severe Parkinsonian rigidity with high fever, Autonomic Nervous System instability (flushing/ pallor, unstable blood pressure, diaphoresis, tachycardia). Tardive Dyskinesia The DSM-IV-TR code is 333. 82, Neuroleptic-Induced TD. The corresponding ICD-9-CM code is likely to be 333. 85, Subacute dyskinesia due to drugs. TD can be a serious adverse effect of psychotropic medications. It is assessed with the A bnormal Involuntary Movement S cale, available from many sites on the Internet. TD usually occurs after 3-6 months, but it can begin after up to 6 years of treatment. Although it is often irreversible, many recover. Irregular/spastic/choreiform or slow/writhing/athetoid movements, chewing, swallowing, lick-ing, sucking, tongue movements, blinking, grimaces (usually involving mouth and sometimes fingers).
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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196 STANDARD TERMS AND STATEMENTS FOR REPORTS ABNORMAL Sy MPTOMSAcute Dystonic Reaction The DSM-IV-TR code is 333. 7, Neuroleptic-Induced Acute Dystonia. The corresponding ICD-9-CM code is 333. 72, Acute dystonia due to drugs. Spasms of the neck/trunk/muscles of the eyes (usually occurring within the first few days of neu-roleptic medication), torticollis, retrocollis, hip rocking, oculogyric crisis, laryngeal spasm. Serotonin Syndrome Due to drug interactions involving Selective Serotonin Reuptake Inhibitors, an excess of serotonin may accumulate and cause significant effects: Confusion, agitation, anxiety, hypomania, insomnia, hallucinations, headache. Hyperreflexia, myoclonus, restlessness, tremor, incoordination, rigidity, clonus, teeth chatter-ing, trismus, seizures. Diaphoresis, hyperthermia, hypertension, tachycardia, pupillary dilatation, nausea, diarrhea, shivering. Immediate medical care is essential. SSRI Discontinuation Reaction If an SSRI is not tapered off over a few weeks, the following symptoms often result. A useful mne-monic is FINISH: Flu-like symptoms: Headache, lethargy/fatigue, achiness/myalgia, sweating, sinus congestion. Insomnia, vivid dreams, nightmares. Nausea. Imbalance, lightheadedness, dizziness, vertigo. Sensory disturbances: “Burning,” “tingling,” “electric-like,” tinnitus, feeling abnormal. Hyperarousal: Anxiety, irritability, agitation/restlessness, jerkiness. This discontinuation reaction occurs in about 20% of all those who stop taking any serotonin- affecting medication. This reaction is more likely when drugs with short half-lives are used or when adherence to medication regimens is poor. It may be confused with absence of improvement, or even with worsening of the depression or anxiety. 12. 37. Sleep Disturbances See Section 3. 27, “Sleep,” for questions. In ICD-9-CM, sleep disorders are coded 327. xx and 307. xx. The DSM-IV-TR code for the majority of sleep disturbances is 307. 4x. Avoid the use of the term “insomnia” alone, as it has multiple meanings and so is vague. ü Continuous sleep of 5-9 hours is typical but not universal. Awakening, engaging in nonstrenuous activity for an hour or two in the “middle of the night,” and then entering a “second sleep” consti-tute a normal variant (Brown, 2006). Sleep and arousal disorders are classified in DSM-IV-TR and ICD-9-CM as Dysomnias (disturbances in the amount, timing, or quality of sleep) and Parasomnias (dysfunctions of arousal and sleep stage transitions). However, the most complete diagnoses are provided in the International Classifi-cation of Sleep Disorders (American Academy of Sleep Medicine, 2005).
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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12. Abnormal Signs, Symptoms, and Syndromes 197ABNORMAL Sy MPTOMSDysomnias Difficulty Falling Asleep: Initial insomnia, sleep latency. Sleep Continuity Disturbance: Interrupted/broken/fragmented sleep, middle insomnia. Early Morning Awakening: Terminal insomnia (frequent in depression). Parasomnias Night Terrors Pavor nocturnus in children, expression of terror with distorted features (reported by others and not recalled by client in morning), sitting up or jumping from bed, profuse sweating, sudden screaming/thrashing/calling out, sleep not interrupted (or if awakened client cannot recall scream or reason for scream), still asleep/cannot be awakened or have terror shortened by others, if awakens does not recognize others/location, hallucinates dream objects, terror may last up to 20 minutes, peaceful sleep upon end of terror. Nightmares Frightening/often paranoid quality, awakening follows, only moaning or small movements, no sweating, no hallucinations, is awake when others arrive and can recall dream, can recog-nize others and surroundings, may stay awake and review dream, maximum duration 1-2 minutes, fairly well recalled in morning. Vivid Dreams “Almost real,” well- organized contents, of neutral mood, felt as very different from usual dream-ing, concerning persons and events from dreamer's remote past. Sleep Paralysis Besides inability to move, reports intense fear/terror/joy/anger, thoughts of imminent death, false belief of having awoken, sensed presence. Clients may also report many kinds of vivid hallucinations, often involving supernatural assaults, near-death experiences, or other paranormal experiences (Cheyne et al., 1999). Other Parasomnias Somnambulism, somnirexia, somniloquy, nocturnal vocalizations. Hypnagogic/hypnopompic hallucinations. Other Patterns Apnea: Central, upper airway, mixed, obstructive. Nocturnal jerking/myoclonus/“restless leg syndrome. ”Itching/crawling symptoms. Bruxism/clenching/grinding teeth. Incontinence, bedwetting/enuresis, urinary urgency. Day-night reversal. Other Aspects of Sleep Disturbance Poor sleep architecture: Extended time to fall asleep, wakes with headache, choking, etc. Sleep deprivation/debt, daytime sleepiness/drowsiness, tiredness/fatigue, repeated or exten-sive daytime napping, wakes unrefreshed.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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198 STANDARD TERMS AND STATEMENTS FOR REPORTS ABNORMAL Sy MPTOMSTotal sleep time decreased/increased/unaffected/normal/underestimated. “Lark” pattern (morning alertness with evening ineffectiveness) or “owl” pattern (the opposite). Etiological Considerations Disorders: Depression, chronic illness, pain, drug/alcohol use to sleep. Poor sleep hygiene: Irregular bedtimes/locations, consumption of meals/stimulants/alcohol/ tobacco/medications/strenuous exercise too near bedtime, disruptive noise or light, effort-ful attempts to go to sleep, television/phone/computer in bedroom, media violence. Disruptions due to bed partner/small children/need to use the bathroom, transmeridianal travel, being away from home, changed family demands. Somatization Disorder See Section 13. 16, “Hypochondriacal Personality. ” The relevant ICD-9-CM and DSM-IV-TR code is 300. 81, Somatization Disorder. (This disorder used to be called “Briquet's syndrome. ”) 12. 38. Stalking See Sections 12. 29, “Rape Trauma Syndrome,” and 12. 41, “Violent Behaviors. ” Common Actions Spying, following, notes sent/left, calls/visits at work, property damage, thefts. Asks others about victim, verbal harassment, threats of harm to victim/family/pets, describes sexual activities. Ignores hints/requests/refusals of contact, spreads false rumors, takes photographs, confronts victim in public, argues/swears/apologizes, etc. The Victim Relationship to perpetrator: Personal (usually ex-spouse or ex-partner), professional, employment-related, through the mass media, through the Internet (“cyberstalking”), casu-ally acquainted, other (specify). Consequences: Life restriction by job change or abandonment, limiting social relationships, isolation, sleep disorders, substance abuse, depression, anxiety symptoms. The Perpetrator Mullen et al. (1999) have classified individuals who stalk others as follows: Rejected individuals, who seek reconciliation, reparation, or both. Those seeking intimacy, who mistakenly believe they are or will be loved by their victims. Incompetent individuals, who are ignorant or indifferent to courting rituals and use means that terrify. Resentful persons, who stalk as vengeance for perceived injury or insult. Predatory individuals, who seek sexual gratification and control (stalking is a rehearsal of vio-lent fantasies). 12. 39. Substance Use, Abuse, and Dependence See Sections 3. 28, “Substance Abuse: Drugs and Alcohol,” and 3. 29, “Substance Use: Tobacco and Caffeine,” for questions. See also Section 13. 11, “Codependent Personality. ”
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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12. Abnormal Signs, Symptoms, and Syndromes 199ABNORMAL Sy MPTOMSICD-9-CM and DSM-IV-TR offer about 100 codes for substance- related disorders. (See Chapter 21, “Diagnostic Statement/Impression. ”) Many terms with different implications are used in different set-tings: “A lcohol and Other D rugs,” “ Drugs & A lcohol,” “ Chemical/ Substance/ Polysubstance A buse/ Dependence,” “alcohol addiction,” and “cross- addiction,” as well as the generic “alcoholism. ” (For signs of intoxication and withdrawal, see Section 3. 28. ) Symptoms of Problem Drinking/Drug Use Tolerance/habituation/increased consumption needed for same effect. Withdrawal symptoms (substance-specific syndromes). Use to control withdrawal symptoms, “hair of the dog,” morning drinking/use. Preoccupation with drinking/use, spends time buying/selling/taking/talking about drugs/alco-hol. Continued use despite physical/medical disorder or social problem made worse by use. Consumption pattern: Impulsive, gulping, in inappropriate circumstances, solitary, secret/hid-den supply, use of drugs and alcohol together. Guilt over drinking/use. Rationalizations: “My medicine”/self-medicating, health benefits, relaxation, social ease, etc. Periodic attempts at abstinence/cutting down. Social avoidance/isolation, frequent intoxication/impairment when expected to fulfill social or occupational obligations. Missing appointments/work/recreation/etc. in order to drink/use. Use to point of intoxication/unconsciousness, loss of control. Arrests for: Driving While Intoxicated/Driving Under the Influence, public intoxication, vio-lence. Stages in the Progression of Alcoholism Jellinek (1960) and others have described a disease model reflecting a sequence/“pathological pat-tern of use,” which is widely accepted but often does not fit the individual's history. Prodromal phase: Periodic excessive drinking, drinking to reduce tension/forget stressors, increased tolerance, furtive drinking, guilt, urgency, blackouts. Crucial phase: Loss of control over drinking, repeated efforts at control (promises, geographical escapes, scheduling, change to “only beer”), excuses for drinking, remorse, use of alibis/ rationalizations, grandiose/aggressive behavior, avoidance of family/friends, work/financial difficulties, loss of interests, tremors, morning drinking, decreased tolerance, deterioration and illness, can stop for days, “benders”/episodic heavy consumption. Chronic/compulsive phase: Defeat, impaired thinking, drinking with inferiors, obsession with drinking, inability to initiate actions, neglect, drinking despite serious consequences, Delir-ium Tremens, hospitalizations, consumption of nonbeverage alcohol. Rehabilitation phase: Learns of disease model, meets formerly addicted individuals, stops drinking, medical aspects attended to, does personal stock taking, group therapy, im proved appearance, appreciates possibilities of different future, regular habits, realistic thinking/recognition of rationalizations, return of self-esteem, new interests, new friends, content-ment in sobriety, economic stability. Stages-of-Change Model See Section 25. 3, “Various Formats for Treatment Plans. ” Temperamental Risk Factors See Section 13. 5, “ 'Addictive' Personality. ” High activity level, disinhibition, impulsivity, short attention span, lack of persistence, high emotionality, low soothability, high sociability.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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200 STANDARD TERMS AND STATEMENTS FOR REPORTS ABNORMAL Sy MPTOMSSex Differences in Drinking Most of the following is based on work by Lawson et al. (2001). Note that females of lower S ocio-Economic Status may have patterns more like males; females of middle and upper SES may show patterns like those below. Middle-and upper-SES women have traditionally been more protected against public disgrace, but more punished within the family, than those of lower SES have been. Less likely than men to get into trouble with the law. Risk factors: Difficulty participating in traditional female sex roles, frustrations in the family and with children. More likely than men to suffer physical illness from drinking and at an earlier stage in the dis-order, and to die of cirrhosis. Blood alcohol levels from the same intake vary with menstrual cycle times. Begin drinking and having problems later than men do. Move more rapidly through stages of abusive drinking than do men. More likely than men to cite a specific stressor or traumatic event that led to abusive drinking. More solitary drinking/more at home, due to greater social disapproval of female drinking. More depressions/guilt/anxieties and fewer sociopathic behaviors than men. More consequences in the family (men have more consequences in the workplace). More likely than men to have a model of abusive drinking in the family (e. g., spouse). A good quick summary can be found online (pubs. niaaa. nih. gov/publications/brochurewomen/women. htm). Points in a Cost-Benefit Analysis Approach The following table is adapted by permission from Horvath (1993). See Miller and Rollnick (2002) for use of this material in “motivational interviewing. ” Benefits/motivators Costs/demotivators Reduction of negative emotions (anxiety, guilt, depres-sion, helplessness, worthlessness). Submission to social pressure of friends to consume/ not be abandoned or criticized. Ability to ignore irresolvable interpersonal conflict. Enhancement of positive emotional states. Prevention of painful withdrawal symptoms. Avoidance of pain, pressures, problems. Hope to improve sexual performance. Elimination or reduction of cravings so as not to “go crazy. ” Opportunity to test self-control. Pleasures of taste, novelty, locations. Improved socializing. Elimination or reduction of sense of separateness because will always have this habit: “the bottle. ” Belonging to a social group. Need to feel normal, not “a wreck” or “falling apart. ”Time filling, pastimes. A way to get going. Expansion of consciousness. Reduced productivity Impaired relationships. Impaired health. Diminished self-respect. Unstable moods and emotions. Legal risks. Financial costs. Diminished sexual enjoyment. Impaired cognitive functioning. Impaired sleep and rest. Impaired response to obligations. Guilt. Uncomfortable cravings. Dishonesty (or temptation thereto). Association with dealers, other addicted individuals. Diminished sense of self-control. Reduced energy, endurance, ability. Reduced available time. Unhealthy appearance. Impaired driving.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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12. Abnormal Signs, Symptoms, and Syndromes 201ABNORMAL Sy MPTOMSFactors Indicating Poor Prognosis Person has no sobriety support system, lives in a high-use area, has low self-esteem/efficacy expectations, has a history of physical/sexual/emotional abuse. Responses to Treatment See Section 25. 5, “Treatment Plan Components for Clients with Substance Abuse. ” Identification as Having Alcoholism/Addiction (↔ by degree) The following groupings are sequenced by degree of increasing identification. Denial: Does not admit to any intemperate use/drinking problem/bingeing/alcoholism, brags about sprees, “not addicted,” does not appreciate the need for treatment, grandiose/superior/arrogant, seeks/exaggerates/manufactures differences between self and other addicts, compla-cent about own patterns of use, hostile to “accusations” of addiction, only external motivators. Minimizes consequences of drinking/use, too easily/glibly admits his/her alcoholism/addic-tion, self-medicates with... (specify substances), acknowledges the negative consequences of his/her use but fails to recognize using as self-defeating, verbally identifies as having alcoholism/addiction but shows no changed behaviors such as improved social skills, resists/denies alternative problem solutions that would support freedom from addiction, is unconcerned/too little concerned with failure of previous treatments for substance abuse, hopeless of change, seeks only to avoid problems from addiction/use or to please other people and not to change own symptomatic behaviors, fearful of facing the outside world, verbalizes motivation but seems insincere, “just going through the motions,” “treatment-wise,” uses defensive anger/blaming/projecting. Identifies self as “an alcoholic”/“in recovery,” has made sobriety her/his first prior-ity, demonstrates insightful identification as having addiction/cross-addiction through change in identification/lifestyle/relationships/behaviors, is open and receptive to/understands the concepts presented, shares honestly her/his complete chemical his-tory, is dealing with the issues from a dysfunctional childhood, knows she/he is pow-erless over alcoholism/addiction and cannot recover without help and support from others, explains progress of the disease and the impact on her/his life, grieves over her/his losses, expresses regret/anger, feels cheated/abandoned, has released a lot of emo-tion/cried, reports hope, demonstrates hope through new behaviors, has prepared an aftercare plan including a daily plan/home group meetings, plans to attend meet-ings per week for a total of meetings/weeks/days, understands Adult Child Of Alcoholic Parent concepts. Able to offer support/be appropriately confrontative, is keeping abstinence as his/her top priority, willing to/does whatever is necessary, has a positive and optimistic attitude toward the future, spiritual commitment is an asset in a continued strug-gle, understands and practices relapse prevention techniques, has resisted/avoided high-temptation situations, recognizes and has plans for preventing Hungry, Angry, Lonely, and Tired cues to drinking, has dealt with the central issues of addiction/anger/denial/grief, has a functioning and non-substance-centered support network/ role models, has stable life in terms of finances/relationships/legal aspects, appreci-ates the need for and uses meetings/sponsor, leads a recovering lifestyle. Spouse's/Partner's Response See also Section 13. 11, “Codependent Personality. ” (↔ by degree) Willing to examine self, becoming involved in her/his own recovery, supportive, participates, blaming/angry/resentful, untrusting, needing to be convinced, uncooperative, codependent.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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202 STANDARD TERMS AND STATEMENTS FOR REPORTS ABNORMAL Sy MPTOMSAlcoholics Anonymous and Other Treatments: Summary Statements This client has a history of previous chemical dependency treatments, going back to (specify date). The longest period of sobriety afterward was . Client denies need for/denigrates/rejects/grudgingly admits need for/is proud of membership in AA/NA/other Twelve-Step group (specify). Client attends Twelve-Step meetings never/occasionally/regularly/daily; he knows name of/is a sponsor. She attended rehabilitation programs with only short-term/time-limited/progressively greater/ excellent success at abstinence/control. He has been exposed to/learned about/understood/applied/changed because of disease concept of addiction/identity as having alcoholism/cross-addiction/codependency/etc. Client has benefited from non-disease- oriented model/non- Twelve-Step program such as Ratio-nal Recovery. Other Summary Statements Concerning her insight, she treats her alcoholism with indifference and resignation; she feels so hopeless and defeated that she continues to abuse alcohol as a lifestyle. He rationalized about his drinking in an illogical manner suggesting its value to him. For exam-ple, he uses it to sleep, control the “shakes,” and loosen up, or reports that being drunk saved his life in an auto accident. This clinically frustrating patient has been approached, encouraged, or lectured by most of the staff to little effect. 12. 40. Suicide See Section 3. 30, “Suicide and Self-Destructive Behavior,” for questions; see also Section 12. 19, “Impulse-Control Disorders,” and 12. 33, “Self-Injurious Behavior. ” Degree of Suicidal Ideation and Behavior (↔ by degree) The following groupings are sequenced by degree of increasing suicidality. “Impossible,” highly unlikely, improbable, against strongly held religious beliefs or philosophy of life, “never” considered, rejected, wishes to live, reasons for living exceed reasons for dying, no thoughts of giving up or harming self, suicidal ideas are convincingly denied. Passive death wishes/escape wishes, “subintentioned/subintended death” (Shneidman, 1980), “chronic suicide” (Menninger, 1967), “wish to die,” would leave life/death to chance, wishes without plan, tired of living. Considered and abandoned, only flimsy rationales for refusing suicide, not currently considered, fleeting thoughts of suicide, passive suicide attempt, would not take steps necessary to save or maintain life, suicidal “flashes,” whims. Thoughts/ideation/wishes to end life, expressed ambivalence, debating, inclina-tion, smoldering ideation, wonders if he/she will make it through this, raises ques-tions of life after death, reunion wishes/fantasies. Verbalizations, recollections of others' suicides, makes plans, discusses meth-ods/means, states intent, used as a threat, thoughts of self-mutilation, asks oth-ers to help kill her/him. Behaviors, gestures, rehearsals, nonlethal/low-lethality/nondangerous method, acts of self-mutilation, symbolic/ineffective/harmless attempts, command hallucinations with suicidal intent.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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12. Abnormal Signs, Symptoms, and Syndromes 203ABNORMAL Sy MPTOMSAttempt(s), deliberateness, action planning, method/means selected/ acquired, high-lethality method, gives away possessions, arranges affairs, wrote note, told others of intent, made “good-bye” calls. Persistent/continuous/continual efforts, unrelenting preoccupa-tion. Risk Factors for Suicide Listed below are most of the factors that increase the likelihood for suicide. These can be seen as warning signs. A useful mnemonic for them is SAD PERSONS: Sex: Male. Age: Young, elderly. Depression. Previous suicide attempts. Ethanol and other drugs. Reality testing/Rational thought (loss of). Social support lacking or lost. Organized suicide plan. No significant other. Sickness/Stated future intent. A fuller explanation of these items can be found online (www. capefearpsych. org/documents/SADPER-SONS-suiciderisk. pdf). A fine article, “Responding to suicide risk,” is on the website of one of its authors (www. kspope. com/suicide). Thorough reviews of the risk factors for subpopulations are valuable and have been done for adults (Maris et al., 1992), adolescents (Lewinsohn et al., 1996), elderly persons (Mc Intosh, 1995), and those with major depression (Peruzzi & Bongar, 1999). Psychiatric Status Having a psychiatric disorder/diagnosis raises the risk 8-10 times, and having depression raises the risk 80-100 times (and severe depression raises it 500 times), all for males. Prior hospitalization raises risk more than outpatient treatment. Risk-increasing diagnoses include psychotic disorders (especially when hallucinated commands to commit suicide are present), alcohol abuse/depen-dence, and Cluster B personality disorder diagnoses. More recent onset of these is riskier. Among psychiatric patients, the rates of suicide for males and females are about equal, because the rate for females rises greatly. Psychological Symptoms Depressive symptoms, such as vegetative symptoms, hopelessness8/helplessness, anhedonia, sense of lessened worth/guilt over fault, increased irritability. Cycling of mood within an episode of depression. Extreme anxiety or panic, continual worry. Psychosis, psychotic symptoms acute rather than chronic, remission of psychotic episode but continuing depression. Severe sleep disturbances are highly correlated with suicide. Confusion and disorganization of thoughts, no sense of control over ideations/etc. Acceptance that painful situation is inalterable/final/irresolvable/incurable/permanent. 8Hopelessness is a much better predictor of suicide than is depression.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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204 STANDARD TERMS AND STATEMENTS FOR REPORTS ABNORMAL Sy MPTOMSConsistent pattern of leaving life crises rather than facing them. Recent angry/enraged/violent behavior. Morbid preoccupation with death/suicide. Incomplete resolution of depression, with increased energy or activation. Demographics European American: Three times (3 ×) more adult and 2 × more adolescent completers than African Americans and other minorities, but rates are more nearly equal in urban centers. 9 Most completers are white, U. S.-born men ages 45-60. Sex: 3-4 × as many male attempters, 70% male completers, 30% female completers. This differ-ence is due mainly to the lethality of the means selected. Lowest-SES groups have highest rates. Age: Young adult (15-24; 50% of attempters are under 30) or geriatric (twice average rate for those 75-84, 4 × for white males age 85). Medical/dental/mental health professionals, lawyers, etc., seem to have higher rates. Protestants higher than Jews or Catholics. Divorced status (4-5 × greater). Divorced people are also more likely to make repeated attempts or to have made an attempt shortly before present one (within 6 months). Never-married or widowed status (“single” is 2 × greater). Married people with children have lowest rates. History of suicide in the family. Feasible Plan of Action Availability of means/method/opportunity/resources (e. g., weapons). Highly lethal method selected. Specific/detailed plan, has made preparations (means, privacy, time, location), with little immi-nence of rescue. Has made final arrangements (a will/funeral/burial), put life's affairs in order, given away favor-ite possessions, written a suicide note. Feels capable/competent/courageous of taking action. Concealed/denied ideation to interviewer. Prior Suicidal Behaviors Note: ü Although 50-60% of those who complete suicide have one previous attempt, only 10-20% of those who attempt suicide complete it. Current ideation of longer duration, higher frequency, greater acceptance. Multiple attempts, multiple threats/statements/gestures, recent attempts. High-lethality/painful/violent/medically severe method in past attempt. Attempts with little chance of discovery. Intended to die in earlier attempts. Attempts on anniversaries of significant events. Social Isolation No friends nearby, living alone or with other than family members, few or no family members available. Highly dependent personality. 9I am grateful to Robert W. Moffie, Ph D, of Los Angeles, CA, for correction and clarification of this issue.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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12. Abnormal Signs, Symptoms, and Syndromes 205ABNORMAL Sy MPTOMSFamily instability/early rejection, loved ones all rejecting/punitive/unsupportive, no warm/ close/interdependent relationships. Loss of sense of continuity with past or present. Partner also suicidal, partner self-absorbed/competitive. No therapeutic alliance with therapist. Stressors/Precipitants Sudden onset of stress. Irrevocable losses: Serious medical illness or disability, chronic illness, failing health (especially in the previously robust). Failure to perform major life role behavior (unemployment, failing grades, etc. ) resulting in humiliations, shame at loss of social status. Self-evaluation excessively based upon performance in standard gender roles. Recent loss of persons/positions/possessions, without replacement. Anniversary of death or loss. Sexual assault, violence in a relationship. Other Risk-Increasing Variables High level of psychological pain, absence of “secondary gain” (e. g., message sending), begin-ning of recovery from depression, recent psychiatric hospital discharge, lack of plans for the future, few or weak deterrents, refusal or inability to cooperate with treat-ment. Impulsiveness, agitation, history of criminal behavior, considering homicide as well as suicide, motivation based on revenge/attention getting, history of life-risking “accidents”/accident proneness. Discussing own funeral/how friends will feel later, suicide attempt modeled on one reported in the media, suicide of friends/coworkers/colleagues. Hypochondriasis, severe physical illness, schizophrenia, or organic brain syndrome. Alcoholism: Current alcohol intoxication, or long history of alcohol abuse without current drinking. Depression with low Cerebro Spinal Fluid level of 5-Hydroxy Indole Acetic Acid/high level of cor-tisol/high ratio of adrenaline to noradrenaline. Death of mother, especially within last 3 years. For a Child or Adolescent : Causes of suicide and rationales differ with developmental age. Risk factors include the following: Girls make 3 × more attempts; boys are more likely to complete suicide. Older adolescents/young adults (15-24) are more at risk. Greater risk in rural areas. Native Americans are at highest risk; African Americans and European Americans are about equal. Earlier attempts. Strained family relationships (in 75% of attempters). Substance abuse in family of adolescent. Stressors such as loss of a significant other, recent suicide of peer or family member (“social contagion”), legal difficulties, unwanted pregnancy, recent changes of school, withdrawal, birth of a sibling.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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206 STANDARD TERMS AND STATEMENTS FOR REPORTS ABNORMAL Sy MPTOMSProtective Factors The absence or a low level of any of the risk factors above is protective. The factors listed below reduce but do not eliminate suicide risk. Abilities/resources for coping with stressors. Some religious beliefs (merciful God, only God decides on life, suicide as unforgivable sin, etc. ). Frustration tolerance. A hopeful orientation toward the future. Desire to finish big project (schooling, seeing a child married, etc. ). Sense of responsibility to care for family/children/beloved pets. Unwillingness to hurt/disappoint partner/family/friends/others. Social supports and connections, group membership/leadership. Positive relationship with therapists. Coping with the Aftermath of Suicide “Suicide survivors” (friends and relatives of those who die by suicide) commonly experience shock, confusion, grief, anger, and despair. According to Lukas and Seiden (2007), they dwell on the cause, their role, and the ways it might have been prevented. Common coping methods include the follow-ing: The long good-bye: Unending mourning and fixation. Scapegoating: Blaming a few others, displacing rage from the suicider. Guilt as punishment: Assumption of responsibility and self-blame. Cutting off: Strangling all feelings, including pleasure. Physical problems: Somatizing and focusing on these. Running: Endless moves and changes. Suicide: Following the suicider in death. Psychological Autopsy To determine the legal cause of death (a useful mnemonic is NASH: Natural cause, Accident, Sui-cide, or Homicide), a thorough investigation of the psychosocial context—a psychological autopsy— may be necessary. See Shneidman and Collins (2004) and Ebert (1987) for guidance. Ways of Classifying Suicidal Behavior Anomic, egoistic, altruistic suicides (Durkheim, 1897/1966). Indirect Self-Destructive Behavior (Farberow, 1980), “parasuicide” (Farberow, 1980), “sub-intended death” (Shneidman, 1980). Death seeker, death initiator, death ignorer, death darer, courts death (Shneidman, 1980). Assessment of Suicidality Two outstanding books address this complicated effort: Jobes (2006) and Shea (2002). Thought Continuity, Content, and Other Aspects See Section 11. 19, “Stream of Thought,” for descriptors. Traumatic Brain Injury See Section 12. 26, “Post Concussive Syndrome. ”
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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12. Abnormal Signs, Symptoms, and Syndromes 207ABNORMAL Sy MPTOMS12. 41. Violent Behaviors See Sections 3. 17, “Impulse Control,” and 3. 31, “Violence,” for questions; see Sections 12. 9, “Conduct Disorder,” and 12. 19, “Impulse-Control Disorders,” for additional descriptors. Targets of Violence Objects, property, self, family, strangers, women, children, animals, authority figures, peers, elderly/weaker persons, any available target, inside/outside the home. Correlates of Serious Aggression Tortures animals. Commits hidden aggressive acts. Fights with weaker opponents. Pride in history of aggression. Profitless damaging of property (especially one's own). Apparently purposeless aggressive actions. Careless of risk of self-harm when acting aggressively. “Out of control” when aggressive. Plans aggressive actions. Other Variables to Be Evaluated for Assessment of Violence This list is based on work by Beck (1990). History of violence before mental health diagnosis/treatment. Mental status: Defective judgment, high arousal level, psychosis, impaired consciousness. Impulsiveness, as seen in history of driving violations, spending money, sexual/social relation-ships, risk-taking behavior, work history. Use of intoxicants, history of drug/alcohol abuse. Availability of weapons/victims. Childhood exposure to violence/abuse/neglect, chaotic family, violent subculture. Instability: Frequent moves, firings, evictions, new partners. Ability to vent frustration/anger nonviolently: Verbal skills, intellect, coping mechanisms, use of support system. Need for external controls when internal ones are lacking/defective/easily overcome. Characteristics of the violent behaviors: Location, time, frequency, others present or alone, method, relationship with object of vio-lence, lethality of method. Motives/benefits/perceptions, threats, precipitants. Other behaviors: Postural tension (on chair's edge, gripping edge), voice (loud, strident), motor activity (restlessness, pacing, leaving), startle response (easily, full). Factors Associated with Violence Recidivism This list is based on work by Monahan (1981). Criminal history: Recidivism increases with each prior criminal act. Risk of recidivism exceeds 50% with more than five prior offenses. Age: Youth is highly associated with crime. Greater risk if a juvenile at first offense. Gender: Males are much more violent. Race: African Americans are at higher risk.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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208 STANDARD TERMS AND STATEMENTS FOR REPORTS ABNORMAL Sy MPTOMSSocio Economic Status: Lower status and job instability. Drug and alcohol abuse history. Nonstable, nonsupportive family environment. “Bad company” peers and associates. Greater availability of victims: Either a broad range of victims, or repeated assaults on a narrow class of victims who remain available (e. g., girlfriends). Access to weapons. Access to alcohol. Homicide Risk Factors Consider your ü Tarasoff duty (the duty to warn/protect possible targets of a client's violence) and take appropriate steps. For more guidance, see Zuckerman (2008, Section 3. 11). Intense wish to kill, specified or named victim, command hallucinations, ambivalent wish to kill, nonspecific hostility. Violent/destructive/antisocial behaviors, violent acts in unrelated settings, unpredictable destruction of objects, arrest/assault repeatedly in the same setting, carrying of weapons, chronic problems with the authorities, criminal record. Attempted to kill by stabbing/strangling/shooting, severe physical abuse causing harm. Young male, little education, patient with psychotic delusions, substance abuse history, char-acter disorder diagnosis. No home/family/friends, no institutional support or involvement, has home but no one can observe the patient, family not interested in patient. Workaholism See Section 13. 4, “A and B Personality Types. ”
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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209 13 Personality Patterns The descriptive words and phrases in this chapter's sections are organized into clusters. No validity claims are made for the clusters or their contents; these are simply descriptors that are commonly used in reports and in research studies. Because the clusters and concepts overlap, do review simi-lar types as cross-referenced. The chapter begins with sections on models of personality diagnosis, assessment methods, and cognitive styles. Subsequent topics are presented in alphabetical order. 13. 1. Models of Personality Diagnosis Millon's Model In Millon's model (see Millon et al., 2004) the focus is on reinforcement: What types of reinforce-ment (positive or enhancing/pursuit of pleasure vs. negative or relieving/avoidance of pain) does an individual of a certain personality type typically seek? What are the usual sources of this rein-forcement (self/independent vs. others/dependent vs. vacillating/ambivalent vs. no one/detached)? And what instrumental processes or strategies (active/modifies environment vs. passive/accommo-dates to environment) does the person employ? These three dimensions result in eight categories of normal personalities (defined as those of indi-viduals who seek positive types of reinforcement) and eight categories of abnormal personalities (those of individuals who seek negative types of reinforcement): Source of reinforcement Strategy Self Others Vacillating Detached Type Active Passive Forceful Confident Sociable Cooperative Sensitive Respectful Inhibited Introversive }Normal, positive reinforcement Active Passive Antisocial Narcissistic Histrionic Dependent Passive-aggressive Obsessive-compulsive Avoidant Schizoid }Abnormal, negative reinforcement The Five-Factor Model of Personality Costa and Widiger (2002) have given the five robust factors of personality the names listed below, and provided the dichotomous descriptors that follow (each factor is thought of as a continuum). Listed below these descriptors are applicable subscales from the well-validated NEO Personality PERSONALITy PATTERNS
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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210 STANDARD TERMS AND STATEMENTS FOR REPORTS PERSONALITy PATTERNSInventory-Revised (Costa & Mc Crae, 1995), and terms from other sources that apply to one pole or the other of the continuum. Neuroticism: Worrying-calm, nervous-at ease, high-strung-relaxed, insecure-secure, vulnerable-hardy. Subscales: Anxiety, Anger-Hostility, Depression, Self- Consciousness, Vulnerability, Impul-siveness. Other terms: Emotionality, temperamental, negative affectivity, hypochondriacal. Oppo-sites: Ego strength, steady, cool, poised, self-confident. Extraversion: Sociable-retiring, fun-loving-sober, affectionate-reserved, talkative-quiet, joiner-loner. Subscales: Warmth, Gregariousness, Assertiveness, Activity, Excitement Seeking, Positive Emotions. Other terms: Sociability, surgency, leader-like, dominance, capacity for status, social pre-science, need for power, not withdrawn, frank and open, adventurous, sociable. Oppo-sites: Reserved, not outgoing, secretive, cautious, reclusive. Openness: Original-conventional, creative-uncreative, independent-conforming, untraditional-traditional. Subscales: Fantasy, Aesthetics, Feelings, Actions, Values, Ideas. Other terms: Open to new experiences, interested in experience for its own sake, eager for variety, daring, imaginative, intellectance, culturedness, unusual ideas, highly tolerant of uncertainty and what others think/do/say, broad-mindedness. Opposites: Concrete, practical, narrow interests. Agreeableness: Good-natured-irritable, courteous-rude, lenient-critical, flexible-stubborn, sympathetic-callous. Subscales: Trust, Straightforwardness, Altruism, Compliance, Modesty, Tender mind ed ness. Other terms: Cooperative, interpersonally supportive, need for affiliation, need for love, friendly compliance, not jealous, mild and gentle, cooperative. Extreme forms: De pendent and self-effacing. Opposites: Grumpy, unpleasant, disagreeable, headstrong, negativistic. Conscientiousness: Reliable-undependable, careful-careless, hard-working-lazy, punctual-late, persevering-quitting. Subscales: Competence, Order, Dutifulness, Achievement Striving, Self-Disciplined, Delib-erative. Other terms: Thorough, ambitious, achievement- oriented, responsible, prudent, will to achieve, constrained, work ethic, fussy and tidy, scrupulous. Opposites: Undirected, lazy, fickle, unscrupulous, undependable. A sixth personality factor may be intelligence. Goldberg (1992) offers 50 bipolar rating scales (10 for each factor), or 100 well- established human traits that are subsumed under the five factors. Clusters of Personality Types from DSM-IV-TR Cluster Diagnoses Informal name Mnemonics A Paranoid, Schizoid, Schizotypal Odd/eccentric Weird Atypical B Antisocial, Borderline, Histrionic, Narcissistic Dramatic/erratic Wild Beast C Avoidant, Obsessive- Compulsive, Dependent Anxious/fearful Worried Coward/Clingy
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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13. Personality Patterns 211PERSONALITy PATTERNSInterpersonal Diagnoses of Personality The DSM's categories are rather insensitive to the social context in which an individual's maladap-tive behavior occurs. A number of models for making interpersonal diagnoses of personality have been developed: 1. The Structural Analysis of Social Behavior (Benjamin, 1996) incorporates the most relevant interpersonal dimensions: friendliness-hostility (affiliation) and control-autonomy giving (interdependence). The SASB is designed not only to categorize interactions in psychother-apy, but to chart changes in a patient's intrapsychic functioning. 2. Transactional Analysis, as formulated by Eric Berne (1964) and others, is a well-worked-out paradigm. (See Section 26. 6, “Transactional Analysis. ”) 3. Schutz's Fundamental Interpersonal Relations Orientation-Behavior describes relationships and personality (see www. cpp. com/products/fir-b/index. aspx). 4. Leary (1957/2004) developed an interpersonal model that deserves more attention than it has received. For other aspects of the evaluation of personality, see Chapter 26. Prototype Approach Personality disorder diagnoses are notoriously overlapping. The DSM's approach bases diagnostic decisions on the presence or absence of individual criteria, the counting of these symptoms, and the imposition of a cutoff score to assert the diagnosis. In contrast, the prototype approach simultane-ously examines clusters of several types of information (symptoms, adaptive functioning, treatment response, etiology) to generate clusters that are more reliable, are easier to use, and have more clinical utility. For more on this very promising alternative approach, see, for example, Westen and Schedler (2007) and Westen et al. (2006). 13. 2. Assessment Methods In the lists below, each entry offers the following information: the title of the current edition or version of each test (with acronym, abbreviation, or common name indicated by underlining); its copyright date if known; its current publisher or distributor; and the applicable age range. Objectively Scored Tests FOR CLINICAL POPULATIONS Millon Adolescent Personality Inventory, Pearson Assessments, 13-19 years. Minnesota Multiphasic Personality Inventory-2 (2001) and MMPI-2—Restructured Form (2008), Pearson Assessments, 17-64 years. Minnesota Multiphasic Personality Inventory-Adolescent, Pearson Assessments, 14-18 years. Personality Inventory for Youth, Western Psychological Services, 9-19 years. FOR NONCLINICAL POPULATIONS NEO Personality Inventory-Revised (1995), Psychological Assessment Resources, 17 years and older. Personality Inventory for Children-2nd ed., Western Psychological Services, 3-16 years. 16 Personality Factor Test, 5th ed., Pearson Assessments, 16 years and older. California Personality Inventory (CPI), Consulting Psychologists Press, 16 years and older.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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212 STANDARD TERMS AND STATEMENTS FOR REPORTS PERSONALITy PATTERNSProjective Tests Children's Apperception Test and CAT-H (1974), Pearson Assessments, 3-10 years. Drawings (House-Tree-Person, Draw-A-Person), Riverside, 5-17 years. Piers-Harris Children's Self-Concept Scale-2nd ed., WPS, 7-18 years. Thematic Apperception Test (1973), Pearson Assessments, children-adults. Rotter Incomplete Sentences Blank, 2nd ed. (1982), Pearson Assessments, high school to adult. Rorschach or Holtzman Inkblots, Pearson Assessments, 5 years and older. Behavior Rating Scales Burks Behavior Rating Scales-2, WPS, 3-6 years, grades K-12. Behavior Assessment System for Children-2, Pearson Assessments, 2:0-21:11 years. Achenbach System of Empirically Based Assessment (Child Behavior Check List, Teacher's Report Form, Youth Self-Report, Direct Observation Form, Adult Behavior Check List, Older Adult Behavior Check List, ASEBA, 11/2-90+ years. Devereaux Behavior Rating Scale— School Form (1993), Pearson Assessments, 5-18 years. Devereaux Scales of Mental Disorders (1994), Pearson Assessments, 5-18 years. Revised Behavior Problem Checklist, Pearson Assessments, grades K-12. 13. 3. Cognitive or Thinking Styles The well-researched personality variables of cognitive or thinking styles have received less attention recently, but are still very powerful in understanding the interactions of personality and cognition: how someone processes information, draws conclusions, and chooses actions in school, on the job, and in relationships. For more information, see Sternberg and Grigorenko (1997). Field-dependent vs. field-independent (psychological differentiation) (Herman Witkin). Impulsive vs. reflective (or cognitive tempo) (Jerome Kagan). Cognitively complex vs. fewer dimensions of a stimulus used (George Kelly). Internal vs. external locus of control (Julian Rotter). Global vs. analytical or scanning vs. focusing. Sharpeners vs. levelers or splitters vs. levelers. Abstract vs. concrete. Constricted vs. flexible control. 13. 4. A and B Personality Types Not in ICD-9-CM or DSM-IV-TR. Type A Time Urgency Impatient, hurries, under pressure, prompt and often early for appointments, watches clock, walks/talks/eats rapidly, does multiple activities simultaneously (multitasks), lives in the future/always planning, feels that “there's never enough time. ” Hates delays, irritable/restless with others' pace, high impatience at having to wait for some-one, rage at having to wait in line, detests wasting time, drives over the speed limit, evades red lights, is “hard on equipment,” always underestimates the time a job will take.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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13. Personality Patterns 213PERSONALITy PATTERNSHostility/Struggle for Control Competitive, “must win,” makes bets, finds competitive aspect of all activities, plays as hard as works, detests losing, plays to win even against children/friends, sets higher goals for self, challenging, hard-driving. Constant struggle for control/avoiding helplessness, helplessness is feared/denied, sees the world as threatening, cycles of desperate efforts to control environment, followed by pro-found abandonment of efforts, reluctant to share power/control/delegate. Dominates conversations, emphasizes words when speaking, finishes others' statements, inter-rupts speakers, dislikes small talk. Aggressive, high, but inhibited need for power. Self-Injurious Behaviors Gorging on high-fat foods, overuse of stimulants, low levels of exercise, high alcohol intake/ smoking, no time for self-care. Works during vacations, overplans vacation's activities, works in bed, inability to relax/be unproductive, fails to notice beauty/scenery/“smell the flowers,” overschedules self, over-committed, guilt over relaxing, always works more than 8 hours a day. Sits on edge of chairs, makes fists, clenches jaws, taps fingers, jiggles legs, rapid blinks, never still. Continual emergency reaction. Cognitions Measures everything in numbers/dollars, attributes success to own speed, concerned with get-ting and having rather than being. Perfectionistic, demands continual self-improvement, demands excellence in every area, always seeking to improve efficiency, underestimates own achievements, underestimates time and effort needed, disappointment/self-doubt. Negative, cynical, critical, ruthless in self-reproach/self-examining. “Workaholic” Traits Ambitious, gets higher grades/income. Overworking, takes on more and more work, pursues more challenging tasks, recreation only with friends from work, better communication at work than at home, organized hobbies, work as substitute for intimate contacts, reading is all work-related, works late more than peers do, when awakened thoughts go to work, lives by deadlines and quotas, creates unnecessary deadlines. Type B Relaxes readily, focuses on quality of life, paces self, easy-going, “one day at a time. ”Less ambitious, lower incomes/grades. Less irritable. Abusive Personality See Section 13. 7, “Antisocial Personality. ” (See also Dutton, 2007. ) There are many lists of “warning signs” of an abuser on the Internet (see, e. g., www. sylviasplace. com/ signs. html or www. hiddenhurt. co. uk/Abuser/signs. htm).
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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214 STANDARD TERMS AND STATEMENTS FOR REPORTS PERSONALITy PATTERNSAdult Children Of Alcoholic/Addicted Parents See Section 13. 11, “Codependent Personality. ” Despite the popularity of the ACOA concept and the multiple publications about it, there has been little empirical support for the validity for a pattern of characteristics in ACOAs or in grandchildren of alcoholic/addicted parents. (See, e. g., Logue et al., 1992, and Sher, 1991. ) 13. 5. “Addictive” Personality Not in ICD-90-CM or DSM-IV-TR. There has been little research support for the concept of an “addictive” personality, perhaps because a particular substance's use creates the traits seen. Some general traits include the following: Dissatisfaction with life. Extreme dependence, resentment of authority, flagrant selfishness, insistence on immediate gratification. 13. 6. Aggressive Personality See also Sections 12. 19, “Impulse-Control Disorders,” 13. 7, “Antisocial Personality,” 13. 8, “Authoritarian Personality,” and 13. 23, “Sadistic Personality. ” Not in ICD-9-CM or DSM-IV-TR. Cardinal Features Aggression, low self-restraint. Behaviors Vicious, brutal, pugnacious, temperamental. Reckless, unflinching, fearless, undeterred by pain/danger/punishment. Interpersonal Aspects Intimidating, dominating, surgent, obstinate, controlling. Humiliating, abusive, derisive, cold-blooded, persecutes, malicious. Cognitions Opinionated, close-minded, prejudiced, bigoted, “authoritarian. ” Self-Image Proud of independence, hard-headed, tough, power- oriented, powerful. 13. 7. Antisocial Personality See also Sections 12. 1, “Abuse,” 12. 9, “Conduct Disorder,” 12. 19, “Impulse-Control Disorders,” 13. 6, “Aggressive Personality,” 13. 8, “Authoritarian Personality,” and 13. 23, “Sadistic Personality. ” The relevant ICD-9-CM and DSM-IV-TR codes are as follows:
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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13. Personality Patterns 215PERSONALITy PATTERNSFor those over age 18: 301. 7, Antisocial Personality Disorder. For those under age 18: 312. 81, Conduct Disorder, Childhood-Onset Type; 312. 82, Conduct Disorder, Adolescent-Onset Type. (See Section 12. 9 for additional ICD-9-CM codes. ) Those over age 18 who engage in criminal behavior without “psychological” motivation should be diagnosed as showing Adult Antisocial Behavior (DSM-IV-TR and ICD-9-CM code V71. 01). Cardinal Features Classic criteria can be found in Cleckley's famous book The Mask of Sanity (1976), as well as in Hare (1999) and Lykken (1995). Predatory attitude and behavior toward others, long-standing indifference to and repetitive violation of others' rights, parasitic lifestyle, repetitive socially destructive behaviors. Absence of delusions or other signs of irrational thinking, of anxiety or other neurotic symp-toms, of suicide attempts, or of a life plan or ordered way of living. Social Aspects Irresponsibility Untrustworthy, evades responsibility, unreliable, rejects obligations, ruthless. Told a lot of lies, used an alias, in trouble because failed to pay her/his bills, multiple financial irresponsibilities. Multiple marriages/divorces, marital instability, frequent marriages, suddenly left/hit/unfaith-ful to spouse, irresponsible parenting, seriously hurt/neglected a child. Cavalier, acting wild, slept around with people he/she didn't know very well, earned money by pimping/prostitution. Selfishness Unique and self-serving ideas of “right and wrong,” lies easily, frequent lying not just to avoid negative consequences, does not believe her/his behaviors/crimes will be or should be pun-ished, uses guilt inductions on others, externalizes all responsibility, blames others, takes no responsibility for unfavorable outcomes. Feels or believes self to be harassed/misused/victimized/persecuted, resents, revengeful, dis-trusts, suspicious, justifies behavior with lies and manipulation, argues about “who's in charge,” petty, superficial relationships. A chronic pattern of infringement on the rights of others, violates social codes by lies or deceits, chronic speeder and drunk driver, reckless, indifferent to the rights of others, breaks rules, rebellious, unprincipled and deceitful in dealing with others who have something he/she wants. Ingratitude, arrogance, sees aggressive persons as strong and prosocial persons as weak. Unethical, unprincipled, unscrupulous, cavalier, showy acts of devotion, disloyal, untrust-worthy, unfaithful. Behaviors General Impulsivity, impetuous, spur-of-the-moment, short-sighted, incautious, imprudent, lack of long-term plans. History of drug/alcohol/etc. overuse/abuse (but this is not the cause of antisocial behaviors). Often likable, attractive, engaging, center of attention, socially skilled/capable/effective, charm-ing/graceful, tells tall tales, brags of unlikely resources/relationships/experiences, flip, glib, fast, overabundant ideas, witty, word plays/puns.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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216 STANDARD TERMS AND STATEMENTS FOR REPORTS PERSONALITy PATTERNSIllegal or Immoral Activities Lying, stealing, swindling, cheating, commission of/involvement in minor or serious illegal/ delinquent acts. Has conned/manipulated/cheated people out of their money/possessions, predatory, often vic-timizes the easiest/weakest members of society, “white-collar” criminal. From an early age: Criminal arrests/convictions, served time, poor probation/parole risk, many types of offenses (including felonies) diagnosed as having antisocial personality. Initiates physical fights, used a weapon in a fight, tortured animals, physically cruel to other people. Has deliberately destroyed others' property, steals/vandalizes/“messes up” property, fire-setting. Has forced someone into sexual activity with him/her, promiscuity. For a Child: See also Section 12. 9, “Conduct Disorder. ” Starting fights, vandalism, tortured/abused (“played tricks on”) animals/pets, early and extensive drug/ alcohol use, behavior difficulties, theft, incorrigibility, running away overnight, bad associates, impulsivity, recklessness/irresponsibility, slovenly appearance, lack of guilt, pathological lying. Trouble with the police/juvenile or school authorities, truancy/plays a lot of hooky, has been a discipline problem/expelled/suspended from school. Cognitions See especially Samenow (2004). Does not believe she/he will be blamed/caught/punished, low planning of escape, no consider-ation of alternatives or consequences, projects blame, rationalizes, Machiavellianism, ends justify any means, does not profit from experience of punishment, low insight. Average or above-average intelligence. Affects Lacking in remorse/guilt/regret/victim empathy, insensitive, lacks compassion, hardened, cal-lous, cold-blooded, emotionally detached, low motivation to change, shallow affects, no deep or lasting emotions. Irritability, aggressiveness, short-tempered, “bottled-up” anger, intolerance of delayed gratifica-tions, easily provoked to violence, low frustration tolerance. Deficient emotional arousal, stimulation/thrill seeking, easily bored. Vocational Aspects Unstable employment: Fired, ran away, quit a job impulsively/without another to start, didn't work because he/she “just didn't want to,” court-martialed/demoted, missed a lot of work. Lack of career or other long-term plans. Anxious Personality See Section 13. 18, “'Nervous' Personality. ” 13. 8. Authoritarian Personality For descriptors, see also Sections 12. 19, “Impulse-Control Disorders,” 13. 7, “Antisocial Personality,” and 13. 23, “Sadistic Personality,” for contrast. Not in ICD-9-CM or DSM-IV-TR.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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13. Personality Patterns 217PERSONALITy PATTERNSSee Adorno et al. (1950/1993), Milgram (1974), and Stone et al. (1993) for detailed discussions of the authoritarian personality. Cognitions Rigid adherence to middle-class/bourgeois/conventional values. Commitment to severe punishment for deviation from conventional values. Reactionary/ultraconservative, moral ideology overrides all other concerns. Prejudiced against minorities, etc., outsiders seen as dangerous/dehumanized (“subhuman,” “animals,” “undeserving”). Social Aspects Blind obedience, conformity, no questioning or criticism of authority, exaggerated need to sub-mit to those above, harshness to those below. Uses official/“clean” vocabulary. Power and dominance are the most central dimensions of relationships, views people as either weak or strong, glorifies toughness/denies tenderness, values stern discipline. Idealizes parents, father seen as stern/harshly punitive/demanding of absolute obedience. 13. 9. Avoidant Personality The relevant ICD-9-CM and DSM-IV-TR code is 301. 82, Avoidant Personality Disorder. Cardinal Features Oversensitive and vacillating, discomfort in all social situations, watchful for any hint of disap-proval. Cognitions Belief that others know of his/her anxiety and are constantly watching for his/her mistakes. Interpersonal Aspects Yearns for closeness/warmth/affection/acceptance but fears rejection/humiliation/disapproval in relationships. Fears “goofing up”/gaffes/social errors/ g a u c h e r i e s /f a u x p a s and so “making a fool of myself,” fears crying/blushing/embarrassment. Wary, distrustful, vigilant for offenses/threats/ridicule/abuse/humiliation, hypersensitive/keen sensitivity to potential for rejection or humiliation by others, expects not to be loved, needs constant reassurance/guarantee of uncritical affection. Withdrawing, guarded, private, lonely, shy/reticent/timid, compliant. Affects Anguished, intensely ambivalent, anxious, “bored. ” Self-Image Devalues own accomplishments, angry and depressed at self for social difficulties, sees self as basically defective/flawed/odd/inadequate.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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218 STANDARD TERMS AND STATEMENTS FOR REPORTS PERSONALITy PATTERNSOther Vicious cycle as follows: Low self-esteem, fear of rejection, shallow or awkward attempts at social relat-ing, hypersensitivity to lack of enthusiasm/disapproval that confirms sense of low worth, feels rejection, withdraws, fears of relationships, loneliness, yearning, trying again, rejection, etc. Extensive reliance on fantasizing for gratification of needs for contact and anger discharge. 13. 10. Borderline Personality The relevant ICD-9-CM and DSM-IV-TR code is 301. 83, Borderline Personality Disorder. These people often present a mixed picture, with elements of other personality disorders present; they often also have mood disorder diagnoses. Cardinal Features Instability in all aspects of living/personality functioning/mood/social relating, lack of person-ality consistency/cohesiveness, abrupt shifts of affect/tone of relationships. Interpersonal Aspects Close/demanding/dependent/intense relationships, disillusionment when intensity is not reciprocated, terror of abandonment. Unstable intimate relationships, rare stable but not intimate relationships, inexplicable changes in attitude/feelings toward others, capricious, “ups and downs,” vacillating reac-tions, dependence-independence struggles, intense dislike of isolation and loneliness so engages in a series of transient/stormy/brief relationships, superficiality of relationships based on alternating idealization and deflation. Affects Labile, mercurial, brittle, erratic, unpredictable, rapid/short-lived but intense mood swings, low tolerance for affects, lacks internalized soothing/holding function so relies on others. Anger barely hidden/under the surface, pessimism, argumentativeness, irritable, easily annoyed, sarcastic, intense and sudden rages or depressions, sudden dramatic and unexpected out-bursts, rage over failure of others to provide soothing, rage at intimates. Spells of emptiness/boredom/dejection/apathy, numbness. Areas of seemingly unalterable and crushing negativity, worthlessness/badness/blame/guilt/ shame/fault assumption, feelings of unlovability. Identity Lack of individuation, identity diffusion/shakiness, shifts of identity/gender identity/career choices/long-term goals, frequent “Who am I?” questions, instability of self-esteem/self-image, uncertain values/loyalties, “incompetence,” “imposter. ” Fragmentation of self, splitting, nebulous/multiple identities/personalities, “parts”/“voices”/ nicknames, threats to right to survive from parts of self. (See Section 13. 14, “Dissociative Identity Disorder. ”) Behaviors Impulsivity/poor judgment, lapses of judgment. Suicide threats/gestures or attempts/overdosing.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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13. Personality Patterns 219PERSONALITy PATTERNSSelf-destructive/mutilating/damaging behaviors. Running up huge bills/shoplifting, gambling sprees, eating binges, sexual acting out. Addictive traits and patterns, drug misuse/abuse, reckless driving. Ambivalence, indecision, procrastination. Treatment Aspects Expect frequent crises, demands for special arrangements, misinterpretations of the therapist's words and motives, intense ambivalences, rapid shifts from idealization to denigration, intolerance of contact of any kind, overreactions to changes of arrangements, confusion of intimacy and sexual-ity, and possible brief periods of psychotic symptoms. Miller (1994) offers a brief but powerful description of borderline personality from a patient's ü perspective. 13. 11. Codependent Personality See also Section 10. 3, “Anxiety/Fear,” Section 10. 7, “Depression,” and the sections in this chapter on many other personality patterns (especially borderline personality). The relevant ICD-9-CM and DSM-IV-TR code is likely to be 301. 6, Dependent Personality Disorder, but dependent and codependent personality are not identical. Codependency as a syndrome has been largely shaped by addiction concepts. Interpersonal Aspects General Descriptors Overresponsible. Self-sacrificing, unassertive, does not pursue own rights, adapts rather than changing a bad situation. Submission to others for predictability/security. Oversensitive to others' difficulties. Puts up a front, hides “true self. ” Features Caretaking: Undeserved loyalty, unappreciated/excessive devotion, excessive caretaking, over-reliable/overresponsible (to compensate for the addicted person's irresponsibility), antici-pates and participates in satisfying the addicted person's needs (“enabling”), need to con-trol people and situations, rigidity. Dependency: Longing for love/approval, tolerates abuse, always meeting others' needs before one's own, especially when stressed. Denial: Ignores/rationalizes/minimizes problem, denies increased substance abuse/dysfunc-tion. Loss of daily structure: Missing appointments, having meals at irregular times, not getting to bed or up on time. Fails to complete tasks/follow through/make plans, easily overwhelmed with tasks, reactive rather than proactive. Crisis orientation, not long-term: Good in crisis situation/beginnings and endings, but not in middles.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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220 STANDARD TERMS AND STATEMENTS FOR REPORTS PERSONALITy PATTERNSRoles Adopted Rescuer: Protecting/covering for the addicted underfunctioning person by making excuses for absences or social mistakes. Caretaker: Minimizing negative consequences of addicted person's negligence through over-responsibility and overfunctioning. Joiner: Rationalizing or participating/assisting in addicted person's using. Hero: Protecting the family's public image, drawing attention away from the addiction with enormous/“superhuman”/self-sacrificing efforts. Complainer: Blaming all the family's problems on the addicted person with no hope of change. Adjuster: Avoiding discussion of the addiction in hopes it will disappear, hiding concern and confusion with apathy. Family Characteristics Extreme family loyalty, but only superficial relationships, no intimate ones. Family rules: “Don't talk, don't trust, don't feel. ”Distorted family image: Happy, no problems, see only the good. Overdeveloped sense of responsibility and concern for others. Control is valued, lack of control is terrifying; order, stability, routine, regularity, peace, not chaos. Self-Image Low self-esteem, self-blame for any problems/other's substance use, guilt, extreme/unproduc-tive self-criticism/flagellation, assumption of blame due to inconsistency of parental behav-iors, insecurity, fear/belief in one's unlovability/insanity/badness/dirtiness, rejects compli-ments. Sense of powerlessness. Shame at addiction, secretive, very reluctant to ask for help. Acts the way he/she believes is “normal,” doesn't know what are normal behaviors/emotional responses, anxious over not feeling/acting sufficiently “normal” or feeling different from anyone else. Adopts extreme role models and standards acceptable to a group with low self-esteem. Affects Depression, negativity, uncontrollable mood swings, no fun in life, dulled feeling, anhedonia, enjoyment only at someone else's expense/vicariously. Seriousness, life as series of problems and crises to be solved, “worry is normal. ”Frequent resentments and anger, “got a raw deal from life. ”Numerous fears/anxieties, fear of anger (own and addicted person's) because it will end the relationship, indecision, fears of being hurt/abandoned/rejected. Cognitions Obsessive thinking, overreliance on analytical thinking, perfectionism. Delusions/irrational beliefs (especially that love conquers all-or at least substance abuse). Dishonest/lies/denial, unaware of dishonesty, “(The addicted person's behavior) is not the 'real' person. ” Low memory of childhood.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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13. Personality Patterns 221PERSONALITy PATTERNSBehaviors Abused, neglected physically/sexually/psychologically. “Addictive” behaviors (eating disorders, substance abuse) to cope with own frustrations/pain. Compulsions as attempts to control. Acting out to get attention or approval. Other Health problems: Stress-related disorders, lack of personal care. Lack of attention in childhood (“stroke-starved”) leads to denial of own needs. For a Child: Premature adulthood and responsibilities, struggle with adult problems as child, loss of child-hood. Impact of addiction varies with developmental stage of child living in addictive household: Bonding stage: World is not safe. Exploratory/separation stage: Sense of being either engulfed or abandoned; passivity; no right to say “No. ” Latency stage: Failure to learn rules, what is normal, problem-solving skills; living with lies, denial, and anxiety. Overachieving: Trying to give the family something to be proud of. Entertaining: Never taking anything seriously in order to relieve tension, “class clown. ”Withdrawing: Escaping to friends' homes or spending time alone. Rebelling: Acting out anger, causing trouble to draw attention away from family problems. Characteristics of Codependent Individuals Schaef (1986) describes the following: External referencing: Distrusts own perceptions, lacks boundaries, believes one cannot survive without a relationship/addicted to relationships, fears abandonment, believes in the per-fect union. Caretaking: Becomes indispensable, becomes a martyr. Self-centeredness: Personalizes all events, assumes responsibility for others' behaviors. Overcontrolling: Increases control efforts when chaos increases, attempts to control everything and everyone, controls without caring for those controlled, believes that with more effort she/he can fix the addict/family. Feelings: Unaware of feelings, distorts emotional experiences/accepts only “nice” feelings, fear-fulness. Dishonesty: Manages all impressions made, omits/lies about the truth, rigidity. Gullibility: Is a bad judge of character, unwilling to confront, overtrusting, accepts what fits the way he/she wishes things were. A critical review of the codependency concept can be found in Babcock and Mc Kay (1995). 13. 12. Compulsive Personality See also Section 13. 20, “Obsessive Personality. ” The relevant ICD-9-CM and DSM-IV-TR codes are 300. 3, Obsessive-Compulsive Disorder(s), and 301. 4, Obsessive-Compulsive Personality Disorder.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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222 STANDARD TERMS AND STATEMENTS FOR REPORTS PERSONALITy PATTERNSNote: ü DSM-IV-TR and ICD-9-CM do not differentiate between Obsessive and Compulsive Per-sonality Disorders. But because the writer of reports is dealing with the unique individual, “obsessive” and “compulsive” are separated here, to allow emphasis on aspects of the presenta-tion. Cardinal Feature Repetitious behaviors/routines/rituals, or else intense anxiety. Behaviors Highly regulated/organized lifestyle, orderliness. Cognitions See Shapiro (1965). Rumination prevents task completion, hypercareful, doubting, indecisive, poor decision mak-ing/follow-through, poor time management. Excessively moralistic concerns, scrupulousness, intense self-evaluation/scrutiny, “black or white” judgments, need for immediate closure. Perfectionistic approach, overattention to detail and avoidance of error, neatness, meticulous, a “stickler for details. ” Officious; concern with form over content, procedures/regulations more than the goals, letter of the law not the spirit, orderly task procedures rather than the outcome; sees the world in terms of schedule/rules/regulations, work as yet undone/burden. Affects Satisfaction in elaborate planning and arranging, only mild/brief pleasure with the completion of projects, a “work, not pleasure” orientation. Joyless, solemn, controls most emotions, unrelaxed, occasional intense righteous indignation, perceived lack of control of environment leads to intense depression, great need/effort to control tension/anxiety. Self-Image Industrious, reliable, efficient, loyal, prudent/careful. Interpersonal Aspects Demands that others do things his/her way. Is seen as somber/formal/cold/grim, a “stuffed shirt. ”Respectful, conventional, follows the proprieties, polite, correct. Shows reaction formation in positive/socially acceptable presentation of self. 13. 13. Dependent Personality See also Section 13. 26, “Self-Defeating Personality,” and 13. 11, “Codependent Personality. ” The relevant ICD-9-CM and DSM-IV-TR code is 301. 6, Dependent Personality Disorder. Note: ü Be sensitive to gender bias in using this diagnosis. Many studies (e. g., Broverman et al., 1970) have demonstrated gender bias in diagnosing various personality disorders: Clini-cians of all stripes equate healthy males with healthy adults, but see females as dependent,
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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13. Personality Patterns 223PERSONALITy PATTERNSself-dramatizing, vain, demanding, and overreacting to minor events-all of which resemble soci-ety's view of “normal” women. A final caution: Do not assume sexual masochism in those with dependent traits, or confuse such masochism with dependent personality. Bornstein (1997), who has written extensively on this pattern, finds (1) that the DSM symptoms of difficulty expressing disagreement and difficulty initiating projects are contradicted by research; and (2) that two of the others (seeking a new relationship as soon as one ends, and needing others to assume responsibility for his/her life) have not been tested empirically. Cardinal Feature A weak and helpless identity, with a resulting search for nurturant and protective relation-ships. Interpersonal Aspects Conciliatory, placates, deferring, uncompetitive, “niceifier,” unwilling to make critical com-ments. Dependent, allows others to assume responsibility for self, childlike, immature, reliance on oth-ers to solve problems or achieve goals, to decide on employment/friendships/child man-agement/vacations/clothing/purchases, absence of independent decision making, avoids external demands and responsibilities, low self-reliance, low autonomy, exaggerated and unnecessary help-seeking behaviors. Submissive, dominated, secondary status, self-defeating, abused, unable to make demands on others, passive, docile, compliant, supplicating. Abused, neglected, insulted, belittled, berated, “imprisoned,” exploited, tolerates partner's abusive affairs/beatings/drunkenness/irresponsibility. Self-sacrificing, subordinates own needs so as to maintain protective relationships/fulfill core role/identity, anxiously watchful and agitated. Overdevoted, superloyal, attached, overloving, “love slob” sacrificing anything for “love,” will-ing to tolerate more negatives in a relationship than the evaluator would. Gullible, too trusting, easily persuaded, naive, unsuspicious, “Pollyanna,” overhopeful of change. Vicious cycle of dependency, abuse, separation/desertion, proof of helplessness and worthless-ness, emotional devastation, terror of being unable to care for self/needs, avoidance of tak-ing self-respecting or independent actions, lessened self-esteem, greater dependency. Behaviors General ineffectiveness in autonomy but not incompetence (may demonstrate exceptional skill in some areas). Lacking in skills/motivation for independent life, ill equipped to assume mature roles. Mood Hidden depression and angers, whiny/tantrums/complains. Tries to keep emotions under tight control. Separation leads to depression/terror of abandonment. Cognitions Believes in magical solutions to problems, belief in salvation through love [ a m o r o m n i a v i n-c i t]. Unimaginative/cognitively constricted.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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224 STANDARD TERMS AND STATEMENTS FOR REPORTS PERSONALITy PATTERNSGuilt proneness, assumes blame. Unwilling to take risks for satisfaction. Preoccupied with fears of desertion/inability to cope on own. Reluctant to make decisions. Fails to identify own needs. Self-Image Weak/helpless, self-derogating, belittling, martyr-like, self-sacrificing, low self-confidence, “infe-riority complex,” “stupid,” untalented, unworthy, humble, self-effacing, self-deprecating, inadequate, inept, fragile. Hidden strengths, denies/undervalues own skills, needs great encouragement. 13. 14. Dissociative Identity Disorder See also Sections 12. 12, “Depersonalization and Derealization,” and 13. 10, “Borderline Personality. ” The relevant ICD-9-CM and DSM-IV-TR code is 300. 14, DID. Its previous name was Multiple Per-sonality Disorder. Note: ü Most studies have found extensive overlap with the symptoms of borderline personal-ity. Ross et al. (1990) have suggested that the crucial differentiator is some form of amnesia or blank spell in DID or MPD. Good references are Ross (1997) and Putnam (1989, 1991, 1997). Characteristics of Separate Selves One central self/primary/host personality: Depressed, anxious, compulsively good, “masochis-tic,” moralistic, seeks treatment. Other personalities/alters: Semiautonomous, numerous [3 to 100, mean = 15], some good and some bad, some believe that the host cannot handle memories/pain, some convinced that host must be punished/should die, may have mutual or unidirectional amnesias for one another and for host (odd names/characterological titles). Common “roles” of alters: Child, protector, persecutor, an opposite-sex person, a perfect per-son. Transitions: Sudden/unexpected, precipitated by stress or some regular pattern of social/envi-ronmental cues, often accompanied by headaches/feelings of weakness/amnesia/black-outs. Presenting Symptoms Coons and Milstein (1986) mention the following symptoms of DID/MPD, listed here in descending order of frequency: Amnesia, depression, history of childhood sexual abuse, fugue, suicide attempts, auditory hal-lucinations, history of drug abuse, history of childhood physical abuse, sexual dysfunction, headaches, child personalities, history of alcohol abuse, history of any type of conversion disorder, history of rape. These are also common: Problems with showing anger/frustration/defiance, problems with trust/safety/betrayal/suspi-cion, assumes that she/he will be disbelieved. Confusion about location/time/person, responding to more than one name, marked and rapid
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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13. Personality Patterns 225PERSONALITy PATTERNSshifts in personality, forgetting recent events, losing track of time, intense and sincere denial of responsibility when confronted, hearing of voices. Extreme or odd variations in skills (e. g., handwriting), food preferences, artistic abilities, responses to discipline. Self-injurious behaviors, somatic complaints or “conversion” symptoms such as sleepwalking, sudden blindness, loss of sensation. The following characteristics of a history of sexual and/or physical abuse are frequently seen: Believes self responsible for abuse suffered, believes deserved abuse because of badness/anger/ imperfection, believes abuse will/does continue although impossible, DID/MPD as a form of coping with victimization. 13. 15. Histrionic Personality The relevant ICD-9-CM and DSM-IV-TR code is 301. 50, Histrionic Personality Disorder. Current usage does not support “hysteric,” and individuals with histrionic personality are not all ü females. (See also the caution concerning sexism in Section 13. 13, “Dependent Personality. ”) Cardinal Feature Attention seeking through self-dramatization and exaggerated emotion. Affects Exaggerated, labile/vivid/shallow affect, easily “overcome” with emotions, easily enthused/dis-appointed/angered, excitable, theatrical/flamboyant/intensely expressed reactions, overly dramatic behaviors, creates dramatic effects/seems to be acting out a role, exaggerated and unconvincing emotionality, weepy sentimentalism. Behaviors Overreacts to minor annoyances, inappropriate. Affectations/affected, overdetermined, facades. Repeated/impulsive/dramatic/manipulative suicide gestures/attempts or similar threats. Creative/imaginative/artistic, stylish, sensitive. Stylized/caricatured “femininity”/“masculinity. ” Cognitions See Shapiro (1965). Forgetting, repression, unreflective, self-distracting/distractible. Lives in a nonfactual world of experience/impressionistic perception/recollection, global/dif-fuse, lacking in sharpness, nonanalytical. Impressionable, susceptible to the vivid/striking or forcefully presented. Magical solutions to problematical situations, hunches, “intuition,” childlike, does not adapt to change well. Superficial and stereotyped insights, “psychobabble. ” Interpersonal Aspects Exhibitionistic, dominates conversation, trivializes topics, lengthy dramatic stories, self- dramatizing, bragging, “life of the party”/center of attention, fickle, wants to please, exces-sive needs for attention/praise/approval/gratification.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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226 STANDARD TERMS AND STATEMENTS FOR REPORTS PERSONALITy PATTERNSRomantic outlook: Fantasies of rescue and victory; nostalgia, sentimentalism, idealization of partner; world of “villains and heroes”; makes poor social relationship choices and deci-sions, poor judgments about partners/friends/spouses; stormy relationships with little real or durable enjoyment, involvement in melodramatic situations. Vain, initially seen by others as warm and affectionate, guileless, vivid. Later seen as self-ish, narc issistic, shallow/superficial and insincere, ungenuine, inconsiderate, self-pitying, shows astonishment at little understanding of the implications of her/his behavior or its consequences/effects on others/destructiveness. Oppressively demanding, taking without giving, egocentric, vain, petulant, easily bored, requires excessive external stimulation, attention-seeking, help seeking, manipulates for reassurances, manipulative, asserts “a woman's right to change her mind”/“masculine prerogatives. ” Helpless, dependent, suggestible, uncritical, unassertive, sees assertion as rude or nasty, seen as fragile. Impetuous, period of wild acting out, irresponsibility, chemical abuse/“bar hopping,” “bed hopping”/sexual promiscuity/casual sexuality, low/poor impulse control/judgment/insight, thoughtless judgments. Self-centered, feels hurt/deserted/betrayed in all relationships, brief and superficial contrition, sees self as sensitive and vulnerable, unsubstantial sense of self, absence of political or other convictions. Coy, seductive, flirtatious, sexually provocative, blushes, easily embarrassed, giggles, naive, lacking in accurate sexual knowledge, seductive but for help rather than sex, seems preoc-cupied with sex, immature, self-dramatizing/sexy/flamboyant/dramatic clothing/hairstyle/ makeup, looks/dresses like a teenager/prostitute/“slut”/“tramp”/“boy toy”/“macho man. ” Self-Image Charming, gregarious, stimulating, playful, sensitive to others/feelings, selective incom-petencies in areas of low importance (e. g., numbers, specifics). Somatic Complaints Vague, changeable, movable, “women's problems,” complains of aging/appearance changes/loss of sexual skills or performances, “faints” at the sight of blood, swoons, “the vapors,” feigns illness, always wrong weight, { l a b e l l e i n d i f f é r e n c e } (infrequent—about 30%). 13. 16. Hypochondriacal Personality See also Section 12. 20, “Malingering. ” The relevant ICD-9-CM and DSM-IV-TR codes are 300. 7, Hypochondriasis; 300. 81, Somatization Disorder. General Characteristics Data do not suggest a more frequent presentation of hypochondriacal personality in elderly persons or in females. Tyrer et al. (1990) have described the following characteristics: Preoccupation with maintenance of health through dietary restriction/“healthy” or “natural” medications/vitamins/herbal products. Distorted perception of minor symptoms so that they are elevated to major and life-threatening diseases. Never feels completely well. Demands medical consultations for investigation/treatment/reassurance, seeks alternative health care providers when these are unproductive.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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13. Personality Patterns 227PERSONALITy PATTERNSRigid and persistent beliefs about health and lifestyles. “Familiar face,” “crock” (treated by a “quack”), “frequent flier,” “thick-chart patient. ”Dependent hostility (expecting both care and failure). Multiple and changing complaints, unusual/singular somatic complaints that are described in affect-laden terms, strange aches and pains, chronic/unvarying fatigue. Hypersensitivity to all medications, many foods, etc. Joyless/unfulfilling lifestyle/overresponsible. Multiple Personality Disorder See Section 13. 14, “Dissociative Identity Disorder. ” 13. 17. Narcissistic Personality The relevant ICD-9-CM and DSM-IV-TR code is 301. 81, Narcissistic Personality Disorder. Cardinal Feature Self-centeredness. Associated Features Exhibitionism, craves adoration. Self-Image Grandiose self, fantasies of self-importance/uniqueness/entitlement/“specialness,” easy loss of self-esteem, “a fraud/fake,” times of intense self-doubt/self-consciousness. Fantasies of continuous conquests/successes/power/admiration/beauty/love, brags of his/her talents and achievements, predicts great success for self, believes self entitled to/deserving of a high salary/honors/etc., overvalues all of his/her own achievements. Interpersonal Aspects Entitled, confident, self-assured, expects to be treated as a sterling success/gifted person or at least better than others, feels special and preeminent, hides behind a mask of intellectual or other superiority, exaggerated self-esteem easily reinforced by small evidences of accom-plishment and easily damaged by tiny slights and oversights. Compliment hunger, demanding of affection/sympathy/flattery/favors, insatiably requires acclaim for momentary good feelings, attention-getting behaviors. Fragile self-esteem, loss of self-esteem when disapproved, crushed/inflamed by life's wounds, responds to criticism with rage/despair/apparent cool nonchalance, compulsive checking on others' regard, may ruminate for a long time over nonthreatening social situations and interactions, extensive brooding. Relationships seen entirely in terms of what others can give rather than as exchanges, exploit-ative, lack of objectivity, arrogant, socially insensitive, resents any failure to immediately and totally gratify her/his needs, shallow relationships, finds it easy to revoke commitments she's/he's made, no deep or abiding relationships, flouts social rules, alternates between idealization of and arrogant contempt for friends, long history of erratic relationships, takes others for granted, drives people away, conversations so self-centered that others lose interest, understanding of social conventions is distorted by egocentrism. Striking lack of empathy, indifferent to rights of others, neglectful, thoughtless, tactless, self-ish, ungrateful, unappreciative.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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228 STANDARD TERMS AND STATEMENTS FOR REPORTS PERSONALITy PATTERNSOppositional/argues with authorities/instructions/examiner/supervisor, insistence on having his/her own way, little attention paid to work tasks, lies to protect ego/privileges/position, rationalizes, self-deceives, distorts facts. Grandiose, cocky, intimidating, belligerent, resentful, pretentious, sarcastic, cavalier, boorish, bumptious, obnoxious, self-indulgent. Affects Nonchalant/imperturbable/insouciant/optimistic unless ego threats/damage occur, chronic unfocused depression, absence of expressions of warmth. Cognitions Envy, solipsism, preoccupation with own performance's value. Approval-Seeking Styles The following table is put together by permission with statements from Goleman (1988). Normal self-interest Self-defeating narcissism Appreciates praise but does not require it to maintain self-esteem. Insatiable cravings for adulation; praise leads to momentary good feelings about self. May be hurt temporarily by criticism. Is inflamed or crushed by criticism, broods at length. After a failure, feels unhappy but not worthless. Failure sets off feelings of shame, enduring mortification and worthlessness. Feels “special” or especially talented, but only to a degree or in some areas. Feels far superior to everyone and superior in many ways, demands recognition for that superiority. Feels good about self despite criticism. Requires continual bolstering from others to have a sense of well-being. Takes life's setbacks in stride, although upset temporarily. Reacts with hurt, depression, or rage over pro-longed periods. Self-esteem is fairly steady in face of rejection, disapproval, and attacks. Reacts to rejection, etc., with keen rage or deep depression and severe loss of self-esteem. Does not feel hurt if no special treatment is received. Feels entitled to special treatment; rules do not apply to him/her as to ordinary others. Is sensitive to the feelings of others. Is insensitive to others' feelings and needs, exploits others. 13. 18. “Nervous” Personality See Section 10. 3, “Anxiety/Fear. ” The most relevant ICD-9-CM and DSM-IV-TR code is 300. 02, Generalized Anxiety Disorder. “High-strung,” worrier, “worry-wart,” anxiety-ridden, “bad nerves,” excitable, easily upset, unstable, moody, skittish, temperamental, low stress/frustration tolerance, “cracks up,” “falls apart. ” Picky, chronically dissatisfied, carping, fault finding. Avoids/dislikes crowds, socially anxious, shy, sensitive, “thin-skinned,” low self-esteem, hard on self and others.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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13. Personality Patterns 229PERSONALITy PATTERNS13. 19. Normal/Healthy Personality See also Section 25. 7, “Checklist of Strengths. ” The relevant ICD-9-CM and DSM-IV-TR code is V71. 09, No Diagnosis or Condition on Axis I/No Diagnosis on Axis II. As alternatives to relying on the absence of pathology, here are several options for describing a healthy or highly functional personality-in other words, criteria for positive mental health. Frisch (1999) offers these 17 areas of life function as assessed by his Quality of Life Inventory: Health. Realistic self-regard. Having a philosophy of life. Work. Recreation. Learning. Creativity. Social service to others. Civic action. Love relationship. Friendships. Relationships with children. Community. Relationships with relatives. Having a home. Having a stable and adequate standard of living. Neighborhood safety/aesthetics/ naturalness/people. Positive psychology focuses on the healthy personality. Some resources for clinicians include Frisch (2006), Diener and Biswas-Diener (2008), and Lopez and Snyder (2009). Freud's famous formula for normality was “ Arbeiten und leben ” (to be able to work and love). Jahoda (1958) mentions the following: Awareness, acceptance, and correctness of self-concept. Mastery of the environment and adequacy in meeting demands of life. Integration and unity of personality, whole-hearted pursuit of one's goals. Autonomy and self-reliance. Perception of reality and social sensitivity. Continued growth toward self-actualization. Shoben (1956) describes these characteristics: Aptitude for capitalizing on past experience. Self-control. Ability to envisage ideals. Social reliability (predictability). Capacity to act independently while still acknowledging the need for relationships (interde-pendence). Finally, W. C. Menninger (1967) offers these criteria for emotional maturity: The ability to deal constructively with reality. The capacity to adapt to change. A relative freedom from symptoms produced by tensions and anxieties. The capacity to find more satisfaction in giving than in receiving. The capacity to relate to other people in a consistent manner, with mutual satisfaction and helpfulness. The capacity to sublimate-to direct one's instinctive hostile energy into creative and construc-tive outlets. The capacity to love.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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230 STANDARD TERMS AND STATEMENTS FOR REPORTS PERSONALITy PATTERNS13. 20. Obsessive Personality See Section 13. 12, “Compulsive Personality,” especially the “Note” there. See also Sections 12. 8, “Compulsions,” 12. 21, “Obsessions,” and 13. 4, “A and B Personality Types. ” The relevant ICD-9-CM and DSM-IV-TR codes are given in Section 13. 12. Cardinal Features Overideational, worries, overconscientiousness. Cognitions See Shapiro (1965). Ruminates, doubting, balances pro and con, overdeliberateness, “thinks too much,” distrusts own judgments, flounders, dithers, ponders endlessly, indecisive, avoids decision situa-tions, reverses decisions, wishy-washy, vacillates. Must never be irresponsible/careless/unappreciative/bad/imperfect/flawed,1 overresponsi bil ity, fears making any mistake, overconscientious. Overdependence on intellect and logic (“lives in head”), overconfidence in own willpower, intolerant of strong affects. Preoccupation with trivial details, overconcern with technical details, compelled attention to details, “can't see the forest for the trees,” “rearranges the deck chairs on the Titanic,” a “fanatic,” a stickler for details, gives unnecessary warnings and reminders. Preoccupation with the mechanics of efficiency, such as list making/organizing/schedule mak-ing/revising/following rules; fears of loss of control. Perfectionism, demandingness, rigidity, inflexibility, “never good enough,” concern with doing things the one right way, judgmental, moralistic, controlled by “tyranny of the shoulds” (Horney), “musterbates” (Ellis). Religious concerns, scrupulosity, seeking repeated reassurance from spiritual guides, repetition of religious rituals because of their possible invalidation, sense of sinfulness and guilt. Attention rigidly and narrowly focused on own interests/technical indicators/details, novel stimuli rejected as distractions, discounts/rejects new ideas or data. Behaviors Procrastinates, dawdles, delays, avoids, denies, ineffective, important tasks done last, mistakes the immediate for the important. Exquisite care of belongings/“preciousness,” meticulous, preserves worthless items. Tense activity, effortful, burdened, driven, suffers under deadlines, pressured, racing thoughts. Mild rituals, ritualistic interests, repeated “incantations,” magical thinking (e. g., her/his spe-cialness, innocence, virtue). Affects Isolation of affect, loss of spontaneity, stiff and formal in relating, incapable of genuine/intense pleasure in anything, ambivalences, mixed feelings, chronic mild depression. Terrified of being embarrassed/humiliated, fears being found inadequate/wanting/making a mistake. Terror of the unknown/uncontrollable/unpredictable. 1This was suggested by Marcia L. Whisman, MSW, ACSW, of St. Louis, MO.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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13. Personality Patterns 231PERSONALITy PATTERNSDetects/discovers feelings through own behaviors (e. g., “I'm crying so I must be sad”). Interpersonal Aspects Proper, careful, dutiful, stilted, dogmatic, opinionated, inflexible. Uncomfortable on vacations or unstructured times, forgets to “smell the flowers. ”Demanding and controlling but resists others' control. 13. 21. Paranoid Personality See Section 12. 24, “Paranoia. ” The relevant ICD-9-CM and DSM-IV-TR code is 301. 0, Paranoid Personality Disorder. Cardinal Features Distrust and vigilance. Interpersonal Aspects Distrusts, untrusting, mistrustful of others, overcautious, suspiciousness, unwarranted dis-trust, expects mistreatment and treachery, distrusts motives of others, suspects manipu-lations, distrusts previous “allies,” questions loyalty of others, believes others are trying to put him/her at a disadvantage/plotting against/manipulating/watching/laughing at/com-menting on him/her. Skeptical/cynical view of others' motives, loyalty, interest in her/him. Vigilant, sensitive to deception/betrayal/deprecation/slights/“putdowns,” listens for insulting/ questioning references, hypersensitivity to criticism, seeks signs of trickery/manipulation/treachery. Guarded, defensive, reinforced expectations lead to isolation/enhancing distrust. Hostile, belligerent, oppositional, confrontational, argumentative, stubborn, quick to take offense, easily offended, desire to vanquish/humiliate/deprecate, makes disparaging re marks. Revenge fantasies, preoccupied with/desires to get even, carries grudges, schemes. Desires to remain independent, no close relationships, refusal to confide, aloof, distant, iso-lated, withdrawn, retreats, secretive, terror of being controlled, continuous and extreme defense of autonomy, dread of passive surrender, a loner unless in total control of other/group, jealous of others' status. Made indirect references/hinted/ideas of reference, knowing looks/winks/oblique references, power themes in all conversations. Difficult, rigid, oppositional, deflects criticism onto others, recognizes no faults in self, denies responsibility or blame, blames others for all negative outcomes and frustrations, external-izes blame, never forgives or forgets, “chip on shoulder. ” Carping, hypercritical, fault-finding. Arrogant, prideful, overbearing, boastful, sensational plans, grandiosity, inflated appraisal of own worth/contacts/power/knowledge, takes a superior posture, disgusted by others' weak-ness. Attention is narrowly focused on searching for confirmation/clues, novel stimuli are interpreted for real meanings, immune to contrary/corrective evidence. Cognitions See Shapiro (1965).
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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232 STANDARD TERMS AND STATEMENTS FOR REPORTS PERSONALITy PATTERNSProjects onto others what is unacceptable about self, distorts the significance of actions and facts, loss of a sense of proportion. Rigid and repetitive searching for confirmation of suspicions/ideas of reference/personalized meanings, attends only to conforming evidence/clues, belief in own convictions of underly-ing truth, magnifies minor social events into confirmations of the evil intentions of others and their lying, exaggerating distortions resulting in delusions, flimsy or unfounded rea-sons produce intense suspicion. Vigilant, hypersensitive, hyperalert, oversensitive to any changes/the unexpected/anything out of the ordinary, fears of surprises. Affects Shallow emotional responses, cold and humorless, absence of tender or sentimental feelings, unemotional, restricted, enigmatic and fixed smile/smug, humorless. Edgy, rarely relaxes, on guard, tense, anxious, worried, threatened, motor tension, touchy, iras-cible, jealous/envious of the progress of others. Self-Image Bitter, feels mistreated/taken advantage of/tricked/pushed around/overlooked/abused/threat-ened, collects injustices, suspects being “framed/set up. ” Grandiose/self-important. Sees self as objective, unemotional, rational, careful, “Just doing what's necessary to survive in a tough world. ” Delusional System See also Section 12. 10, “Delusions. ” Belief in unusual or irrational ways of knowing (e. g., reading the future, magical thinking, Extra Sensory Perception). Delusions of power/status/knowledge/contacts. Creates a “pseudocommunity” (Cameron & Rychlak, 1968) of persons for and against her/him, schemes, etc. Other Auditory hallucinations/voices that command, mock, or threaten. Litigious tendencies. Passive Personality See Section 13. 13, “Dependent Personality. ” 13. 22. Passive-Aggressive Personality The relevant ICD-9-CM code is 301. 84, Passive-aggressive personality disorder. DSM-IV-TR offers Passive-Aggressive Personality Disorder (Negativistic Personality Disorder) as a diagnosis for fur-ther study. Cardinal Features Intentional ineffectiveness and unacknowledged hostility.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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13. Personality Patterns 233PERSONALITy PATTERNSInterpersonal Aspects Superficially submissive. Indirect control of others without taking responsibility for actions or anger, denies/refuses open statements of resistance/maintains own “good intentions. ” Cannot say a direct “No,” indirectly expressed resistance to demands of others for performance, thwarts/frustrates authority/spouse/partners/relatives. Intentional but unconscious passivity to hide aggression, denial of/confusion over own role in conflict, gives mixed signals (“Go away and come close”), hostile defiance alternating with contrition. Overcritical, “left-handed” compliments, subtle attacks, blames, insults, complains to others, critical of boss/all authorities/those with power/control over him/her, carping/fault-finding as defense against intimacy/commitment, unnecessary and prolonged argu mentativeness. Autocratic/tyrannical, demanding, manipulative, harassing, ruminates, troubled/conflictual relationships. Affects Denial of most emotions (especially anger, hurt, resentment), hostile motives, deeply and per-sistently ambivalent, sullen, envious, resentful. Vocational/Academic Aspects Intentional inefficiency that covertly conveys hostility, veiled hostility, resents control/ demands. Qualifies obedience with: Tardiness, dawdling, sloppiness, stubbornness, sabotage, “acciden-tal” errors, procrastination, forgetfulness, incompleteness, withholding of critical informa-tion/responses/replies, leisurely work pace, fails to meet deadlines. Not lazy or dissatisfied with job, but spotty employment record/no promotions despite ability. Psychopathic Personality See Section 13. 7, “Antisocial Personality. ” 13. 23. Sadistic Personality See also Sections 12. 19, “Impulse-Control Disorders,” 13. 6, “Aggressive Personality,” 13. 7, “Antisocial Personality,” and 13. 8, “Authoritarian Personality. ” Not in ICD-9-CM or DSM-IV-TR. Cardinal Feature Cruelty. Behaviors Demeaning, aggressive/dominating behavior pattern, embarrasses/humiliates/demeans others. Brutal, enjoys making others suffer, has lied to make others suffer, intimidates/frightens/ter-rorizes others to gain own wants, restricts others' autonomy, uses power in harsh man-ner for discipline or mistreatment, uses threats/force/physical cruelty to dominate others, quickly escalates level of violence to reestablish dominance when challenged, fascinated by violence/injury/torture/weapons/martial arts.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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234 STANDARD TERMS AND STATEMENTS FOR REPORTS PERSONALITy PATTERNSNote: ü According to Weinberg et al. (1984), consensual sadomasochistic activities have these char-acteristics: 1. Agreement about which partner is dominant/submissive (“top/bottom”). 2. Shared awareness that they are play-acting (“in scene,” “subspace,” with costume, bondage equipment/“toys”). 3. Informed, voluntary, explicit consent (agreed-upon “safe word” to stop, discussion of and respect for “bottom's” limits). 4. A sexual context. 5. Shared awareness that this behavior is sadomasochistic, “kinky,” “BDSM,” unusual, etc. 13. 24. Schizoid Personality The relevant ICD-9-CM and DSM-IV-TR code is 301. 20, Schizoid Personality Disorder. Cardinal Features Social remoteness, emotional constriction. Social Aspects Solitary, aloof, social isolation, no close friends, “loner,” withdrawn, unobtrusive, “fades into the background,” remote, indifferent to others' praise/feelings/criticism, complacent. Solitary interests, daydreams, self-absorption, may seem “not with it,” inaccessible. Limited social skills, lacking in social understanding, maladroit, says inappropriate things and may immediately apologize, unresponsive, unable to form attachments, peripheral roles, rarely dates or only passively, attends to only the formal and external aspects of relation-ships. Normal or below-average work performance and achievement unless work does not require social contact. Victimized, abused, taken advantage of. Cognitions Circuitous thinking, preoccupied with abstract/theoretical ideas, vague and obscure thought processes, unconventional cognitive approach, cryptic. Intellectualizes, mechanical, impoverished/barren/sterile cognitions. Vague and indecisive, absent-minded. Excessive compulsive fantasizing, fantasies are sources of gratification and motivation, hostile flavor to fantasies. Behaviors Lethargic, low vitality, lack of spontaneity, sluggish. Affects Emotional coldness, limited capacity to relate emotionally, flat, impassive, blunted affect, emo-tional remoteness, absence of warm emotions toward others, no deep feelings for another, unfeeling, only weak/shallow emotions, weak erotic needs, cold/stark affects.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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13. Personality Patterns 235PERSONALITy PATTERNS13. 25. Schizotypal Personality The relevant ICD-9-CM and DSM-IV-TR code is 301. 22, Schizotypal Personality Disorder. Cardinal Features The interpersonal difficulties of the schizoid personality, plus eccentricities or oddness of thinking/behavior and/or perception. Behaviors Idiosyncratic, odd, curious, bizarre. Odd speech with vague/fuzzy/odd/idiosyncratic expressions. Odd clothing or personal style. Cognitions Magical thinking, superstitiousness, clairvoyance, telepathy, precognition, recurrent illusions, undoing of “evil” thoughts/“misdeeds,” sometimes paranoid ideation and style. Autistic, ruminative, metaphorical; poorly separates personal from objective, fantasy from com-mon realities; dissociations/depersonalizations/derealizations; sees life as empty and lack-ing in meaning. Affects Chronic discomfort, negative affects, painfully shy. Interpersonal Aspects Suspicious, tense, wary, aloof, withdrawn, tentative relationships, gauche, eccentric, periph-eral, clandestine, dull, uninvolved, apathetic, unresponsive or obliquely reciprocating. 13. 26. Self-Defeating Personality See also Section 13. 13, “Dependent Personality. ” Not in ICD-9-CM or DSM-IV-TR. Note: ü Beware of gender bias in the application of this diagnosis. (See the caution concerning sexism in Section 13. 13. ) Cardinal Features Chooses situations that will cause him/her to suffer mistreatment, failure, or disappointment. Interpersonal Aspects Excessive and unsolicited self-sacrifice, sacrifice induces guilt in others and then avoidance, provokes rejection by others and then feels hurt or humiliated, responds to success with depression/guilt/self-harming behaviors. Avoids pleasurable or success experiences, does not perform success-producing tasks despite possessing the ability. Rejects or does not pursue relationships with seemingly caring or needed/helpful individu-
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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236 STANDARD TERMS AND STATEMENTS FOR REPORTS PERSONALITy PATTERNSals (e. g., a therapist), undermines self, “snatches defeat from the jaws of victory,” chooses unavailable partners, seeks hurt/humiliation, sees those who treat her/him well as boring or unattractive, selects relationships with abusive persons, possibly sexually stimulated in relationships with exploitative or insensitive partners, “masochistic,” incites anger/abuse/rejection. Sociopathic Personality See Section 13. 7, “Antisocial Personality. ” Tests of Personality See Section 13. 2, “Assessment Methods. ” Type A and Type B Personalities See Section 13. 4, “A and B Personality Types. ”
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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C. The Person in the Environment Subdivision C's Chapters: Page 14. Activities of Daily Living 239 15. Social/Community Functioning 245 16. Couple and Family Relationships 247 17. Vocational/Academic Skills 252 18. Recreational Functioning 260 19. Other Specialized Evaluations 262 The larger world that the client lives in, and how well or poorly he/she functions in it, are matters of concern. Therefore, this subdivision offers ways to describe the client's performance of the basic Activities of Daily Living, his/her involvement in society and community, the extent and qualities of intimate relationships, his/her competence in vocational and academic skills, and other more specialized areas of evaluation.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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239 14 Activities of Daily L iving Note: ü If there are deficits in ADLs or there has been a change generally, indicate the reasons for this situation. And, as applicable, describe behaviors or deficits that limit independent living. 14. 1. Assessment The core ADLs are bathing, dressing-undressing, eating, transferring from bed to chair and back, using the toilet, and walking. Since we all depend on others for some supports, assessment has to take context into account. Many measures, for different populations, can be found online. Some commonly used ADL assess-ment tools are listed below. Each entry offers the title of the current edition or version of each test (with acronym, abbreviation, or common name indicated as usual by underlining); its copyright date if known; its current publisher or distributor; and the applicable age range. Adaptive Behavior Assessment System-II (2003), Pearson Assessments, 0-89 years. American Association on Mental Retardation Adaptive Behavior Scales—School, 2nd ed. (1993), PRO-ED, 3-18:11 years. American Association on Mental Retardation Adaptive Behavior Scales—Residential and Com-munity, 2nd ed. (1993), PRO-ED, 18-80 years. Adaptive Behavior Inventory, PRO-ED, 6-18:11 years. Scales of Independent Behavior—Revised (1996), Riverside, infancy-80+ years. Vineland Adaptive Behavior Scales—II (three versions) (2005), Pearson Assessments, 0-18 years. Occupational therapists have many tools for assessment of specific ADLs and ways to inter-ü vene. 14. 2. Assistance Level Required/Degree of Independence (↔ by degree) Incapable/unable, needs 1:1/hands-on assistance, limited by physical/medical con-ditions rather than psychiatric ones, only simple tasks, helps spouse/partner/family with chores, participates, needs to be reminded/prompted/monitored/supervised, does with help, finishes unassisted, initiates/independent/autonomous. ADLs done by spouse/partner by tradition/agreement/default/because of physical limitations. ADLs performed by children/relatives/landlady/landlord/live-in friend/paid helpers/publicly provided aides. ADLs
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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240 STANDARD TERMS AND STATEMENTS FOR REPORTS 14. 3. Child Care (↔ by degree) Abuses, exploits, neglects, feeds regularly/appropriately/healthily, bathes regularly/ safely, changes diapers and clothes, dresses child appropriately for weather and setting, performs routines (bedtimes, up and off to school, mealtimes), is affectionate with, actively interacts with/enjoys child's presence, does not leave alone, babysits, defends, amuses/entertains, teaches, enjoys child's growth, brags about, disciplines effectively, advocates for. 14. 4. Chores/House Care/Domestic Skills Cleaning Food cleanup: Sets the table, clears table, washes, dries, puts away, silverware, does pots, uses dishwasher correctly, cleans up kitchen. Neatens up house: Runs sweeper/vacuum, straightens up bedroom, takes out trash, dusts, mops, cleans bathroom. (↔ by degree) House is immaculate/neat/clean/functional/cluttered/disorganized/chaotic/in dis-repair/dangerous, filthy, infested, smells of . Clothing Care Laundry: Recognizes dirty, collects, separates, washes/runs washer, dries, folds, irons, puts away. Sews/repairs/replaces. Other Maintenance: (↔ by degree) Recognizes malfunctioning appliances, recognizes emergencies, calls for help/repair persons, shovels snow, mows lawn, can turn off electricity and water supplies, changes light bulbs, does minor repairs, changes faucets/switches, does major repairs. Decoration: (↔ by degree) Chooses bed covers/rugs, chooses and hangs curtains/slipcovers, paints, wallpapers, remodels. Plant/pet care: (↔ by degree) Cares for plants, fish, cat, dog, safely and effectively. 14. 5. Cooking (↔ by degree) Must have all meals prepared and served, eats all meals out, eats only snacks/fast foods/prepared foods/takeout/carryout, prepares boxed or canned foods (e. g., canned soup and sandwiches), no/simple preparation, top-of-stove/light cooking (fries, boils), full menu, nutritionally balanced, uses all kitchen appliances, coordinates foods' types and prepara-tion times, bakes, entertains. 14. 6. Financial Skills See also Section 17. 4, “Math Ability. ” (↔ by degree) Has receptive and expressive recognition of denominations of coins/metal money/ currency/checks, counts, makes change, handles all finances on a cash basis, can per-ADLs
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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14. Activities of Daily Living 241 form arithmetic calculations sufficient to allow over-the-counter purchases, buys money orders, uses debit card, has checking account (writes checks, deposits checks, able to do routine banking), saves money for large purchases, has credit card, manages all financial resources. (↔ by degree) Squanders resources, impulsive/inappropriate/useless/wasteful purchases, easily duped into situations leading to financial risks/difficulty, not able to manage own finances, mathematically/intellectually/emotionally incompetent/incapable, not financially compe-tent, able to handle small sums but not larger sums/own purchases/checking account/bill paying/saving/investing. 14. 7. Hazard Recognition and Coping Traveling Wanders away from home. Gets lost; does not recognize route home, streets, or house numbers. Travels through dangerous places unaware of risks. Fails to look for approaching traffic. Does not respond to stop or direction signs when walking. Fire Knows how to evacuate home. Can check and service smoke alarm. Overuses electrical outlets or extension cords, does not replace frayed/loose wires. Smokes in bed or reclining chair, careless with matches/candles. Heats home with oven, lets food burn. Recognizes smell of gas, but searches for gas leak with a flame. Home Care Cannot state what to do about a leaking faucet or pipe. Cannot keep thermostat at a regular setting. Leaves doors or windows open inappropriately. Mixes or misuses cleaning products. Fails to clean up spills, broken glass, or other risks safely. Fails to care for pets/plants, causes suffering or death. Food Preparation Does not eat healthily (only snacks, meals too small or too few, fails to follow prescribed diet). Does not store food safe from deterioration, will consume spoiled food. Fails to set proper cooking temperatures, fails to monitor cooking progress on stove/oven/ toaster/microwave. Leaves refrigerator/oven open, water running, food to burn. Clothing Wears loose or otherwise dangerous clothing. Clothing inappropriate for weather or season. ADLs
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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242 STANDARD TERMS AND STATEMENTS FOR REPORTS Illness/Injury Does not recognize signs of serious illness or injury and respond appropriately (cleaning wound/ burn, ointment, bandage, taking medications, seeking professional help). Does not take medications appropriately or as prescribed, takes wrong doses, wrong schedule. Does not recognize side effects of medications. Hazard Recognition: Summary Statements Cannot be left unattended because simply cannot respond appropriately to environment. Appears to be completely unaware of dangers, risks, and demands of situation. Knows functions of police, fire, emergency medical services and how to reach them. 14. 8. Living Situation/Level of Support Needed (↔ by degree) Lives independently in own home/apartment, uses community's support services (e. g., soup kitchen, food bank/community pantry, “Meals on Wheels,” homemaker ser-vices, special buses), lives with spouse/children/partner/parental family/relatives/friends/roommate, occupies single/sleeping room with/without cooking facilities, lives in moni-tored individual apartment, attends partial/day hospital/sheltered workshop/day activities center, lives in residential drug/alcohol treatment program, in rehabilitation facility, in a Community Living Arrangement/Community Rehabilitative Residence/group home/super-vised group apartment, in a boarding home, in a custodial/domiciliary care facility, in a personal care home/nursing home, in a Skilled Care Facility, in an Acute Care Facility, in a private/ community/state/city/Department of Veterans Affairs hospital, in an Intensive Care Unit. 14. 9. Quality of Performance Each area of ADL performance can be evaluated as to its safety, independence, appropriateness, and effectiveness. Has a history of accidents/is “accident-prone,” performance of ADLs is unsafe/self-and other- endangering (e. g., gets lost, burns food). Is aware/unaware of the large hazards of life and can/cannot avoid them. (↔ by degree) Makes it worse, disorganized, ineffective, needs to be redone, unacceptable, sloppy, casual, neat, orderly, fussy, fastidious, meticulous, obsessive. 14. 10. Self-Care Skills Eating and Toileting Feeding: (↔ by degree) Cannot feed self, assists with own feeding, feeds self. Eating: Eats ir-/regularly, appetite in-/appropriate, food preferences, good/poor balance/nour-ishment, restrictions, allergies. Toileting: Problems with elimination/urination/using toilet, uses laxatives/stool softeners/etc., incontinence (stress, night/day), uses pads. ADLs
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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14. Activities of Daily Living 243 Grooming See also Sections 7. 1, “Appearance,” and 7. 2, “Clothing/Attire. ” Bathing: Bathes ir-/regularly, requires prompting, attends to basic hygiene, uses makeup/shaves, gets haircuts, trims nails. Dressing: (↔ by degree) Dons and doffs clothing, dresses self, dresses appropriately for weather/ occasion, does laundry, buys clothing. Health Care Exercise: (↔ by degree) No activity, stretching, regular exercise, aerobic movements. Sleep: (↔ by degree) Sleeps well, has occasional difficulty, has significant problems. (See Section 12. 37, “Sleep Disturbances. ”) Medications: Takes prescribed medications without prompting, with reminders/prompts/urg-ing/seldom/irregularly/refuses, misuses/takes other's medications, takes many unnecessary over-the-counter medications. 14. 11. Shopping (↔ by degree) Unable to shop alone, can for snacks/toiletries/own clothes/simple foods/prepared foods/full menu foods/presents, can run errands for self/others, shops as entertainment, waits for and recognizes bargains/sales, makes major purchases effectively. Is able to estimate the costs of common foods/items, knows which store sells which kinds of mer-chandise, can separate needs from wants/can control impulse shopping, is a wise consumer. 14. 12. Transportation (↔ by degree) Does not travel at all, needs companion, uses special bus/paratransit/“jitney”/taxi/ regular buses/mass transit, gets about by walking/bicycling/hitchhiking, driven by family/friends/spouse/etc., drives with companion, drives alone, vacations independently. 14. 13. Caregiver Burden Needing to feed/toilet/dress/clean up after other. Time demands, lessened or no privacy, routines disrupted, personal plans and activities dis-rupted, lessened self-care. Caregiving is confining, restricts travel/visiting/employment/recreation/church involvement/ etc. Financial losses/costs of care/strains. Difficulty accessing services. Disturbed sleep, physical strains, injuries. Interpersonal emotional disruptions (e. g., arguments, noncooperation, withdrawal, false accu-sations), loss of life partner without death, feeling overwhelmed. 14. 14. Summary Statements Level of personal independence is adequate, given Socio Economic Status and lifestyle. The client has adapted well to reduced circumstances. ADLs
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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244 STANDARD TERMS AND STATEMENTS FOR REPORTS She is intellectually and psychologically capable of performing ADLs but does not, due to physi-cal limitations/primarily due to physical/medical circumstances. He is not able to care for his own needs, and so requires support services. (See also Chapter 22, “Recommendations. ”) She is functional in her current lifestyle/supportive situation, but in a more independent set-ting (i. e., living independently/alone), she appears to lack adequate self-direction and other resources for maintenance/continued functioning. For a Child: He goes to bed by himself and does not need a night light. She does not go into parents' bed during night. Child can sleep over at friend's house or visit for a day. Self-care is age-appropriate. ADLs
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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245 15 Social/Community Functioning This chapter covers social and community activities only. Descriptors for interpersonal behavior in the interview can be found in Chapters 8 and 9, and for couple and family relationships in Chapter 16. Note: ü If social relating has been reduced in any area, try to indicate why and when this hap-pened. 15. 1. General Lifestyle Location Rural, farm/ranch, suburban, urban, small/medium/large city, commuter, inner city. Qualities (↔ by degree) nomadic unstable solitary low variety low activity comfortable vagrant limited by vegetative low stress no productive independent wanders poverty homebound low intensity activities autonomous migratory survival reclusive low demand low ambition satisfied roams marginal minimal unproductive productive “street person” mundane indolent panhandles circumscribed recumbent constricted parasitic limited predatory regressed symbiotic centers around TV chaotic routinesimplemonotonous regularity “just killing time”SOCIAL FUNCTIONING
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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246 STANDARD TERMS AND STATEMENTS FOR REPORTS SOCIAL FUNCTIONING15. 2. Involvement in Social/Community Activities (↔ by degree) The following groupings are sequenced by increasing degree of involvement. Hermit, recluse, isolated, withdrawn, aloof, avoidant, no interest in social relationships, unin-terested in people and relating, no social activities, keeps to self. Goes only to medical appointments/etc., no outside interests or functioning in any organi-zations, talks on phone, visited but does not visit, gardening/bird watching/other solitary pursuits, hunts/fishes alone, attends sporting events as spectator. Window-shops, church attendance only on major holidays, visits/goes out with/drinks with friends, drops in on nearby friends, writes to or calls friends, hangs out with/visits family/neighbors, eats out with others, regular “coffee klatch”/“breakfast club”/“night out,” interested/participates in community groups, small outings (church, bingo, bowl-ing, senior center, movies), friends help if he/she is sick, gets along selectively/appropri-ately with friends/family/authorities/public, shops in a variety of stores for all needs. Gregarious, actively participates in church/religious group/social club/commercial sports weekly or more often, has out-of-town guests, goes to movies/sports events, visits museums, participates in musical and other cultural activities, votes in elec-tions. Attends adult school or classes, active in the community, plans life goals/self-improvement, plays team sports, visits out of town alone, does volunteer work, fully participates in society. Note: ü If client reports “attends church/temple/synagogue/mosque” or “plays cards,” inquire what she/he does there, what the name of the clergyperson is, or which games are played. This will enable you to assess level of interests, demands (active or passive, skill or chance), satisfac-tions, and the quality and intensity of her/his social performance. For a Child: Because a child's social activities are usually dependent on a caregiver's efforts, question care-ü fully to separate out child's interests, skills, and performance. 15. 3. Problems/Conflicts in Community Relating Problems at Work See also Chapter 17, “Vocational/Academic Skills. ” Warnings, close supervision/monitoring, reprimands, suspensions, firings. Fighting/arguing with peers, given “cold shoulder,” teases/provokes, threatening/disruptive behaviors. Legal Aspects Police contacts, warnings, tickets, summary offenses, arrests (indicate for what, when, with whom, and consequences), misdemeanor/felony, trials, convictions, probation, jail/prison time, parole. History of public drunkenness, Driving Under the Influence/Driving While Intoxicated, assaults. Evictions, bankruptcies. Conflicts with neighbors, agency personnel, landlords/landladies, store clerks. Child/spouse/partner/relative/animal abuse, Protection From Abuse orders.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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247 16 Couple and Family Relationships DSM diagnoses are almost exclusively about individuals, not intimate relationships, situations, or interactions. Yet current understandings of disorders emphasize interactions, stressors and diathe-ses, family therapy, systems thinking, etc. Therefore this chapter lists several ways to evaluate couple and family relationships and interactional processes, and I would be grateful for your suggestions of more and better ways. You can record much useful information about couples and families on a genogram. ü (See Section 6. 6, “Family Genogram/Family Tree/Pedigree. ”) 16. 1. Systemic Family Constructs Structure/coupling: Involvement, enmeshed vs. disengaged (Minuchin, 1974), isolation, indi-viduation, power structure. Boundaries: Rigidity vs. flexibility, closed vs. open, generational boundaries. Coalitions: Schism, skew (Lidz & Fleck, 1985), pivotal members, dyads, triangles, labels, identi-fications, mappings, alliances, interfaces, relationship of spouses. Style: Closed (traditional/authoritarian) vs. open (collaborative/democratic), random (indi-vidualistic/permissive) vs. synchronous (perfectionistic/consentient); note family image vs. actual behaviors on these style criteria. Dynamics: How problem works, who is involved, who is served by the problem. Motivators, demotivators. Strengths. Disablement: Who is blocked from which targets, collective failings. Subsystems: Couple system, sibling system, intergenerational system. Boundaries, patterns, alliances, ethnic influences, “shoulds,” conflict and cooperation, cut-offs. Other subsystems: Friends, work, school, church, professionals, agencies. Support systems: Relatives, friends, etc. Other aspects: Family lifestyles, themes, myths (security, success, taboos, secrets). Pseudomutuality (Wynne, 1988). RELATIONSHIPS FUNCTIONING
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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248 STANDARD TERMS AND STATEMENTS FOR REPORTS RELATIONSHIPS FUNCTIONINGScapegoating (Ackerman, 1982): Scapegoat, persecutor, family healer. Paradoxes, double binds (Bateson, 1972). Discordance, disturbance, disruption. Centripetal and centrifugal family interaction patterns (Beavers, 1990). Formulate hypotheses re: maintenance of symptoms, functional analysis, payoffs, trade-offs, homeo-stasis. 16. 2. Assessment of Families at Intake Evaluate both current and previous marriages/relationships/families. ü Presenting Problem, Chief Complaint/Concern, Referral Reason These are listed in alphabetical order. Abuse/violence/neglect (spouse/partner, child; sexual, physical). Adolescent adjustment problem. Chemical abuse (parent, child). Child behavior problem/parenting problem. Child custody. Divorce mediation/adjustment. Enrichment (marital, family, personal, relationship). Health/medical/nutritional/physical conditions. Legal difficulties (child, parent, other; civil, criminal, misdemeanor, felony; incarceration). Marital/couple conflict. Parenting (skill enhancement). “Poor communication. ”School problem (behavior, academic, peer). Separation/breakup, spouse/partner absence. Sexual dysfunction/patterns/conflicts. Time management/conflict/absence. [Ask about each member's daily schedule. ]Truancy/runaway. Other: Cultural problems, religion, job/financial problems, education, peer problems, relatives. Who? Ask these questions: “Who is seeking treatment? Why?”“Who is involved in the problem?”“Who currently resides in the household?” Perceptions of Problem and Circumstances Ask: “What is 's (the referrer's) perception of the problem?”“Why is help being sought now?” (Possible precipitants: Changes, births, illnesses, deaths, re-/ marriages, divorces, moves, job changes, departures, other transitions. ) “What is each family member's perception of... the problem?”the major tasks/changes desired/facing the family now?”the time frame for improvement?”who has the problem (i. e., is the Identified Patient)?”
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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16. Couple and Family Relationships 249RELATIONSHIPS FUNCTIONINGPrevious Solutions Find out about the following: Efforts/attempts, outcome, ineffective attempts to maintain homeostasis. Previous treatment of whom, for what, when; intervention, outcome. Developmental Issues Learn about individual development issues for children and adults. History of adults' relationship: How met, courtship, each family's attitude. Relationship to grandparents, other relatives. Beginning expectations, satisfaction/fulfillment levels. Children's birth, blended family (if applicable). Family stage/life cycle: Courtship, early marriage, child bearing, child rearing, parents of teen-agers, launching, middle years, retirement, transitions. Legal and Social Status Ascertain the following: Adults' current status— describe as: Never married, “single,” living together, People of Opposite Sex Sharing Living Quarters, par-amours, “live-ins,” roommates, boyfriend/girlfriend, fiancé/fiancée, common-law mar-riage, civil law partners, married, “commuter marriage,” separated/living apart, estranged, divorced, remarried, marriage of convenience/outward appearance of a marriage. Previous relationships/cohabitations/marriages: For each, note duration, satisfaction, reasons ended/termination reasons, age and date at termination. Number, names, ages, and genders of all children. Relationship with spouse/partner, ex-spouse/partner (if applicable), children. Adultery/extramarital relations/satellite relationships, expectations of exclusivity/monogamy. Whether an adult is in process of divorcing/ex-spouse-to-be/“pre-ex. ” Other: Summary Statements [name] is ignored by, distanced, never/rarely visited, only fought with, only contacted by phone, estranged, struggling to individuate from family of origin. [name] feels he/she gets much/some/no support from spouse/ partner in parenting/child management/child raising/child care, doing chores, handling finances, dealing with relatives, doing home maintenance, supporting household. Child rearing is viewed as unsuccessful/overwhelming/stressful/difficult at times. A high priority/high risk/danger/matter of great seriousness is (specify). is an emergency/crisis/critical need, recurrent crisis/problem requiring only ordi-nary procedures, past crisis/chronic crisis. 16. 3. Family Interviewing Method Questions to Ask Each Member “What are the main problems in your family?”“What do you have to do in this family to... be alone/maintain your privacy?”get others to stop bugging you?”
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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250 STANDARD TERMS AND STATEMENTS FOR REPORTS RELATIONSHIPS FUNCTIONINGget attention, appreciation, physical contact, love?” be listened to?”get the family together?” “When do you feel... tense, depressed, upset, worthless?”best, freest, most worthwhile, proudest, optimistic, loving, loved?”you have to conceal your feelings/fake it?” “How do you show your feelings of... anger, disappointment, frustration, sadness, tension?”affection, love, appreciation?” “Whom do you depend on?” “Whom can you count on to... ?” “Who helps with... ?” “What big changes/problems have happened in this family?”“Have you been disappointed in your marriage/family/children/relatives?” Questions to Ask the Family as a Group “Do you ever plan things you can all do together?”“What are your family's biggest goals/plans/fears?”“What are the strengths in this family?” “Who has athletic skills? Manual skills? Academic skills? Musical skills?”“Best sense of humor? Smartest? Most faith?” “Besides you, who else is part of this family?” (Relatives, friends, boarders, pets, etc. ?)“When do you all get together?”“Who's the boss of this family?”“Who calls the shots in what areas?” 16. 4. Child Rearing/Raising: Aspects Parental Restrictiveness Limits: Overprotection/excessive restriction, overpermissiveness/indulgence, unrealistic demands. Strictness/leniency re: feeding, mobility, interruption by children, table manners, neatness, cleanliness, bedtime, noise, radio and TV, chores, obedience/compliance, aggression. Restrictiveness regarding sexuality (nudity, modesty, masturbation, sex play), anger, emotional-ity. Aggression: Encouraged to fight back/defend self, toward parents/sibs/peers, inhibited, redi-rected. Parental differences: High/low ratio of maternal to paternal discipline, mother/father views other parent as overly strict, conflicts over discipline. Problematic discipline: Lack of discipline, inconsistent discipline, chaotic/harsh/overly severe discipline, fear/hatred of parent, decreased initiative/spontaneity, unstable values. Parental Acceptance Warmth: Sympathetic/rejecting response to crying, open/muted/no demonstrations of affec-tion, fun/no fun in child care, great/little/no warmth of bond, playtime initiated by mother/father/no one. Use of praise: For table manners, for obedience, for nice play/amount of play, no use of praise. Other: Positive/negative feelings when pregnancy discovered.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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16. Couple and Family Relationships 251RELATIONSHIPS FUNCTIONING16. 5. Couple Relationships: Aspects For questions and descriptors pertaining to sexual aspects of couple relationships, see Sections 3. 25, “Sexual History,” 6. 4, “Adjustment History,” and 10. 12, “Sexuality. ” See also Sections 12. 1, “Abuse,” and 12. 5, “Battered-Woman Syndrome. ” Dating Intensity (↔ by degree) Never, seldom/rarely, only periodic/special events/holidays, group/car date/dyadic, “gets together with,” interested in more dates but... (specify), frequently, dates compulsively/ promiscuous, many dating partners, has many/only brief relationships, “dating” same per-son for many years, exclusive relationship/“going steady,” serial monogomy, progressively better relationships, has a single committed long-term relationship. Other Qualities (↔ by degree) Physical/verbal/emotional abuse, abusing spouse/partner, abused spouse/partner, neglecting, exploitative, punishing, parasitic, repeatedly unfaithful, avoidant, fragile, distant, boring, stale, stalemate, “truce,” unhappy, mismatched, ill-considered, hasty, unhealthy, unsup-portive, limiting, unsatisfying, symbiotic, stable, functional, adequate, satisfying, reward-ing, close/tight, intimate, enhancing, loving, fulfilling. 16. 6. Summary Statement The family history is positive for , , and (specify conditions) involving an immediate/nuclear family member. The V codes in ICD-9-CM and DSM-IV-TR offer many labels for relationship issues and problems. (See Section 21. 21, “V Codes, Etc. ”)
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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25217 Vocational/Academic Skills This chapter covers much of the information you may need for disability reports, as well as other evaluations of vocational and academic functioning. 17. 1. Basic Work Skills Energy Level (↔ by degree) Sickly, easily fatigued, requires frequent rest periods, low energy, adequate/normal, healthy, vital, vigorous, has stamina, excessive, driven. Motor Skills Coordination (↔ by degree) Poor coordination, good/adequate/normal dexterity, dexterous, excellent coordi-nation. Pay particular attention to different types of coordination (eye-hand, cross-body, fingers, etc. ), ü as well as to balance, gait, and other job-relevant aspects of movement. Fine Motor Skills Can make fast/repeated movements of fingers/hands/wrists, can use hand/power tools safely and effectively, writing is legible, requires and benefits from as assistive equipment. Gross Motor Skills Strong, can stretch/bend/twist/reach/etc. rapidly and effectively, can run/climb/jump, can lift/ carry heavy weights, can carry medium weights (suitcase, stepladder, etc. ), can hold but not lift/carry objects. Hearing No significant limitations, copes with the use of hearing aid/sign language/interpreter/writ-ten communications/etc. VOCATION/ ACADEMICS
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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17. Vocational/Academic Skills 253VOCATION/ ACADEMICSVision Normal or near-normal vision with/without glasses/contact lenses, some difficulties, requires modification of work setting/equipment/procedures. Appearance (↔ by degree) Shows minimal/unacceptable regard for personal attire or cleanliness, disheveled and sloppy/ wears dirty clothes, needs a bath or shave, adheres to standards of nonoffensive personal cleanliness, is cleanly but inappropriately dressed, appears typical of his/her community's workers in grooming/cleanliness/attire choice. Concentration (↔ by degree) See also Section 11. 4, “Concentration/Task Persistence. ” Deficiencies of attention/persistence, low frustration tolerance, occasionally distracted, can focus and maintain attention for expected periods. Motivation to Work (↔ by degree) Refuses, apathetic, indifferent, is minimally motivated/compliant without complaint/positive/ eager, willing to work at tasks seen as monotonous or unpleasant. Memory (↔ by degree) Is unable to retain instructions for simplest of tasks, requires constant/hands-on/one-on-one supervision/continual reminders/prompts/cues/coaching to perform routine tasks, requires reinforcement to retain information from day to day, requires little or no direction after initial instruction or orientation, remembers locations/work procedures/instructions/rules, able to learn job duties/procedures from oral instructions/demonstrations/written directions, carries out short/simple/detailed/multistep instructions. Mistakes (↔ by degree) Makes an un-/acceptable number of errors that must be corrected by client/coworkers/super-visors, does not notice exceptions/failures, has low/poor/adequate/high inspection skills, monitors own quality, conceptualizes the problem, corrects situation/alters own behavior, quality/accuracy increases (or waste/scrap decreases) with repetition/training/supervision. Productivity (↔ by degree) Minimal/below expected/equal to % of average competitive worker's rate/quantity of work, increased production/productivity by % over original measured rate, quantity/produc-tivity increases with practice/repetition/training/supervision, shows acceptance of compet-itive work norms, able to enter and sustain competitive employment. Attendance (↔ by degree) Unreliable/inadequate/minimal/spotty/deficient, has unusual/large number of unexcused ab sences per month/calls in sick, seldom/generally punctual for arrival/breaks/lunch hours, performs without excessive tardiness/rest periods/time off/absences/interruptions from psychological symptoms, dependable, responsible.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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254 STANDARD TERMS AND STATEMENTS FOR REPORTS VOCATION/ ACADEMICSCommunication (↔ by degree) Seldom communicates beyond the minimum and often misunderstands directions, is misun-derstood by peers/supervisors, can comprehend some nonconcrete aspects of work situa-tion, communication is usually understood by others, communications are clear and work-relevant, uses telephone properly, has the ability to ask questions or seek assistance as needed. Response to Supervision (↔ by degree) Rebels against supervision, is oppositional to requests of supervisor, does not seek supervi-sion when needed, personalizes supervisor-worker relationship, often withdraws/refuses offers of interaction, is difficult to get along/work with, requires firm supervision, asks for unnecessary help/requests excessive supervision, interacts with the general public/ coworkers/supervisors without behavioral extremes/appropriately, reports appropriately to supervisor, improves work methods/organization under supervision, works in small/large groups, is helpful to supervisor and peers. Emotional Responsiveness (↔ by degree) Tends to become emotional/angry/hurt/anxious when corrected/criticized/cannot have own way and is unable to continue work, argues, responds angrily or inappropriately to comments but with counseling or encouragement can remain at work site, verbally denies problems but has an “accident” whenever eligible for promotion or transfer, maintains composure and attention to task, takes corrective action, anticipates others' needs, responds appro-priately by adjusting behavior or work habits, apologizes, reacts appropriately to conflict/authorities/peers/coworkers, maintains even temperament. Adaptability (↔ by degree) “Set in her/his ways,” exhibits serious adjustment problems when work environment changes, is unable to cope with job's pressures, displays inappropriate or disruptive behavior only briefly after work changes and is able to return to task with supervisory encouragement, generally adapts to/copes with/tolerates work changes/schedules/deadlines/interruptions/pressures, accepts instructions/criticism/authority/supervision/feedback/rules, relies on own resources, learns from mistakes/instruction/supervision. Hazard Awareness Oblivious to/aware of hazards and able to take precautions, seems to be “accident-prone” beyond usual frequency of accidents. Decision Making (↔ by degree) Cannot make simple decisions to carry out a job, indecisive, confused by choices and criteria, cannot organize himself/herself/prioritize work/arrange materials, becomes paralyzed by decisions, makes correct routine decisions, handles exceptions and disruptions, makes up own mind, effectively sequences steps in a procedure. Pacing/Scheduling (↔ by degree) Cannot conform to a schedule/tolerate a full workday/perform within a schedule/sustain a routine, shows an uneven/unsteady work pace throughout workday, shows necessary/ expected/normal/required stamina, maintains motivation, completes assignments, finishes
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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17. Vocational/Academic Skills 255VOCATION/ ACADEMICSwhat she/he starts, continues despite obstacles/opposition/frustrations, works in a time- conscious manner. Conscientiousness (↔ by degree) Irresponsible, unaware/inconsistently aware of the consequences of own activities, wastes materials/damages equipment, does not adjust/maintain or service/repair/replace equip-ment and materials as needed, cares for tools/supplies/equipment/products effectively. Travel to Work (↔ by degree) Will not use available travel options, makes unreliable travel arrangements, travels reliably to work site, uses public transportation effectively, drives to work consistently. Relationship to Peers/Coworkers (↔ by degree) Avoidant, distant, shy, self-conscious, nervous, conflictual, domineering, submissive, com petitive, suspicious, attention-seeking, clowning, immature, provocative, inappropri-ate, dependent, troublemaker, ridiculing, teasing, <normal>, friendly. Maladaptive or Odd Behaviors Too introverted/withdrawn, loud/domineering, manipulative/takes advantage of peers, limits conversation to “yes” or “no” answers, will not look at person he/she is addressing, gossips, will not start a conversation, seeks unwanted/ill-timed/inappropriate physical contacts, has attention-getting odd behaviors/offensive personal hygiene, confuses actual and imagined abilities, makes excessive or unrealistic complaints. Assessment The following tests are commonly used for assessment of basic vocational skills and for guidance. Each entry offers the title of the current edition or version of each test (with acronym, abbrevia-tion, or common name indicated as usual by underlining); its copyright date if known; its current publisher or distributor; and the applicable age range. Differential Aptitude Tests for Personnel and Career Assessment, 5th ed. (1990), Pearson Assess-ments, grades 7-12 and adults. Holland Self-Directed Search (1994), www. self-directed-search. com, high school and older. Strong Interest Inventory (1994), Consulting Psychologists Press, adolescents and older. Kuder Occupational Interest Survey, www. kuder. com, adolescents and older. 17. 2. History of Work Ask the following questions: Has client ever been employed/“worked”/had a wage-earning job outside the home? If so, num-ber/duration/kind of jobs? Is client currently employed/unemployed/laid off/underemployed/retired? If employed, is employment marginal/labor pool/temporary/seasonal/part-time/full-time? Is employment history regular/irregular/interrupted/sporadic? Number and reasons for firings? Problems with absenteeism, conflict with customers/peers/coworkers/supervisors? Any job trials, work attempts, job coaches, job-finding clubs, work-hardening programs?
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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256 STANDARD TERMS AND STATEMENTS FOR REPORTS VOCATION/ ACADEMICSHave any background factors (e. g., medical, home, school) kept client from benefiting from formal education? Does client have a history of low productivity/achievement/advancement throughout life? 17. 3. Language Skills: Reading and Writing Ability See also Section 18. 4, “Reading Materials. ” Reading Comprehension Test client with a paragraph from a magazine on a current topic, and ask about its meanings. (↔ by degree) Alexic, illiterate, functionally illiterate, lacks basic/survival reading skills. (↔ by degree) Names letters, says simple words, reads out loud/silently, only small sight reading vocabulary, reads signs/directions/labels/instructions/recipes, low/normal comprehension, deciphered word meanings, slow reader, basic functional literacy, no reading for pleasure, usual skills, literate, avid, scholarly. Summary Statements His/her reading is limited to a small group of memorized words. He/she has rudimentary phonetic abilities, but cannot decipher unfamiliar or phonetically irregular words. His/her poor reading skills prohibit responding to/guidance by written instructions. She/he worked hard, asked appropriately for assistance, recognized errors, used word attack skills to successfully identify/decipher unfamiliar words on a reading test. Reading skills are adequate for basic literacy and utilization of written materials for get-ting directions. Literacy “Functional literacy” varies with time and location, because it is the ability to use reading, writing, and computational skills at a level adequate to meet the needs of everyday situations. (↔ by degree ) The following three paragraphs are sequenced by increasing degree of functional literacy. Extremely low literacy: Grammatical errors producing confusion, missing punctuation, mis-spelling common words, childish word choice, malformed letters, swear words/insults. Low to low-average literacy: Spelling as words sound, incorrect punctuation, slang terms, vague expressions/terms. High literacy: Complex sentence structure where appropriate, sophisticated word choice, correct spelling and punctuation, abstract thoughts, powerful metaphors, lucid. Spelling/Writing Spelling: (↔ by degree) Agraphic, letter-sound relationships are absent/poor/need strengthen-ing, spelling skills are poor/good/excellent, shows/demonstrates a solid grasp of underlying phonetic principles. Writing from dictation: Reversals, omissions, substitutions, additions, confused attack on let-ters, labored writing, reckless spelling. Handwriting: Good/poor quality, problems with upper-/lower-case letters, inversions, reversals,
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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17. Vocational/Academic Skills 257VOCATION/ ACADEMICSconfused one letter with another, degree of effort required, awkward handgrip position/use of the page, size of letters. Statements of Implications for Vocational/Academic Functioning Relationship of client's skill level to expected school/work achievement is... (specify). Areas of educational strength/weakness/handicap and need for intervention suggest... (spec-ify). 17. 4. Math Ability See also Section 14. 6, “Financial Skills. ” (↔ by degree) The following groupings are sequenced by degree of increasing skill. Anumerate, can say the digits, knows the sequence, holds up the correct number of fingers when asked for a number, counts items, knows which number is larger. Can do simple tasks of counting and measurement but not computation beyond addition and subtraction. Can do simple addition and subtraction of single-digit/double-digit numbers but only when borrowing is not involved. Ability limited to simple computation in orally presented arithmetic problems, can do problems requiring addition/subtraction/multiplication/division. Can solve problems when regrouping is required. Can correctly do problems involving decimals/fractions/measurements. Understands prices, counts change, makes change, possesses basic sur-vival math (measurements, portions, percentages, fractions, weights, etc. ), knows basic business math/consumer's math, is fully numerate. 17. 5. Special Considerations for Disability Reports If a client has an attorney and is not working, record this in the report. ü Note also that in a disability report, you should not state unequivocally that the client is or is not ü “disabled. ” This is usually an administrative decision and is based on criteria beyond just your findings. 17. 6. Vocational Competence/Recommendations Overall Competence: Summary Statements Normal This client is capable of performing substantial gainful employment at all levels. There are no psychological barriers to employment. She can perform in a competitive work setting/in the open labor market. Somewhat Limited He is intellectually limited, but not to the extent that would preclude appropriate employ-ment.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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258 STANDARD TERMS AND STATEMENTS FOR REPORTS VOCATION/ ACADEMICSShe could understand, retain, and follow instructions within the implied limitations of her borderline intellectual functioning/mild mental retardation/mild intellectual disability. The client is able to understand, retain, and follow only simple, basic instructions. He would be able/unable to meet the quality standards and production norms in work com-mensurate with his intellectual level. She can perform activities commensurate with her residual physical/functional capabilities/ capacity. He is able to relate to coworkers and supervisors, handle the stresses and demands of gainful employment within his intellectual/physical limitations. Significantly Limited He/she can function only in a stable setting/sheltered program/very adapted and supportive setting. The client requires appropriate prevocational experiences/work adjustment training/work- hardening program/diagnostic work study/evaluation of vocational potential. This person can/can't tolerate pressures of workplace, is un-/used to the regularities and demands of the world of work. No Residual Functional Capacity for Substantial Gainful Activity. The cumulative impact of the diagnoses presents a very significant deterrent/obstacle to employ-ment/productivity/substantial gainful activity. Setting and Tasks Needed (↔ by degree) The following groupings are sequenced by degree of increasing demand on the cli-ent. Nonstressful/unpressured/noncompetitive setting, simple/basic/repetitive/routine/non com-plex/slow-paced/unpaced/nonspeeded tasks that do not require facility in academics. Solitary/nonsocial tasks, working alone/no contact with the public. Closely supervised. Sheltered/highly supportive, stable. Part-time/flexible hours, full-time, overtime. Employment Level (↔ by degree) Unskilled/helper/laborer, semiskilled, skilled, professional, managerial, self-employed. Supervision (↔ by degree) Requires continual redirection, repetition of instructions, working under close and support-ive supervision, instruction only, monitoring only, occasional overview, can work indepen-dently. Ambition (↔ by degree) Avoidant, lethargic, indolent, listless, lackadaisical, self-satisfied, content, eager, persistent, hopeful, ambitious, enterprising, greedy, selfish, opportunistic, pretentious, unrealistic. Self-Confidence (↔ by degree) Highly/counterproductively self-critical, has low opinion of own abilities, normally self-assured, realistic self-appraisal, overconfident, impractical/unrealistic confidence, grandiose.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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17. Vocational/Academic Skills 259VOCATION/ ACADEMICSJob Seeking/Hunting (↔ by degree) The following groupings are sequenced by degree of increasing effort on the client's part. Poor/low/inadequate knowledge of vocational and educational resources. Employment is seen as too/highly/moderately/mildly stressful. Has no actual or realistic history of seeking, efforts have been episodic/half-hearted, efforts have been determined but initiative is now exhausted. Has job-finding skills/interviewing skills, can identify obstacles to successful com-pletion of training/skill development/employment, has a feasible vocational goal/ time frame for actions. Obstacles to Success: Summary Statements This client is academically so deficient that he/she cannot find or hold a job. Engages in excessive off-task behaviors. She invents excuses for lateness/absences/mistakes/inattention, is irresponsible. He avoids some essential tasks. She engages in inappropriate or disruptive behaviors/agitates intentionally. She does not work effectively when under any/normal/expected pressure. He responds to criticism with anger/anxiety/hurt/withdrawal. She uses/overuses offensive language. The client does not appear disabled, but is not employable because... (specify). In the course of his life he has changed jobs to manage his symptoms better.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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26018 Recreational Functioning 18. 1. Entertainment: TV/Radio/Music (↔ by degree) Avoids, dislikes, confused/overstimulated by, just as background/passive listener, aware of news/weather, selective/chooses/plans for particular programs, “Must see my stories/soaps,” recalls, actively records/purchases music, attends musical events regularly, plays musical instrument. 18. 2. Hobbies (↔ by degree) No hobbies, does puzzles/plays computer games/letter games/board games (cards, checkers, Monopoly), does crafts/needlecrafts, tinkers, paints by numbers/in water/oil/acrylics, builds models, takes photographs, hunts/fishes, gardens, reads, collects, repairs, plans, travels, builds. Cares for pets (feeds, exercises, cleans up after, grooms, teaches, consults veterinarian, etc. ). Recreational use of the Internet: Reads magazines/news articles/blogs, e-mails, shops online, uses search functions, is a member of e-mail lists (listservs), writes using word processor, writes a blog. Plays online games (Sudoku, card games), Multiplayer Online Games such as Second Life. Uses social networking websites (Facebook, My Space, Twitter, etc. ). For a Child: Plays with toys/dolls/miniatures, builds models (airplanes, cars, etc. ), has/maintains collec-tions. 18. 3. Sports Specify the sport(s) with which the client is involved. (↔ by degree) Watches on TV, attends/spectates, reads about, discusses, participates in, Special Olympics, bowling league, plays on sports team, has individual sport(s), regularly partici-pates in sport, competitive player. Exercises regularly, walks, jogs, aerobics, health club, golfs, swims, lifts weights, other. RECREATION
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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18. Recreational Functioning 261RECREATION 18. 4. Reading Materials See also Section 17. 3, “Language Skills: Reading and Writing Ability. ” Newspapers (↔ by degree) Headlines only, comics, horoscopes, simple stories, advertisements/prices, classifieds, news, columnists, editorials, news analyses, arts sections, reviews. Magazines (↔ by degree) Word-finding magazines, children's books/magazines, comic books, adventure, gossip, super-market, women's, men's, newsweeklies/current events, crosswords, science fiction, special interest (e. g., war, detective, biker, guns, wrestling, hobby, trade, technical, professional, literary, arts). Books (↔ by degree) Comics/picture, children's books, graphic novels, romances, short stories, mysteries, novels, Westerns, horror, adventure, science fiction, contemporary literature, poetry, biographies, self-help, nonfiction, texts, classics. 18. 5. Participation/Performance Quality (↔ by degree) No recreational activities, nothing for relaxation/fun, very few pleasurable activi-ties, moderate interest in recreation, active and satisfying recreational life, recreation inte-grated into work and social lives. (↔ by degree) Discontinues, has many unfinished projects, completes but only at a very low quality, takes much longer than usual/previously, is very slow, forgets, neglects/distracted from activities, finishes only the simplest/quickest, usually completes, always finishes, compulsively completes. For a Child: (↔ by degree) Autistic movements/manipulation, watches/participates passively only, parallel play, stereotyped actions built into toys, has imaginary playmates, takes active part in play/sporting activities, creative, makes own toys, involves others.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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26219 Other Specialized Evaluations This chapter covers a variety of other dimensions of functioning that clinicians are often asked to evaluate. 19. 1. Coping Ability/Stress Tolerance See also Section 6. 4, “Adjustment History. ” Types and Dimensions Instrumental, affective, and escape coping. Frustration tolerance, ability to delay gratifications, tolerance for ambiguity/uncertainty/con-flict/low information/structure, hardiness. Coping Skills (↔ by degree) Inept, incompetent, “can't cope,” unadaptable, rigid, inflexible, stubborn. Has developed specific psychological skills: Anger management, assertiveness, rational self-talk, has developed self-soothing techniques. Uses social support system/friendships/informal consultants. Resourceful, skilled, “survivor,” courageous, realistic, adaptable, flexible, adjusts, conforms, bends, resourceful, “just down on his/her luck,” valiant, proud. Assets/Strengths and Liabilities/Weaknesses See Section 25. 7, “Checklist of Strengths. ” 19. 2. Culturally Sensitive Formulations Culture may include ethnicity, race, religion, social class, gender, age, and similar categories. We all know that culture can affect behaviors, personality, self-image, symptoms, complaints, response to treatment, and other clinical data. These interactions are very complex, usually underestimated, and poorly understood. To add to the complexity, some aspects of culture may affect some clinically interesting phenomena in different ways and to different degrees in different people. Our ethical guidelines require us to have “cultural sensitivity (i. e., awareness of cultural variables that may affect assessment and treatment) and cultural competence (i. e., translation of this aware-ness into behaviors that result in effective assessment and treatment” (Paniagua, 2005, p. 8). It is OTHER EVALUATIONS
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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19. Other Specialized Evaluations 263OTHER EVALUATIONSimpossible to know well all of the cultures we encounter as clinicians, but we must learn what we can, and we should be constantly aware of our assumptions, expectations, stereotypes, and ethno-centrisms. DSM-IV-TR (American Psychiatric Association, 2000) offers some guidance. First, what little is known is indicated in the DSM-IV-TR's descriptions of many disorders, under “Specific Culture, Age, and Gender Features. ” Second, DSM-IV-TR's Appendix I contains a “Glossary of Culture-Bound Syndromes,” as well as an extremely useful “Outline for Cultural Formulation,” which is adapted (by permission of the American Psychiatric Association) and expanded below. Please con-sider this only a beginning, and just one formulation of factors to be considered. 1. The client's cultural identity:a. Ethnic or cultural reference group as seen in his/her preferred self-descriptions. b. Degree of involvement with the culture of origin and host culture. c. Language abilities and preferences, ability to switch between standard English and the language used with family and friends, preference of idioms, etc. d. Other aspects of communication, such as interpersonal distance and eye contact. e. Other behaviors, such as clothing choices, food preferences, and religious practices. 2. The individual's cultural explanation for the illness:a. The “idioms of distress through which the symptoms... are communicated (e. g., 'nerves,' possessing spirits, somatic complaints, inexplicable misfortune). ” b. The “meaning and perceived severity of... symptoms in relation to norms of the cultural reference group. ” c. The explanatory models of causation offered by the culture. d. Expectations about the course and outcome of the disorder. e. The use of any culture-bound syndrome diagnoses (see the “Glossary” in Appendix I of DSM-IV-TR). 3. “Cultural factors related to psychosocial environment and levels of functioning. ” These include culturally relevant interpretations of the following:a. Social stressors of all kinds and sources. These may include traumatic experiences of losses, deaths, torture, dislocation, separation, flight, etc., due to war, disaster, persecu-tion, or other experiences unfamiliar to you as the clinician. Attend to racial and ethnic prejudice, victimization, oppression, and rejection. b. Supports of all kinds, including ones the clinician may not use. DSM-IV-TR suggests inves-tigating the “role of religion and kin networks in providing emotional, instrumental, and informational support. ” Also investigate individual coping strategies, defenses, and atti-tudes toward helpers. c. The resulting levels of functioning and disability, again within the client's culture's expec-tations. Also, inquire into the client's history of higher and lower functioning. 4. “Cultural elements of the relationship between the individual and the clinician”:a. Differences in social status. b. Racial, ethnic, religious, and other differences. c. Any “problems that these differences may cause in diagnosis and treatment (e. g., diffi-culty in communicating in the individual's first language, in eliciting symptoms or under-standing their cultural significance, in negotiating an appropriate relationship or level of intimacy, in determining whether a behavior is normative or pathological). ” d. The patient's current preferences for and past experiences with professional and cultur-ally sanctioned sources of care and about expectations for treatment. The best and most readily available introductory books in this area are by Sue and Sue (2008), Ped-ersen et al. (2008), Ponterotto et al. (2010), Tseng (2003), and Paniagua (2005).
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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264 STANDARD TERMS AND STATEMENTS FOR REPORTS OTHER EVALUATIONS19. 3. Developmental Stages Erikson's (1963) “eight stages of man” are highly psychosocial and hopeful. Each stage presents a challenge to the ego to learn new adaptive skills or suffer limitations on ego identity. Psychosexual stage Crisis/conflict Strength, virtue Oral-sensory Basic trust vs. mistrust Drive, hope Muscular-anal Autonomy vs. shame, doubt Self-control, will Locomotor-genital Initiative vs. guilt Direction, purpose Latency Industry vs. inferiority Method, competence Puberty and adolescence Identity vs. role confusion Devotion, fidelity Young adulthood Intimacy vs. isolation Affection, love Adulthood Generativity vs. stagnation Production, care Maturity Ego integrity vs. despair Renunciation, wisdom Mahler's (1975) stages: Normal autism, normal symbiosis, separation- individuation (sub phases: dif-ferentiation, practicing, rapprochement, individuality, and emotional object constancy). Splitting, rein-tegration vs. fragmentation. Piaget's stages (see Gruber & Von Eiche, 1977): Sensorimotor, preoperational, concrete operations, formal operations. Assimilation, accommodation, conservation. Freud's stages: Oral, anal, phallic, latency, genital. Maslow's (1962) hierarchy of needs: Physiological, safety, belongingness/social, esteem, cognitive, aes-thetic, self- actualization, peak experiences. In Kohlberg's (1984) stages of the development of moral reasoning, morality is defined as follows at each stage: Premoral level 1 Obedience to avoid punishment. 2 Gains reward. Instrumental purpose and exchange. Conventional level 3 Gains approval and avoids disapproval of others. Interpersonal accord and conformity. 4 Defined by rigid codes of “law and order. ” Social accord and system maintenance. Principled level 5 Defined by a “social contract” agreed upon for the public good. Utility and individual rights. 6 Personal moral code based on universal, abstract ethical principles. 19. 4. Financial Competence/Competence to Manage Funds See also Section 14. 6, “Financial Skills,” and 14. 11, “Shopping. ” Note: ü “Incapacitated” is currently preferred to “incompetent,” as it is less sweeping and focuses on receiving and evaluating information, which are more capable of accurate evaluation. Standards/Criteria Ability to manage own property/likelihood of dissipating own property. Likelihood of becoming the victim of designing persons. Ability to make or communicate decisions about the use and management of entitlements.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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19. Other Specialized Evaluations 265OTHER EVALUATIONSComponents of Financial Competence Assessment Psychological/psychiatric evaluation/Mental Status Evaluation/data base of testing of orienta-tion, memory, judgment, reading ability, emotional disturbance, intelligence. Address issues like these: This person's orientation to time, place, person, common items. Presence or absence of adequate memory functions, social judgment, test judgment, control of emotions. Quality of person's reality contact (delusions, hallucinations, thought disorder, disordered thought processes, etc. ). Person's ability to recognize currency, make change, identify values/costs of several common items, do simple/basic arithmetic, perform relevant calculations. Person's factual knowledge of the source and extent of her/his assets, understanding of finan- cial terms and concepts. Person's functional ability/behavior, such as observed/historical ability to conduct trans- actions/conserve assets, competent performance of financial management/responsibilities, perception of situations of potential exploitation. Summary Statements On the basis of the present evaluation, this person is considered to be... incapacitated in all financial areas. able to manage only small amounts of money, about $ to $ . able/not able to manage his/her property, likely/unlikely to dissipate/squander his/her property. able/unable to manage benefits/entitlements, and make long-range financial decisions autonomously, responsibly, and effectively. likely/unlikely to fall victim to/become the victim of designing persons, be exploited. able/unable to make/communicate responsible decisions about the use and management of his/her entitlements and assets. likely/unlikely to hoard funds rather than make necessary purchases. If benefits are awarded, this person would use the money for drugs/alcohol/gambling or disor-ganized/impulsive purchases, and therefore he/she may/will/should not be the best recipi-ent of funds for his/her management. 19. 5. Homosexual Identity: Stages of Formation Coming out to oneself, family, and others is a difficult, continuing, and universal struggle. There are several models in use, but the most widely accepted is this set of seven stages about identity, partly quoted and partly adapted from Cass (1979). Confusion: Conscious awareness that homosexuality has relevance to oneself: “My behavior may be called homosexual. Does this mean that I am a homosexual?” turmoil, alienation, searching denial of personal relevance, antihomosexual stance, or inhibition of homo-sexual behaviors foreclosure. Comparison: “I may be homosexual” “I'm different, I don't belong to society at large,” “I do not want to be different. ” Tolerance: “I am probably a homosexual. ”Acceptance: “I am a homosexual. ”
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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266 STANDARD TERMS AND STATEMENTS FOR REPORTS OTHER EVALUATIONSPride: “Gay is good,” “Gay and proud. ” Activism: Confrontation activities, disclosure as a strategy. “How dare you presume I'm hetero-sexual?” Also, “them and us”—“Homosexual is good, heterosexual is bad. ” Synthesis: “There are some heterosexual others who accept (my) homosexual identity as I do. ” At this stage homosexual identity is no longer “seen as the identity, it is now given the status of being merely one aspect of self. ” 19. 6. Impairment's Effects on a Person (↔ by degree) Has become psychotic, suicidal, decompensated, devastated, catastrophic reaction, regressed, denial of event or its consequences, overwhelmed, maladaptive, deteriorating, marginal functioning, depressed, adjustment disorder, prolonged/delayed mourning, sad-dened, adjusting to disability/losses, adequate/fair functioning, functional, adapting, assim-ilating, accepting, accommodating, using psychological coping mechanisms, compensating, has devised compensatory/prosthetic/mnemonic/coping devices, successful, mature, is challenged, is growing, overcompensating. Summary Statement The cumulative impact/effect of this client's emotional and physical impairments results in no/ insignificant/mild/significant/moderate/severe/crippling limitations. 19. 7. Puberty Puberty is physical; adolescence is social. Tanner Staging System Several decades ago, Tanner (1962) defined the stages of puberty as follows: Stage Pubic hair Breast Penis Testes I Preadolescent Preadolescent Preadolescent Preadolescent II Sparse, long, lightly pigmented, downy, straight hair Breast bud; breast and papilla elevated, with increased areolar diameter Slight enlargement Enlarged scrotum, pink, texture roughened III Increased pigmentation, more curly Enlarged breast and areola with no contour separation Increased length Increased size IV Adult type, but less Areola and papilla form secondary mound Glans enlarged, increased breadth Enlarged, scrotum darker in color V Adult distribution with spread to medial thighs Nipple elevated, areola contour continuous with breast Adult size Adult size Tanner's data were based on European children and on North American children of European descent. There are variations between ethnic groups; for example, people of African ancestry tend to begin puberty 1-2 years earlier. Moreover, with better nutrition, the age of puberty is decreasing for all ethnic groups. Precocious puberty is defined as follows: male, genital stage II before age 91/2 years; female, breast or pubic hair development before age 8 years. The sequence of hair develop-
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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19. Other Specialized Evaluations 267OTHER EVALUATIONSment is pubic first, then axillary, then facial. About 40% of girls will have menarche by stage II and 90% by stage IV. The median age for first ejaculation in boys is between 121/2 and 14 years in the United States, and is affected by psychological and cultural as well as hereditary and biological fac-tors. First ejaculation usually occurs about 1 year after the accelerated penile growth. Gynecomastia is common (up to 70%) in young adolescent boys and usually resolves within 1 year. 19. 8. The Refugee Process This material is adapted by permission from Gonsalves (1992). Phases of the Process Preflight: Mounting anxiety, sense of abandonment, “victim of fate,” “no one cares. ”Flight: Traumatizing experiences, varying in intensity, duration, and number; returning as intru-sive memories, often on anniversary dates. Resettlement: Complex; a lifetime process of coping with different language, traditions, etc. Stages of Resettlement Early Arrival From 1 week to 6 months after their arrival in the new country, refugees learn the surroundings/“lay of the land”; remain involved with their homeland; and experience disorientation, low energy, sad-ness/loss, anger, guilt, relief, and excitement. Examiners should be alert to possible PTSD symp-toms. Destabilization From 6 months to 3 years after arrival, refugees acquire survival tools; develop a support group; and learn the language/social customs/culture due to economic pressures. They may experience great stress and pain, hostile withdrawal from the new culture, resistance to the new culture, or uncriti-cal compliance with the new culture. They generally view the old country as better, feel lonely, and show denial. Exploration and Restabilization From 3 to 5 years after arrival, refugees usually develop more flexible culture-learning methods, and often experience marital conflict and adjustment. They may also resist further adaptation; remain linked to other refugees; experience anger at their lowered status, fear of failure, and isolation; and/or undergo premature culture or identity closure. Return to Normal Life From 5 to 7 years after arrival, refugees generally maintain flexible cultural accommodation while retaining some old values; develop realistic expectations for new generations; develop a positive identity; and expect these personality changes to last. They may also show delayed grief reactions, and experience rigidity and intergenerational conflict. Decompensation Some refugees may decompensate at any time from 1 week to 7 years after arrival, as they struggle to meet survival needs; modify identity; enter the new culture; continue family commitments; and
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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268 STANDARD TERMS AND STATEMENTS FOR REPORTS OTHER EVALUATIONSconnect to the past, present, and future. They may experience psychosis, identity disorders, depres-sion, and existential crises. 19. 9. Religious and Spiritual Concerns The relevant DSM-IV-TR and ICD-9-CM code is V62. 89. (See Section 21. 21, “V Codes, Etc. ”) Note: ü It can be very difficult to distinguish a religious crisis from a manic episode, delusions from personalized beliefs or overvalued ideas, or obsessive scrupulousness from piety. Different religious traditions raise different spiritual issues, so please use your knowledge to modify these points for the evaluation of religious and spiritual concerns. History Ask about the following: Role of religion during childhood, adolescence, adulthood; church attendance, praying, holi-days. Spiritual concerns during these periods: Existential concerns, search for life-guiding values, spiritual health. Past and present religious affiliations/membership, attendance, involvement in activities such as individual and communal prayer, meditation, meeting with a spiritual leader, study of scripture, etc. Frequency of religious observance— describe as: Only in crises, holidays/with family, routine, daily. Attitude/devotion/commitment—describe as: Compulsive, pious, observant, routine, agnostic, hostile, atheistic. Perception of Higher Power/God/prophets. Concerns about Morality Conflicts among moral/ethical behavior of self or others, values, religious training, society. Excessive or minimal guilt, feelings of being punished, need to atone, inability to feel for-given. Confusion about sin/evil, right vs. wrong, responsibility, practices. Concerns Related to the Loss or Questioning of Faith Differences/conflicts/problems with a church/organization, teachings, clergy, scripture/sacred texts/prayers (e. g., hypocrisy). Doubts because of injustice/suffering/illness/deaths/unfulfilled prayers. Anger, fears, or distrust of Higher Power. Doubts because of loss of control/illness/losses/despite religious conformity or sinlessness. Difficulty believing in or getting closer to a Higher Power. Conflicts between concepts of a Higher Power as judgmental and demanding vs. accepting, lov-ing, and forgiving. Concerns Related to Conversion from or Marriage into a Different Faith Difficulties with initiation procedures into new faith. Being considered apostate/unchurched/lost/dead by family/members of former faith. Questions about arrangements of marriage, handling of ceremonies/holidays, religious training of children.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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19. Other Specialized Evaluations 269OTHER EVALUATIONSConcerns about Death and Suicide Fears about dying (e. g., unfinished spiritual business, arrangements for funeral/burial). Beliefs about what happens after death (e. g., reunion with decedents/never-ending sleep/dark-ness, judgment after death, an afterlife in Heaven or Hell, reincarnation, etc. ). Religious beliefs against suicide. Religious Experiences Responses to prayer or effects of praying. A vocation/call. Special revelations. Demonic possession, being the Messiah/a prophet/etc. Abandonment by God. Other Concerns Demand for a therapist of client's faith. 19. 10. Testamentary Competence/Competence to Make a Will The individual must understand (1) the nature and extent of her/his property; (2) the identity and relationships of the usual beneficiaries; and (3) the nature and (4) effects of making a will. The book by Melton et al. (2007) covers testamentary competence in detail.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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D. Completing the Report Subdivision D's Chapters: Page 20. Summary of Findings and Conclusions 273 21. Diagnostic Statement/Impression 276 22. Recommendations 307 23. Prognostic Statements 312 24. Closing Statements 314 The chapters in this last subdivison of Part II flow logically. They start with a pulling together of your findings and observations, so that you can offer a diagnosis that is a professional shorthand version of your conclusions. From these two summaries of your understanding of the client, you are in a position to make meaningful recommendations for treatment or other services. Then you can offer a statement of expected outcomes—a prognosis. The last chapter addresses the issues of closing the report and contains the standard language.
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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273 20 Summary of Findings and Conclusions 20. 1. Overview The summary of findings and conclusions is the place to offer your integration of history, findings, or observations, and your understanding of the client's functioning in the areas most relevant to the referrer's or reader's needs. If there is a referral question, it is likely to be answered here. How-ever, for referral questions seeking a disposition, a separate “recommendations” section may be a more appropriate heading for such an answer (see Chapter 22, “Recommendations”). A summary is the appropriate place to review the episode of therapy you have conducted or the conclusions you have drawn from an evaluation you have conducted. Diagnostic statements are usually also in a separate section (see Chapter 21, “Diagnostic Statement/Impression”). But if there are no changes to a previous diagnosis, that statement can be included in the summary. Because there will always be readers who need or want to read only a brief summary, be sure to include the information or conclusions with the most important implications for the client. 20. 2. Beginning the Summary Open the summary with one of these phrases or a similar version: In summary/In short/To summarize... In my professional opinion, and with a reasonable degree of professional/medical certainty... Then give a brief description of the client's demographics: (Name of client)/this (age), (gender), (any other decision-related factors, such as marital status or parental status) client/patient/consumer/etc.... Under the “Attributions” heading, “Getting Oriented to the Clinician's Thesaurus” provides other terms to use for variety in referring to a client. 20. 3. Summary of Previous Information Condense the background information and history (see Chapter 6) and the referral reasons (see Chap-ter 5) into a few sentences or a short paragraph. SUMMAR y OF FINDINGS
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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274 STANDARD TERMS AND STATEMENTS FOR REPORTS SUMMAR y OF FINDINGS20. 4. Relevant Findings and/or Conclusions In a separate paragraph, or as part of the summary of previous information, offer only the most referral-relevant three or four major findings or conclusions. For treatment summaries, offer the most important themes of the therapy process, with an eye to assisting the client's next therapist. For other situations, tailor the list of your findings to your understanding of the report's audience. For testing reports, findings should be organized by topic (integrating the results of different tests)—such as cognitive functioning, emotional controls, interpersonal relations, etc., depending on the referral questions. A reliability statement is also needed (see Section 4. 6, “Reliability/Validity Statements”). If the psychological symptoms presented may be due to a medical condition, see Chapter 29, “Psychiatric Masquerade of Medical Conditions. ” 20. 5. Diagnostic Statement Generally a diagnostic statement is in a separate section of a report, following the summary of find-ings and conclusions. However, if the diagnosis is simple or does not alter current treatments or previous diagnoses, it can be included in this summary section. (For more on diagnoses, see Chapter 21, “Diagnostic Statement/Impression. ”) 20. 6. Consultations and Further Evaluations Record the following about all outside consultations performed on the client: reasons/need; type of evaluation; name(s) of consultant(s); date(s) performed; conclusions and recommendations; and, if not apparent, the locations and dates of the original copies of those consultations (so that they can be requested by others). If your suggestions for further evaluations are simple or routine for your setting, they can be included here; if they are more complex, describe them more fully in the recommendations section of your report (see Chapter 22, “Recommendations”). 20. 7. Summarizing Treatment Services Provided Record the types of services rendered (consultation, assessment, evaluation, treatment, etc. ), as well as the number of sessions (including those missed, as relevant) and the dates of the first and last sessions. Termination Note the source of the decision to terminate (client, therapist, client and therapist together, agency, managed care, other), as well as the reason(s) for termination. Descriptors for termination reasons include: Refused services, excessive/unexplained no-shows, little/no progress, planned pause in treat-ment, successful completion of program/achievement of goals, transfer to another therapist or service provider because... (specify), referred elsewhere, no longer eligible for services because... (specify), other (specify).
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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20. Summary of Findings and Conclusions 275SUMMAR y OF FINDINGSOutcome Summary Statements Treatment has been a complete/partial/minimal success. Some/the majority of/nearly all goals were exceeded/achieved/not achieved. This patient has followed a productive hospital course. He is in good remission due to medications/is in good chemical remission. She has received maximum benefit from treatment/hospitalization/services. Treatment received has had no success/been ineffective in removing/reducing symptoms. Treatment has had a negative outcome for this patient. This patient's condition has shown adverse reactions/worsened/stayed the same/shown no improvement. Disposition Describe the disposition of the case as appropriate (inactive, closed, transfer, aftercare, referral).
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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27621 Diagnostic Statement/Impression Although they are not so tightly tied to treatment in the mental health field as in medicine, diag-noses are a kind of professional shorthand for integrating many kinds of data. In most cases, your diagnosis should follow from and sum up the data you have reported earlier. A diagnosis also ori-ents your reader to the recommendations and treatment planning that follow it. Generally offer only the most important one or two diagnoses, unless diagnosing was the reason for the referral, you are in training, or your setting's culture requires a fuller listing. You should include all five axes of a DSM-IV-TR (or ICD-9-CM) diagnosis and any “R ule-Outs” or other quali-fications (see Section 21. 1, below). Offer a “diagnostic impression” if you are not qualified to offer a DSM-IV-TR diagnosis or if you are quite uncertain. 21. 1. Qualifiers for Diagnosis A DSM-IV-TR diagnosis may be described or qualified with one of the following terms: Initial, deferred, principal, additional/comorbid, Rule Out..., admitting, tentative, working, final, discharge, in remission, quiescent. DSM-IV-TR offers these qualifiers: If the criteria are currently met for a diagnosis, Mild, Moderate, or Severe; or if the criteria are no longer met, In Partial Remission, In Full Remission, or Prior His-tory. Not Otherwise Specified is used when not all the criteria are met. ICD-9-CM does not have qualifiers that apply broadly across diagnoses, but, like DSM-IV-TR it offers qualifiers for some specific conditions. 21. 2. ICD Versions Currently the United States uses both DSM-IV-TR (2000; see Section 21. 3) and the International Clas-sification of Diseases, 9th revision, Clinical Modification (1980, but updated yearly). The ICD-9-CM was made the official standard for medical records and payment for health care by the Health Insur-ance Portability and Accountability Act of 1996, which was implemented in 2003. ICD-10 (World Health Organization, 1992) is used in the rest of the world and is due to become the standard in the United States in October 2013 (as required by the Department of Health and Human Services). More information on all of these can be found at the website of the Centers for Disease Control and DIAGNOSIS
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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21. Diagnostic Statement/Impression 277DIAGNOSIS Prevention (www. cdc. gov/nchs). In the lists that follow, the abbreviation cce means Conditions Clas-sified Elsewhere (usually medical, not psychiatric, disorders). 21. 3. DSM-IV-TR The current U. S. reference for mental disorder diagnoses is the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (American Psychiatric Association, 2000). The DSM-IV-TR system is multiaxial. The five axes are as follows: Axis I: Clinical Disorders (but not Personality Disorders) and Other Conditions That May Be a Focus of Clinical Attention (most V codes; see Section 21. 21). Axis II: Personality Disorders (long-standing patterns, in adults) and Mental Retardation. Axis III: General Medical Conditions. Axis IV: Psychosocial and Environmental Problems. (See Section 21. 22. ) Axis V: Global Assessment of Functioning Scale. (See Section 21. 23. ) The major categories and the diagnoses presented in the bulk of this chapter are given in order from the most to the least commonly used. The listing is almost complete (except for some rare sub-stance use conditions) and is a “crosswalk” of the diagnostic labels and code numbers from DSM-IV-TR and ICD-9-CM. It is offered only as a convenient reference for the knowledgeable clinician. If there is any uncertainty about the choice of diagnosis, the DSM-IV-TR or ICD-9-CM should be consulted. The DSM and ICD systems are not identical. The DSM-IV-TR codes and diagnoses are given in the left-hand column; the right-hand column contains what I believe to be the correspond-ing ICD-9-CM codes and their diagnostic labels. The DSM-IV-TR codes are reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Copyright 2000 American Psychiatric Association. 21. 4. Anxiety Disorders See Sections 21. 6 for codes for Acute Stress Disorder, Post Traumatic Stress Disorder, and Adjustment Disorders; see Section 21. 12 for codes for Substance-Induced Anxiety Disorders. DSM-IV-TR ICD-9-CM 300. 00 Anxiety Disorder NOS 300. 00 Anxiety state, unspecified 300. 01 Panic Disorder Without Agoraphobia300. 01 Panic disorder without agoraphobia 300. 02 Generalized Anxiety Disorder 300. 02 Generalized anxiety disorder 300. 09 Anxiety states: Other 300. 10 Hysteria, unspecified300. 20 Phobia, unspecified 300. 21 Panic Disorder With Agoraphobia 300. 21 Agoraphobia with panic disorder Panic disorder with agoraphobia 300. 22 Agoraphobia Without History of Panic Disorder300. 22 Agoraphobia without mention of panic attacks 300. 23 Social Phobia 300. 23 Social phobia 300. 29 Specific Phobia 300. 29 Other isolated or specific phobias 300. 3 Obsessive-Compulsive Disorder 300. 3 Obsessive-compulsive disorders Mixed Anxiety-Depressive Disorder is a diagnosis proposed for further study; see Appendix B of DSM-IV-TR. 799. 2 Nervousness
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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278 STANDARD TERMS AND STATEMENTS FOR REPORTS DIAGNOSIS 21. 5. Mood Disorders See Sections 21. 6 for codes for Adjustment Disorders, and 21. 12 for codes for Substance-Induced Mood Disorders. The following specifiers can be applied to various DSM-IV-TR mood disorder diagnoses: Chronic, With Catatonic Features, With Melancholic Features, With Atypical Features,With Postpartum Onset, With Seasonal Pattern, With Rapid Cycling, With/Without Full Interepisode Recovery. DSM-IV-TR ICD-9-CM 300. 4 Dysthymic Disorder Specify if: Early/Late Onset, With Atypical Features300. 4 Dysthymic disorder. Reactive depression 296. xx Episodic mood disorders (Use the following 5th digits for the 296 conditions: 0, unspecified; 1, mild; 2, moderate; 3, severe, without mention of psychotic behavior; 4, severe, specified as with psychotic behavior; 5, in partial or unspecified remission; 6, in full remission) 296. 20 Major Depressive Disorder, Single Episode, Unspecified296. 20 Major depressive disorder, single episode: Unspecified 296. 21 Major Depressive Disorder, Single Episode, Mild296. 21 Major depressive disorder, single episode: Mild 296. 22 Major Depressive Disorder, Single Episode, Moderate296. 22 Major depressive disorder, single episode: Moderate 296. 23 Major Depressive Disorder, Single Episode, Severe Without Psychotic Features296. 23 Major depressive disorder, single episode: Severe, without mention of psychotic behavior 296. 24 Major Depressive Disorder, Single Episode, Severe With Psychotic Features296. 24 Major depressive disorder, single episode: Severe, specified as with psychotic behavior 296. 25 Major Depressive Disorder, Single Episode, In Partial Remission296. 25 Major depressive disorder, single episode: In partial or unspecified remission 296. 26 Major Depressive Disorder, Single Episode, In Full Remission296. 26 Major depressive disorder, single episode: In full remission 296. 30 Major Depressive Disorder, Recurrent, Unspecified296. 30 Major depressive disorder, recurrent: Unspecified 296. 31 Major Depressive Disorder, Recurrent, Mild296. 31 Major depressive disorder, recurrent: Mild 296. 32 Major Depressive Disorder, Recurrent, Moderate296. 32 Major depressive disorder, recurrent: Moderate 296. 33 Major Depressive Disorder, Recurrent, Severe Without Psychotic Features296. 33 Major depressive disorder, recurrent: Severe, without mention of psychotic behavior 296. 34 Major Depressive Disorder, Recurrent, Severe With Psychotic Features296. 34 Major depressive disorder, recurrent: Severe, specified as with psychotic behavior
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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21. Diagnostic Statement/Impression 279DIAGNOSIS DSM-IV-TR ICD-9-CM 296. 35 Major Depressive Disorder, Recurrent, In Partial Remission296. 35 Major depressive disorder, recurrent: In partial or unspecified remission 296. 36 Major Depressive Disorder, Recurrent, In Full Remission296. 36 Major depressive disorder, recurrent: In full remission 296. 00 Bipolar I Disorder, Single Manic Episode, Unspecified296. 00 Bipolar I disorder, single manic episode: Unspecified Hypomania (mild) NOS, Hypomanic psychosis. Mania (monopolar) 296. 01 Bipolar I Disorder, Single Manic Episode, Mild296. 01 Bipolar I disorder, single manic episode: Mild 296. 02 Bipolar I Disorder, Single Manic Episode, moderate296. 02 Bipolar I disorder, single manic episode: Moderate 296. 03 Bipolar I Disorder, Single Manic Episode, Severe Without Psychotic Features296. 03 Bipolar I disorder, single manic episode: Severe, without mention of psychotic behavior 296. 04 Bipolar I Disorder, Single Manic Episode, Severe With Psychotic Features296. 04 Bipolar I disorder, single manic episode: Severe, specified as with psychotic behavior 296. 05 Bipolar I Disorder, Single Manic Episode, In Partial Remission296. 05 Bipolar I disorder, single manic episode: In partial or unspecified remission 296. 06 Bipolar I Disorder, Single Manic Episode, In Full Remission296. 06 Bipolar I disorder, single manic episode: In full remission 296. 10 Manic disorder, recurrent episode: Unspecified 296. 11 Manic disorder, recurrent episode: Mild 296. 12 Manic disorder, recurrent episode: Moderate 296. 13 Manic disorder, recurrent episode: Severe, without mention of psychotic behavior 296. 14 Manic disorder, recurrent episode: Severe, specified as with psychotic behavior 296. 15 Manic disorder, recurrent episode: In partial or unspecified remission 296. 16 Manic disorder, recurrent episode: In full remission 296. 40 296. 40Bipolar I Disorder, Most Recent Episode Manic, Unspecified Bipolar I Disorder, Most Recent Episode Hypomanic296. 40 Bipolar I disorder, most recent episode (or current) manic: Unspecified 296. 41 Bipolar I Disorder, Most Recent Episode Manic, Mild296. 41 Bipolar I disorder, most recent episode (or current) manic: Mild 296. 42 Bipolar I Disorder, Most Recent Episode Manic, Moderate296. 42 Bipolar I disorder, most recent episode (or current) manic: Moderate
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Edward L. Zuckerman PhD - Clinicians Thesaurus 7th Edition_ The Guide to Conducting Interviews and Writing Psychological Reports The Clinicians Toolbox 2010.pdf
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