Internship 10 Case File

INDEX
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PSYCHO-DIAGNOSTIC REPORT
Case 1
DEMOGRAPHIC DETAILS:
Name: Mrs. Sushma Srivastava
Age: 26 years
Gender: Female
Educational Qualification: M.Com
Date of Assessment: 31st July 2023
TESTS ADMINISTERED:
1. International Personality Disorder Test (IPDE)

2. Thematic Apperception Test (TAT)
3. Rorschach Inkblot Test (RIBT)
RATIONALE FOR ASSESSMENT: To assess for personality disorder and internal needs
and conflicts for therapeutic intervention.
BRIEF HISTORY: The patient was apparently maintaining well till 2017. Apparently, one
day suddenly the patient started to display behaviour like laughing and crying uncontrollably,
started feeling that something is inside her body (who she has termed as ‘gin’). She reported
that this happens when her menstrual cycle is delayed by a few days (interpreting it as gin
killing the baby), or when she is wearing red lipstick, keeping her hair open and wearing a red
bindi. The last episode of the same was reported to be on 10th August 2019. Currently, the
patient is reported to have difficulty walking and reports weakness in her body. The patient
was brought on a wheelchair by her parents, husband and in-laws to the present setup with the
aforementioned complaints. Post a week of medicinal intervention, the assessments were
conducted when the patient was speaking, waking appropriately.
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BEHAVIOURAL OBSERVATION:
Cooperation: Satisfactory
Attention & concentation: Attention could be aroused and sustained. client was conscious,
alert and oriented during the testing.
Appearance: She was kempt and groomed.
Rapport: Rapport could be established with ease. Eye to eye contact was made and
maintained.
Psychomotor activity: Agitated.
Comprehension: She could comprehend the test instructions well and was cooperative.
2. TEST FINDINGS: International Personality Disorder Test (IPDE)

On the screening questionnaire, the patient reported presence of Paranoid, Emotionally
Unstable- Impulsive Type, Emotionally Unstable-Borderline type, Histrionic, Anankastic,
and Dependent Personality traits.
Disorder Disorder name No. of Dimensional Diagnosis

code criteria met score
F 60.0 Paranoid 0 1 Negative
F 60.1 Schizoid 0 0 Negative
F 60.2 Dissocial 0 0 Negative
F 60.30 Emotionally 0 1 Negative

Unstable
Impulsive Type
F 60.31 Emotionally 0 1 Negative

Unstable –
Borderline Type
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F 60.4 Histrionic 0 1 Negative
F 60.5 Anankastic 4 8 Positive
F 60.6 Anxious 0 0 Negative

(Avoidant)
F 60.7 Dependent 1 4 Negative
On the interview schedule, the client has scored a definite diagnosis for Anankastic Personality
Disorder.
The patient was reported to have excessive doubt while doing anything and would go about
doing things cautiously. Since adolescence, the patient was reported to follow all the rules and
regulations, and excessive anxiety if not obeying them. She reported to have had fights with
her friends due to them not adhering to social norms. She insists on keeping things in symmetry,
putting back things exactly where taken from and there are frequent fights with husband
regarding the same.
IMPRESSION: The present assessment results are in favour of no definitive diagnosis of

Anankastic Personality Disorder.
2. TEST FINDINGS: Thematic Apperception Test (TAT)
1. Main theme
Majority of themes were interpretative in nature. In most of the stories, the hero is in a conflict
with a hostile environment. The theme revolves around the struggle of the hero with the
dominant environment. The hero emerges hopeless and dejected in most of the stories.
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2. Hero
The hero was found to be inadequate throughout the stories. The stories are indicative of
presence of an environment with obstacles which the hero fails to overcome. There is no
initiation to resolve conflict and there seems to be excessive anxiety regarding facing the hostile
environment. The hero is mainly succumbing to the environment around and is sad and helpless
in the situation. There are doubts about self and preoccupation with performing tasks perfectly.
3. Main needs
The most prominently expressed need was of abasement. There is a need to submit passively
to the external environment, to surrender and become resigned to fate. Need for affiliation is
found to be present. There is a need to maintain relationship, seek affection and remain loyal.
There is a need to autonomy, to break get free, shake off restraint and break confinement.
4. Conception of environment
The environment is perceived to be emotionally overwhelming for the hero, which leads to
feelings of despair and helplessness. It is perceived to be dominant and hostile. The difficulties
in the environment are interpreted to be uncontrollable, and there is resignation and anxiety
regarding the same.
5. Perception of different kinds of figures:

The stories reflected the others in the environment to be experiencing negative emotions. They
seem to be helpless and passive figures. They are supportive of the hero and are distressed due
to the conditions that the hero is facing. There seems to be a fear of abandonment due to the
circumstance, which the hero is able to overcome.
6. Significant conflict
The most prominent conflict was seen to be between the need for abasement and need for
autonomy. The hero is submitting passively to external force, which is conflicting with the
need to break free of the restraints and dominating environment.
7. Nature of anxieties
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The nature of anxieties were commonly related to feeling overpowered and dominated by the
hostile environment and not being in control. The anxiety is regarding the presence of an
aggressive figure in the environment and not being able to overcome it.
8. Defences
The main defence used in the stories is of Projection.
9. Adequacy of superego
As reflected in the stories, Superego is found to be inflated.
10. Integration of the ego

The stories were elaborate, structured and original. The degree of organization was adequate.
The hero is found to be inadequate, in the face of conflict the hero would submit to the hostile
and dominating environment. The hero was seen to be sad, helpless and submissive in the face
of difficult environment.
Summary of the test findings:
1. Unconscious structure and needs:

An inadequate hero displays prominent behavioural needs of autonomy with viewing the
environment as being oppressive and hostile. The outcomes are based mostly on submitting to
demanding situation or conflict.
2. Conception of the world and perception of the significant others

The environment is perceived to be emotionally overwhelming, and dominating for the hero.
The conception of significant others is found to be passive. The hero was found cherishing the
significant others.
3. Relevant dimension of the personality

The client’s main conflicts are between the need for Autonomy and Abasement.
She wishes for freedom and restrict dependence. It conflicts with the need to accept blame,
submit passively to the external force.
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Impression: Patient’s need for autonomy is not seemingly fulfilled which seems to be leading
to emotions of despair, helplessness towards the surrounding environment. Findings suggest
need for autonomy, and the need to submit passively to the environment conflicting and
resulting in severe distress, helplessness and hopelessness.
3. TEST FINDINGS: Rorschach Inkblot Test (RIBT)

Processing
The test findings indicate a conservative approach to processing. Considerable scanning shifts,
with focus on minute or unusual features of the blots. The findings are indicative of less
effective or less mature patterns of adjustment. Her processing approach seems to be overly
cautious, marked by an orientation to simplify things.
Mediation
Results are indicative of a significant mediation impairment and reality testing is found to be
noticeably affected. These findings are suggestive of impaired grasp of the reality and that the
subject is a victim of some disabling problem as the basic ingredient for adequate reality testing
and mediation is found to be impaired. It is likely that this degree of impairment in the
mediation processes may present a psychotic like picture.
Ideation
The findings are indicative of the subject relying heavily on ‘conceptual thinking’. She is
inclined to think through and delay behaviours until she has considered various options. She is
prone to trust internal evaluations more than external feedback and tries to avoid being overly
influenced by emotion. She seems to be generally cautious during problem solving. She
typically uses ideation style of coping, instances may occur in which feelings contribute
significantly to decisions.
Control and Stress Tolerance
The findings suggest that the subject has tolerance for stress than most and suggests a greater
capacity for volition for control of behaviour. From the results it is evident that the person is
facing some distress. She is involved in more self-inspecting behaviours that focus on negative
features of the self. This may lead to experience of discomfort and self-deprecation.
Affect
The results are indicative of an introversive style of coping. She is likely to think things through
before making decisions and prefers to keep her emotions aside during those times and tends
to delay initiating behaviours until she has had time to consider various options. She prefers to
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keep feelings at a more peripheral level during problem solving and decision making. She
avoids trial and error behaviours whenever possible and relies more on internal evaluations
rather than external feedbacks. She may be willing to display feelings openly, but is more likely
to be concerned about modulating or controlling those displays.
Self Perception
There seems to be self examination and introspection which involves some risks as it at times
represents a deliberate challenge to one’s own integrity. The responses seem to indicate a
presence of negatively introspecting about self and thus causes negative emotions to occur.
Interpersonal Perception
The results are indicative of the subject being interested in people although the individual’s
perception of people is not reality based. It is possible that the subject does not understand
people very well. She generally engages in forms of interpersonal behaviour that are likely to
be adaptive for the situation, which are considered favourable by others.
IMPRESSION: Overall findings indicate toward a diagnosis of Anankastic Personality

Disorder. There is a need for autonomy prevalent in the subject which is conflicting with the
need for abasement and a hostile conception of the environment. This is leading to significant
distress and anxiety in the subject, a probably reason for the dissociative episodes. The findings
are suggestive of a psychotic like presentation of symptoms in the subject, indicated in
impaired reality testing.
Recommendation:
1. Psychiatric consultation and compliance to medication to continue.

2. Psycho education for the client and family.
3. Individual psychotherapy focusing on anxiety management.
4. To build and enhance effective coping strategies.
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PSYCHO -DIAGNOSTIC REPORT
Case 2
Socio-Demographic Details:
Name Sanju
Age 16y
Gender Female
Education Pursuing 10th Grade
Date Of Assessment 4 august 2023
Referral Diagnostic clarification
Test Administered:
Rorschach Inkblot Test (RIBT), with Exner’s method of interpretation.
Brief History:
Sanju, a 16 year old, studying in class 10th had chief complaint of being able to hear voices of a boy
from neighbourhood, who she believed was in love with her. The onset of this complaint was
observed around beginning of her new academic year in April. It was reported that she had for the
first time received academic set back in internal examinations in her ninth grade last year. Since then
she was reported to be tensed and worried about her academic success and felt unconfident in her
abilities. Eventually, she also experienced sense of guilt and shame in facing her classmates. Her
stress to perform increased significantly with the beginning of the new academic year.
Behavioural Observations:
Appearance: She was well kempt and cordial with the examiner.
Rapport: Rapport was established with ease and she understood the instructions with ease.
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Comprehension: She was little apprehensive about the outcome of the test before initiating the
test. She found it difficult to conceptualize responses and understand what exactly she should see in
the cards and hence the productivity of the responses was low.
Attention & concentration: attention could be aroused and sustained.
Psychomotor activity: normal
Overall Results:
A total of 18 responses were given, with lambda value of 2, which indicates avoidant response style.
Majority of responses were located in the D area (11) with 2 space responses. Most often the
content of the responses included animals and animal details. There were no pure Human contents.
The protocol had no blend responses. Coping Deficit Index was positive with a value of 4. There were
a total of 3 ALOG responses with no other cognitive special scores. Most often the form quality was
noted to be unusual (10). These findings are also indicative of problems in reality testing.
Control and Stress tolerance:

The presence of avoidant coping style leads to a marked tendency to simplify complexity and
ambiguity by ignoring or denying its presence. Personality organization is somewhat less complex
than might be expected, which creates vulnerability for problems in coping with the requirements of
everyday living, especially in interpersonal sphere and can easily contribute to problems in control
when they occur.
Interpersonal Relationships:
She has tendency to shy away from social interactions and settle for an isolated life style that
consists only of superficial relationships, and her overall interest in people is lower than most others.
However, her social aspirations are not much different than most people. Ineptness in social
relationships, frequently makes her less acceptable to others or even vulnerable to rejection. Due to
this tendency she easily becomes dissatisfied with her life and often experiences a sense of
confusion or helplessness about her social situation. Such a finding in adolescents is indicative of
some problem in establishing or maintaining relations with others.
She expresses her need for closeness in ways that are dissimilar to those of most people. However, it
doesn’t mean she fails to have such needs. Instead, it indicates that she is more conservative than
might be anticipated in close interpersonal situations, especially involving tactile exchanges.
Self Perception:
The findings indicate that her estimate of personal worth tends to be negative. Therefore she
regards herself less favourably when compared to others and may be less involved with self-
awareness.
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Affect:
She has marked tendency to avoid emotional stimuli, hence she tends to become socially
constrained or even isolated. The responses are also suggest that many everyday exchanges that
contribute to development are being avoided or approached with caution. The psychological
organization is less complex and hence would result in behavioural disturbances when confronted
with emotional situations.
Processing:
The presence of avoidant style is substantial and limited processing effort might create a potential
adjustment problem. The processing efforts are also indicate that she tries to minimize any
perceived ambiguity. However, she tries to accomplish more than may be reasonable in light of
current functional capacities. If this tendency occurs in everyday life, she is likely to experience
frustration from resultant failures.
Mediation:
The responses are indicative of problems in reality testing which seems a result of affective problem,
mostly negativism or anger. The dysfunction in mediation are of pervasive nature. Her mediational
decisions most often disregard social conventions or expectations than do most people.
Ideation:
The protocol indicates presence of ideational discontinuity or faulty conceptualization that cloud
thinking and promote faulty judgement. These deficits in reasoning are a result of strained reasoning
which is simplistic in nature.
Summary:
An avoidant coping style indicates that processing and conceptualization of the problems is not
complex, especially due to marked negativism. Along with that positive Coping Deficit Index leads to
inefficient problem solving as there persists a negative view of self and most often manifested in
social interactions which are avoided however needs such as positive regard are still warranted. An
impaired reality testing is resultant of faulty conceptualization of problems and these
conceptualizations are mostly simplistic in nature thus adding to the perceived stress and
inadequacies.
Recommendation:
1. Psychoeducation to the patient and family
2. Personal goal setting and stress reduction techniques
3. Teaching problem solving skills and social skills
4. Teaching emotion regulation skills with special emphasis on emotion regulation
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CASE 3
Socio-demographic details
Name Ritika
Age 30
Gender Female
Marital Status Married
Date Of Assessment 11 AUGUST 2023
Test Administered:
Thematic Apperception Test (TAT)
Brief History
ritika 30 year old married, hailing from Jabalpur, had chief complaint of excessive urge
to self-harm with suicidal intention. She has been disturbed with family altercations and
finding it difficult to face the same.
Behavioural Observation:
Appearance: well kempt and cordial with the examiner.
Rapport: Rapport was established with ease.
Comprehension: she understood instructions easily.
Reaction time: adequate, however, she didn’t like the kind of cards shown to her in both the tests as
she found them to be really dark and gloomy.
RORSCHACH INKBLOT TEST (RIBT)
Overall Results:
The protocol consisted of twenty responses. The responses indicated extroversive coping style. All
the responses were located in the whole of the card and consisted of seven blends. Most often
Animal content was noted (11). A high frequency of cognitive scores were also noted, especially DR.
The protocol had high frequency of MOR an AG responses.
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Self-Perception:
The protocol indicates she has a sense of pride in self and high sense of self-worth. This
characteristic is very influential in her decisions and behaviours and probably creates some
difficulties for her in creating and maintaining mature interpersonal relations. However, under
present circumstances there seems to be a serious conflict regarding self-image and/or self-value,
which in turn may lead to substantial mood fluctuations and behavioural dysfunctions. This is
substantiated with presence of high MOR scores, signifying that self-image is notably marked by
negative features especially with regards to body image and suggesting that her perception tends to
be quite pessimistic, however this distress seems to be over-emphasized. Social interactions have
probably contributed significantly to formulations regarding self.
Interpersonal Relations:
She manifests with high dependency behaviours and hence she is more inclined to rely on others for
direction and support. In such a situation, she expects others to be more tolerant of her needs and
demands. However, she conceptualizes others in ways that are reality based. There is high likelihood
of less effective interpersonal behaviours which are regarded unfavourably by others.
Stress Control
The protocol signified that she has a sturdy tolerance for stress than do most and she is far less likely
to experience problems in control especially in the domain of volitional control of behaviour.
Affect:
She has an extratensive coping style wherein she tends to intermingle feelings with thinking during
problem solving or decision making activities. She is prone to be influenced by emotions and
generally disposed to test out postulates and assumptions through trial and error behaviours.
Chronic failures can be quite intense for her. She is prone to display her feelings openly and tend to
be less concerned about carefully controlling those displays. In present case, there is significant lax
in emotion modulation and may be frequently regarded by others as impulsive. The extratensive
style is observed to be inflexible and pervasive, in that the style can become a liability in situations in
which delay and thoughtfulness may be a much more effective tactic.
However, she may be slightly aware of the emotional modulation or control problems and may be
avoiding the same where these difficulties might exacerbate. She also tends to use
intellectualization defence, wherein, the impact of emotional situations or experiences is reduced or
even neutralized by dealing with them at a thought level. Yet there is reduced likelihood that
problems will be dealt with directly or realistically.
Processing of Information
The response style indicates that more effort than necessary has been put into processing of the
inkblots, though the quality of processing is adequate. She is striving to accomplish more than may
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be reasonable in light of current functional capacities. If this tendency occurs in everyday
behaviours, the probability of failure to achieve objectives is increased and the consequent impact
of those failures to achieve objectives is increased and the consequent impact of those failures can
be frustration.
Mediation:
Mediation is usually appropriate to the situation and basic ingredient necessary for reality testing is
intact. The protocol indicates that most mediational decisions are unconventional. They do not
reflect a reality testing problem because they are appropriate, albeit unusual, for the situation.
Instead, they indicate that the person is not very influenced by social demands or expectations.
However, when occasional mediational dysfunction occurs, it may be a defensive distortion of
reality.
Ideation:
Presence of extratensive coping style make her inclined to merge feelings with thinking during
problem solving or decision making. She will tend to count on external feedback for reassurance and
her judgements are often based on trial and error behaviour. The style is noted to be pervasive and
less flexible, and hence emotions take precedence almost always while problem solving.
A high MOR responses also indicate the presence of pessimistic sets which cause her to
conceptualize his or her relationship to the world with a sense of doubt and discouragement. It
often causes her to anticipate gloomy outcomes for her efforts, regardless of quality of the efforts.
Pessimistic outlook also makes her often disregard faulty judgements even though awareness for
the same might be present. This pattern of ideation or conceptualization of problems can lead to
disorganization in the same. Also, the conceptualization of problems is affected by internal need
states causing frequent and chronic peripheral mental activity which further increases likelihood for
interference with attention and concentration.
Most often, conceptualization of the problems tend to be disorganized, inconsistent and uncommon
and marked by flawed judgements. Bizarre conceptualizations are not uncommon and usually she
will be unable to contend with demands of everyday living in ways that will be persistently effective.
Summary of RIBT Findings:

Pervasive extratensive style of coping makes her intermingle feelings with thinking during problem
solving or decision making activities, and more so by feelings. Everyday living is affected majorly by
two aspects. First, a high sense of self-worth which influences decision making which interferes with
interpersonal relations as she expects others to be more tolerant of her needs and demands and
there is high likelihood of less effective interpersonal behaviours which are regarded unfavourably
by others. Second, even though excessive effort is put in understanding problems, they are
conceptualized in highly pessimistic manner which leads to faulty and disorganized judgements and
hence she is unable to cope with daily life effectively
Thematic Apperception Test
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The Main Theme
Main theme of the stories was interpretive, wherein stories are extended beyond description of the
cards and they incorporate elaboration of the situations, emotions and outcomes.
Main Hero
The main hero identified in the stories is approximately the same age and gender as that of the
patient. The hero is not presented adequately as she is unable to carry through tasks under external
and internal difficulties in an emotionally acceptable/desired manner. The hero is also seen to be
struggling with her needs in contrast to the environment.
Main Needs and Drives of the Hero

The main needs and drives identified were that of Autonomy, indicating a need to break free, shake
of restraint, to break out of confinement and to resist coercion and restriction; Affiliation, to draw
near and enjoyably cooperate or reciprocate with a near one, especially the one who resembles
herself or whom she likes and to please and win affection of the same; and Succorance, indicating
her desire to gratify her needs by the sympathetic aid of a loved one, to remain close to a devoted
protector and to be supported, sustained, surrounded, protected, loved, guided and consoled. Most
often parental figures were introduced in the story and no significant figures or objects were
omitted.
The conception of environment

The environment was conceptualized of critical situations requiring decision making and was often
perceived to be controlling and hostile where the hero found it difficult to fulfil her needs.
Figures seen as
Parental figures were seen to be caring and supportive. However, contemporary figures were
observed to be selfish, dominating and indifferent to the hero.
Significant Conflicts
Major conflicts were identified as Autonomy versus Abasement, Autonomy versus Dominance and
Affiliation versus Abasement. In most situations, the hero desired to break free from the constraints
put on her which she was compelled to submit to due to societal and parental pressures. Also, in
some situations, she was not able to break free due to environmental control over her. She has
strong need to be loved and be in company of the similar, which again is not fulfilled due to forceful
submission to the societal or family pressures.
Nature of anxieties
Anxieties were related to the external forces which pressurized her need to break free and made her
feel overpowered and helpless.
Main Defences
The main defence used to deal with abasement or dominance was rationalization and sometimes
intellectualization. She was seen often reasoning out her passive submission and giving up on her
needs as needed and a desired way.
Adequacy of Superego
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The expression of the superego is missing in the stories and seems to be governed by reality testing
principle. However, in one of the stories, the manifestations suggest a developed superego as the
nature of the punishment to the severity of the offence is harsh.
The Integration of Ego

The quality of reality testing is adequate and intact, however in order to deal with the demands of
the situations her needs are compromised which in turn reflects in interpersonal altercations and
cognitions of helplessness. Therefore, mediation between different conflicts and use of
interpersonal skills of the hero are also inadequate
Summary of TAT findings

Unconscious structure and needs:
The main theme identified is descriptive and the hero is of the same age and gender as that of the
client. The dominant needs projected in the stories are that of Autonomy, Affiliation and
Succorance.
Conception of the world and perception of significant persons:

The environment was conceptualized as controlling and hostile and significant others, mostly
spouse, were perceived to be selfish and controlling with indifference towards her needs.
Relevant dimensions of personality:

Significant conflict of her needs was with pressure to submit and dominance from environment
experienced especially with regard to partners. Anxieties were experienced in form of being
overpowered and helplessness. Though reality testing is intact, it leads to severe compromise in
fulfilment of her needs and mediation between different conflicts and use of interpersonal skills of
the hero are inadequate and poorly developed superego and weak ego integration.
Overall Impression and Diagnostic Consideration:
Both the tests indicate self-worth and ambitions are in conflict with demands of everyday life
leading to significant interpersonal altercations which in turn reinforces the pessimistic view of the
environment. The test findings are indicative of Cluster B associated with self-indulgence longing for
appreciation and consistent desire to achieve self-needs, which may not be fulfilled adequately
leading to distress.
Recommendations:
2. Psychotherapy to focus on self-concept and self-worth with special emphasis on personal goal
setting and stress reduction techniques Cognitive restructuring for better problem
conceptualization, especially in interpersonal domain leading to interpersonal effectiveness.
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PSYCHO- DIAGNOSTIC REPORT
CASE 4
Name Kritika
Age 25
Gender Female
Education Pursuing P.hd
Date Of Assessment 17th August 2023
Test Administered:
Brief History:
The client has lately been in an estranged relationship which is not yielding in satisfactory resolution.
As a result she complaint of having low mood, irritability, impaired attention and concentration,
inability to find interest, and an increase in sexual arousal. These symptoms are interfering in her
ability to function adequately in the professional and personal front.
Appearance: well kempt and cordial with the examiner.
Rapport: Rapport was established with ease
Comprehension: adequate . She was little apprehensive about her performance in initial two-three
cards but eventually was able to understand task at hand. She took some time to conceptualize her
responses and had elaborated upon them in vivid details.
Overall Results:
The protocol consisted of 24 responses with a positive Hypervigilance Index (HVI). The responses
indicated ambitent coping style. Most often, the responses were located in the whole of the card
(17) and consisted of 13 blends. Both human and animal content was frequently reported with
several special scores of aggression, and morbid. The protocol also consisted several cognitive
special scores, especially DR.
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Self-Perception:
There is an indication for exaggerated self-involvement and sense of personal worth which tends to
dominate her perception of the world and there is frequent need for reaffirmation reinforcement of
the same. If this reaffirmation of self-worth is not present, it may lead to asocial sets. She also
routinely engages in self-inspecting behaviours. The responses also indicate the likelihood of
rumination about body and/or self-image and may indicate a disconcerting sense of vulnerability.
Moreover, her self-image is notably marked by negative features and suggesting that her perception
of herself tends to be quite pessimistic. This perception is based on experience and social
interactions rather which may not be accurate or realistic.
Interpersonal Relations:
She is prone to mistrusting people and quite cautious in forming interpersonal relations. Even in
relationships she tends to feel vulnerable and thus may formulate and implement behaviours very
cautiously. Therefore, need for control in relationship may be seen to be high. For example, her
need for confirmation for marriage in the relationship and doubt if her partner still has a romantic
interest in her. An increased need for control in relationship may manifest itself as paranoid
tendencies.
Contrary to need for control in a relationship, she also manifests high dependency behaviours and
hence she is more inclined to rely on others for direction and support. In such a situation, she
expects others to be more tolerant of her needs and demands. Thus complementing need for
control as this apparent need for dependency represents reassurance of her integrity.
She expresses her needs in interpersonal situation in ways that are dissimilar to others. Overall, her
interpersonal world tends to be fraught with problems which are often marked by less effective and
sometimes inappropriate behaviours that are usually regarded unfavourable by others. Therefore,
she often finds herself in relative void of rewarding relationships.
Stress Control
The protocol signified that she has a sturdy tolerance for stress than do most and she is far less likely
to experience problems in control especially in the domain of volitional control of behaviour,
however it is overly conservative or misleading. The response pattern also reveal that needs related
demands often intrude on more deliberate patterns of thought and thus interfere with
concentration and attention. For example, she was unable to perform well during her masters exams
when she was in relationship.
Processing of Information
The response style indicates that more effort than necessary has been put into processing of the
inkblots. She has an overincorporative style of processing, which means she wants to avoid being
careless and this motivates her to exert more effort than may be necessary to scan features of a
situation. As an asset this quality helps in incorporating all elements of the stimulus into processing.
However, this can also have a disadvantage when psychological disorganization is present, causing
unnecessary ambivalence in decision making.
Mediation:
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Moderate level of mediational dysfunctions are indicated in the responses, which are of pervasive
nature. There is substantial likelihood of more atypical or even inappropriate behaviours than might
be expected. The proneness towards unconventional behaviours is most likely to be induced by
forms of mediational dysfunction and problems in reality testing.
Ideation:
Ambitent coping style makes her prone to needing more time to reach efficient solution. Being
ambitent can lead to her psychological effort being a liability because it requires investment of more
time and effort in contending with demands of everyday life. The ideational sets are fixed and
difficult to alter.
A positive Hypervigilance Index (HVI) indicates that she tends to use a considerable energy to
maintain a continuous state of preparedness. This anticipatory state is related to a negative or
mistrusting attitude towards environment that typically evolves during developmental years. A
positive HVI also leads to a sense of insecurity and vulnerability and a tendency to become more and
more cautious when forming or implementing behaviours.
The internal need states are causing her to experience a substantial level of peripheral mental
activity. Usually this situation is more chronic than transient and increases likelihood for frequent
interference with attention and concentration. Most often her conceptualizations about the
problems tend to be disorganized, inconsistent and uncommon. Due to such a pattern she is unable
to contend with the demands of everyday living in ways that will be persistently effective.
Affect:
She has an ambitent coping style wherein she hasn’t developed a consistent approach to problem
solving or decision making. The lack of consistency in use of feelings frequently causes her to
become confused by them and hence erratic forms of emotional display, with impression of
impulsiveness. It is also indicated that an increase in complexity of psychological experience
increases the likelihood that affect will have a detrimental influence on the behavioural consistency
and/or stability.
Summary:
An ambitent coping style indicates that there is frequent lack of consistency in use of feelings and
causes her to become confused by them and hence erratic forms of emotional display, with
impression of impulsiveness. Moreover, an exaggerated self-involvement and sense of personal
worth tends to dominate her perception of the world. Additionally a positive HVI index makes her
prone to mistrusting people and quite cautious in forming interpersonal relations and
conceptualizations about other problems tend to be disorganized, inconsistent and uncommon.
Recommendations:
2. Cognitive restructuring for better problem conceptualization
3. Personal goal setting and stress reduction techniques
4. Teaching emotion regulation skills with special emphasis on emotion regulation
19
Psycho- diagnostic Report
CASE 5
Demographic Details
Name Dr. ARNAV KUMAR
Age 66 years
Gender Male
Occupation Retired government teacher and ayurvedic

doctor
Informants Daughters
Date of Assessment 19 AUGUST 2023
Reason for Referral Personality Assessment
Brief Clinical History:
The patient reported with symptoms of increased aggression, overspending and inflated self-esteem
approximately 7/8 years ago for which treatment was sought and improvement was noted. However,
since the past 4/5 years the patient has been reporting of a persistent low mood, feelings of fatigue, loss
of interest in almost all activities, poor appetite, social withdrawal and difficulty in initiating and
maintaining sleep, preference for staying aloof. These low mood symptoms have exacerbated in the
past 1 year.
Behavioral observation:
Appearance: kemp
20
Attention & concentration: attention could be aroused but not sustained
Rapport: rapport could not be established easily
Psychomotor activity: retarded
Emotional problems: yes
Test Administered:

2. Thematic Apperception Test (TAT)
Test Findings:
1.Rorschach Inkblot Test (RIBT):
There was a total of 17 responses on ten cards. There were 4 W responses, 13 D responses. There are
11 pure form responses, 1 movement response,4 CF responses, 1 pure C response, 2 pair responses.
Form quality of 9 responses were ordinary, 3 unusual, and 4 negative responses were given. There are
5 botany content responses, 5 animal responses, 1 human content response, 2 anatomy
responses,1animal detail response. The Lambda value was found to be 1.83.
The patient has scored positive findings on Depression Index.
Affect
There is a definitive evidence confirming the presence of depression. The patient probably has a
personality organization which has a potential for affective disruption.
He probably has an avoidant - extratensive style of orientation. He is more prone to using his feelings
more directly in decision making by merging them with their thinking. When he intermingles feelings
with thinking during decision making, the feelings may be afforded much more or much less than
appropriate for the situation. He might be prone to use and be influenced by emotions than others. He
might tend to disregard complexity and keep things simple. They might often become negligent about
21
controlling emotional displays and may seem to be impulsive at times. He might be very attracted by
emotional stimulation, probably has a stronger interest in emotions, this can become a liability if there
are problems with control and modulation.
Control
The patient might have a process of dealing with stimulus on a simple economic level ignoring the
complexity of a situation. He might have an avoidant response style of dealing with situations. The
subject is being overwhelmed by or flooded by emotions. This has developed due to inability to contend
effectively with unusually powerful emotions. The intensity of these feelings is disruptive and creates
a form of lability in which emotions become provocative and overwhelming, which leads to behavior
that might not occur otherwise.
Situational stress
There is a presence of overload state in which the person is experiencing more internal demands than
he/ she can respond to easily and effectively.
Processing
The assessment indicates the patient probably has an avoidant style of coping and a tendency to avoid
complexity which has a substantial influence on him and might create a potential for adjustment
problems. His processing effort and strategy during problem solving tends to be irregular.
Mediation
It suggests that he might have a moderate level of mediational dysfunction which is pervasive and
problems in reality testing. He has a substantial likelihood of more atypical behavior or even
inappropriate behavior than might be expected. This loss of mediational effectiveness or reality testing
can be caused by numerous elements as emotional or ideational interferences cause this to occur. The
individual tends to be less conventional. The proneness to unconventional behavior is more likely to be
induced by problems of reality testing.
Ideation
The findings signify the patient tends to develop a great deal on external feedback and often becomes
involved with trial and error behavior when confronted with decision making. He has a tendency to not
fully differentiate emotional experiences and their feelings often become overly influential on their
thinking. People with an avoidant extravensive style typically function most successfully in
environments that are predictable and uncomplicated. Ideational activity is marked more often by
slippage or faulty judgment than is common.
22
Self-perception
It indicates that the patient has a low self esteem than should be the case, when he makes comparative
judgments between self and others, the result tends to be negative. He has an unusually strong concern
with the self which easily leads to a neglect of the external world. This characteristic is often a precursor
to depression. The likelihood of mood fluctuations is substantial and behavioral dysfunction is likely.
He tends to be less mature and frequently has distorted notions of self. He has limited self awareness
which sometimes serves very negatively in decision making and problem solving activity and creates a
potential for difficulties in relating to others.
Interpersonal perception
It indicates that the patient might be less socially mature than might be expected and tend to have
problems in establishing and maintaining relationships. He is probably emotionally withdrawn or
socially isolated from their environment. He probably doesn’t anticipate positive interactions among
people as a routine affair. He is prone to feeling less comfortable in interpersonal situations and might
be regarded by others as being more distant or aloof. He tends to be less active in social interactions
than is expected. He may shy away from social intercourse and settle for a more isolated lifestyle that
consists only of superficial relationships, emotionally withdrawn from social situations.
The patient has scored positive findings on Depression Index. There is a definitive evidence
confirming the presence of depression. He probably has an Avoidant - Extratensive style of
orientation. He is more prone to using his feelings more directly in decision making by merging them
with their thinking. The patient might have a process of dealing with stimulus on a simple economic
level ignoring the complexity of a situation. He might have an avoidant response style of dealing with
situations. The subject is being overwhelmed by or flooded by emotions. He is probably emotionally
withdrawn or socially isolated from their environment. He is prone to feeling less comfortable in
interpersonal situations and might be regarded by others as being more distant or aloof. He tends to be
less active in social interactions than is expected.
2.Thematic Apperception Test (TAT)
1. Main theme
23
Majority of themes were brief in nature. In most of the stories, the hero is mostly submitting passively
to external force, is resigning to fate and surrendering. The themes revolve around interpersonal
conflicts, abandonment and ultimately death. The hero is dissatisfied with the environment and the
people around.
2. Hero
Most of the stories had an adequate hero of approximately the same age and sex; and in a hopeless
situation and despair who is eventually surrendering to death.
3. Main needs
The most prominently expressed needs were of Abasement and Affiliation. There is a strong need to
be loved, understood and supported. The hero wants to be heard and given affection. The hero is
surrendering to the resigned fate in most of the stories, is helpless and in despair.
4. Conception of environment
The environment is perceived to be emotionally overwhelming for the hero with lack of stability.
Most of the stories revolved around family and interpersonal conflicts especially focusing on
dissatisfaction with current life scenarios and lack of support from family members where in hero is
ultimately submitting passively to the demands of others.
5. Perception of different kinds of figures:
The stories reflected the others in the environment to be experiencing negative emotions. The others
in the stories are reflected as not being able to understand the hero, being emotionally detached or
cold towards hero, and hostile, which leads to instability and abandonment in the relationships. The
family members are viewed as having a careless attitude towards the hero.
6. Significant conflict
The most prominent conflict was seen to be between the need for affiliation and the need for
abasement. There is a need to be supported and loved but at the same time would resort to giving up
or resigning to fate to avoid rejection rather than trying to sustain the relationships. In the face of
rejection, strong and intense emotions are experienced.
7. Nature of anxieties
The nature of anxieties was commonly related to being felt misunderstood by others and unloved
which lead to feelings of helplessness, losing out on love and deprivation from interpersonal
24
interaction. The stories also reflect him being stuck in a life different from what the hero desires and
feels overwhelmed with intense emotions, as soon as something unexpected happens in the
environment.
8. Defences
The main defence used in the stories was of rationalization.
9. Adequacy of superego
As reflected in the stories, Superego is inadequate and inconsistent as the hero is surrendering to death
in most stories in face of conflicts.
10. Integration of the ego
The stories were brief and structured. The degree of organization was adequate. They were real and
appropriate to the form demand of the picture. The hero was adequate.
Summary of the test findings:
1. Unconscious structure and needs:
An adequate hero displays prominent behavioural needs of abasement with viewing others as not
understanding the Hero. The outcomes are based mostly on submitting passively to the resigned fate.
2. Conception of the world and perception of the significant others
The environment is perceived to be emotionally overwhelming for the hero with lack of interpersonal
relationships who understand him.
3.Relevant dimension of the personality
The most prominent conflict was seen to be between the need for affiliation and the need for
abasement. There is a need to be supported and loved but at the same time would resort to giving up
or resigning to fate to avoid rejection rather than trying to sustain the relationships. In the face of
rejection, strong and intense emotions are experienced.
25
DIAGNOSTIC CONSIDERATION:
F31.4 Bipolar affective disorder, current episode severe depression without psychotic symptoms
Recommendation:
1. Psychiatric consultation and to continue the compliance to medication.
26
CASE 6
Name: Parveen Sharma
Age: 17years 10 months
Date of birth: 17/08/2004
Gender: Male
Education: Class 9th
Date of Assessment: 24th AUGUST 2023
REASON FOR REFERRAL:

1. To assess the intellectual functioning and personality functioning of the client.
BRIEF CLINICAL HISTORY:
parveen was born to non-consanguineous parents from a full-term caesarean delivery at a

hospital with immediate birth cry and normal birth weight. No significant pre or peri natal
complications were reported. The developmental milestones were achieved on time except for
speech milestones which were slightly delayed. The informant (mother) reported that currently
the patient has become very aggressive, verbally abusive, irregular at school, excessively using
phone. He had also started bunking classes in grade 3 due to lack of interest in attending classes.
The patient also indulges in threatening behaviours towards parents inorder to get what he
wants. The patient’s irregularities in terms of attending school have increased since the past 6
months.
TESTS ADMINISTERED:
1. Binet Kulshreshtha Test of Intelligence
Appearance: well kempt.
27
Rapport: Rapport could be established with ease. Eye contact could be established and
maintained.
Attention & concentration: Attention could be aroused and sustained.
Comprehension: Adequate. He was cooperative during the assessment and was compliant
with the instructions.
Motivation: He was motivated throughout the testing period.
Psychomotor activity: normal range.
1. BINET KULSHRESHTHA TEST OF INTELLIGENCE :
TEST FINDINGS:
Parveen obtained a basal age of 11 years and a ceiling age of 17 years. He obtained a mental
age of 13years 6months suggestive of an IQ of 94.
The IQ of 94 indicates that the patient has Average level of Intellectual functioning
wherein he can function age appropriately and is capable of acquiring the concepts and
skills taught to him.
2. RORSCHACH INKBLOT TEST :
TEST FINDINGS:
Controls and stress tolerance
The findings indicate that the patient has a more sturdy tolerance for stress than do most other
people and is less likely to experience problems in control. However, it is not indicative of
better adjustment. A reliable and valid index of capacity for control and tolerance for stress is
found. The findings indicate excessive internalization of feelings that he would want to
externalize, this leads to experiences of discomfort including anxiety, sadness, tension,
apprehensiveness which might manifest in terms of anger and irritation towards immediate
caregivers.
Situational Stress
Situations may be experienced as stressful by the patient and the experience of the stress is
substantial. Some situational stress is present and the stress tolerance of the patient is lower
28
than usual, typical capacities for control may be lessened, decisions or behaviours may not be
well thought through or implemented, and a proclivity for impulsiveness exists.
Affect
The findings indicate that the personality organization of the subject includes a potential for
frequent experiences of affective disruption. The patient may experience recurring bouts of
moodiness, depression, tension or anxiety. The patient has an introversive coping style and
prefers to think through before making decisions. He prefers to keep his emotions aside during
these times and tend to delay initiating behaviours until they have had time to consider various
options. However, situations do occur in which feelings are permitted to merge more directly
with thinking and contribute significantly to the process of decision making. Findings further
indicate the presence of marked tendency to avoid emotional stimuli and feeling of discomfort
when dealing with emotions. As a result of which they often become socially constricted or
even isolated. The patient indulges in a process to reduce or neutralise the impact of these
emotions and this may lead to distortion of the true meaning as well as the impact of the
situation. The findings indicate mild level of complexity in psychological functioning which
increases the likelihood that affect will have an effect on his behavioural consistency and
stability.
Information Processing
The findings are indicative of a processing effort similar to that of most people. It can be
assumed that the processing efforts and habits are regular and predictable. The patient is
striving to accomplish reasonably in light of current functional capacities. The patient often
indulges in underincorporative form of scanning wherein he scans hastily and haphazardly,
missing important bits and cues that exist in the stimulus field. It signifies liability because
under-incorporation creates a potential for faulty translation of cues that are present, leading to
less effective patterns of behaviour. The quality of processing is found to be less than adequate,
probably more so in complex situations.
Mediation
The findings suggest that the individual is oriented to be precise in mediating stimulus inputs
and probably has been well motivated in taking the test. The basic ingredient necessary for
conventional reality testing is intact. The events of mediational dysfunction occur not more
than frequently for the patient as compared to most individuals. Reality testing tends to falter
29
significantly in situations where cues to appropriate translations are not obvious. He tends to
make more mediation decisions that are less conventional and disregard social demands or
expectations than do most people. Sometimes, this is the product of a conflict with the
environment and/or system of values that vary considerably from those usually endorsed by
the environment. Findings indicate a likelihood that there will be more frequent patterns of
less conventional behaviours, but it does not necessarily mean that those behaviours will be
unacceptable or antisocial. It represents social alienation or social defensiveness, that is, the
patient tends to avoid convention as a way of maintaining distance from an environment that
is perceived as threatening, demanding and ungiving.
Ideation
The findings are indicative that the patient uses an Introversive coping style and relies on
conceptual thinking. He is inclined to think things through and delay behaviours until various
options have been considered. He is prone to trust internal evaluations more than external
feedback and tries to avoid being overly influenced by emotions. He prefers not to become
over involved in trial and error behaviour. However, incidents and situations in the patient’s
life will occur in which feelings will contribute significantly to decisions. The ideational sets
of the patient are probably well fixed and relatively inflexible. The patient uses
intellectualization as a defence in dealing with situations and is more prone to than most
individuals to intellectualise feelings, which further indicates that he might adopt or accept a
distorted form of thinking that serves to deny the true impact of the situation. The
conceptualizations of the individual are very prone to be influenced by flawed logic or faulty
judgement inorder to quickly reduce needs or avoid them altogether. The quality of thinking
was found to be concrete and immature which may indicate that thinking is being impaired by
peripheral thoughts.
Self perception
The findings suggest the patient’s estimate of his personal worth tends to be less favourable
and negative when compared to others. This increases the likelihood of mood fluctuations and
behavioural dysfunctions.
Interpersonal perception and behaviour
The findings indicate that the patient tends to express his needs of closeness in ways that are
dissimilar to those of most people. He is more conservative than might be anticipated in
30
interpersonal relationships especially those involving tactile exchange. He may be much more
concern with personal space and is more cautious about initiating and maintaining close
emotional ties with others. The patient often engages in forms of interpersonal behaviours that
are likely to be less adaptive for the situation than might be desirable. He tends to perceive
aggressiveness as a natural part of interpersonal relationships and sometimes may indulge in
such behaviours as a defensive tactic designed to contend with a sense of insecurity in
interpersonal situations. He finds it difficult to create and sustain smooth interpersonal
relationships.
Summary of RIBT findings:
The patient has an introversive coping style and relies on conceptual thinking. He often
indulges in underincorporative form of scanning which creates a potential for faulty translation
of cues that are present, leading to less effective patterns of behaviour. The findings indicate
excessive internalization of feelings that he would want to externalize, this leads to experiences
of discomfort including anxiety, sadness, tension, apprehensiveness which might manifest in
terms of anger and irritation towards immediate caregivers. He estimates his personal worth
negatively or less favourable compared to others. He often engages in forms of interpersonal
behaviours that are likely to be less adaptive for the situation than might be desirable.
OVERALL IMPRESSION:
Test findings indicate Average level of intellectual functioning (IQ of 94). On RIBT, findings
are suggestive of difficulties in information processing due to underincorporative form of
scanning, vulnerability to frequent bouts of moodiness disrupting interpersonal ties and
findings are also indicative of low personal self-worth. However, his stress tolerance is sturdy
but excessive internalization of feelings often leads to feelings of discomfort.
RECOMMENDATIONS:
1. Psychiatric consultation and compliance to medication to continue.

3. Psychotherapy for reduction of problem behaviours.
31
Psycho- diagnostic Report
CASE 7
Demographic Details
Name Mr. MUKESH
Age 22 years
Gender Male
Education Currently pursuing graduation
Informants Parents
Date of Assessment 24 AUGUST 2023
Reason for Referral 1.Personality Assessment
2. Assessment of Intellectual Functioning
Brief Clinical History :
The child was born through a full term normal vaginal delivery at the hospital. Birth cry was immediate.
All developmental milestones were achieved age appropriately. He had jaundice at the age of 7 years.
He would remain silent and withdrawn. By the time he was in IX Std., the parents noticed that he would
wash hands repetitively and would not like if anything would be kept out of place, if someone would
interfere with his way of keeping things he would report feeling anxious. His social withdrawal
increased. He would not be keen in forming friendships. He currently reports of having disturbing
images of sexual and moral content and engages in frequent reassurance seeking for every trivial matter.
According to the parents he doesn’t prefer talking to anyone, stays aloof, and lacks street smartness. He
has discontinued his studies after first year of graduation. He is currently not motivated to engage in
productive activities.
Behavioral observation:
32
Appearance: well kemp & groomed
Attention & concentration: attention could be aroused but could not be sustained
Psychomotor activity: normal range
Tests administered:
1. Stanford Binet Test of Intelligence : Hindi Adaptation (BKT)

Test Findings :
1. STANFORD BINET INTELLIGENCE SCALE HINDI ADAPTATION (BKT)
Test findings: He obtained a basal age of 8 years and a ceiling age of 15 years 4 months. He obtained
a mental age of 152 months suggestive of an I.Q. of 79 indicative of Borderline Intellectual
Functioning.
Impression: Borderline Intellectual Functioning
2. Rorschach Inkblot Test (RIBT) :
There were a total of 16 responses on ten cards. There were 3 W responses, 11 D responses, 2 Dd
responses. There are 12 pure form responses, 2 movement responses, 1 FC, Form quality of 12
responses were ordinary, 1 synthesized was response, 1 unusual, and 2 negative responses were given.
There are 2 human content responses, 3 human detail responses, 8 animal responses, 3 art responses,
and 1 botany response. The Lambda value was found to be 3.
Control
The patient’s capacity for control and ability to deal with stress effectively is similar to most of the
people of his age bracket. There is a presence of affective problems which may have served as a
predisposition for him to develop disorganization under stress. He tends to ignore the complexity and
ambiguity of situations and stays contended in doing the more basic or obvious things. He might be
exhibiting defensiveness while taking the test.
33
He tends to have limited resources, which implies he functions most effectively in environments that
are well structured and reasonably free of ambiguity.
Situational stress
There is no current stressor experienced by the patient. The impact of situational stress is probably
rather modest. There is no evidence of loss of control leading to impulsiveness.
Affect
He has an avoidant style of orientation. He has trouble in handling complex or ambiguous situations.
He is more vulnerable to adjustment problems due his inconsistency in handling his emotions and
disposition to avoid complexity. He tends to inhibit his feelings. He is less interested to process
emotional stimuli.
He experiences feelings more intensely than others and sometimes has more difficulty in bringing
closure to emotional situations and remains confused. He has difficulty in seeking resolution of the
issue.
Processing
The assessment indicates the patient to be having an avoidant style. It simply reflects the cautious or
conservative orientation towards the environment. The influence of the avoidant style is very substantial
and the limited processing effort might create a potential for adjustment problems. It can be assumed
that he is very economical in the processing efforts. His processing efforts and habits are predictable
and regular. He is very guarded and tries to minimize involvement with any perceived uncertainty.
The patient tries to accomplish more than may be reasonable in light of current functional capacities. If
this tendency occurs in everyday behaviors, the probability of failure to achieve objectives is increased,
and the consequent impact of those failures can often include the experience of frustration.
Mediation
It suggests that the individual is oriented to be somewhat precise in mediating stimulus input and
probably has been well motivated in taking the test. The meditational dysfunction occurs no more
frequently than for most of the people. There is an affective disturbance of mediation. His interference
to mediation is related to self image issues. The avoidant style is being maintained by reality distortions.
There is a presence of some sort of meditational dysfunction that interferes with his orientation
occasionally. The patient does not react in unconventional ways in situations which are simple or
precisely defined.
Ideation
34
The findings signify the patient to be avoidant- ambitent. His orientation to avoid complexity overlays
the inconsistency in conceptual thinking and the end product is much greater inefficiency because the
array of possible conceptualizations is reduced significantly. He is vulnerable to less sophisticated
thinking and more frequent incidents in which his emotions are less well modulated. He experiences
difficulty in adapting effectively in a complex environment. Due to an avoidant coping style, it is
probable that he tends to react quickly to reduce irritations created by the intrusions of peripheral
thoughts. Although the tactic is positive when viewed from a homeostatic perspective but hastily
formulated responses are often not well thought through and their long-term effectiveness may be very.
He has a distinct tendency to defensively substitute fantasy for reality in stressful situations more often
than most people do.
His thinking is seriously disturbed. His reality testing is marginal, at best. His thinking tends to be
disorganized, inconsistent and frequently marked by very flawed judgment. Bizarre conceptualizations
are not uncommon. He probably is unable to contend with the demands of everyday living in ways that
are persistently effective.
Self-perception
It indicates that the patient has a low self esteem than should be the case, when he makes comparative
judgments between self and others, the result tends to be negative. He has an unusually strong concern
with the self which easily leads to a neglect of the external world. This characteristic is often a precursor
to depression. The likelihood of mood fluctuations is substantial and behavioral dysfunction is likely.
He tends to be less mature and frequently has distorted notions of self. He has limited self awareness
which sometimes serves very negatively in decision making and problem solving activity and creates a
potential for difficulties in relating to others.
Some unusual body concern or preoccupation is also present. It suggests likelihood of rumination about
body and/or self image and may indicate a disconcerting sense of vulnerability.
Interpersonal perception
It indicates that the patient often assumes a passive, though not necessarily submissive role in
interpersonal relationships. He prefers to avoid responsibility for decision making and is less prone to
finding out new patterns of behavior
He may shy away from social intercourse and settle for a more isolated lifestyle that consists only of
superficial relationships, emotionally withdrawn from social situations. The patient does not anticipate
positive interactions among people as a routine event. He is prone to feel less comfortable in
interpersonal situations.
A pervasive Avoidant style of coping makes the patient tends to react quickly to reduce irritations
created by the intrusions of peripheral thoughts. He experiences difficulty in adapting effectively in a
35
complex environment. His thinking is seriously disturbed. His reality testing is marginal, at best. His
thinking tends to be disorganized, inconsistent and frequently marked by very flawed judgment. He
patient has a low self esteem. He has an unusually strong concern with the self which easily leads to a
neglect of the external world. He has limited self awareness which sometimes serves very negatively
in decision making and problem solving activity and creates a potential for difficulties in relating to
others . He may shy away from social intercourse and tends to settle for a more isolated lifestyle that
consists only of superficial relationships
Recommendation :
1. Consultation with psychiatrist

2. Individual Psychotherapy
36
CASE 8
Name: Mr.SUBHASH
Age: 33 years
Gender: Male
Educational Qualifications: BA
Date of Assessment: 27 AUGUST 2023
TEST ADMINISTERED:
The Rorschach Inkblot Test (RIBT)
Appearance: The client was well kempt.

Attention and concentration: attention could be aroused easily and was sustained for the
required period of testing.
Rapport: Rapport could be established with ease. The client was cooperative during the
assessment.
Motivation: adequate. Certain apprehensions were present before the initial few responses,
but eventually smooth conduction took place.
TEST FINDINGS:
The client gave a total of thirty responses, with no card rejection. The most prominent
determinant used was of form with a total of seven ‘form’ responses. There are three blend
responses. Form quality was most frequently observed to be ‘ordinary’. The obtained lambda
value is 1.30, indicating the presence of an avoidant response style, oriented to reducing
stimulus situation to the easily managed level. The obtained EB value is 2:8, indicating that
the client is an avoidant extratensive.
The client scored positive on one constellation index - Depression Index (DEPI).
Control and Stress Tolerance:

Test findings indicate that the client is currently experiencing some distress. His need states
are being experienced in atypical ways. It is also indicated that the client is internalising his
feelings, which is making him tensed, uncomfortable and low in mood. Thus, though the
client’s capacity for control and distress tolerance is neither excessive nor depleted, currently
he is internalising his feelings and hence, feeling apprehensive and worried.
It is reasonable to assume that the thoughts and feelings of the client are impacted because
of the diffused stress.
37
Affect:
Test findings indicate that the client’s personality organisation is vulnerable to experience
frequent emotional disturbances. Negative emotional experiences like low mood and tension
are commonly experienced. It is likely that affective problems exist, forming a core from which
the current complaints of anxiety and disturbed mood stem from. These emotional
disturbances also influence the client’s decision making.
The extratensive coping style makes the client more likely to be intuitive and his decision
making is done using feelings merged with his thinking. However, it is important to note that
the client’s avoidant extratensive coping style may make him negligent in controlling his
emotional displays, making him impulsive on certain occasions. Thus, while the extratensive
coping style makes the client more tolerant of the errors, the blending of avoidant coping style
might make it likely for this tolerance to be excessive causing him to behave ineffectively. The
avoidant coping style also limits the client’s willingness to process emotional material. Thus,
the presence of this emotional material is denied and substituted by an inappropriately positive
emotion. It is likely that the client has difficulty in dealing with negative feelings and is prone
to modify reality in an attempt to avoid the anticipated harshness in the environment.
Test findings also indicate that the client is probable of having a negative or oppositional set
about his environment. The difficulty in modulating emotions has a negative impact on the his
attempts to adjust in social settings, making it difficult to create and sustain harmonious
relationships.
Processing:
Processing refers to the mental procedures entailed in the input of information.
It is indicated that the client is usually guarded and attempts to minimise his involvement in
ambiguous situations. The findings suggest that the client is striving to achieve more than the
current functional capacities. If this happens too often, it can consequently lead to the
experience of frustration.
Mediation:
It is found that there is no cause for concern about the effectiveness of his mediational
process. The client is likely to adapt strategies in which he avoids facing the reality of the
situation by making attempts to amend it mentally. Consistent with his history as well as the
previous findings, he is likely to be socially defensive or alienated as a way to maintain
distance from an environment that is perceived to be threatening or ungiving.
Ideation:
The findings indicate that the client’s feelings usually play a very important role in his thinking
and might influence decision making. It is also found that this style is quite pervasive and
emotions always have a considerable influence in his life. Thus, he is likely to function well in
environments which are predictable and not complicated. It also seems important for the client
to be in an environment wherein an open expression of feelings is appreciated. It is probable
that he tends to react quickly in order to reduce the distress.
Self Perception:
It is seen that the client’s personal worth tends to be negative and he regards himself less
favourably as compared to others. A positive finding that needs to be addressed includes the
likelihood of the client engaging in self inspecting behaviours routinely.
38
Consistent with the client’s history, test findings indicate that unusual body concern or
preoccupation is present, making it likely for him to ruminate about body and/or self image. It
is likely that social interactions have contributed significantly to formulations regarding the self.
A disconcerting sense of vulnerability may also be present.
Interpersonal Perception and Behavior:

It is found that the person probably acknowledges and expresses needs for closeness in ways
similar to other people. He is likely to be defensive in interpersonal situations and relies on
displays of information as a way of maintaining a sense of security in those situations. Test
findings also indicate that he is more socially isolated and finds it difficult to connect well with
others. He usually finds himself relatively void of fruitful relationships.
Impression:
Test findings indicate that the client’s personality organisation is vulnerable to experience
emotions disturbances, causing him the current difficulties of low mood and anxiety. These
emotional disturbances often influence his decision making and his view about his
environment. He is usually guarded and socially defensive in environments perceived
threatening. A preoccupation with his body along with a sense of vulnerability is also likely to
be present.
DIAGNOSTIC CONSIDERATIONS:
1. Depressive Disorder
RECOMMENDATIONS:
2. Psycho-education for the client and family members.

3. Social Skill Training for the client.
4. Psychotherapy focusing on enhancing coping mechanism, emotional regulation and
decision making.
39
PSYCHO -DIAGNOSTIC REPORT
CASE 9
Name Mrs Neelam
Age 38
Gender Female
Marital Status Married
Informant Self and Sister-in-law
Source of Referral Sister in law
Referral Diagnostic Evaluation
Date Of Assessment 29 AUGUST 2023
Tests Administered:
1. Million Clinical Multiaxial Inventory(MCMI)
Appearance: well kempt
Rapport: Rapport could be established but difficulties.
During conduction of MCMI the patient often began crying but was able to answer the
questions appropriately. During RIBT she had to be probed in the beginning and would often
get lost in the imagination of the responses. As a result of which she had to be pushed to the
task frequently. However, was cordial during the entire interview and test conduction.
Million Clinical Multiaxial Inventory
40
The index subject has obtained high scores on the following scales:
1. Personality Pattern Scale: Dependent (3), Anankastic(7), Avoidant(2A)
2. Clinical Syndrome Scales: Paranoid (P), Delusional disorder (PP)
The analysis of the responses given by the subject indicates that, she seems to experience few
positive reinforces from herself or others. She seems to be vigilant and always on guard ready
to distance self from anxious anticipation of life’s painful or negatively reinforcing
experiences. The adaptive strategy reflects fear and mistrust of others. There is tendency to
maintain constant vigil to prevent the impulses and longing for affection from resulting in a
repetition of pain and anguish which she might have experienced with others. Active
withdrawal seems to be a way to protect herself. Despite her desires to relate to others, he seems
to find it best to deny these feelings and to keep a good measure of interpersonal distance.
As a result of which, there seems to be learning of not only to turn to others for nurturance and
security but to wait passively for their leadership in providing them. They seem to search for
relationships in which they can lean on others for affection, security and guidance. They seem
to have assumed a passive role in interpersonal relations, accepting whatever kindness and
support they may find and willingly seem to submit to the wishes of others in order to maintain
their affection.
Due to the above style of emotional transaction adopted by the patient, they seem to have been
intimidated in to accepting the demands and judgments imposed on them by others. Their
prudent, controlled and perfectionistic ways derive from a conflict between hostility towards
others and fear of social dis-approval. They seem to resolve this ambivalence by suppressing
their resentment and by over confirming and placing high demands on themselves and others.
Their disciplined and self-restrained attitude serves to control intense, though hidden,
oppositional feelings, resulting in an overt passivity and public compliance. However, there
may be occasional breakthrough in their control.
Findings indicate that there seems to be tendency to display vigilance, mistrust of others and
defensiveness against anticipated criticism and deception. There seems to be irritability and
tendency to precipitate exasperation and anger in others. She may feel fearful of losing
independence, leading to resist external influence and control. There may be inflexibility of
thoughts.
41
She may further be paranoid and voicing irrational but interconnected delusions of persecutory
or grandiose nature. There may be disturbance in thinking, and ideas of reference. The mood
seems to be inclined towards hostility may feel picked on and mistreated. Suspiciousness,
vigilance and alertness to possible betrayal are typical.
Impression on MCMI: Overall findings suggest that the patient seems to be having avoidant,
dependant and anankastic personality traits and a tendency to display vigilance, mistrust of
others, and defensiveness against anticipated criticism and deception. Additionally, she may
be paranoid and voicing irrational but interconnected delusions of persecutory.
Rorschach Inkblot test (RIBT)
Test Findings:
Control and stress tolerance: She is being overwhelmed by affect due to unusually powerful
emotions. She is more likely to become disorganized by many of the natural everyday stressors
of living in a complex society and will function better in structured environment. Her needs
states are acted upon more rapidly than is the case for most people.
Affect: She is being overwhelmed and flooded by emotions, which are interfering markedly
with her thinking and decision making, due to which behavioral impulsiveness may occur. She
has an inclination to avoid situations in which difficulties may be exacerbated, to limit
complexity, indicating an avoidant style. She seems overly emotionally and less mature,
resulting in potentially maladaptive behavior, making it difficult for the formation of
harmonious social relationship.
Information processing: The influence of her avoidant style is very substantial and the limited
processing effort might create a potential for adjustment problems. However, her processing
style is regular and predictable. She may be striving to accomplish more than may be
reasonable in light of current functional capacities. This may in turn increase the probability of
failure to achieve objectives thereby, increasing the consequent impact of those failures, which
may include frustration. She has a tendency to invest more effort and energy into scanning
activities to avoid being careless. Quality of processing in less than adequate, more so in
complex situation.
42
Meditation: It suggests dysfunction is severe and reality testing will be markedly impaired.
Also, it can be assumed that the impairment is global. Although the person is indicative of
having an avoidant style in general, this style now seems to have become ineffective and is
being maintained by reality distortions.
Ideation: It is probable that she tends to react quickly in an attempt to reduce needs when they
are experienced by conceptual tactics, to reduce the intrusions of peripheral thoughts. Although
these tactics are positive, they are not well thought through and therefore, their long term
effectiveness may be limited. Thinking tends to be disorganized, inconsistent and frequently
marked by very flawed judgments.
Self-Perception: She tends to regard herself less favorably when compared to others. She seems
to be more naive about herself than might be desirable. It is almost certain that some unusual
body concern or preoccupation is present. It also suggests the likelihood of rumination about
body/self-image and may indicate a disconcerting sense of vulnerability.
Summary:
Over all findings suggests that the patient is being overwhelmed and flooded by emotions,
which are interfering markedly with her thinking and decision making. She has an inclination
to avoid situations in which difficulties may be exacerbated, to limit complexity, indicating an
avoidant style of personality. Although the person is indicative of having an avoidant style in
general, this style now seems to have become ineffective and is being maintained by reality
distortions. Her quality of information processing in less than adequate, more so in complex
situation, is creating a potential of adjustment problems. The mediation processes dysfunction
is severe and reality testing is markedly impaired. It is probable that she tends to react quickly
in an attempt to reduce needs. Therefore, her thinking tends to be disorganized, inconsistent
and frequently marked by very flawed judgments. She tends to regard herself less favorably
when compared to others, indicating a disconcerting sense of vulnerability.
Overall Impression and Diagnostic Consideration:
Overall findings suggest that the patient seems to be having avoidant, dependant and anankastic
personality traits and a tendency to display vigilance, mistrust of others, and defensiveness
against anticipated criticism and deception. Additionally, she may be paranoid and voicing
irrational but interconnected delusions of persecutory. She has an inclination to avoid situations
43
in which difficulties may be exacerbated, to limit complexity, indicating an avoidant style of
personality. The mediation processes dysfunction is severe and reality testing is markedly
impaired. She tends to regard herself less favorably when compared to others, indicating a
disconcerting sense of vulnerability.
RECOMMENDATIONS:
1. Psychoeducation to the patient and family.
2. Psychotherapy to focus on self-concept and self-efficacy, and coping strategies.
3. Pharmacotherapy to be continued.
44
PSYCHO- DIAGNOSTIC REPORT
CASE 10
Name: Mr. ARYAN

Age: 13 years
Gender: Male
Education: 8th grade
Occupation: Student
Marital Status: Unmarried
Domicile: Urban
Religion: Hindu
Socio-Economic Status: Higher Middle
Informant: Parents and self
45
HISTORY OF PRESENT ILLNESS:
The patient is admitted to the current set up as student as the current set is a vocational training
center for people with special needs. According to the parents the patient has poor memory, is
poor in academics and often forgets basic instructions given to him, he is unable to handle
money like people of his age does and is unable to socialize appropriately with new people due
to which he only has few friends.
The parents reported that the patient failed in exams in the 9 th grade. He had difficulty with
performing complex mathematical skills such as multiplication, division. Apart from that, he
had difficulty in comprehending concepts of science, remembering history and political
science.
According to patient, he finds difficulty in initiating conversations with people round him and
finds it hard to develop friendships with people around him as he believes that people will make
fun of him, He reported that if he goes to a social event, he is usually sitting in the corner,
sipping his cold drink, he would not usually leave his chair to go and interact with other people
as he feels that others might make fun of him or mock him.
This idea hinders his ability to socialize more and hence, he prefers to stay alone instead of
opening up. However, he wishes to develop friendships with people his age, but fails to do so
as they dismiss him. He further reported that whenever he sees them playing football outside
together in the park, he would often sit on the corner of the park and watch them play.
The patient further reported that he often forgets instructions given to him or small little tasks
that he has to perform due to which, he often gets scolded by his mother.
The parents further reported that he can purchase a few items however, he has difficulty in
performing calculations of addition and subtractions (only when the numbers are three digits
46
and above) and multiplication and division, which further hinders his ability to buy a lot of
items from the market.
They further reported that the patient has color, time and money concept, but lacks complex
mathematical skills due to which he is unable to buy items from the market and can only buy
basic items from the market.
The parents further reported that the patient enjoys working at the vocational center and is good
at the vocational work. They reported that they have received no complaints from the center
regarding his behavior.
Onset-insidious, Course– Continuous, Progress- static
NEGATIVE HISTORY:
No history suggestive of
1. Head injury
2. Palpitations, increased breathing, increased heart rate, restlessness, fatigue, sweating in
social situations
3. Repetitive behavior patterns
4. Impaired social communication
PAST HISTORY OF PSYCHIATRIC ILLNESS:
47
The parents reported that the patient has a history of seizures. The patient had his first seizure
at the age of 2 years. The seizures would be visible on the right side of the body. The patient
would have jerky movements. The last seizure was reported in August 2019, since then the
patient has been doing well.
PAST HISTORY OF PHYSICAL ILLNESS
No history of physical illness was reported.
FAMILY GENOGRAM
FAMILY HISTORY
48
No significant family medical or psychiatric history reported. Patient is only child. His mother
(53) is a homemaker and his father (55) a serviceman. The patient lives in a nuclear family
with his parents. The patient is closer to his mother.
Consanguinity status in patient’s parents: Non consanguineous
Family Interaction pattern-
The communication between the family members was reported to be direct. The patient’s
parents together make the decisions. The role relations were reported to be adequately fulfilled
by the family members. Cohesiveness is present.
PERSONAL HISTORY:
Prenatal/Perinatal/Post-natal history
Pre-natal history
No complications were reported.
Perin-natal history
The patient was born full term at nine months via normal delivery at home. Birth cry and weight
were not recorded by the parents. They reported that the baby seemed healthy to them.
Post-natal history
On the 6th day after birth, the child developed high fever, 103°c and was subsequently
diagnosed with hydrocephalus, which was shun from the brain at the age of 2.5 months.
49
CHILDHOOD HISTORY
His developmental milestones were reported to be delayed. His neck control was achieved by
1.5 years of age, sitting by 2 years, crawling by 2 years, 4 months, walking by 2 years 8 months.
The patient started babbling by 2 years, 2 word phrases by 2.5 years, and started speaking in
complete sentences around 4 years. Toilet control was achieved by 8 years.
The parents reported that the patient has a history of seizures. The patient had his first seizure
at the age of 2 years. The seizures would be visible on the right side of the body. The patient
would have jerky movements. The last seizure was reported in August 2019, since then the
patient has been doing well.
Currently the patient is able to maintain eye contact, smiles at inappropriate times. He is able
to perform activities of daily living and take care of toilet needs. The patient has color concept
but has no money concept. The patient is able to comprehend environment and communicate
well. The patient has also attended normal schooling till 8th grade.
EDUCATIONAL HISTORY
The patient attended formal schooling till 8th grade. After which he was admitted to a special
school. The patient enjoys playing badminton with other students at the center. The patient also
enjoys making paper bags in the center.
The parents reported that the patient failed in exams in the 9 th grade. He had difficulty with
performing complex mathematical skills such as multiplication, division. Apart from that, he
had difficulty in comprehending concepts of science, remembering history and political
science.
50
The special educators reported that in the classroom set-up, the patient is well behaved and
completes his vocational work properly. They further reported that the patient has fixed set of
friends and would only interact with them.
MENTAL STATUS EXAMINATION
General Appearance and Behavior:
A male, broad built, kempt and groomed, wearing clean clothes, combed hair entered the
interview room, greeted the examiner and sat on the chair.
Attitude towards the examiner:
Attitude towards the examiner was cooperative. Eye contact was made. Rapport could be
established with ease. He was attentive, and cooperative throughout the interview.
Psychomotor activity:
Psychomotor activity was within normal limits.
Speech:
Speech was spontaneous, with normal pitch. The rate, volume and tone of the speech were
normal. The tone varied according to the situation. Speech was unclear but relevant, coherent
and answers were appropriate and understandable.
Mood and Affect:
Subjective: “theek hu ma’am.”
Objective: Euthymic
51
Quality, Range of affect and reactivity: normal
Congruency: present.
Perception: No perceptual abnormalities were reported.
Thought:
Form: No Formal thought disorder was elicited.
Stream– Goal directed, no thought block elicited
Content:“log mera mazak udayenge isliye main baat nai karpata”
Impression: anxiety regarding social interaction
Orientation: Oriented to place, person and self, and time.
Attention: Aroused and sustained
Memory:
Immediate recall: Intact (Pen, chair, flag)
Recent recall (After 5min): Intact
Remote: (Childhood incidents and date of birth): Intact
Abstract thinking:
Similarities between: Mango and Banana
Answer: dono fruits hai
52
Proverb: Don’t cry over the spilled milk
Answer – “pata nahi”
Judgment:
Social: Intact
Personal: Intact
Test: Intact
Insight:
“log mera mazak udayenge isliye main baate nahi karta”
Impression: Level 2
DIAGNOSTIC FORMULATION
Mr. Ayan, unmarried-hindu male, educated up to 8th grade, currently is a student at the
vocational center, presented with the chief complaints of poor comprehension, inability to
understand all the instruction in one go, is poor in academic concepts, forgetfulness, inability
to socialise appropriately, and inability to perform complex calculations since childhood.
Examination revealed intact personal and social judgement, anxiety in social situations, with
insight level of 2.
PROVISIONAL DIAGNOSIS
• ICD 10
53
F70
Mild Intellectual disability
TESTS ADMINISTERED
1. Vineland Social Maturity Scale- It was administered in order to assess the social
maturity
2. Developmental Screening Test- It was administered in order to assess the
developmental quotient
3. Weschler’s Adult Performance Intelligence Scale- it was administered in order to
assess the intellectual quotient
TEST RESULTS
Vineland social maturity scale
Social age: 10 years
Chronological Age: 24 years, 11 months
SQ = 66
Developmental screening test
Developmental Age: 10 years
Chronological Age: 24 years, 11 months
DQ = 66
Weschler’s adult performance intelligence scale
54
Sno. Subtest Score
1. Picture completion 10
2. Digit symbol 5
3. Block design 3
4. Picture arrangement 7
5. Object assembly 1
Total score: 26 IQ: 64
IMPRESSION
The test findings are suggestive of mild level of intellectual disability.
55
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INDEX

1. CASE STUDY ________________________________________PAGE 2

Name: Mrs. Sushma Srivastava

Educational Qualification: M.Com

Date of Assessment: 31st July 2023

1. International Personality Disorder Test (IPDE)

2. TEST FINDINGS: International Personality Disorder Test (IPDE)

Disorder Disorder name No. of Dimensional Diagnosis

F 60.0 Paranoid 0 1 Negative

F 60.1 Schizoid 0 0 Negative

F 60.2 Dissocial 0 0 Negative

F 60.30 Emotionally 0 1 Negative

F 60.31 Emotionally 0 1 Negative

F 60.5 Anankastic 4 8 Positive

F 60.6 Anxious 0 0 Negative

F 60.7 Dependent 1 4 Negative

IMPRESSION: The present assessment results are in favour of no definitive diagnosis of

2. TEST FINDINGS: Thematic Apperception Test (TAT)

5. Perception of different kinds of figures:

10. Integration of the ego

Summary of the test findings:

1. Unconscious structure and needs:

2. Conception of the world and perception of the significant others

3. Relevant dimension of the personality

3. TEST FINDINGS: Rorschach Inkblot Test (RIBT)

Control and Stress Tolerance

IMPRESSION: Overall findings indicate toward a diagnosis of Anankastic Personality

1. Psychiatric consultation and compliance to medication to continue.

Education Pursuing 10th Grade

Date Of Assessment 4 august 2023

Referral Diagnostic clarification

Attention & concentration: attention could be aroused and sustained.

Psychomotor activity: normal

Control and Stress tolerance:

2. Personal goal setting and stress reduction techniques

3. Teaching problem solving skills and social skills

4. Teaching emotion regulation skills with special emphasis on emotion regulation

Referral Diagnostic clarification

Date Of Assessment 11 AUGUST 2023

Thematic Apperception Test (TAT)

Rapport: Rapport was established with ease.

Comprehension: she understood instructions easily.

RORSCHACH INKBLOT TEST (RIBT)

Summary of RIBT Findings:

Thematic Apperception Test

Main Needs and Drives of the Hero

The conception of environment

The Integration of Ego

Summary of TAT findings

Conception of the world and perception of significant persons:

Relevant dimensions of personality:

Overall Impression and Diagnostic Consideration:

Education Pursuing P.hd

Date Of Assessment 17th August 2023

Referral Diagnostic clarification

Rapport: Rapport was established with ease

2. Cognitive restructuring for better problem conceptualization

3. Personal goal setting and stress reduction techniques