Review the PSYCHOLOGICAL EVALUTATION of Jessica Smith. Provide a multiaxial diagnosis for the case study. Identify and discuss at least two differential diagnoses for each of the Axis I and Axis II disorders that you gave. Please read below and follow closely.  It seems like a lot but it is actually pretty simple.  Do not hesitate to contact me for questions. Please read the below PSYCHOLOGICAL EVALUATION and see the GRADING RUBIC below it.  The professor will use the grading rubic to grade the assignment.  Basically, figure out what disorders the patient has, i.e., · Bipolar Disorder · Adjustment Disorder · Major Depressive Disorder · Eating Disorder · Acute Stess Disorder · Borderline Personality Disorder BELOW are the DSM AXIS I, II, III,  IV, V.  Using the grading rubic below discuss the rationale why each disorder applies to the patient and each AXIS that goes with each disorder. PLEASE let me know if you have any questions..... I need citations and references in APA format.  Thank you. Psychological Evaluation Confidential: For Professional Use Only Name:                                  Jessica E. Smith Date of Birth:                     7-18-68 Date of Evaluation:          4-12-09 Clinician:                              S. Freud, PhD Reason for Referral Smith was referred for a psychological evaluation by Bart Jackson of the Division of Vocational Rehabilitation to assess her current level of cognitive, behavioral, and emotional functioning and to provide recommendations for vocational service planning. Background History The following background information was obtained from an interview with Smith and a review of the demographic information sheet that she completed before the evaluation. Smith is a forty-one-year-old Caucasian female who was referred for a psychological evaluation by the Division of Vocational Rehabilitation to assist with determining eligibility and to assess whether her emotional problems are interfering with her ability to work.  She initially requested assistance from the Division of Vocational Rehabilitation in October 2008 to assist her with maintaining employment.   At this time, she is interested in learning new skills to enable her to find full-time work in an office setting. Smith was born in Jersey City, New Jersey, and raised in a small nearby town, Williamsport, Pennsylvania.  She is the oldest of three children born to her mother and father following an uncomplicated pregnancy and deliver.  Her younger sisters relied upon her for their after-school child care once their mother returned to work and when she was twelve years old.  She spoke of her mother as having been physically and emotionally abusive in the past, often yelling, hitting her, and pushing her around.  While her mother took her frustration out on Smith, her father would drink alcohol in excess.  To cope with the difficult situation at home, she began to drink alcohol and cut herself with a straight-edged razor.  Smit.

1. Review the PSYCHOLOGICAL EVALUTATION of Jessica
Smith.
Provide a multiaxial diagnosis for the case study.
Identify and discuss at least two differential diagnoses for each
of the Axis I and Axis II disorders that you gave.
Please read below and follow closely. It seems like a lot but it
is actually pretty simple. Do not hesitate to contact me for
questions.
Please read the below PSYCHOLOGICAL EVALUATION and
see the GRADING RUBIC below it. The professor will use the
grading rubic to grade the assignment. Basically, figure out
what disorders the patient has, i.e.,
·
Bipolar Disorder
·
Adjustment Disorder
·
Major Depressive Disorder
·
Eating Disorder
·
Acute Stess Disorder
·
Borderline Personality Disorder

2. BELOW are the DSM AXIS I, II, III, IV, V. Using the grading
rubic below discuss the rationale why each disorder applies to
the patient and each AXIS that goes with each disorder.
PLEASE let me know if you have any questions.....
I need citations and references in APA format. Thank you.
Psychological Evaluation
Confidential: For Professional Use Only
Name: Jessica E. Smith
Date of Birth: 7-18-68
Date of Evaluation: 4-12-09
Clinician: S. Freud, PhD
Reason for Referral
Smith was referred for a psychological evaluation by Bart
Jackson of the Division of Vocational Rehabilitation to assess
her current level of cognitive, behavioral, and emotional
functioning and to provide recommendations for vocational
service planning.
Background History
The following background information was obtained from an
interview with Smith and a review of the demographic
information sheet that she completed before the evaluation.
Smith is a forty-one-year-old Caucasian female who was
referred for a psychological evaluation by the Division of
Vocational Rehabilitation to assist with determining eligibility
and to assess whether her emotional problems are interfering
with her ability to work. She initially requested assistance from

3. the Division of Vocational Rehabilitation in October 2008 to
assist her with maintaining employment. At this time, she is
interested in learning new skills to enable her to find full-time
work in an office setting.
Smith was born in Jersey City, New Jersey, and raised in a
small nearby town, Williamsport,
Pennsylvania. She is the oldest of three children born to her
mother and father following an uncomplicated pregnancy and
deliver. Her younger sisters relied upon her for their after-
school child care once their mother returned to work and when
she was twelve years old. She spoke of her mother as having
been physically and emotionally abusive in the past, often
yelling, hitting her, and pushing her around. While her mother
took her frustration out on Smith, her father would drink
alcohol in excess. To cope with the difficult situation at home,
she began to drink alcohol and cut herself with a straight-edged
razor. Smith was active in school-related activities. She did
not receive special educational services or have significant
behavioral problems in school, describing the classroom as a
safe place where she could be a "kid." Smith graduated from
high school, and began attending a business college in
Allentown, Pennsylvania.
After attending classes for several months, Smith dropped out to
spend more time with her friends and to begin working at
various part-time jobs. She worked as a waitress, in a grocery
store, and as a babysitter. After leaving school, Smith returned
home, where she began spending time with old friends who
drank alcohol and used recreational drugs. By the age of
eighteen, she had begun to starve herself and burn herself with a
lighter. Her second to youngest sister was killed in a car wreck
around this time. To assist her with coping, Smith began to
drink on a regular basis and rely upon crank (crystal meth) to
regulate her mood. She attempted suicide by taking someone
else's prescription medications and slitting her wrists. She was

4. subsequently hospitalized on a psychiatric unit for one week.
After her discharge, Smith did not follow through with
recommendations to follow up with outpatient counseling.
Instead, she resumed her alcohol and drug use as a means of
coping with the emptiness that she was feeling inside. As her
substance use became more problematic, Smith began to
participate in inpatient and outpatient substance abuse
programming. She met with a counselor at the local community
mental health center and was admitted to a residential rehab
program. She remained drug free since leaving the program in
2004; however, she has had difficulty in remaining sober.
Smith has been arrested three times for drinking under the
influence (DUI) and at times, has temporarily lost her driver's
license. In November 2005, she sought mental health services
again to assist her with remaining sober and to address her
underlying history of depression. She continued to attend
outpatient counseling on a sporadic basis until August 2006
when she recognized that her depressed mood rendered her
incapacitated. Thus, she began attending two individual
psychotherapy sessions per week, biweekly psychiatric
consultations, and participating in weekly home-based case
management services.
Smith identifies her eight-year-old daughter and her boyfriend
as her supports and sources of motivation to remain sober. She
describes having had a series of physically and emotionally
abusive relationships with men in the past, which have affected
her mood and ability to cope with difficult situations. Smith
has often become depressed and had thoughts of suicide after a
relationship ended. She acknowledges turning to alcohol or
isolating herself when she feels overwhelmed. She initially
moved to Jersey City two years ago to get away from the people
whom she described as "bad influences." She has worked part-
time at a local grocery store and participated in the vocational
rehab program to assist her with returning to work. Despite
their interventions, Smith has failed to maintain employment for

5. longer than six months. She has also described herself as
having difficulty maintaining friendships and trusting others.
Smith currently lives in New Jersey with her daughter. She is
unemployed and receives food stamps and Medicaid.
Behavioral Observations
Smith is a Caucasian female of average build who appeared to
be her stated age. She was dressed casually and her grooming
and hygiene were adequate. She wore small, round-framed
glasses, with her short-brown hair pushed back behind her ears.
She maintained good eye contact with the examiner often
pushing her glasses up on her nose or placing her hair behind
her ears as she spoke of something that made her feel
uncomfortable. Smith was cooperative during the evaluation,
appearing motivated to answer all questions posed to her in an
honest and forthright manner. She seemed alert and well rested,
relating appropriately to the examiner. Smith often apologized
for not knowing an answer to a test item or stated that she could
not do something that she perceived as difficult.
Tests Administered
·
Wechsler Adult Intelligence Scale (WAIS-III)
·
Wide Range Achievement Test (WRAT-3)
·
Minnesota Multiphasic Personality Inventory (MMPI-2)
·
Bender Visual-Motor Gestalt Test
·

6. Clinical Interview
Mental Status Examination Results
Smith reports an extensive history of mental health treatment,
having received inpatient and outpatient treatment for
depression and substance abuse. She has been prescribed
Prozac, Paxil, Remeron, Klonopin, Xanax, Valium, and Librium
to assist with managing her depressive symptomology and
difficulties with controlling her anxiety and physical withdrawal
from alcohol and methadone. Smith's attitude toward this
evaluation seemed quite positive as evidenced by her interest in
participating in the evaluation and self-report. She appeared to
answer all questions honestly and did not appear to be irritated
with the evaluation process. Her responses were spontaneous
and she needed minimal redirection to respond to the questions
that were asked of her. Smith was oriented to person, place,
and time and denied having experienced auditory or visual
hallucinations. She denied current thoughts of suicide;
however, she acknowledged having attempted suicide as a teen.
She reportedly used a razor blade to slash her arms, hit herself
with a hammer in the face, took someone else's prescription
medication, and burned her arms with a lighter after fighting
with her mother, breaking up with a boyfriend, feeling rejected,
and losing her younger sister. She reported having had a couple
of mutually fulfilling relationships in the past, although she
indicated that she had difficulty getting along with people. Her
remote and recent memory showed no signs of impairment;
however, her ability to make realistic life decisions was
marred. Medical history is significant for a back injury that
occurred following a car wreck (1984) and removal of her gall
bladder (1996). Since the car wreck, Smith has experienced
lower back pain when lifting heavy weights or moving in an
awkward fashion.

7. Assessment Results and Interpretations
Intellectual Functioning
The WAIS-III was administered to obtain an estimate of Smith's
current level of cognitive functioning. The results from this
evaluation suggest that Smith is functioning within the Low
Average range of cognitive functioning with no significant
difference evident between her verbal and nonverbal reasoning
abilities. Overall, Smith demonstrated abilities ranging from
the Low Average to Average range with relative strengths in her
word knowledge, categorical thinking, and ability to distinguish
essential from nonessential details with a relative weakness in
her abstract reasoning skills.
Smith's WRAT-3 performance showed high school level
reading, eighth grade level spelling, and fifth grade level
arithmetic skills. She achieved a Low Average range standard
score on the reading and spelling subtests with a Borderline
range standard score on the arithmetic subtest. She reported
having had difficulty with arithmetic in school and often
becoming anxious to complete her assignments or finish test
items. Thus this score is likely an underestimate of her current
level of functioning. Results suggest that her fundamental
academic functioning is below average; however, due to the
lack of discrepancy between her achievement and intelligence
test scores, the presence of a learning disorder was not
evidenced.
Visual Processing and Visual Motor Integration
Smith's ability to reproduce or copy designs was assessed on an
instrument involving visual motor integration and fine motor
coordination. She appeared to accurately see the stimulus
figures and understand what she saw; however, she had
difficulty translating her perceptions into coordinated motor

8. action. She completed the Bender-Gestalt test in two minutes,
forty-two seconds and incurred four errors of distortion and
rotation. A short completion time such as this is often
associated with impulsiveness and limited concentration.
Personality Assessment Results
The MMPI-2 was administered to assess Smith's personal
attitudes, beliefs, and experiences. Smith's MMPI-2 profile
suggests she acknowledges that she is experiencing a number of
psychological symptoms. She is likely to be experiencing a
great deal of stress and seeking attention for her problems. At
times, Smith becomes across as a confused woman who is
distractible, has memory problems, and may be exhibiting
personality deterioration. Thus, she is in need of intensive
outpatient therapy and psychotropic medication to continue to
address her long-term personality problems. Smith might be
described as an angry woman who is immature, engages in
extremely pleasure-oriented behaviors, and feels alienated. She
is likely to feel insecure in relationships, act impulsively, and
have difficulty developing loving relationships with others. She
often manipulates others (men) and may hedonistically use other
people for her own satisfaction without concern for them. She
has difficulty meeting and interacting with other people, is
uneasy and overcontrolled in social situations, and tends to be
rather introverted.
Smith has a negative self-image and often engages in
unproductive ruminations. She frequently reports having
numerous somatic complaints when she is anxious and feels as
though other people are talking about her. Under stress, her
physical complaints will likely exacerbate. Her insight into her
problems is limited and she often attempts to find solutions that
are simple and concrete. She may prefer to be alone or with a
small group due to feeling alienated from the environment. She
often exhibits poor judgment, emotional liability, and

9. impulsivity. Smith may become upset easily and overreact to
situations. Her profile reflects a chronic pattern of
maladjustment, which may affect her ability to solve problems
and fulfill her obligations. It is likely that Smith has a history
of underachievement in school and in the work force due to her
inability to cope with difficult situations.
PLEASE READ AND FOLLOW THE GRADING RUBIC
BELOW:
GRADING RUBIC:
Assignment Component
Proficient
Max Points
Provide a
multiaxial diagnosis for the case study by addressing each of
the five axes.
Students addressed each of the five diagnostic axes.
/40pts
Discuss the
rationale
for
EACH
diagnoses.
Students discussed clear reasons for their diagnoses based on
the DSM criteria.
/32 pts
Identify a minimum of two differential diagnoses for each Axis
I and Axis II disorder.
Two plausible differential diagnoses were provided for each
Axis I and Axis II disorder.
/40 pts

10. Discuss the reasons for their differential diagnoses.
Students discussed clear reasons for their differential diagnoses
based on the DSM criteria.
/32 pts
Justify why their initial diagnoses are a better fit than the
differential diagnoses.
Students clarified why their actual diagnoses are better suited
for the person in the vignette than any of the differential
diagnoses.
/40 pts
Write in a clear, concise, and organized manner; demonstrates
ethical scholarship in accurate representation and attribution of
sources (i.e., APA); and displays accurate spelling, grammar,
and punctuation.
Wrote in a clear, concise, and organized manner; demonstrated
ethical scholarship in accurate representation and attribution of
sources; and displayed accurate spelling, grammar, and
punctuation.
/16 pts
Total
/200 pts
BELOW IS FOR INFORMATION PURPOSE (AXIS I - IV)
Multiaxial Assessment
With the intent of capturing a good deal of the complexity of
psychological problems, the DSM focuses simultaneously on
several dimensions. This effort is referred to as multiaxial
assessment. Simply stated, an axis is a dimension to be
considered in assessment. Recent versions of the Diagnostic and
Statistical Manual of Mental Disorders developed by the
American Psychiatric Association (see DSM-IV, 1994) include a

11. focus on five dimensions -- thus the term multiaxial. The five
are:
Axis I
Clinical Disorders
-- the focus is on assessing symptoms to identify whether
criteria are met for assigning one of the psychiatric disorders
(or other conditions that may be the focus of clinical attention)
identified in the DSM-IV classification scheme.
Axis II
Personality Disorders Mental Retardation
-- the focus is on facets of an individual's persona or
intellectual ability that are likely to be resistant to change.
Axis III
General Medical Conditions
-- the focus is on any medical conditions that may be
contributing to psychological problems or may be a factor in
intervention.
Axis IV
Psychosocial and Environmental Problems
-- the focus is on specific contextual factors that have relevance
for conclusions about differential diagnosis, treatment, and
prognosis
Axis V
Global Assessment of Functioning
-- the focus is on how well the individual is presently
functioning.
For the four axes (I-IV) that focus on specific areas, the DSM-
IV classification scheme provides a range of possible categories
and delineates relevant criteria. The categories are:
Axis I
-Disorders usually first diagnosed in infancy, childhood, or
adolescence (excluding Mental Retardation, which is diagnosed
on Axis II)
-Delirium, dementia, and amnestic and other cognitive
disorders
-Mental disorders due to a general medical condition

12. -Substance-related disorders Schizophrenia and other
psychotic disorders
-Mood disorders
-Anxiety disorders
-Somatoform disorders
-Factitious disorders
-Dissociative disorders
-Sexual and gender identity disorders
-Eating disorders
-Sleep disorders
-Impulse-control disorders not elsewhere classified
-Adjustment disorders
-Other condtions that may be a focus of clinical attention
Axis II
- Paranoid personality disorders
-Schizoid personality disorders
-Schizotypal personality disorders
-Antisocial personality disorders
-Borderline personality disorders
-Histrionic personality disorders
-Narcissistic personality disorders
-Avoidant personality disorders
-Dependent personality disorders
-Obsessive-compulsive personality disorders
-Personality disorder not otherwise specified
-Mental retardation
Axis III
-Infectious and parasitic diseases
-Neoplasms
-Endocrine, nutritional, and metabolic diseases and immunity
disorders
-Diseases of the blood and blood-forming organs
-Diseases of the nervous system and sense organs

13. -Diseases of the circulatory system
-Diseases of the respiratory system
-Diseases of the digestive system
-Diseases of the genitourinary system
-Complications of pregnancy, childbirth, and the puerperium
-Diseases of the skin and subcutaneous tissue
-Diseases of the musculoskeletal system and connective tissue
-Congenital anomalies
-Certain conditions originating in the perinatal period
-Symptoms, signs, and ill-defined conditions
-Injury and poisoning
Axis IV
-Problems with primary support group
-Problems related to the social environment
-Educational problems
-Occupational problems
-Housing problems
-Economic problems
-Problems with access to health care services
-Problems related to interaction with the legal system/crime
-Other psychosocial and environmental problems
With respect to
Axis V
(Global Assessment of Functioning), the point is to clarify the
level of coping ability/adaptive functioning. The assessor rates
the individual on a scale of 1 to 100.
91-100 = superior functioning, no symptoms
81-90 = good functioning, minimal symptoms
71-80 = a few transient and commonplace symptoms
61-70 = mild symptoms but functioning pretty well
51-60 = moderate symptoms and functional problems
41-50 = serious symptoms and impairment in functioning

14. 31-40 = some impairment in reality testing or major
impairment in several functional areas
21-30 = delusions or hallucinations or serious impairment in
judgment or inability to function
11-20 = some danger of hurting self or others or occasional
failure to maintain hygiene
1-10 = persistent danger of severely hurting self or others or
inability to maintain hygiene