CASE PREENTATION casessssssssssssssssssss.pptx

Presented by:
Ms. Rani Chandran
M.Phil. Clinical Psychology Trainee (Part I)
AICP, AUR
Amity University Rajasthan
Kant Kalwar, NH11-C, RIICO Industrial Area,
Jaipur, Rajasthan (303002)
Amity Institute of Clinical Psychology (AICP)
Case Presentation

OVERVIEW
• Case History
• Mental Status Examination
• Case Summary
• Diagnostic Formulation
• Diagnosis
• Assessment plan and rationale
• Assessment Summary
• Case Conceptualisation
• Clinical Impression

Name : GY
Sex: Male
Age : 21
Education- BA. LLB 3dh year
College – Private University , Jaipur
Occupation : Student
Marital status : Unmarried
Religion : Hindu
Language – Hindi and English
Domicile - Urban
Address – Narnaul , Haryana
SES : Upper Middle class (II)
Date and time – 22nd
April 2024 , 4 PM
Reason for referral – Self- Referred
Informant – Self
SOCIO-DEMOGRAPHIC DATA

Reliability and adequacy
HEADINGS RELIABILITY ADEQUACY
IDENTIFICATION DATA Reliable Adequate for the purpose of diagnosis
CHIEF COMPLAINTS Reliable (complaints clearly
described)
Adequate for the purpose of diagnosis
HISTORY OF PAST ILLNESS Reliable – coherent and
consistent ,corroborated by Projective
test
Adequate for the purpose of diagnosis
PAST HISTORY AND
TREATMENT HISTORY
Reliable Adequate for the purpose of diagnosis
FAMILY HISTORY Not reliable- collateral history is
needed
Not adequate – collateral history
from family is needed
PERSONAL HISTORY Partially reliable Adequate for the purpose of diagnosis
PRE-MORBID PERSONALITY Not reliable Adequate for the purpose of diagnosis

 Overthinking, doubts and confusion regarding hookup culture
 Always wants things to be perfect 3 years
 Interpersonal conflicts with friends
 Feeling of loneliness
 Inner conflicts between increased sexual urges and high moral standards 1 year
Associated Disturbances
Sleep - Decreased
Social functioning - Patient social functioning is impaired with characterized by marked social withdrawal and
avoidance of peer interaction

Duration of illness : 3 Years
Onset of illness : Insidious
Course of illness : Continuous
Progress : Deteriorating
FACTORS OF ILLNESS
Precipitating Factors: Exposure to hookup culture in college led to confusion and conflict with his personal values
Perpetuating factor: Rigid standards , beliefs and values and extremes in perception
Predisposing factor: Success driven upbringing , Frequent criticism at home and personality marked by heightened
self-focus, sensitivity to criticism, and a strong desire for admiration and recognition
HISTORY OF PRESENT ILLNESS

The index patient was functioning well until 2022 when he enrolled in a BA LLB course and began attending
college regularly. It was during this time that he encountered the prevailing culture of casual dating and
hookups among his peers. This experience challenged his long-held, idealistic views of love ,where he
believed in a lifelong commitment with one partner. Discovering that many around him engaged in physical
relationships without emotional connection caused him significant emotional distress. He began to question
and doubt his own beliefs, feeling increasingly out of place among his classmates due to this difference in
mindset.
Over time, he started overthinking the situation as he felt pressure to adapt to the casual dating culture in order
to fit in and survive socially. These conflicting thoughts led to intense inner turmoil and emotional discomfort.
In an attempt to find peace, he turned to spiritual practices and rituals more, hoping to calm his mind and
emotions.
During this period, three girls from his class approached him, but he rejected all of them. He felt their
intentions were not aligned with his values, and he was also focused on building his career. Additionally, he
became increasingly determined to start earning as soon as possible, believing that early financial success
would help him stand out from others in his class and gain the recognition he desired. During the first
semester, the patient exhibited excessive detail orientation and rigidity, particularly in academics. He was
highly meticulous in completing projects and assignments, often double-checking, rewriting, and reviewing
his work repeatedly out of fear of making mistakes.
NARRATIVE ACCOUNT OF INCIDENT

He reported a strong preoccupation with doing things the 'right' way and feared that any error would damage
his reputation or draw negative judgment from others. Even minor deviations would cause him distress His
academic performance was outstanding ,he consistently ranked first in class, which made him the center of
attention. His dedication and leadership earned him the position of class representative. He was admired by
many for his discipline and intelligence, and he enjoyed the status this brought him.
However, his highly competitive nature and rigid approach to academics began to create friction with his
classmates. He followed a strict personal routine from his bathing schedule to sleep times, down to the way
he stood during presentations or classroom discussions. He adhered to rules and regulations with great
intensity, often correcting others or insisting they follow procedures exactly as prescribed. His punctuality
was rigid, and he expected the same level of discipline from classmates. When involved in group
assignments, he was controlling and inflexible, wanting others to work according to his standards, which
often created tension
He often stood against the majority and dismissed their opinions, believing that their thoughts were not
worth his time and he believed what he is doing is right. He also felt that his peers were envious of his
discipline, achievements, and leadership .This attitude caused his peers to distance themselves from him,
eventually leading to social isolation and loneliness.

By the second semester, he began to feel the effects of this loneliness deeply. He was no longer the center of
attention and admiration, which affected him emotionally. He withdrew from social interactions, stopped initiating
conversations , although many classmates often approached him and showed interest in speaking with him, he
rarely felt inclined to engage with them and didn’t care what others are feeling and started keeping to himself both
in class and in his room. He felt intellectually disconnected from others and believed that no one in his class
matched his level as he considered other people as ‘cheap” as according to him no one was ambitious about their
future and none of them valued money. He felt that his goals, discipline, and level of thinking were far more
advanced than those around him. According to him, no one else in his class had the kind of clarity, purpose, or
potential he possessed , as he believed , he’s way ahead of them and what he’s doing now , his classmates will take
years to even think about. As a result, he started feeling misunderstood and disconnected from others.
During this phase, a girl reached out to him, and they started chatting. He initially appreciated the company due to
his loneliness, but later stopped talking to her as she according to the patient “ dishonored him “ after she accused
him of being self-centered .
By the third semester , in 2023 overwhelmed by everything, he applied for a withdrawal from the course, although
he later took it back as his academic performance began to decline sharply as he struggled to balance studies with
work and also, He often found himself daydreaming for long periods about becoming rich and successful. He also
felt increasingly frustrated by what he perceived as a lack of ambition and competition among his peers which was
a major reason for him to leave the course.

In the fourth semester, in 2024 his behaviour changed again. He began flirting frequently with female
classmates, which led to him being labelled a "womanizer" by some. Although this reputation frustrated him,
he admitted that he found it difficult to control the urge to flirt. Around this time, he developed an interest in
another girl, and their conversations gradually became more sexual in nature.
This was his first such experience, and afterward, he was overwhelmed by feelings of guilt, believing he had
gone against his moral principles. When the girl eventually proposed a relationship, he rejected her, saying
she did not meet his expectations in terms of appearance and personality. Later, in 2025 he acted on his
growing sexual urges and was physically involved with another classmate. However, this too was followed by
guilt, as he believed sex before marriage was wrong. He was unable to continue a physical relationship with
the same girl or anyone else afterward. He gradually distanced himself from her, saying she was judgmental
and not trustworthy.
He reported that his sexual urges have continued to increase, but he now consciously tries to suppress them.
He has chosen not to masturbate, believing that it is spiritually wrong and could negatively affect his future
sexual and physical health.
Lately, he has experienced a persistently low mood, with feelings of loneliness, conflict, and dissatisfaction
dominating his emotional state. He sought psychotherapy with the primary concern of resolving the ongoing
internal battle between his increasing sexual desires and his deeply ingrained moral beliefs and also to explore
more about himself. This conflict, combined with his perfectionism, rigidity, and isolation, has significantly
impaired his emotional well-being and social functioning

No history suggestive of-
• intrusion of insistent and unwelcome thoughts or impulses, perfectionism that interferes with task
completion ,Impulsivity, self harming behaviour, suspiciousness of others, aggression, law-breaking, or
lack of remorse, no excessive need to be taken care of, submissiveness, or fear of separation
• Loss of pleasure, fatigability , hopelessness , pessimistic view of future, acts of suicide , suicidal ideation
or attempt , Feelings of inadequacy, Difficulty making decisions without reassurance
• excessive or uncontrollable worry, apprehension , panic attacks, restlessness, fatigue, muscle tension, or
autonomic symptoms such as palpitations or gastrointestinal discomfort
• fear or specific places, events or people
• marked or excessive fear or anxiety that occurs in one or more social situations
• marked and excessive fear or anxiety about separation from those individuals to the person is attached
NEGATIVE HISTORY

• elevated mood, increased energy, decreased need for sleep, overfamiliarity , increased speech and psychomotor activity
• sexual dysfunction such as reduced sexual desire, erectile difficulties, premature or delayed ejaculation, anorgasmia, or
sexual pain.
• complete or partial loss of the normal integration between memories of the past, awareness of identity, immediate sensations
and control of bodily movements.
• seeing things, or hearing voices not heard or seen by others
• any fixed, firm or unshakable beliefs
• own impulses and feelings being controlled by external agency
• own thoughts being taken away from the mind or being inserted by an external agency or being known to others
• staying in abnormal body postures/ staring for long hours
• repetitive thoughts which causes distress, repetitive behavior
• use of any psychoactive drugs
• brain injury or trauma or any organic brain disease

MEDICAL HISTORY – NIL significant
PAST HSITORY – NIL significant
TREATMENT HISTORY – NIL significant
HISTORY OF PAST ILLNESS & TREATMENT
(PSYCHIATRY & MEDICAL)

The index patient was born out of a non consanguineous marriage and lives in a nuclear family. He is
the youngest of the three siblings , with two older unmarried sisters. His father, aged 46, is by
profession junior engineer is the functional and nominal head of the family, and his 40-year-old mother
is a homemaker. The patient currently does not share a close emotional bond with any family member.
Although the family environment was outwardly cordial, the patient experienced it as emotionally
distant and critical. He reports that parenting was marked by high expectations and a strong emphasis on
achievement, with limited emotional validation. Feedback from parents was often harsh and focused on
performance, and any failures were met with critical or doubting remarks. He recalls being frequently
compared to his sisters, whose successes were highlighted while his own capabilities were questioned.
This dynamic led to long-standing sibling rivalry and a sense of not being trusted or valued. His sisters
often criticized him during failures, further eroding his self-confidence.
Recent stress in family – Negative
Family history of mental illness and substance abuse -There is a positive family history of substance
use. The patient reports that his paternal uncle consumes alcohol daily, with significant impairment in
occupational and social functioning. The pattern of use and resulting dysfunction is suggestive of
Alcohol Dependence Syndrome

Birth and early development : Type of Birth : The Patient was born out of a full term gestation period
through normal delivery at hospital . Birth cry was present . Normal birth weight ,Complications- Absent ,
No congenital anomalies reported ,Milestones - Attained at appropriate age
Behaviour during childhood: The patient was raised in a nuclear family under the care of both parents. From
early childhood, he was described as shy, quiet, and emotionally reserved, choosing to speak only when
necessary and primarily engaging with individuals he perceived to be on a similar intellectual or mental
level. He was often selective in his social interactions. He reflected a strong sense of order, discipline, and
personal hygiene, with a rigid adherence to daily routines and school schedules. He did not show much
interest in outdoor or physical sports, instead gravitating toward indoor activities that involved mental
stimulation, such as brain-teasing games, puzzles, or logic-based challenges. In terms of family
relationships, he did not share a close bond with his two sisters, largely due to frequent comparisons made
by the parents, which fostered feelings of competition, resentment, and emotional distance. His relationship
with his father was marked by respect but emotional distance. He struggled to relate to his father, who he
perceived as emotionally unavailable and lacking in recognition or praise for his efforts
Physical illness during childhood: Positive, patient had digestive issues and frequent vomiting till 12th
grade
PERSONAL HISTORY

Home atmosphere during childhood: The patient grew up in a highly competitive and judgmental home
environment, where parenting was characterized by strict expectations, critical feedback, and performance-based
validation. From an early age, he was subjected to harsh criticism from his parents, who frequently questioned his
capabilities and emphasized achievement as a primary measure of worth. The household placed a strong focus on
success and discipline, with limited space for emotional expression or validation. He was often compared
unfavorably with his elder sisters, whose accomplishments were highlighted in contrast to his own perceived
shortcomings. Emotional support was minimal, and expressions of vulnerability were either ignored or
discouraged, reinforcing the belief that acceptance had to be earned through excellence
Education: The patient began his formal education at the age of 5 and studied in a private CBSE-affiliated school
until 8th standard. He then completed his 9th to 12th grade from another private CBSE school. He reported being
an average student until the 8th standard, after which his academic performance improved significantly. He scored
77% in his 10th board examinations and 89% in his 12th. The patient expressed a preference for his previous
school, stating that the academic environment there was more competitive and intellectually stimulating. He found
it difficult to adjust to the new school environment, perceiving the students as less career-oriented and the level of
competition and teaching as average. He felt intellectually disconnected from peers in the new setting. Following
12th grade, he opted to pursue BA LLB , not out of intrinsic interest in the subject, but as a means to broaden his
understanding of legal systems, enhance his knowledge base, and gain intellectual credibility. He believed studying
law would increase his status, make him more respected, and provide a foundation for future ambitions in business
and entrepreneurship. Currently he’s pursuing BA. LLB from private university , Jaipur, Rajasthan

Occupation History : The patient is currently a full-time student and has been working part-time in an affiliate
marketing company since March 2024 at the age of 20 years. His role is conducted online, where he directly engages
with clients, managing communications and promotional strategies. He reports being currently satisfied with his work,
finding it intellectually stimulating and aligned with his interests. The experience appears to contribute positively to
his sense of competence and autonomy. Looking ahead, he expresses a strong aspiration to continue in the same field,
with the long-term goal of establishing his own independent marketing venture or company.
Sexual history: The patient reported gaining knowledge about sex at the age of 14 through peers and exposure to
pornographic material. He has not received any formal sex education. Around the same age, he began engaging in
regular masturbation every 2–3 days, which he recently stopped due to spiritual and moral concerns. The patient
reports a strong desire to engage in sexual activity only with someone he deeply loves and intends to marry. He
describes an internalized fantasy of an ideal woman who is “perfect in every way,” emotionally and morally
compatible, and deserving of complete devotion. During his fourth semester of college, he began flirting with multiple
female classmates, which led to him being labeled a "womanizer" by peers. However, when approached by some of
these women with sexual interest, he rejected their advances, stating that they did not match his standards and that
engaging in sex with them would violate his values. Over the past two months, the patient reported a noticeable
increase in sexual urges. One month ago, he engaged in his first sexual intercourse with a female classmate. He
described the experience as physically pleasurable, but it was followed by intense guilt and moral distress. Since then,
he has not engaged in any sexual activity or masturbatory practices. He consciously suppresses his sexual urges,
driven by the belief that such behaviors are spiritually and morally inappropriate and could negatively impact his
mental and physical well-being. He reports experiencing internal conflict related to these concerns
Marital history: NA
Substance use: NIL
Forensic History: NIL

Social relations: The patient maintained a small but select group of friends with whom he was well-regarded
and notably popular. He described himself as someone who generally "got along with everyone," yet his
close associations were limited to individuals he felt intellectually or motivationally aligned with. Though
outwardly sociable, there appeared to be an underlying selectiveness in interpersonal connections, shaped by
his internal standards of ambition and capability. He preferred to engage with people who matched his drive
and perspective on success, and often felt disengaged or disinterested in those he perceived as lacking vision
or intensity. Despite a friendly demeanor, his emotional investment in others was conditional, often filtered
through his own ideals of excellence.
Use of leisure time: He typically engaged in media consumption, especially television and social media,
which he used both for entertainment and, at times, to stay connected with broader trends, aspirational
figures and status-oriented content about how to become rich and start earning at a younger age . His online
interests often centered around content related to success, entrepreneurship, and personal development
Mood: His mood used to be stable but marked by intermittent irritability, frustration, or low mood when faced
with unmet expectations or perceived criticism from family.
PRE-MORBID PERSONALITY

Character: The patient was known to be exceptionally driven, highly focused, and morally upright,
holding himself to strict personal standards. He demonstrated an enduring sense of purpose and
ambition, striving toward significant life goals that centered around achievement, influence, and success.
He held an unwavering belief in the value of structure, order, and consistency, often organizing his day
around carefully planned routines. He had difficulty tolerating inefficiency, unpredictability, or lack of
direction
Attitude towards self and others: He held a positive and confident self-image, often describing himself
as capable and destined for great things. His self-concept was structured around being different from the
average person, particularly in terms of mental drive, goals, and moral values. While generally neutral
toward others, he frequently expressed disappointment in people who lacked ambition, and saw them as
not operating on the same mental or motivational level.
Attitude towards work and responsibility: He approached work with seriousness, dedication, and
perfectionism. He held himself to exacting standards and expected the same from others. He derived a
significant portion of his self-esteem from his work ethic and accomplishments, and would often become
distressed when faced with disorganization, inefficiency, or deviation from expected outcomes. He was
known to over-prepare or over-control his environment to maintain performance and avoid failure. His
sense of identity and worth was strongly tied to competence and productivity.

Reaction pattern to stress: Under stress, the patient exhibited rigid and avoidant coping mechanisms. He
would often become irritable or withdrawn when events diverged from his expectations or when others
failed to meet his standards. He had a low tolerance for ambiguity or perceived failure, and would at
times emotionally disengage or become tearful in high-pressure situations.
Fantasy life: The patient frequently fantasized about becoming a highly successful, admired, and wealthy
figure, with strong identification with public icons known for their influence and accomplishments. He
envisioned a life of financial freedom, respect, and recognition, aspiring to become a widely praised
entrepreneur and self-made figure of admiration. He viewed success as both a personal obligation and
proof of self-worth, and firmly believed that wealth and public recognition were essential to fulfillment.
Habits: The patient’s eating, and excretory function were within normal ranges of functioning. He
maintained a structured and disciplined lifestyle, engaging in daily routines such as morning spiritual
chanting and a regular running regimen. A central part of his morning ritual was a one-hour chanting
session, which he practiced consistently as a form of spiritual alignment and moral grounding .These
activities were performed with consistency and dedication.

GENERAL APPEARANCE AND BEHAVIOUR
Appearance Appeared to be of stated age, normal built, round eyes, fair
complexion
Level of grooming Well kempt and Tidy
Level of cleanliness Adequate
Level of Consciousness Fully conscious and in touch with surroundings
Mode of entry Came willingly
Cooperativeness Normal
Eye to eye contact Eye contact maintained
Rapport Therapeutic alliance was initiated and established with ease

PSYCHOMOTOR ACTVITY – Within normal range
PSYCHOMOTOR ACTIVITY

Initiation Spontaneous
Reaction time Normal
Speed Normal
Intensity Soft (Audible)
Prosody Variation
Quantity Increased productivity
Quality normal volume, relevant and coherent and goal directed
SPEECH

Subjective “ haa sab sahi hi hai”
Objective Dysphoric
Intensity of Affect Within normal range
Range of affect Normal
MOOD

Stream Thought flow was rapid
Form No formal thought disorder was present
Possession No evidence of thought alienation phenomena
and obsessive compulsive phenomena
Content
Thought Sample
“ mere liye successful hona bahut jaroori hai ,
paisa hi sab kuch hota hai, aagr aap successful
nahi ho and paisa nahi hai to fir whats the
purpose of a person to live ,paisa hai to log bhi
aapko puchnege , money decides a persons
worth in todays world “
Impression Preoccupied with themes of success,
recognition
THOUGHT

No abnormalities was elicited ( No hallucinations, illusions and any other perceptual disturbances elicited)
PERCEPTION

Attention and concentration The attention was normally aroused , but not sustained (DF- 6,
DB – 3)
Orientation The patient was oriented to time, place ,person and passage of
time
Memory Impaired Immediate memory , recent and remote memory was
intact
The general fund of knowledge Adequate
Intelligence The index patient’s intelligence was adequate
Abstract ability Concrete level
COGNITION

Personal Impaired
Social Intact
Test Intact
JUDGEMENT

Grade 3 (Awareness of being sick, but it is attributed to external or physical factors.)
INSIGHT

Index patient Mr GY 20 yr old, Male, hindu, unmarried, currently pursuing BA. Llb , belonging to upper middle
socio-economic status (II) of urban area of Haryana, currently residing in Jaipur, rajasthan , presenting with the
complaints of overthinking, doubts and confusion regarding hookup culture, Always wants things to be
perfect ,Interpersonal conflicts with friends ,feeling of loneliness ,inner conflicts between increased libido and
high moral standards . The total duration of illness is 3 years, the onset of illness is insidious, course is continuous
and progress is deteriorating. The precipitating factor getting exposure to hookup culture after coming to college ,
predisposing factors is success driven upbringing , frequent criticism at home and personality marked by
heightened self-focus, sensitivity to criticism, and a strong desire for admiration and recognition and perpetuating
factor is rigid standards , beliefs and values and extremes in perception
The patient is a BA LLB student who was functioning well academically and personally until 2022, when he
entered college and was exposed to a social environment centered around casual dating and hookup culture.
Having held an idealistic and traditional view of love, he found it difficult to reconcile this new reality with his
personal beliefs. This realization caused emotional distress, self-doubt, and a growing sense of disconnection from
his peers. Despite being approached by several female classmates, he rejected them due to his conflicting values
and focus on building a career . He became highly driven by the desire to succeed, maintaining excellent academic
performance and earning the role of class representative. However, his competitive attitude, punctuality, and
disregard for others' opinions led to interpersonal friction and social withdrawal.
CASE SUMMARY

He began to feel lonely and emotionally detached, believing that he was intellectually different from his peers and thus
unable to relate to them. Despite occasional attempts to connect with others, he remained emotionally distant, further
isolating himself. As semesters progressed, the patient began to experience increased sexual urges, which conflicted with
his moral values. He engaged in flirtatious and sexual conversations with one peer, followed by a physical encounter with
another, both of which led to intense guilt and regret. He later distanced himself from these individuals, perceiving them
as judgmental or unworthy. Simultaneously, he stopped engaging in sexual activity and even avoided masturbation,
believing it to be spiritually and physically harmful. These ongoing inner conflicts between his rising sexual impulses,
rigid moral standards, and desire for emotional and intellectual compatibility led to persistent low mood, withdrawal from
social life, and a decline in academic focus. The emotional burden of these unresolved issues eventually led him to seek
psychotherapy.
Family history reveal patient’s family environment has been critical since his childhood and there was high expectation
from his parents and history of family mental illness is positive as his paternal uncle has a pattern of binge drinking
alcohol .
Personal history revealed currently patient is having increased sexual urges which he’s trying to suppress. Pre-morbid
personality is characterized by heightened self-focus, sensitivity to criticism, morally inflexibility and a strong desire for
admiration and recognition
Mental status examination revealed, variations in prosody of speech ,increased productivity ,dysphoric mood, thoughts of
preoccupation with success and recognition, impaired attention and immediate memory , impaired personal judgement
and grade 3 level insight

Index patient Mr GY 20 year old, male, hindu, unmarried, currently pursuing BA. Llb , belongs to upper middle
socio-economic status of urban area of Haryana, presented with an illness of 3 years duration, insidious onset,
continuous course, deteriorating progress, with chief complaints of Overthinking, doubts and confusion regarding
hookup culture ,Always wants things to be perfect ,Interpersonal conflicts with friends ,Feeling of loneliness ,
Inner conflicts between increased libido and high moral standards , precipitating factor is Exposure to hookup
culture in college led to confusion and conflict with his personal values, predisposing factor is Success driven
upbringing , Frequent criticism at home and personality marked by heightened self-focus, sensitivity to criticism,
and a strong desire for admiration and recognition ,perpetuating factor as Rigid standards , beliefs and values and
extremes in perception ,family history suggestive of excessive alcohol consumption in paternal side , personal
history marked by high parental expectation and critical comments and increased sexual urges with a premorbid
personality characterized by inflated self view, moral inflexibility and self righteousness. MSE revealed variation
in prosody of speech, increased in productivity ,dysphoric mood, and preoccupation with thoughts success and
recognition ,impaired attention and immediate memory, impaired personal judgement grade- 3 insight.
DAIGNOSTIC FORMULATION

PROVISIONAL DAIGNOSIS
6D10.1 Moderate personality Disorder
6D11.2 Dissociality
6D11.4 Anankastic
DIFFERENTIAL DAIGNOSIS
6A72 Dysthymic Disorder

ASSESSMENT ADMINITERED
RATIONALE AND FINDINGS

TEST RATIONALE
1. Hamilton Depression rating scale
( Hamilton. , 1960)
To assesses the severity of depression across core,
cognitive, affective, somatic, sleep-related, and anxiety-
related domains to aid in diagnosis and treatment
monitoring
2. Adult Attachment Scale
(Hazan.& Shaver. ,1987)
To assess attachment style in adult interpersonal
relationships, especially in close, emotional relationships
3. Mini Mental status examination
(Folstein, et al., 1975)
Assesses orientation, attention, memory, language, and
visuospatial skills

TEST RATIONALE
4. International Personality Disorder Examination
DSM V
(Loranger .et al. ,1994)
To assess and identify personality disorders and
clinical syndromes
5. Sacks Sentence completion test
(Sacks .,1948)
To assess personality traits, emotional concerns, and
psychological conflicts through sentence completion
6. Thematic Apperception Test
(Murray.,1943)
To assess personality and uncover underlying
motivations, emotions and conflicts
7. Rorschach Ink Blot Test
(Rorschach.,1921)
To assess personality structure and underlying thought
processes, emotional functioning and conflicts

The patient was cooperative throughout the assessment, though the testing process was marked by noticeable deviations
from the topic when presented with certain screening questions. When asked specific queries, the patient tended to
elaborate extensively, often diverging into tangential details unrelated to the primary question. This pattern was recurrent
and suggests a difficulty in maintaining focus or a strong internal preoccupation with emotionally significant material .
At times, the patient appeared emotionally aroused while recounting particular experiences like voice modulation, facial
expressions, and body language reflected distress and engagement. Despite these emotional moments, the patient
demonstrated the ability to eventually return to the original question and provide a relevant response, albeit after
considerable elaboration.
Overall, the patient’s behavior during the assessment reflects an emotionally reactive cognitive style with a tendency
toward over-inclusiveness in thought. These observations are clinically relevant, particularly in understanding the
individual’s emotional regulation, narrative coherence, and processing of personal experiences.
TEST OBSERVATION

Baseline psychological test / Rating scales
TEST SCORE FINDINGS
Hamilton Depression rating
Scale
11 Mild
Adult Attachment scale Close – 15
Anxiety – 19
Demand - 17
Anxious / ambivalent
attachment style
Mini mental Status
examination
Score - 30 No evidence of
cognitive impairment

International Personality disorder examination DSM 5
module
Disorder Number of Criteria Met
Borderline Probable
Histrionic Negative
Anankastic Definite
Narcissistic Definite
Dependent Negative
Screening phase – The patient scored high scores on personality traits on borderline, Histrionic , Anankastic ,
Narcissistic , Dependent personality traits.
Interview Phase –
1. Work: The patient reported a marked preference for working independently and tends to avoid group settings. He
believes others may not perform tasks with the same level of precision or dedication as he does. He expressed strong
dissatisfaction with the idea of delegating responsibilities, as he perceives others as incompetent or lacking his
intellectual and qualitative standards. This reflects a pattern of perfectionism and control,, as well as a self-inflated
view of his abilities.

2. Self: The patient holds an exaggerated sense of self-worth, often considering himself intellectually
superior to those around him. He described others as being “not on his level,” and finds it difficult to
relate to peers whom he deems emotionally or mentally inferior. While outwardly confident, there
were subtle indications of fragility in self-esteem, especially when discussing recent changes in his
social standing. He expressed frustration at not being the center of attention in current settings,
which appears to affect his mood and self-perception.
3. Interpersonal Relationships: The patient maintains limited social interactions and currently does
not have close friends. He described most people as disappointing or unworthy of meaningful
connection, reinforcing his belief in being different or “above” others. He tends to emotionally
distance himself, expressing disinterest in others’ opinions unless they offer admiration or validate
his self-view. However, he also conveyed feelings of being left out and emotionally isolated,
suggesting underlying interpersonal difficulties and possible unmet dependency or relational needs.
4. Affect: While the patient initially appeared emotionally controlled, further exploration revealed
feelings of sadness, social withdrawal, and a sense of alienation. He acknowledged feeling “left out”
and stated that others “don’t understand or match” his level of thinking. These affective shifts seem
linked to disruptions in his need for admiration and affirmation. Despite projecting emotional
detachment, the patient demonstrated subtle signs of emotional vulnerability and dysphoria when
discussing interpersonal rejection or neglect.

Sacks Sentence Completion Test
Cognitive function : The index subject demonstrated average cognitive abilities with coherent sentence construction and a
logical sequence of thought. He was able to comprehend the sentence completion tasks and responded with clarity, although
his responses showed a recurring pattern of self-focus and evaluative thinking with some tendency to become rigid or fixed
in ideas
Self concept – The patients self perception encompasses with guilt feelings, self worth ,past experiences, future
experiences and goals .He experiences significant guilt regarding the time he wasted on non productive activities and to not
to do things perfectly during his childhood . Regarding the self worth ,the patient reflects confident In his own ability and it
appears to revolve around a strong internal need to maintain an idealized version of himself. Reflecting on the past, Patient
wish to be more productive in his childhood the way he is now . He often reflects on his past, particularly moments where
he felt accomplished and appreciated such as the Annual Day event where he was praised for his performance which serve
as anchors to his sense of self-worth. Looking toward the future, GY consistently expresses a strong wish to become rich,
indicating that financial success is central to his ideal self-image. His repeated mention of this goal across various responses
suggests that material success is not only a personal aspiration but also tightly linked to how he measures self-worth and
societal validation. His future aspirations center around personal excellence and achieving respect and admiration

Adjustment to environment and coping -. GY’s interpersonal style is marked by emotional distancing and
selective engagement, shaped by a rigid internal hierarchy of worthiness. This is particularly evident in his
attitude toward women, where he demonstrates a clear idealization-devaluation dynamic .He idealize this
perfect partner in theory but struggle with real relationships. Because of his black-and-white thinking, many
women may be devalued if they don’t meet these high, sometimes unrealistic, standards. Hence, women who
assert their own needs, independence, or fail to offer continuous admiration may be viewed negatively (e.g.,
labeled as “gold diggers” or unworthy). There is also an emerging theme of feeling disconnected or
underappreciated, which contributes to his discontent in current social or professional settings. he experiences
difficulty adjusting to environments that require collaboration, compromise, or reliance on others. He displays
a preference for solitary functioning, largely because of a perceived inefficiency or inferiority of others. His
coping mechanism includes rationalization, reaction formation ,projection ,splitting and isolation
Emotionality : The patient exhibits moderate emotional suppression. While his responses lack overt emotional
expression, there are subtle signs of sadness, alienation, and inner dissatisfaction. His emotionality is shaped
by a chronic sense of not being understood or acknowledged by others. Although he appears composed
externally, there is evidence of internal conflict and emotional arousal, particularly in situations where his
competence or authority is questioned. Emotional regulation is maintained through intellectualization and
avoidance, rather than open expression or seeking emotional support. He may find it difficult to acknowledge
vulnerability, resulting in feelings of being emotionally distanced or isolated.

Interpersonal relations : GY interpersonal functioning reveals patterns of emotional distancing, control, and
mistrust ,especially in familial and peer relationships. His responses indicate a strained relationship with his father,
characterized by feelings of inadequacy and critical judgment. He believes his father thinks he "can’t do anything in
life," which may contribute to an inner narrative of having to constantly prove his worth. His inability to complete a
sentence about his father further suggests emotional avoidance or unresolved conflict in this domain. His mother,
while more emotionally attuned, is described as being worried about his career reinforcing a subtle but persistent
pressure to succeed and perform. In peer relationships, GY desires admiration and emotional availability from
acquaintances, expecting them to be open-hearted and to listen attentively to him. This reflects a need to be seen as
influential, dominant, or "the boss" in social settings. There’s a strong underlying expectation that others align with
his views and respect his perceived superiority. This social posture limits the possibility of genuine reciprocity or
mutual emotional connection. His idealization of powerful industrialists like Tata and Ambani further reflects his
deep internalization of success, status, and dominance as core relational values. It’s likely that his admiration for
such figures is less about shared humanity and more about aspiring toward the image they represent - control, power,
and societal reverence.

THEMATIC APPERCEPTION TEST
Formal analysis
GY TAT stories are framed around familial and interpersonal themes, suggesting a relational orientation. The
narratives show a tendency to externalize issues and situate them in domestic or marital contexts, particularly
involving conflict, emotional distance, and the desire for affection and understanding. His perception and
expression appear moderately structured, though often clouded by grammatical errors and fragmented
thoughts, indicating cognitive interference likely due to emotional tension or poor verbal organization. The
language used reflects a moderate level of abstraction and some impairment in logical continuity. His
narrative structure also reflects a degree of self-focus and inflated self view, such as a need for validation and
difficulty in acknowledging personal faults.
Thematic Analysis and Interpersonal Relations:
The themes across GY’ s stories prominently involve struggles within family systems—mother-child conflicts,
marital issues, sibling relationships, and misunderstandings among neighbors. His protagonists often seek
peace, emotional connection, and validation but are met with denial, arguments, and restrictions. There is a
recurrent pattern of emotional neglect. There is a discernible self-referential pattern in the narratives, where
the protagonist often assumes a morally justified or misunderstood role

These interpersonal interactions reflect a high need for nurturance and affiliation but are complicated by underlying
frustrations, rejections, and defensive behaviors. There is a noticeable pattern of the protagonist assuming a morally
superior or victimized stance, reflective of interpersonal functioning where self-image preservation overrides mutual
understanding.
Content analysis
GY narratives are mostly realistic with occasional idealistic elements. He identifies with both male and female protagonists
depending on the story context. The content remains focused on everyday experiences such as school issues, family
restrictions, marital dynamics, and community gossip. These suggest a grounded, emotionally laden worldview with limited
fantasy or escapist elements, indicating a predominantly reality-bound cognitive style, possibly driven by past traumas or
emotionally significant lived experiences. However, the central characters often assume roles where they are morally
justified or victimized by the ignorance or cruelty of others, which may reflect tendencies such as self-righteousness and
difficulty with emotional reciprocity.
Analysis of Need and Press
The dominant needs reflected in GY stories include affiliation, succorance, autonomy, and aggression. Affiliation and
nurturance are expressed through recurring themes of desiring familial closeness and emotional bonding. Autonomy needs
are evident in children or individuals striving for independence or to break away from restrictive environments. Aggressive
elements are mostly passive or verbal, with some signs of rebellion and frustration (e.g., disrespecting mother or quarreling)

Achievement and dominance needs are less pronounced but appear subtly in the form of restoring peace or
asserting oneself. Environmental presses consistently include Rejection, Dominance Abasement and
Deference .These suggest that GY often perceives the world as critical, invalidating, or overly controlling.
Parental figures are often seen as obstructive, overly evaluative, or emotionally unavailable The narratives
often emphasize the protagonist’s emotional needs being misunderstood, which reflects traits such as
entitlement and a hypersensitivity to perceived slights or rejections.
Significant Conflicts and Defence:
The most significant conflicts Autonomy vs. Rejection Affiliation vs. Rejection and Acquisition vs.
Intraggression He desires closeness and validation from others, yet anticipates rejection or emotional
disappointment when this closeness is attempted. This results in emotional ambivalence. Defensively, GY
employs projection (blaming external others), rationalization (explaining misbehavior), and reaction
formation (showing affection despite anger). Isolation is seen in moments where the character passively
accepts fate or isolates emotionally. Defenses such as splitting (idealization and devaluation of others) are
also observed characters are often polarized as entirely good or bad, with little nuance, reflecting black-and-
white thinking.

Ego Structure and Adjustment:
His ego structure appears to be moderately developed with notable weaknesses in affect regulation and
reality testing under stress. His capacity to process interpersonal experiences is limited by emotional
sensitivity and a need to maintain self-esteem, often at the cost of realistic appraisal. His defenses are
relatively immature, with tendencies toward denial, projection, and splitting. Adjustment is marked by
instability in relationships, inconsistent self-view, and difficulty integrating conflicting emotional
experiences. While he shows insight into his emotional world, the adaptive use of this insight seems
compromised by persistent self-referential thinking.
Feelings and Emotional Patterns:
The emotional landscape in GY stories is turbulent yet managed with external composure. Recurrent
emotional states include Guilt Inferiority , Ambition , Jealousy ,Anger ,and a striving for
Independence. .While many stories suggest emotional struggle, the affective tone is often
subdued ,indicating internal regulation rather than free emotional expression. GY seems to experience
emotional pain in response to perceived failures, loss of control, or rejection, but expresses these feelings
obliquely or through alternative emotional channels like competitiveness or idealized ambition. These
suggest emotional containment and selective disclosure, rather than openness.

Basic Personality Traits:
GY’s personality profile is marked by heightened emotionality, impulsivity, intraceptive orientation, and moderate
deliberation. He shows an emotionally sensitive disposition and tends to process conflict internally, often ruminating or
anticipating relational disappointments. He shows average endurance and intraceptive tendencies ,he tries to understand
internal motives but is overwhelmed by emotion. His creativity is moderate but often entangled in real-life conflicts. He
seems somewhat anxiety-ridden, with traits of endocathection (internal focus on emotions and memories) and low
deliberation. There is a noticeable struggle between idealized desires and harsh realities, pointing to inner conflict. Traits
such as self-enhancement, emotional vulnerability, externalization of blame, and a tendency to idealize self while devaluing
others are also evident
Interpretation and Recommendations:
The TAT findings for GY indicate deep-rooted interpersonal conflicts, emotional vulnerability, and a fragile self-concept
marked by a recurrent theme of rejection, emotional neglect, and unmet needs for validation. His narratives consistently
reflect a morally superior or victimized stance, suggesting defensive grandiosity and difficulty acknowledging personal
flaws. Defenses such as projection, rationalization, and splitting are prominent, along with impaired emotional regulation
and a heightened sensitivity to interpersonal stress. There is also evidence of cognitive disorganization under emotional
strain and a strong need for nurturance, autonomy, and affiliation. Therapeutically, GY would benefit from long-term
psychodynamic or schema-based therapy to address identity instability, maladaptive relational patterns, and emotional
regulation. Interventions should focus on improving self-awareness, developing interpersonal effectiveness, and building a
more stable, realistic self-concept while also addressing depressive features and perfectionistic tendencies.

Domains Findings
Needs Predominant needs were Affiliation (Cards 2, 3, 6, 7, 9, 10), Succorance (Cards 2, 3, 5, 9, 10), and
Autonomy (Cards 3, 4, 7, 8, 9, 10). These reflect a simultaneous desire for emotional closeness,
dependency, and freedom.
Press Major environmental pressures were Rejection (Cards 2, 4, 5, 6, 7, 9, 10), Dominance (Cards 3, 4,
7, 8, 10), Abasement (Cards 2, 5, 9), and Deference (Cards 3, 6, 8). These indicate frequent
perceived threat from authority or emotionally withholding figures.
Significant Conflicts Recurring internal conflicts included Autonomy vs. Rejection (Cards 3, 4, 7, 8), Affiliation vs.
Rejection (Cards 2, 6, 9), and Acquisition vs. Intraggression (Cards 5, 10). Suggests tension
between asserting independence and fear of emotional loss or failure.
Defense Mechanisms Frequently used defenses were Reaction Formation (Cards 2, 6, 7, 9), Projection (Cards 2, 3, 6, 7),
Rationalization (Cards 2, 7, 10), and Isolation (Cards 5, 9, 10), Splitting (Cards 1,3,5,6,10 ).
Indicates a pattern of emotional suppression, denial, and externalization of inner conflicts.
Emotions/Feelings Commonly experienced emotions were Guilt (Cards 2, 6, 10), Inferiority (Cards 2, 3, 5, 9),
Ambition (Cards 3, 6, 8, 10), Jealousy (Cards 2, 6), Anger (Cards 4, 5, 9), and Independence
(Cards 4, 7, 8, 10). Reflects emotional turbulence and striving despite insecurity.
Interpersonal Relations Characterized by non-cordial and rebellious attitudes toward both parents (Cards 2, 3, 4, 5). Other
relations showed emotional tension, dependency, or conflict in romantic/familial roles (Cards 6, 7,
9, 10). Attachment figures are often ambivalent or disappointing.
Personality Traits Personality appears marked by high emotionality, impulsivity, intraception, and deliberation. These
traits point toward emotional sensitivity, internal conflict processing, and efforts at thoughtful
control, though often overridden by emotional drives.

RORSCHACH PROFILING
Rorschach Variable Observed Pattern Clinical Interpretation
Lambda (λ) Low Openness to emotional input, reduced defensive structure, emotional
flooding under stress.
Adj es High Heightened emotional reactivity and stimulation; increased affective
complexity and hypersensitivity.
D / Adj D Negative Poor stress tolerance, chronic overload, difficulty modulating
internal experience under pressure.
FM > 5 Elevated peripheral ideation Increased ideational activity driven by unmet needs; difficulty
concentrating.
SumC > 2 Excessive emotional internalization Suppressed affect leading to discomfort (anxiety, sadness, tension).
SumT > 1 Emotional deprivation Chronic unmet relational needs; long-standing loneliness.
EB: Extratensive + EBPer > 2.5 Emotion-dominant style Overreliance on feelings; impulsive, trial-and-error decisions.
Color-shading blends (C+Y) Emotional confusion Difficulty modulating affect under stress; emotional disorganization.
CF+C > FC; Pure C > 1 Affective immaturity Intense, impulsive emotional expression; poor affect control.
W:M ratio = 4:1 High ambition with low capacity Overreaching efforts; vulnerability to failure; performance strain.

Zd > +3.0 Overincorporation Perfectionistic scanning; inefficient processing due to overanalyses.
DQv + FQ– (Form Quality
Minus)
Poor reality testing Impaired judgment; perceptual distortions under stress.
XA% > .90; WDA% ≥ XA% Precise mediation Perfectionistic style; obsessive concern for accuracy.
X+% .55–.69; Xu% ≥ .20 Deviation from norm Social detachment, possible alienation or conflict with environment.
OBS Positive Perfectionistic traits Concern with correctness and control; driven by insecurity.
Fr or rF Present + Hx + AB Narcissistic traits Inflated self-focus with internal conflict and distorted self-view.
Egocentricity Index – High Elevated self-focus Self-centered, possible limited empathy, unstable self-image.
MOR Elevated Negative or damaged self-concept; internalized trauma; pessimistic
thinking.
CDI = 4–5 Immature social functioning Poor social insight, relational confusion, interpersonal ineffectiveness.
T > 1 Strong need for intimacy Unfulfilled need for closeness; chronic emotional loneliness.
Low Human Content (H) Social withdrawal Detachment from others; diminished interest in social world.
COP ≥ 3 and AG > 2 Interpersonal conflict Relational ambivalence; confusion about interpersonal roles.
Rorschach Variable Observed Pattern Clinical Interpretation
Isolation Index 26–32 Limited social participation Reduced interaction; preference for isolation or emotional distance.

RORSCHACH INK BLOT TEST
Stress Tolerance and Control
The profile indicates a chronically low capacity to manage internal and external stress effectively. The individual appears highly
susceptible to emotional and cognitive disorganization under pressure. While some achievements in academic or occupational
domains are evident, they seem to coexist with underlying instability and disordered internal functioning. Intrusive ideation,
suggestive of ungratified needs, interferes with concentration and leads to a scattered or distracted cognitive style. There is
evidence of internalized affective strain, marked by emotional constriction and possibly somatic discomfort. The chronic
nature of this deprivation suggests long-standing interpersonal deficits rather than recent losses. Emotional needs appear to
surpass normative expectations, indicating a pervasive sense of aloneness and unmet closeness. Moreover, the presence of
color-shading blends involving Y (diffuse shading) but no C, T, or V blends implies emotional confusion exacerbated by a
lack of clarity in affective experience. This confusion, combined with the negatively skewed D score, intensifies the risk of
impulsive responses and psychological disorganization during stress. Despite a slight indication of increased psychological
complexity, the emotional turmoil under stress appears to disrupt the internal equilibrium and results in reduced functioning.
Situationally Related Stress
The patient's current experience of stress is profound and significantly impacts cognitive and behavioral domains. There is
strong evidence of disrupted attention and a subjective sense of helplessness. Under stress, their psychological operations are
easily destabilized, leading to inconsistency in functioning

The presence of stress-related ideational confusion is further supported by signs of attentional shifts and intrusive mental
content. Emotional confusion under stress increases the potential for maladaptive and impulsive behaviors, particularly
when attempts at regulation fail. Although there is some psychological complexity, it appears insufficient to buffer the
overwhelming impact of situational stress. The presence of emotional ambiguity in the absence of well-formed
modulation strategies suggests that coping efforts are overwhelmed. This renders the individual more vulnerable to
impulsive reactions and maladaptive decision-making in demanding environments.
Affect
A pervasive emotional style characterizes this individual’s psychological functioning. The extratensive coping style,
driven by emotion over logic, results in trial-and-error decision-making and impulsive behavior. Emotional input
dominates their approach to problem-solving, often to the detriment of reflective judgment. Emotional displays are
unmodulated, open, and sometimes intense, reflecting poor affective control. High internalization of affect results in
irritability, mood lability, and chronic emotional discomfort such as tension, anxiety, or sadness. There is a tendency to
intellectualize emotions to manage their intensity, which reduces emotional awareness but does not resolve underlying
conflicts. While this process may help regulate overt expression, it sacrifices genuine insight and emotional
integration. The person demonstrates a decreased willingness to engage with emotional stimuli and prefers to
disengage from affectively complex situations. This avoidance reflects a defensive stance and could signal deeper fears
of emotional vulnerability. Blends involving shading suggest very painful and intense emotions that exert a pervasive
impact on cognition and interpersonal perception

Emotional torment distorts judgment and erodes attention and concentration. This depth of affective disturbance
likely drives much of the impulsive or erratic behavior. The presence of color-dominant responses with minimal
form control points to affective exuberance and immaturity. Although not overtly primitive, emotional reactions
are often poorly modulated and infused with confusion.
Information Processing
Cognitive processing is notably effortful and detailed. There is a preference for highly specific, sometimes obscure
details over global perception, leading to a fragmented and inefficient processing style. This obsessive-like focus
on minutiae can delay decision-making and diminish overall cognitive flexibility. The individual demonstrates
over-incorporative tendencies—scanning stimuli excessively and often inefficiently in a bid to avoid errors.
Despite the impressive effort invested, their cognitive economy is questionable, especially under complexity. They
may vacillate or become fixated when expected outcomes are not clear. Their high need for cognitive control,
driven by underlying insecurity, leads to thorough yet often overcautious engagement with stimuli. The W:M ratio
indicates overachievement tendencies which may drive them to attempt more than they can reasonably manage,
increasing the likelihood of failure or burnout. Form quality analysis suggests that under strain, processing quality
declines. When internal conflict or ambiguity arises, the person may abandon previously constructed frameworks,
resulting in disorganized cognitive products. There is also a preference to avoid complexity when possible, which
might lead to the premature closure of cognitive tasks. Despite these difficulties, their dominant cognitive mode is
logical and deliberate—although strained by internal pressure and perfectionism

Cognitive Mediation
The person exhibits a meticulous and cautious style of mediation, characterized by an emphasis on precision and
correctness. This orientation, consistent with an obsessive personality configuration, manifests as a need to perceive and
respond to the world in a highly structured and accurate manner. There is a heightened sensitivity to detail and an
overemphasis on being correct, which may result in delayed or overanalytical responses. Although the person can mediate
information in socially acceptable ways, there is also an emerging pattern of deviation from convention—suggesting
individualistic or possibly oppositional tendencies when faced with normative expectations. The presence of perfectionistic
tendencies is particularly strong. This style likely serves a defensive function, aimed at masking underlying insecurities
about personal adequacy. While it may contribute to high performance in structured tasks, it becomes maladaptive in novel
or emotionally charged situations, where the need for control is undermined. Over time, this pattern may lead to cognitive
rigidity, self-doubt, and eventual disengagement due to perceived risks of failure. The desire to maintain control may also
limit spontaneity and interpersonal adaptability.
Ideation
Ideational patterns are emotionally saturated and exhibit limited flexibility. The individual’s style is intuitive and emotion-
driven, often relying on external validation. Emotional influence on thought is not only pervasive but also problematic,
particularly when logical processing would be more adaptive. Ideational rigidity is marked, with difficulty altering
perspectives or adapting beliefs in light of new information. The conceptual system is marked by pessimism, self-doubt, and
an expectation of negative outcomes ,likely influencing both self-evaluation and worldview.

The combination of obsessive and pessimistic ideational sets results in excessive preoccupation with correctness
and an undercurrent of hopelessness. Despite considerable ideational activity, clarity is compromised by
emotionally charged and negatively skewed expectations. Peripheral ideation appears frequently, likely triggered by
interpersonal and social challenges, contributing to intrusive and distracting thought patterns . There is a tendency to
deny the full emotional impact of situations through intellectualization, which may lead to distorted or incomplete
conceptualizations. This denial, though protective, hinders emotional integration and contributes to internal conflict.
Self-Perception
The individual demonstrates strong perfectionistic and narcissistic tendencies. While the outward expression of self-
image is marked by confidence and self-focus, there is also evidence of internal conflict and fragility. The
narcissistic posture serves as a defensive shield against perceived inadequacies and is often reinforced through a
rigid perfectionistic standard. Reflection responses point to a heightened self-focus and suggest ambivalence or
distress related to self-worth. This ambivalence may alternate between inflated self-appraisal and harsh self-
criticism, depending on external feedback. Multiple FD responses, in the absence of depth-related (Vista) responses,
highlight a ruminative focus on self-image potentially suggestive of obsessive self-monitoring. The effort to portray
oneself as distressed or helpless further underscores the fragility of self-worth and possible manipulative or
defensive presentation styles. Despite an average egocentricity index, the content and special scores (e.g., Hx + AB)
indicate distorted self-evaluation and possible difficulties in maintaining a coherent or grounded sense of self.

Attempts to intellectualize distress may further distance the individual from genuine emotional insight, contributing
to unstable self-perception. These features suggest the use of narcissistic defenses in the face of deep-seated self-
doubt and emotional pain
Interpersonal Perception and Behavior
Interpersonal functioning is immature and conflicted. Although the person appears to desire close, meaningful
relationships, they lack the skills and emotional insight to sustain them. This discrepancy often results in
dissatisfaction, superficial connections, and recurrent rejection. Emotional withdrawal and social discomfort are
evident. There is a clear longing for emotional intimacy, yet the individual remains confused about how to engage
effectively, leading to relational inconsistency and unpredictability.
The profile suggests a history of unmet emotional needs and possible social disappointment, which has led to
persistent loneliness. The individual may feel misunderstood or isolated, and although interest in social interaction
exists, participation is hesitant and emotionally distant. When combined with narcissistic self-focus and affective
immaturity, interpersonal relationships are likely to be unstable, shallow, and reactive.
Confusion about appropriate interpersonal behavior is further indicated by conflicting markers of cooperative versus
aggressive tendencies. These inconsistencies reflect inner ambivalence and may lead to mixed signals in social
settings, further complicating relationships and contributing to feelings of rejection or failure.

SUMMARY
The Rorschach protocol reveals significant emotional and interpersonal instability, with a low
capacity to manage internal stress effectively. The individual exhibits a scattered cognitive style,
intrusive ideation, and impaired affect regulation, especially under stress. There is evidence of
emotional confusion, internal tension, and chronic unmet interpersonal needs, leading to impulsive
or maladaptive responses. Affective constriction and somatic discomfort suggest internalized distress
and emotional suppression. Cognitive processing is overly detailed and rigid, often driven by
perfectionism and fear of failure, resulting in reduced flexibility. Thought processes are emotionally
saturated, with pessimism and rigid beliefs, reflecting obsessive ideation shaped by self-doubt and a
need for control. Self-perception is marked by inflated self-focus, vulnerability to criticism, and a
defensive reliance on perfectionistic and narcissistic self-enhancement. Intellectualization and
emotional distancing limit authentic self-awareness. Interpersonally, the profile reveals difficulty
forming meaningful relationships, marked by emotional withdrawal, mistrust, and ambivalence.

Time taken and hours in assessment –
• Number of sessions – 4 sessions
• Time taken – 5 hours
The assessment results indicate that Index patient GY exhibits mild depressive symptoms with Inflated self-image. Strong desire to
be recognized and respected. MMSE revealed intact cognitive functions. The IPDE revealed borderline at probable level and
Anankastic and narcissistic at definite level . TAT responses reflect a personality dominated by emotional sensitivity, interpersonal
conflict, and a strong need for validation and nurturance. His narratives frequently involve themes of familial tension, emotional
neglect, and moral superiority, with protagonists often positioned as misunderstood or victimized. Defenses include projection,
denial, and splitting, with ego weaknesses in affect regulation and realistic self-appraisal . The Rorschach profile indicates marked
emotional instability, low stress tolerance, and difficulty regulating affect, leading to impulsivity and cognitive disorganization
under pressure. It also reflects a rigid, perfectionistic cognitive style marked by intense self-focus, emotional constriction, and a
strong need for control. Ideation is shaped by narcissistic features, including inflated self-regard, sensitivity to criticism, and a
defensive need to maintain an idealized self-image. Interpersonal functioning is impaired by defensiveness, fragile self-esteem,
and a reliance on external validation, contributing to relational difficulties and affective discomfort.
ASSESSMENT SUMMARY

Heinz Kohut’s Self Psychology Model, 1970
(PSYCHODYNAMIC MODEL )

The clinical presentation and psychological assessment findings of GY are consistent with a personality
structure marked by significant emotional vulnerability, inflated sense of self, rigid self-concept, and chronic
interpersonal dysfunction. GY exhibits a longstanding pattern of seeking admiration and validation, often
accompanied by emotional withdrawal when expectations are unmet. His interpersonal relationships are
unstable and characterized by alternating idealization and devaluation, along with hypersensitivity to
perceived slights or criticism. There is also evidence of perfectionistic and rigid thinking patterns,
accompanied by excessive self-monitoring, which contributes to distress and social detachment
The clinical presentation aligns with ICD-11 criteria for Moderate Personality Disorder, with prominent
Dissociality and Anankastic (Obsessive-Compulsive) Pattern Qualifiers. GY demonstrates a stable pattern of
self centeredness , lack of empathy , self-enhancement, emotional overcontrol, rigid perfectionism, and a
strong need for external validation, alongside significant difficulties in interpersonal functioning. His sense
of self is fragile and overly reliant on achievement and admiration, with frequent experiences of frustration
when others fail to meet his expectations. Interpersonal relationships are marked by detachment, moral
superiority, and idealization-devaluation cycles
CLINICAL IMPRESSION

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