Psychological Report

Strictly Confidential

I. Identifying Information
Name : CyCy
Sex : Female, Bisexual
Age : 20 years old
Birthday : January 21, 2000
Civil Status : Single
Address : Batangas City
Occupation : Student
Religion : Iglesia Ni Cristo
Assessor : Lanz Paolo G. Olegario, MA, RPsy

II. Referral Information

CyCy was referred to undergo a psychological assessment for anxiety. CyCy tends to
worry about many things, even minor things, and she continues to worry even if she
knows it is not a big deal. She is experiencing physical symptoms of anxiety, such as
hyperventilation, being easily fatigued, and muscle tension. She also mentioned that
she experiences these symptoms in an open space or a large crowd. She has been
experiencing these symptoms for more than six months. Moreover, she also
mentioned that she is dealing with depressive mood, irritability, and anger
management problems. She described these experiences as 'extremely severe.'

This psychological assessment is done to evaluate CyCy's symptoms, relevant

history, and to come up with a diagnosis if warrented. This assessment will also
determine the extent of how disabling her symptoms are.

III. Evaluation Procedures

Tool Date Administered

Clinical Interview October 20 and November 24, 2023
DSM-5-TR Self-Rated Level 1 Cross- October 20, 2023
Cutting Symptom Measure—Adult
 Severity Measure for Generalized Anxiety October 20, 2023
Disorder—Adult
Patient Health Questionnaire (PHQ-9) October 20, 2023
The Personality Inventory for DSM-5 October 20, 2023
(PID-5) – Adult
World Health Organization Disability October 20, 2023
Assessment Schedule 2.0
WHO Quality of Life Scale – Brief October 20, 2023
PROMIS Emotional Distress – Anger – November 8, 2023
Short Form
Altman Self-Rating Mania Scale (ASRM) November 8, 2023
Severity Measure for Agoraphobia November 8, 2023
PROMIS Sleep Disturbance – Short Form November 8, 2023

IV. Case History

CyCy's symptoms started eight years ago, when she was in 6th grade. The first
symptom she experienced was trouble breathing, in which the medical doctor told her
and her parents that there was nothing physically wrong with her to cause the
symptom. It began after she experienced verbal bullying from her classmates that
affected her self-esteem. She was told that she was maarte, bobo, pandak, panget,
and ang taba. She was also being left out on purpose. She tried telling her teacher
about these incidents, but her teacher sided with the bullies. She lost motivation to
study, and her grades suffered. She then transferred to a different school, and she did
everything to avoid bumping into her old classmates who bullied her. Currently, she
thinks that it is silly to let herself be affected by this kind of verbal bullying. When she
was in high school, she experienced symptoms of anxiety, such as hyperventilation,
even without a trigger. At present, her triggers include school, especially when there
is an exam. She quickly gets stressed because she thinks that she is not academically
competent. She also gets worried when she gets low scores. Another trigger is her
breakup with her boyfriend a year ago, coupled with a separation from her friends. Her
issues with her friends, who are also her schoolmates, were not resolved. However,
these unresolved issues do not make her too anxious but rather angry. She learned
that her former friends were still talking about her behind her back. Because of all
these, it gets to the point that just thinking about going to school makes her anxious.

CyCy is also experiencing extreme anxiety when she goes outside, especially when
she is alone. Sometimes, she endures this anxiety because she cannot delay her
errands anymore. However, she tends to procrastinate because of her worries about
going outside, open spaces, public transportation, and large crowds.

When she was young, CyCy experienced what she considered abuse from her
mother. Her mother would slap her and lock her inside a dark room for long periods.
Even up to this day, CyCy still experiences verbal abuse from her mother, even
through video chats. Her mother has been an OFW for 16 years already; throughout
the 16 years, she has only gone home four times. CyCy's only memories with her
mothers are the "bad ones." She finds it awkward to be alone with her mother.
Additionally, she felt threatened by her mother's family to join Iglesia Ni Cristo. If she
did not follow them, her mother would not give her any money and let her suffer. She
hates being affiliated with this religious community, and she feels trapped.

CyCy has a memory that she experienced sexual trauma from her older male cousin
when she was 13 years old. She was groped. However, this instance was repressed
until it was triggered when she was talking with her cousins about "deep talks" and
traumatic experiences. She suddenly remembers this traumatic memory vividly. She
then felt the emotions associated with the traumatic experience, and she felt disgusted
with herself. When she decided to tell her parents about this memory, she was blamed
for it and was told why she had not done anything about it during that time. At present,
she is not too disturbed by the memory. However, every time she sees her cousin, she
feels like she will have a panic attack.

CyCy also experienced bouts of depressive episodes, where she would lose
motivation, have trouble sleeping, experience poor appetite, feel fatigued, and have
thoughts of suicide. She cannot explain why she experienced these episodes. There
was a time when she was hospitalized because she had no energy to get up to pee.
 In 6th grade, CyCy started to self-harm. This ended when she was in 10th grade. She
did this when she felt empty and wanted to feel things. At one time, she tried to end
her life by taking sleeping pills that belonged to her father, but it did not work. She just
experienced stomach pain. She was brought to the hospital. Presently, she does not
have suicidal behavior, but she considers vaping a self-destructive behavior that she
cannot give up. When she opened up about these depressive symptoms to her
parents, they told her that she was just "tamad" and she felt invalidated, especially by
her mother. She was told that she had no right to feel that way because other people
experienced harder things than her.

V. Observational Behaviors

CyCy was friendly and cooperative during the whole duration of the assessment. Her
drive to know her clinical picture and diagnosis is noticeable. Her mood was euthymic,
coupled with negative stories and instances about her life. She did not bring up any
positive stories or instances unless asked. Her affect was full and congruent with the
content being discussed. Her thought process was logical and coherent. Her speech
was of regular rate and rhythm. Any form of psychosis was not observed during the
assessment. Although no formal assessment of intellectual level has been done, both
CyCy's verbal conceptual skills and oral presentation suggest at least average to high
average intellectual capacity. Her verbal processes are organized and reflect no
memory impairment. While she is oriented in all three spheres, she has concerns with
potential memory problems due to her symptomatology.

VI. Psychological Test Interpretation

a. Self-Concept

CyCy presents a deeply conflicted self-concept, expressing a pervasive dislike for

herself and feeling undeserving. Despite having a few friends, she often encounters
relationship issues, leading to a sense of being disliked. Her efforts to hide personal
problems around others suggest a tendency to mask inner struggles. Engaging in
activities like reading, watching anime, and playing musical instruments provides
occasional joy, but there are times when a decrease in motivation appears, leading to
prolonged periods in bed. Though she lacks clear plans for the future, there's a strong
desire for comprehensive life changes driven by dissatisfaction with her life. Aspiring
improved communication skills and emotional regulation reflect a proactive stance
toward personal growth. Despite her susceptibility to anxiety and depression, the
expressed goal of finding happiness and contentment in the following years indicates
a hopeful outlook amid ongoing challenges.

b. Socio-Emotional Functioning

CyCy articulates a multifaceted socioemotional experience. She grapples with a sense

of parental disappointment, attributing it to perceived intellectual shortcomings
compared to her cousins and the recent disclosure of her bisexuality. While
maintaining a positive relationship with her father, there is noted discord with her
mother. However, she finds support and understanding from her half-sister. She
places high value on platonic relationships but acknowledges the potential strain her
mental health issues may impose on friends. This is accompanied by a lack of
motivation in academics, compounded by an underlying fear of failure. The clinical
picture is further characterized by anxiety, a depressive disposition, impulsivity, and
separation anxiety.

c. Anxiety

CyCy displays a marked tendency towards pervasive and anticipatory anxiety, as

evidenced by her endorsement of various worry-related statements. Her concerns
extend to a wide range of potential negative outcomes, reflecting a generalized anxiety
about future events and past mistakes. The persistent and constant nature of her
worrying suggests a chronic state of apprehension. Moreover, her inclination to
consistently expect the worst and express nervousness about the future indicates a
heightened baseline anxiety level. Overall, CyCy identifies strongly with an anxious
disposition, constantly expecting the worst and experiencing heightened worry when
contemplating the future.

CyCy also experiences heightened anxiety and fear in various situations, such as
crowds, public spaces, and using public transportation. She reports physical
symptoms like a racing heart and trouble breathing, along with avoidance behaviors
like leaving early or staying close to exits. These reactions are associated with
thoughts of panic attacks and discomfort. CyCy spends considerable time preparing
for or procrastinating about facing these situations, uses distractions to avoid thinking
about them, and recognizes the need for external help.

d. Depression

CyCy expresses profound and pervasive feelings of despair and self-worthlessness,

as evidenced by her endorsement of statements conveying depression. Her belief that
nothing she does matters and her persistent dissatisfaction with herself point toward
a significant emotional burden. The alarming thoughts about the world being better off
without her, coupled with frequent discussions of suicide, raise serious concerns about
her mental well-being. The repeated themes of feeling like a failure, being useless,
and viewing life as bleak and pointless align with symptoms indicative of clinical
depression. Additionally, the acknowledgment of an anticipated future suicide
underscores the urgency for immediate clinical attention. The prevalence of guilt and
an overarching sense of misery further highlights the gravity of her emotional distress.
In addition, CyCy indicates a moderate level of reduced pleasure and enjoyment in
everyday activities, expressing infrequent feelings of happiness or enthusiasm. This
suggests a potential presence of anhedonia, a diminished capacity to experience
positive emotions.

e. Disability

CyCy notes moderate challenges in focusing on tasks and remembering important

matters. She also expresses difficulty in problem-solving for daily issues, moderate
difficulty in learning new tasks, and mild difficulty in initiating and sustaining
conversations. Additionally, CyCy reports severe difficulty in interacting with unfamiliar
individuals and expressing discomfort in social situations. Moreover, she notes
moderate challenges in maintaining existing friendships and making new connections.

CyCy also faces challenges in her school-related responsibilities, including day-to-day

schoolwork, completing essential tasks well, and meeting deadlines promptly. This
 signifies notable impairments in academic functioning. However, due to fear of failing,
she is still able to complete her academic requirements.

CyCy faces substantial difficulties joining community activities due to mental health
barriers. The attitudes and actions of others significantly impact her sense of dignity,
leading to emotional distress. A significant portion of her time is devoted to worrying
about her physical and mental health condition, leaving limited room for social and
personal activities.

VII. Summary

CyCy was referred primarily for her anxiety symptoms, but her assessment revealed
that she does not have just anxiety but also clinical depression. Her symptoms started
when she was in 6th when she experienced bullying. This incident resulted in anxiety,
as well as a loss of motivation and academic decline. Aside from the bullying, CyCy
also experienced verbal abuse from her mother and she has a memory of sexual
abuse from her cousin. Her anxiety and bouts of depression continue up to this day,
and they affect her daily life, including her participation in society, meeting new people,
getting around outside her home, and her academic tasks. However, her fear of failure
motivates her to do tasks in school. The stressful and traumatic experiences she had
most probably contributed to the over-activation of her sympathetic nervous system,
which contributed to overarousal, leading to chronic feelings of anxiety. Furthermore,
the bullying and the trauma she went through most probably contributed to the
development of her negative self-concept and the way she relates to other people.

VIII. Diagnostic Impression

Upon careful assessment of her symptoms, CyCy met the diagnostic criteria for the
following disorders listed in the DSM-5-Tr:

F41.1 Generalized Anxiety Disorder

F40.00 Agoraphobia

F33.1 Major Depressive Disorder, Recurrent Episode, Moderate

 Following a detailed evaluation of her symptoms, the following disorders are ruled out:
Pervasive Depressive Disorder and Bipolar Disorders. A major differential question is
the possible presence of panic disorder. However, CyCy's anxiety symptoms are
mostly cued.

IX. Recommendations
a. Referral to a psychiatrist for a psychotropic medication consultation. If medication
is warranted, it should be monitored when it comes to compliance, side effects,
and effectiveness.
b. Establish safety around the home, school, and other places that causes CyCy to
experience anxiety.
c. Refer CyCy to cognitive behavioral therapist, with the following goals to be
accomplished:
i. Learn and implement calming skills to reduce overall anxiety and manage
anxiety symptoms.
ii. Assist CyCy in analyzing her worries by examining potential biases such as
the probability of the negative expectation occurring, the real consequences
of it happening, her ability to control the outcome, the worst possible
outcome, and her ability to accept it.
iii. Identify, challenge, and replace biased, fearful self-talk with positive,
realistic, and empowering self-talk.
iv. Undergo gradual repeated imaginal exposure to the feared stimuli such as
thoughts of academic failure and agoraphobic situations.
v. Identify and work through the significant life conflicts from the past and
present that form the basis for present anxiety.
vi. Learn and implement behavioral strategies to overcome depression.
vii. Identify and replace negative self-talk messages used to reinforce negative
self-concept.
viii. Identify and engage in activities that would improve self-image by being
consistent with one’s values.
ix. Help CyCy identify, challenge, and replace biased, negative, and self-
defeating thoughts resulting from her traumatic experiences.
 x. Use role-playing and behavioral rehearsal to improve CyCy’s social skills in
greeting people and carrying a conversation.
xi. Develop a plan with CyCy, identifying what she will and won’t do when
experiencing suicidal thoughts or impulses; encourage her to be open and
honest regarding suicidal urges, reassuring her regularly of caring concern
by therapist and significant others.
d. Learn self-help strategies to cope with anxiety and depression such as meditation,
mindfulness, journaling, radical acceptance, and bibliotherapy.
e. Practice good sleep hygiene, such as restricting excessive liquid intake or heavy
evening meals; exercising regularly, but not within 3–4 hours of bedtime;
minimizing or avoiding caffeine, alcohol, tobacco, and stimulant intake.
f. Consider the Guidance Office of CyCy's school as a mental health resource,
especially in times when she experiences academic stress, anxiety, or burnout due
to the school environment.

Prepared by:

Lanz Paolo G. Olegario, MA, RPsy

PRC I.D. No. 0001731
Date: December 7, 2023