Emma Kate Roey
Emma Katherine Roey

Summary and Recommendations:  The purpose of the current evaluation is to determine psychological/emotional factors involved in Emma’s recent problems determine a diagnosis, and make recommendations regarding her treatment.  A review of Emma’s family history is negative for the presence of any reported severe psychiatric diagnoses such as major depression, anxiety disorders or thought disorder.  Her extended family appears somewhat unusual in terms of relatively low cohesion and emotional support and what is described as being long standing emotional distance and/or conflict.  A review of Emma’s relationships with her parents suggests possible longstanding conflict between herself and her mother and a generally positive though somewhat physically distant relationship with her father.  Emma appears to experience a low degree of emotional support from extended family.

Note:  Looking back now, although it is difficult and painful to read this paragraph, it is also interesting because of Emma’s description of “longstanding conflict between herself and her mother.”  So much of the time, I was Emma’s best friend.  We could argue over little things, like getting her to do her chores, pick up after herself, etc. but as I mentioned earlier, I was always the one she wanted to cuddle up and talk with.  The worst stress in our relationship came after Emma accused me of “physically abusing her.”  I did not take being accused of a crime well, and Emma seemed to enjoy the power it gave her.  I was so hurt by what she did, I spent a lot of time crying, and a lot of time angry.  Emma seemed to enjoy going back and forth sometimes telling me she knew I didn’t do what she said, and she didn’t know why she said those things, and then when she was angry at me, she would say, “I just don’t remember what happened.”

Emma’s health history is significant for the problem of cyclic vomiting syndrome.  This medical condition appears to have significantly impacted her ability to attend school on a regular basis and perhaps also her socialization in general.  She also describes having severe headaches.  The possibility that Emma’s recent problems may be related to a seizure disorder cannot be totally ruled out based on the current testing.  No medical records were available to review at the time of this evaluation.

Obviously, Emma’s allegation of sexual molestation by her priest is a very significant part of her history.  During the current evaluation Emma did describe to the examiner in a fairly detailed way the events surrounded the molestation and the actual molestation itself.

  (Note:  I believe Emma got her details from her reading and the internet.  Emma frequently read depressing teenage stories, and would tell me about them.  I thought it was just a teenage phase at the time, to read all these depressing teenage tales.)

The results of the current cognitive testing indicate that Emma enjoys very strong intellectual capabilities within the very superior range.  Her intellectual capabilities suggest that she could pursue college level and graduate level education without apparent difficulty.  Emma’s verbal comprehension skills are better developed than her nonverbal reasoning abilities.  Her nonverbal reasoning abilities and her working memory abilities are comparable.  Emma’s abilities to process visual information quickly are less well developed than her other abilities.  A relative strength in verbal comprehension skills may make it easier for Emma to apply these skills in problem-solving tasks which are primarily language-based.  A relative weakness in her abilities to process visual information quickly, however may make it more difficult for her to process more complex information.  Overall,, her performance across these domains is somewhat scattered and suggests variability in her abilities.

There were indications during her cognitive testing that her ability to concentrate may be a relative weakness for her.  This may be related to emotional factors.  Her cognitive testing did not suggest the presence of any learning disability.  Her basic academic skills may be somewhat below what her expectancy is but at the same time her skills are above the norm for her age group.  A review of Emma’s current psychological and Emotional testing suggests that she is a young woman who is rather defended and perhaps somewhat guarded in her acknowledgement of problems.  The psychological testing results are remarkable for the relative absence of and denial of virtually any and all emotional distress.  Emma may be an individual who is prone to avoid and deny the existence of problems.  Although Emma’s somewhat defensive response to style makes it more challenging to interpret her testing, it can be said that none of her testing protocol suggest the presence of any disordered thinking, bizarre ideation or delusional thoughts.

Emma appears to be somewhat social isolated yet at the same time appears to be an individual who desires to please and win the approval of others.  She has been raised in a church environment and appears to have a very strong sense of right and wrong and a Christian faith.  She expresses interest in pursuing medical missionary work and aspires to help others.

NOTE: I don’t even know where to begin on Emma’s Christian faith.  Of course, that is between her and God, but having been her closest friend and confidant, she knows I know the truth about her accusations against the priest, against me, her lies pretty much causing her parents’ divorce, etc.  I’ve often wondered how she sits in church or prays to God and keeps up the act.

In summary, Emma is a young woman who is gifted with very strong intellectual capabilities as well as artistic talents.  She is an individual who appears to care about others and who desires to please and gain the approval of others.  Her current emotional testing suggests that she is rather well guarded and defended in acknowledging problems.  As a result it is more difficult to determine a mental health diagnosis.  Nevertheless all of her testing does not indicate the presence of features that this examiner would consider suggestive of schizophrenia or an underlying thought disorder.  The testing does suggest an individual who is prone to intellectualization of her problems, avoidance, and denial.  She may lack insight and awareness of her emotions.  She may lack effective emotional coping and self care skills.  She appears to be an individual who may have a higher than normal degree of felt need to remain in control.  Based upon this examiner’s consultations with trauma specialists, these features are not uncommon among individuals who have been victims of physical or sexual trauma.

Emma appeared to exhibit mood congruent thought throughout the evaluation and presented in a credible manner during all the interviewing.  She is a bright, engaging young woman with some obvious positive characteristics and features.

In regards to Emma’s recent episodes, it is this examiner’s opinion that these episodes likely represent a dissociative process triggered by intense emotional conflict and stress.  In the clinical literature there are experience referred to as dissociative trance and pseudoseizure disorder that appear consistent with Emma’s episodes.  These experiences differ from dissociative identity disorder in that there is not the presence of two or more distinct personality states.  These conditions are sometimes comorbid with a seizure disorder diagnosis as well as anxiety or depression and are not infrequently misdiagnosed as schizophrenia.  In Emma’s case, these dissociative experiences appear to be acute, and in response to sever stressors.  Hopefully, with continued treatment there will be a decline and eventual remittance of these symptoms.  It is the impression of this examiner that EEG studies have been performed with Emma to rule out a seizure disorder.

The following recommendations are offered regarding Emma:

1.  It is strongly recommended that Emma continue in her individual therapy.  There are indications that she may lack emotional awareness and insight.  She is also a ver bright individual who may find it very easy to intellectualize her emotions.  She also appears to be an individual who may have a higher than normal degree of need for control.  She may strive harder than most to please and win approval of others.  These features are not uncommon among the population of sexual trauma survivors.
2. Emma appears to be minimizing the presence of emotional distress, yet acknowledeges on at least one survey the presence of episodic suicidal ideation.  The anecdotal information availiable regarding the proposed diagnosis would tend to suggest consideration of either antidepressant or anticonvulsant medication.
3. 3.       The DFACS investigation into Emma’s allegations is reportedly ongoing.  There may be a pending evaluation of her mother.  Observations made during the current evaluation suggested that Emma presented in a consistent and credible manner.  This is not to say that this is assuming that she is totally accurate in her reports of what has happened with her mother.  Obviously there is a great deal of emotional stress within this family at the present time and hopefully in time there will be family therapy that will help to heal the relationships.  The goal of the current evaluation was to determine diagnoses and make treatment suggestions, and not to determine validity of any reports of abuse.

DSM-IV Diagnosis

AXIS I:  300.15 Dissociative Disorder NOS (Acute)

AXIS II:  V71.09 No Diagnosis

AXIS III:  Cyclic Vomiting Syndrome

AXIS IV:  Severe-social

AXIS V:  Current GAF 55

Richard R. Born, Ph.D.

Licensed Psychologist