Psychological Evaluation Tony P Martin

William Bigwood. MSc

Bigwood. Strokes & Hunt Mental Health Practice
73a Church Road,
Saltdean,
East Sussex.
BN2 1TL
+44 (0)20 7501 1900
After our sessions in my Brighton office I submit the following psychological evaluation for
your records. Given the severity of your condition I recommend that you seek additional help
without delay using the information provided within my report. Do not worry about where
you are right now mentally but REMEMBER where you are going. The path you are going to
take will provide a fundamental change to your wellbeing and one that will last for the rest of
your life. In closing there are most certainly treatments available to you that will help
improve the symptoms you are experiencing.
The following are the areas of concern and based upon my professional experience in the
field of human psychology. You may of course seek a second opinion and are recommended
to do so if you believe it will help.

Panic Disorder

Your responses suggest that you may be suffering from Panic Disorder. This means that you
experience repeated periods of intense fear or physical discomfort, which occur without
warning or obvious precipitating events. These attacks are disturbing to you or cause you to
limit your activities.
The DSM-IV criteria for Panic Disorder are as follows:
Recurrent attacks of at least four of the following symptoms:
o Heart palpitations, feeling like the heart is racing or pounding.
o Sweating.
o Trembling or shaking.
o Shortness of breath, sensation of being smothered or choked.
o Chest pain.
o Nausea or other forms of stomach upset.
o Feeling dizzy, lightheaded, or faint.
o Feeling detached from reality or a sensation of being outside of oneself.
o Fear of losing control or going "crazy".
o Fear of dying.
o Numbing or tingling sensations.
o Chills or hot flashes.
The attack or attacks have been followed by a minimum of one month in which the
person experiences one of more of the following:
o Persistent concern and worry about having another panic attack.
o Worry about what the attacks mean, what could be causing them, or what
could happen as a result of the attacks.
o Change of behaviour as a result of the attacks.
The person is not suffering from Agoraphobia, which is roughly defined as being
anxious about suffering a panic attack in situations where escape is difficult or
embarrassing, and limiting behaviour as a result of this anxiety.
The panic attacks are not due to another disorder, such as Social Phobia (e.g. if they
occurred mostly in social situations), Specific Phobia (e.g. if they had only one type
of situation or object that caused them to experience attacks), Obsessive-compulsive
Disorder, or Post-traumatic Stress Disorder (in response to things that remind them of
the difficult scenario.
Panic Disorder can be debilitating. Untreated, it can be a frightening and limiting disorder. If
you feel that you are suffering from this, speak to a mental health professional to prevent it
from further disrupting your life and to develop a treatment plan that fits your needs. The
treatments used might include Exposure Therapy, which slowly builds up from mildly
frightening situations to more frightening ones, or other forms of Cognitive Behavioural
Therapy. These forms of therapy will usually be used in conjunction with pharmaceutical
drugs, including anti-anxiety drugs and some forms of anti-depressants.

Relational Difficulties

Your responses indicated that your relationships are at least in some way dysfunctional, and
may be causing problems in your life. While not an official diagnosis in the DSM IV, there
has been some discussion about adding relationship issues to the next edition. The bottom
line is that if you are unhappy with the way you relate with others, or feel that a particular
relationship you have with someone is unhealthy, seeking help from a therapist can help you
resolve these issues.

Paedophilia

Your responses in this section indicate that you have a sexual interest in children. These
abnormal sexual impulses towards minors are a major concern. Seek help immediately to
prevent yourself from acting on these impulses.

Voyeurism

It appears from your responses that you have a strong desire to view other people in the nude
or having sexual contact, which is called voyeurism. Your strong desire to view the intimate
moments of others is a concern if you actually seek out such experiences. In many cases, you
may actually be breaking the law. Seek therapy if this is the case for you.

Exhibitionism

It appears from your responses that you show signs of exhibitionism. Your strong desire to
expose yourself to others without consent is a cause for concern, especially if you actually
seek out such experiences. By acting out these desires, you would likely be breaking the law.
Seek therapy if this is the case with you.

Frotteurism

Your answers on this assessment indicate that you appear to have a strong desire to rub
yourself against un-consenting strangers. This is a cause for concern if you actually seek out
such experiences. By acting out these desires, you are likely breaking the law. Seek therapy if
this is the case with you.

Symptoms Detected

You show symptoms of several mental health disorders. While they have not reached the
level of full diagnosis, seeking the advice of a therapist is recommended, as the symptoms
may become overwhelming, more frequent, and more serious.

Manic Episodes

You appear to have showed some signs of experiencing a manic episode. People who
experience manic episodes have times when they feel extreme emotional "highs"
accompanied by a variety of other symptoms, such as racing thoughts, extreme talkativeness,
and reduced need for sleep, among others.
According to the DSM-IV, a manic episode consists of the following:
A discrete period of time when there is an extremely elevated or expansive mood, or
high levels of irritability.
As well as three or more of the following symptoms:
Exaggerated sense of self-esteem or grandiosity.
Greatly reduced need for sleep.
Excessive talkativeness and feeling of internal pressure to keep talking.
Thoughts race quickly and change rapidly from topic to topic.
More easily distracted than usual.
Increase in goal-setting activity or in unproductive physical activity, such as fidgeting,
pacing, or finger-tapping.
Risky, impulsive, and unconsidered behavior, with the potential for serious and long-
term consequences (e.g. reckless spending, sex with strangers, foolish business
decisions).
The symptoms must be severe enough to disrupt functioning in important life areas, such as
the ability to function at work, to have healthy relationships, and to take care of oneself. If
hospitalization is required, this criterion is considered to have been met.
If you feel that your symptoms are a problem for you, speaking with a professional therapist
or psychiatrist, or a medical professional is your first step towards obtaining help. The most
effective treatment for Bipolar Disorder appears to be pharmaceutical drugs, in particular
lithium, anticonvulsant mood stabilizers, and atypical antipsychotic drugs. Cognitive Therapy
might also be useful for Bipolar patients, mostly to assist in understanding the illness, dealing
with its consequences, preventing relapse (monitoring symptoms and adjusting medications
before a full-blown relapse occurs), and ensuring adherence to the drug regime.

Bipolar Disorder

You appear to have some symptoms of Bipolar Disorder, but not enough to meet all the
criteria for a diagnosis. A person is considered to have this disorder if they have experienced
one or more Manic episodes or Mixed episodes (a Mixed episode refers to manic episodes
interspersed with depressive episodes in quick succession).
According to the DSM-IV, these are the criteria for a Manic episode, the main requirement
for Bipolar disorder:
A discrete period of time where there is an extremely elevated or expansive mood, or
high levels of irritability.
As well as three or more of the following symptoms:
Exaggerated sense of self-esteem or grandiosity.
Need for sleep is greatly reduced.
Excessive talkativeness and feeling of pressure to keep talking.
Thoughts race quickly and change rapidly from topic to topic.
The individual is more easily distracted than usual.
Increase in goal-setting activity or in unproductive physical activity, such as fidgeting,
pacing, or finger-tapping.
Taking part in risky, impulsive, and unconsidered behavior, with the potential for
serious and long-term consequences (reckless spending, sex with strangers, foolish
business decisions).
The symptoms must be severe enough to disrupt functioning in important life areas, such as
the ability to function at work, to have healthy relationships, and to take care of oneself. If
hospitalization is required, this criterion is considered to have been met.
There are a number of similar disorders in the Bipolar spectrum. If you are concerned about
the symptoms you might be experiencing related to this disorder, speaking with a
professional therapist, psychiatrist, or a medical professional is your first step towards
obtaining a definite diagnosis. The most effective treatment for Bipolar Disorder appears to
be pharmaceutical drugs, in particular lithium, anticonvulsant mood stabilizers, and atypical
antipsychotic drugs. Cognitive Therapy might also be useful for Bipolar patients, mostly to
assist in understanding the illness, dealing with its consequences, preventing relapse
(monitoring symptoms and adjusting medications before a full-blown relapse occurs), and
ensuring adherence to the drug regime.
Suicide Prevention Hotlines and Resources:
If you are thinking of suicide, please do reach out to get the help you need. Here are some
links and phone numbers that can get you started.
In the United Kingdom The Samaritans: (08457) 909090
If you are unable to find resources on your own, see a physician or go to an emergency room
- someone there should be able to help you. Do not suffer in silence.



Specific Phobia

You show some signs of suffering from a Specific Phobia, but not enough for a definitive
diagnosis. People with a Specific Phobia have a strong, unreasonable fear of a particular
object or situation.
The DSM-IV describes the signs and symptoms of Specific Phobia as follows:
Excessive fear of an object of situation that is cued either by the presence or
anticipation of being exposed to that stimulus.
Exposure of the object or situation almost always provokes a strong and immediate
anxious response, or results in panic attacks related to the phobia.
The fear is recognized by the individual as being unreasonable and out of proportion.
Contact with the object or situation is avoided if at all possible, or endured only with
great anxiety and/or distress.
The issues surrounding the phobia, such as distress, panic attacks, and avoidance of
the phobia interfere with the individual's life.
The symptoms of Specific Phobia cannot be better explained by another disorder,
such as Panic Disorder, Social Phobia, Post-traumatic Stress Disorder, or Obsessive-
Compulsive Disorder.
This type of phobia can often be easily treated with Cognitive or Behavioral Therapy
techniques. Exposure Therapy, for example, slowly builds up from mildly frightening
situations to more frightening ones in order to reduce the phobic reaction. Flooding, which
entails placing the individual into the situation they find frightening and then teaching them
how to relax in that scenario, can also help. Drug therapies might also be used.

Social Phobia

Your responses suggest that you show some signs of suffering from a Social Phobia, but not
enough to meet the criteria for this disorder. People diagnosed with this disorder have a
strong, irrational fear related to social situations or public speaking.
The DSM-IV specifies the following signs and symptoms as being necessary for the
diagnosis of Social Phobia:
Extreme and persistent fear regarding social interactions or situations where the
person must appear in front of others; the individual worries about embarrassing him
or herself as well as showing his or her anxiety to others.
Being exposed to social or performance situations invokes a great deal of anxiety
and/or leads to panic attacks in response to the anxiety.
The person realizes that his or her reaction to these situations is above and beyond
what is reasonable.
Contact with unfamiliar others and performance situations is avoided if at all possible,
or endured only with great deal of anxiety and/or distress.
The issues surrounding the phobia, such as distress, panic attacks, and avoidance of
the phobia interfere with the individual's life.
The symptoms of Simple Phobia cannot be better explained by another disorder, such
as Panic Disorder with or without Agoraphobia, a Developmental Disorder, Schizoid
Personality Disorder or Body Dysmorphic Disorder.
Social skills training can be of great help for people with this disorder, as can Exposure
Therapy, which slowly builds up from mildly frightening situations to more frightening ones.
Flooding, which entails placing the individual directly into the situation they find frightening
and then teaching them how to relax in that scenario, can also help. Drug therapies might also
be used to quell some of the anxiety experienced in social situations. Speak to a professional
to confirm the diagnosis and determine a treatment plan for you.

Obsessive Compulsive Disorder

You appear to suffer from a few of the symptoms of Obsessive Compulsive Disorder;
however, you do not meet all the criteria. This disorder entails recurrent obsessions
(excessive and uncontrollable thoughts) and/or compulsions (uncontrollable, repetitive
behaviors) that are disruptive to the individual's functioning, are distressing to him or her, are
time consuming and recognized by him or her as being excessive.
The DSM-IV lists the following signs and symptoms that point to Obsessive Compulsive
Disordee: Obsessions and/or compulsions must occur.
Obsessions consist of all of the following:
Recurrent thoughts, impulses or images that keep popping up uncontrollably, are
recognized as not being appropriate, and that cause distress and concern in the
individual.
These thoughts and worries experienced are not simply extreme examples of worry
about real-life problems.
The individual tries to repress these thoughts, images, or impulses or prevent them
from occurring by performing another action or thought.
The individual recognizes that these thoughts, images, and impulses are a product of
his or her own mind.
Compulsions consist of both of the following:
The person performs repetitive behaviours (washing his or her hands, checking that
the doors in his or house are locked over and over, or repetitively straightening
objects in his or her house, and similar behaviours) or mental acts (counting to the
same number over and over, praying, repeating words or phrases internally) in
response to an obsession.
These behaviours are either meant to calm the individual, or are aimed at preventing
something bad from happening; however, these actions cannot logically stop these
things from occurring or are clearly excessive.
In addition...
The obsessions and/or compulsions are seen as unreasonable and/or excessive.
They are also disturbing to the individual, take up unreasonable amounts of his or her
time, or interfere with his or her life.
These obsessions or compulsions are not solely related to another disorder, or a result
of a drug or medication, or a medical condition.
Treatment for OCD can be very effective. They include medications, or behavioural and
cognitive therapy, among others. A mental health professional can assist you in developing a
treatment plan to help you.

Post-Traumatic Stress Disorder

You show some of the signs of Post-Traumatic Stress Disorder (PTSD) but do not fulfil all
the diagnostic criteria. This disorder, which can occur after a traumatic experience, involves
intense feelings of anxiety and even flashbacks of the experience.
The DSM-IV describes the following signs and symptoms of Post-Traumatic Stress Disorder:
The person witnessed, experienced, or was otherwise confronted with a traumatic
event or series of events that involved threat of death or injury to him or herself or
others.
The person's response to this event involved intense fear, feelings of helplessness, or
horror.
The person repeatedly re-experiences the event in at least one of the following forms:
o Repetitive, intrusive recollections of the event, including images, thoughts or
perceptions (visions, hearing or smelling the same smell or sounds that
occurred that day, etc.).
o Recurrent dreams or nightmares about the event in question.
o Feeling as if he or she is reliving the traumatic experience (i.e., experiencing
flashbacks, hallucinations or other vivid sense of experiencing the event
again).
o The person experiences extreme psychological distress upon being reminded
of or thinking about the traumatic experience.
o The person has an actual physical reaction upon being reminded of or thinking
about the traumatic experience.
o The individual avoids experiencing stimuli associated with the traumatic event
or shows signs of general numbing of feelings and interest in everyday life, in
the form of three or more of the following:
Avoiding thinking about or discussing the traumatic event.
Avoiding the place, people, or activities that are associated with the
traumatic event.
Blocking out (experiencing amnesia about) important memories
associated with the precipitating event.
Diminished interest in or participation in formerly enjoyed activities.
Feelings of emotional detachment or estrangement from others.
Dampening of emotions -- feeling that emotions have a restricted
range, i.e. unable to feel love towards others.
Expectations about future are foreshortened; that is, the person believes
that his or her life will be cut short, or that he or she will never reach
normal milestones, such as marriage, birth of children, career, etc.
o The person experiences frequent and persistent symptoms of increased
physiological arousal (his or her body appears ready to react rapidly in case of
another stressful event), in the form of two or more of the following:
The person has difficulty falling asleep or staying asleep.
He or she appears irritable or has emotional or angry outbursts.
He or she experiences difficulty concentrating.
His or her senses are hyper vigilant and she or he appears to be
constantly on the lookout for threats.
He or she startles easily.
o The symptoms related to this experience went on for more than one month and
caused distress or impairment in social, occupational, or other important areas
of functioning.
You've experienced a traumatic event in your life, and are obviously suffering. A
mental health professional can help guide you in the healing process and can help you
learn to live with the memories of this difficult experience. The treatments for PTSD
include Exposure Therapy, which slowly builds up from mildly frightening situations
to more frightening ones, as well as relaxation techniques for handling anxiety and
group therapy, among others.

Generalized Anxiety Disorder

Your answers indicate that you show some of the signs of Generalized Anxiety Disorder, but
not enough of them to meet all the criteria. People suffering with this disorder are on edge
most of the time, with no obvious precipitating event. This is a very common disorder and
there are many effective treatments available.
The DSM-IV states that the following signs and symptoms must be apparent for a diagnosis
of Generalized Anxiety Disorder to be made:
The individual must experience excessive anxiety and worry more days than not for a
minimum of six months. The concern must be about a number of different events or
areas of life, not focused on one or two specific issues.
The person must have a difficult time controlling his or her worry.
The anxiety and worry must be associated with at least three of the following physical
or emotional symptoms:
o Feelings of restlessness, edginess, or unease.
o Feeling easily fatigued.
o Difficulty maintaining concentration or a feeling of his or her mind going
blank.
o Irritability.
o Tense muscles.
o Sleep disturbance in the form of insomnia or difficulty staying asleep, or
feeling unsatisfied with his or her sleep.
The anxiety and worry must not occur solely as a result of another disorder, such as
Social Phobia, Obsessive Compulsive Disorder, Anorexia or Bulimia, Post-Traumatic
Disorder, Panic Disorder, Somatization Disorder, or Hypochondriasis.
The anxiety, worry and accompanying physical and emotional symptoms must cause
the person distress or lead to impairment of his or her functioning at work, in his or
her personal life, or in other life areas.
The anxiety is not due to a physical condition or drug use (illegal or medical), and
does not occur only during a mood disorder such as Depression, in the course of a
Psychotic Disorder, or due to a Pervasive Developmental Disorder (such as Autism).
Treatments for Generalized Anxiety Disorder include anti-anxiety medications, relaxation
therapy, and Cognitive-Behavioural Therapy.

Premature Ejaculation

You appear to experience symptoms of Premature Ejaculation but do not report that these
issues are impacting your relationships or causing you distress. You tend to orgasm too early
when having sexual contact with your partner. While it can be embarrassing to talk about
sexual problems with medical or mental health professionals, they are accustomed to dealing
with these issues, and the potential payoff is worth it if your difficulty begins to take a toll on
you or your relationship.
The DSM-IV criteria for Premature Ejaculation are as follows:
Persistent or recurrent tendency to ejaculate before sexual intercourse begins or
shortly thereafter, or any time before the person wishes it.
This dysfunction must cause distress or impact negatively on personal relationships.
The disorder cannot be better accounted for by another mental disorder, by drug use
(medical or illegal) or by a general medical condition.
Conclusion

Given your background in broadcast media and television production I would recommend
that you cancel all pornographic website subscriptions immediately and uninstall the webcam
from your computer to prevent any accidents from happening between now and the time you
receive treatment for your mental problems.
Since our last session I have also noticed that you spend a great deal of time forming new
companies in Brighton most of which appear to be unsuccessful as they are either liquidated
or struck off in the London Gazette. In order to reduce your financial losses which you
brought to my attention recently you might like to consider getting in touch with a qualified
financial advisor such as those found in High Street banks.
Good luck!

Sincerely,



William Bigwood. MSc.