Psych Eval / *encrypted*
William Boyd, Detective
Male
35 yoa
Referred by: Lt. Nathan Tyndall, Internal Affairs, LAPD
Performed by: Brandon Walsh, Ph.D.
Tests Administered:
Wechsler Adult Intelligence Scale-3 (WAIS-3)
Impact of Event Scale - Revised (IES-R)
Novaco Anger Scale and Provocation Inventory (NAS-PI)
Cognitive Distortion Scales (CDS)
Clinician-Administered PTSD Scale (CAPS)
Structured Clinical Interview for DSM-IV PTSD Module (SCID)
Reason for Referral:
Detective Boyd (hereafter referred to as Bill) was referred for a Psychological Evaluation due to participation in an Officer involved shooting (ref. Case # 2003-07-259645B), a requirement imposed upon active duty police personnel when involved in any event considered traumatic in LAPD's policies and procedures. Also noted in the request for evaluation are alleged incidents of verbal misconduct, and suspicions by investigating officers that exposure to trauma from the aforementioned incident has "compromised Bill's ability to defuse tense situations and/or increases his tendency to escalate such situations or create confrontations." Bill has no formal psychological diagnosis at this time. He has no previous mental health interventions.
General Observations:
Bill's primary language is English. He has no known physical or mental defects that might indicate problems in responding to testing.
Bill's appearance at this evaluation was normal in every aspect. He is shorter than average, his weight appropriate to his height. His grooming was impeccable. His attire was neat and professional. Bill's posture was correct, his bearing confident. His activity level was high, and was characterized by a quick, concise methodology performing required tasks. His impulse control was good as evidenced by superior ability to perform set tasks. Bill's articulation was characterized by a pronounced, but completely understandable, Scottish accent. His voice quality fluctuated during the course of various tests performed, and during the verbal assessment that followed. Speech productivity was restricted and short during performance of tasks, while his manner of speech varied widely between tasks. His conversation style was seen to be forthright.
Bill gave maximum effort throughout testing. His interaction with the examiner was informally polite and direct. His comprehension of test questions was seen to be appropriate. His problem solving strategies were meticulous, and categorized by resourceful and innovative solutions. Bill's pace was steady and deliberate, and his motivation in the testing situation seemed high. He exhibited a flexible image. His facial expressions and demeanor were entirely variable from one phase of testing to another.
Family History:
Bill is unmarried and lives in an apartment (flat). He has never been married, and exhibits neither particular aversion to nor aspirations to matrimony. He reported that he is not currently in a serious relationship. He has no children. Present Family relationships are seen to be nonexistent.
Bill's parents are both deceased, and have been since his early adolescence. He reports one sister, living in Scotland, with which he claims to have a "normal" relationship. He has not seen her in four years. He speaks with her on the phone several times a month.
Physical/Medical History:
Bill reports no known medical conditions and takes no medication on a regular basis. He has had the usual childhood diseases, and suffered a broken arm during childhood. He had no developmental delays.
Bill has been injured in the line of duty three (3) times, none of which have been life-threatening injuries. He has occasional difficulty sleeping. He has a good appetite. He exercises regularly through a variety of martial arts routines.
Educational Background:
Bill graduated from UCLA in 1993. He majored in Computer Sciences and Psychology. He indicates that he enjoyed both of his chosen fields, but believes he is more capable with computers than with psychology. He states his grades were above average, and that he generally enjoyed College.
Skill Training and Vocational History:
During College, Bill worked a variety of part-time jobs for extra money, though the majority of his education was paid for with Scholarships. He also did work as a tutor and a guitar instructor. Bill has been employed as a Police Officer with Los Angeles Police Department for the last 10 years. He went through the Police Academy during his senior year of College. He has been a Police Officer for the entirety of his adult life.
Mental Status:
Bill was fully oriented to time, place and person. He was able to give the proper date, month and year. He was aware of the physical location. He was able to give correct answers concerning his street address, city and state. He was able to give his own name and knew his marital status and vocation.
Bill was asked about his memory functioning and reported that he had observed no problems. Observations by the examiner during the assessment found him to be precise in responding. His short-term memory was found to be normal based on the Wechsler Digit Span subtest. Delayed recall after interference was assessed by asking Bill to recall three words after a five to ten minute delay with other questions interspersed. He recalled all three words, suggesting good delayed recall. Recent memory appeared to be good. He was able to describe what he had eaten for breakfast and he could recall what his activities had been during the previous evening. His remote memory was intact. He knew his birthday, where he was born and the highest grade that he attained in school.
During the interview and testing Bill was not observed to show lapses of attention and focus. He showed no symptoms of Depression or Anxiety that could have interfered with concentration to tasks. He was asked to perform the Serial Sevens task, which required him to count by sevens backward from one hundred and he completed the task without apparent difficulty. As a further measure of concentration he was asked to recite the months of the year, the days of the week and the spelling of his own name backward. His persistence to task was good, and the task was completed quickly and accurately.
Bill's observed fund of information was consistent with reported cultural and educational experiences. On the Wechsler Information subtest, which measures the acquisition of general knowledge, Bill scored above the average range. Based on his responses to higher-level questions, he was seen to have a good fund of general knowledge. He could name the last five presidents of the United States, the temperature at which water freezes, and the longest river in the United States.
Throughout the assessment Bill was observed to have good ability to interpret proverbs. On the Wechsler Similarities subtest, which is a measure of abstract reasoning, Bill scored within the superior range. He was asked to explain the meaning of two proverbs, "Don't count your chickens before they hatch," and "Every cloud has a silver lining." His responses indicated good ability to think abstractly. He was asked to respond to the similarities between various items and his responses suggested superior ability to use abstract reasoning. His amount and productivity of speech was seen as concise and the coherence and progression of his speech was appropriate when answering questions. His general intellectual abilities were seen to fall above the average range. His judgment was considered to be appropriate.
Functional Limitations:
The Relationship between Bill and his sister appears to be limited. He had very few friends or acquaintances. His circle of peers consists of his co-workers, and he freely admits that it has declined markedly in the past few years due to the nature of his most recent assignment. He is involved with no community activities. Day to day activities include Work, martial arts performance practices, and playing his guitar.
Bill is average in performing the activities of daily living. When faced with stress, he demonstrates good coping skills. He is able to recognize normal hazards. He does not have any Adaptive Behavior Deficits.
Bill cooks simple meals and maintains his own domicile, performing all household tasks himself. He reads at or above college-level. He can manage all finances independently.
Test Results:
Bill's Full Scale IQ as measured by the WAIS-3 falls into the superior range of intellectual functioning. Both Verbal IQ and Performance IQ scores were well into the superior range. The difference between the Verbal and Performance IQ scores is meaningful, however. His somewhat lower Verbal IQ score reflects a mild level of impatience, possibly with imprecise forms of communication.
Bill's word understanding and expressive-language skills are remarkable in that he is cross-cultural, and spent his entire childhood in a country in which many words are used differently than they are used in this country. I noted extreme disparities in Bill's use of language, mostly reactive, reflecting exposure to a wide cross-section of the populace -- not uncommon for Police Officers. His use of language is relative to the use of language by those he interacts with, displaying adaptive communicative ability. His fund of information acquired from educational and life experiences is in the above average range. He showed superior abilities in conceptual thinking, quantitative reasoning, and concentration. His practical judgment in social situations was in the average range, but due to his high scores in other areas, it's an interesting disparity in his mental acuity, probably founded in his lack of experience with sincere social relationships.
Bill's visual-motor and visual-integrations skills were at an age appropriate level. He had superior abilities in abstract visual-spatial integration tasks. He showed superior abilities when he was required to anticipate and plan for the future. His ability to recognize and analyze visual detail was excellent. Bill's psychomotor speed and his ability to learn new information from rote memory was exceptional.
I used several standard tests, both self-reports and clinically administered interviews, to measure the effect of the event in terms of Bill's activation threshold for aggression and the level of stress created by the event.
On the IES-R, Bill scored under a reasonable level in all areas. His Avoidance Subscale was the lowest of the three areas measured by the IES-R, showing virtually no tendency toward suppressing high emotion engendered by the event through avoidance of situations, thoughts, or actions that might initiate recall. This result is in line with Bill's overall personality as demonstrated in clinical interviews and information contained in his file. The Intrusion Subscale was somewhat higher, but still well below even a moderate exhibition of symptoms. It shows that Bill has occasional thoughts about the event, that it effects his ability to sleep, as he mentioned himself in his clinical interview, and that he feels a healthy level of guilt and responsibility in relationship to the event. These results display typical and appropriate human reaction to events of this nature. The Hyper Arousal Subscale, measuring the extent to which the event affected the physical response to stimulus, places Bill midway between mild and moderate reactions. The verbal portion of the clinical interview reveals this to be mostly attributed to sleeping difficulties since the event, including nightmares of moderate strength but short duration and difficulty falling asleep due to thoughts concerning the event on an occasional basis. The test indicates a mild increase in his level of watchfulness, and mild physical reactions to thoughts of the incident, such as increased heart rate and sweating. Bill reports physical symptoms occur randomly and are of short duration.
On the NAS-PI (Novaco Anger Scale and Provocation Inventory) Bill specifically requested that his results be compared to a database of Law Enforcement Professionals as well as the standard mean. When I requested further explanation of this request, Bill expressed understanding that nearly all Law Enforcement Professions scored higher on NAS-PI than the general public. I expressed concern to Bill at the level of separation he felt from what he termed the "general public." He responded that it wasn't a matter of separation, that the request was instead congruous with asking for a Jury trial, in that he desires to be judged based on his peers. Bill's background in Psychology indicates that he has a clear understanding of the request made, and I acquiesced to it. There is no disparity to be found in valuing the test in this manner, since the question is not one of Bill being more likely to display anger and act violently than a member of the "general public," but whether or not Bill would be more likely to display anger and act violently than the average member of the Law Enforcement Community. He is essentially correct in his assertion.
Bill's inclination toward anger on the whole shows to be slightly higher than the public mean. Based on a panel of law enforcement professionals, however, this scale places Bill at the lower-average end of the spectrum. Essentially, Bill is more inclined to become angry -- based on cognitive, arousal, and behavior subscales -- than your average person, but less likely to become angry than your average police officer.
His cognitive subscale shows a definite inclination toward general suspicion and anger justification. He feels strongly that most people have something to hide, and it's just a matter of finding out what (this is a paraphrasing of something Bill vocalized to me during the verbal portion of this test). He has standing anger issues with both authority figures, and those that flout authority, another interesting dichotomy in his character, but one that helps to balance him. He feels constrained by rules, but does not espouse the absence of rules. He understands the need for black and white rules of conduct, but feels frustration at the areas that are not covered, or are covered in an inappropriate or ineffective manner by those rules.
The arousal subscale displays fairly high scores in all four categories, high-average compared to other law enforcement personnel and above average on the mean. Bill becomes angry easily. The intensity and duration subcategories varied widely dependent on situation. Somatic tension and irritability were more moderate, showing long-term presence.
The behavior subscale shows Bill's anger is usually expressed verbally and with indirect expression. His scores in physical or impulsive expression of anger compared low, both in regards to law enforcement and public mean. It is exactly in line with his personality as demonstrated in other tests and the verbal interview, and with reports extant in Bill's employment file. Bill becomes angry easily, but is careful to direct that anger with deliberation. He is aware of his own activators, and directs emotion deliberately into non-violent channels.
The anger regulation subscale shows to be very high compared to both groups; Bill is able to regulate anger-engendering thoughts, effect self-calming, and engage in constructive behavior when provoked. He is not a "loose cannon" or a danger to the public. I don't deny that Bill activates quickly under certain stressors, but if anything, he is more capable than the average police officer at containing and effectively and appropriately utilizing this activation.
The provocation index portion of the test indicates that Bill's stressors fall heavily into frustration, annoying traits of others, and irritations. He scored minimally in disrespectful treatment and unfairness. The validity index suggests Bill's answers to be totally consistent. Normative data in this case was compiled of 1,546 anonymous subjects for the public mean, and 512 police officers from the Los Angeles greater metropolitan area for the law enforcement mean.
On the CDS (Clinical Distortion Scales), Bill scored at a non-clinical level in all areas. He did not exhibit any particular signs of a distorted self-image or an altered perception of the world. He scored highest in the PWD (Preoccupation With Danger) category, but was still well below clinical levels. Bill shows no indication of negative thinking patterns that might interfere with optimal functioning.
I chose to administer the CAPS (Clinician-Administered PTSD Scale), in spite of the fact that Bill only barely meets the guidelines for administration, as it was specifically requested by Lieutenant Nathan Tyndall.
Guidelines for PTSD are stringent and specific. The person has to have been exposed to a traumatic event in which both of the following were present. a) The person experienced, witnessed or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others; and b) The person's response involved intense fear, helplessness, or horror.
The first is unquestionably true; the second is subjective. Bill's sleeping difficulties and occasional physical reactions to memories of the event might be construed as intense fear, helplessness, or horror.
Bill freely admits to dreaming occasionally about the event, and has had at least one physiological reactivity flashback on exposure to internal cues. However, PTSD guidelines require these things to be persistently re-experienced, and that does not appear to be the case here. He exhibits symptoms of psychological distress within the normal range. He has not experienced dissociative flashbacks, illusions, or hallucinations of any sort.
There appears to be no effort on Bill's part to avoid stimuli associated with the trauma, and I've noted no numbing tendencies. His diminished relationships among his co-workers were present before the event, and cannot be considered reactive. His range of emotion appears undiminished, and he does not seem to have a sense of foreshortened future. His feelings of detachment from the public were another factor present long before the event, and cannot be taken into account for the purposes of a diagnosis.
He does show persistent symptoms of increased arousal, such as difficulty falling asleep and hypervigilance, including an exaggerated startle response demonstrated by several exercises performed throughout testing, but records indicate that both of the latter were present in Bill's initial psych evaluation upon hiring into the department. Police officers in general are well known to have a higher average in these areas that the general mean, and there is no indication that Bill's scale is any higher than the average police officer's. The same is true with his general irritability. This is a personality trait that has been present in Bill for years, and cannot be used to determine a PTSD diagnosis.
The duration of what few symptoms might be assigned to the event are indeterminate at this time, and Bill shows no clinically significant distress or impairment in social, occupational, or other important areas of functioning.
SCID (Structured Clinical Interview for DSM-IV PTSD Module) is simply another form of PTSD testing. Due to Lt. Tyndall's stressing of the PTSD testing for Bill, I chose to double up on this, performing both tests, although they follow similar criteria. Doing so lessens the chances of the test being effectively manipulated, and counteracts any inadvertent dishonesty or manipulation on the part of the subject.
The SCID results were in all areas similar to the CAPS results. There is no indication whatsoever that the results of any of the tests administered were skewed or manipulated by Bill in any fashion. His background in psychology makes it remotely possible that he could choose to skew the results of a particular test, but it is highly unlikely that he would be able to recreate the results of a deliberately falsified clinically administered test in a second similar, but not identical, test. None of the inconsistencies that would indicate such an attempt appear in the results of either version of the test given.
A diagnosis of PTSD cannot be supported here.
Aside from some very minor social dysfunctions, in fact, no psychological diagnoses can be supported here. Bill falls within the normal range in every test, and appears to have no evident psychosis. His reactions toward the event are those of a normal, healthy law enforcement professional, demonstrating appropriate guilt and responsibility for his actions. There are no apparent impulse control issues to address, and Navoco indicates superior impulse control to counteract quick activation of impatience. There is no indication of Bill being a danger to the public in any way.
I find all concerns listed in the request for psychological evaluation to be wholly unfounded, and recommend that Bill be returned to full and active duty, with all rank and privileges to be fully reinstated.