On the wiki: Nick used to have a forum that was decently popular. It wasn't HUGE, but there was a small, fairly dedicated userbase. I think I remember him initially creating the wiki as a place to put inside jokes from the forum and general stuff along those lines, but I could easily be mistaken. It's been a long time.
On the teeth thing: As I previously mentioned, awful teeth seem to be a family thing. Now, I would be shocked if he actually brushed them, but I'm also not entirely sure he's seen a dentist in a long time, if at all, just judging by how Amber's teeth seem to be going in much the same direction. Like I said, his family is super neglectful and lazy. My guess is that it's a combination of terrible hygiene and the fact that he's still pretty much dependent on his family (and probably always will be), who don't seem to care much about anything, including their children.
As for why he doesn't brush them, I can only speculate that he justifies it using the same logic he uses to justify not bathing or showering: he "doesn't get dirty" (meaning, in this specific case, that he doesn't participate in any specific activities that'd cause him to become covered in grime...although one would think masturbating with his own feces would count), so he believes he has no need to shower or clean himself in any way. He has a really fundamental misunderstanding of how most things work, and hygiene is one of those things.
On his fear of water: It's not a fear of water per se, I don't think. It's a more specific fear called ablutophobia, which is the fear of bathing. Remarkably, this is a documented phobia...but it's only even remotely common among very young children. And I'm frankly not inclined to believe he actually suffers from such a phobia--I think it's just something he claims to make his refusal to bathe more "acceptable".
Coffee Crew
Nick Bate's Web Comic the Coffee Crew
Showing posts with label malodorus. Show all posts
Showing posts with label malodorus. Show all posts
Tuesday, August 19, 2014
Wednesday, May 28, 2014
Friday, May 10, 2013
COMPREHENSIVE PSYCHOLOGICAL EVALUATION
NICKALAUS STOUTZENBERGER
MAY 10, 2013
Identifying Information
Birth Date: 09/01/91
Gender: Male
Age: 21 years, 8 months
Race: Caucasian
Community Systems Involved:
TEAMCare Behavioral Health, LLC: Therapist - Tara Tumility; Psychiatrist - Dr. Biever
Community Services Group, Intensive Case Management - Chad Wickenheiser
Reason for Referral
Nick was referred for a comprehensive psychological evaluation by his outpatient therapist, Tara Tumility, to clarify diagnosis and to determine if Nick's demonstrated social weaknesses may be related to cognitive defects, personality factors, and/or a developmental disability.
Relevant Information
Background History
Strengths
Nick is a 21 year, 8 month-old Caucasian male, with self-reported strengths that include an interest in music, writing and drawing. Family strengths include a supportive maternal aunt who provides housing and money management for Nick. She has also arranged for a variety of services for him. These areas of individual and family strengths represent domains that can be further developed for use as a foundation for a strength-based plan.
Family
Nick is presently living alone in an apartment in Columbia, PA which is owned by his maternal aunt, Joyce. He has never married and he has no children. His parents are divorced; his mother is remarried and his father resides with his girlfriend. Both his parents live locally, but Nick reported that he does not see them often. He reported that his mother and step-father will not allow him to come to their house although Nick reported that he does not know what prompted that decision. When he inquired about this to his step-father, Nick indicated that his step-father said, "You know why." Nick reported that he does not like his mother or step-father because "they are very conservative and not very tolerant." He acknowledged that his aunt, Joyce, is his primary social support, but he reported that he does not have a good relationship with her. His main source of conflict with her is that she controls his money and will not allow him discretion with his purchases; specifically she will not allow him to purchase women's clothing for himself. Nick did report that he was in agreement with her being his representative payee because he feels that he would not be capable of managing his own money.
Nick does have a 10-year-old maternal step-sister and he reported that he has a good relationship with her, but he is not allowed to see her without a parent present. He denied any past violence or inappropriate behavior towards her.
Nick lived with his biological parents until they divorced when he was a young child. Nick reported that he does not recall much about his childhood, although his aunt reported that his father was alcoholic, abusive, and unpredictable. His aunt could not recall any specific incidents. Nick remained living with his mother when his parents divorced and after his mother's second marriage. Nick was homeschooled for a period of a couple years in high school. His aunt, Joyce, was his primary instructor. After Nick completed high school, his aunt assisted him in applying for social security disability, helped him to get connected with a mental health case manager, and allowed him to live in an apartment that she owns.
With regard to his living situation, Nick has concerns about his ability to live independently. At one point, his voice became loud and he appeared to be in distress and stated, "Why would these people even think I could live alone?" He reported that he is fearful to leave his house or to answer his door. He acknowledged that his decision-making skills are poor at this time. When asked what he would do if there were a fire on his stovetop, he responded, "I would have to text my aunt." When further prompted, he said maybe he could put something over the fire because he did not think you could throw water on a stove, but at no point did he mention calling 911 or using a fire extinguisher.
In terms of family psychiatric history, his aunt reported that his maternal grandmother was diagnosed with dementia recently and may have previously been diagnosed with bipolar disorder. Some extended cousins are reported to have been diagnosed with bipolar disorder. Family substance abuse is significant in that Nick's father was reportedly an alcoholic and according to Nick, his father also abused marijuana, allowing Nick to smoke with him.
Cultural Considerations
Nick's family composition is Caucasian. There is no report of any adverse impact as a result of cultural factors. There is no report of any negative impact due to environmental factors. Nick reported some concerns with his finances as he is currently receiving Social Security Income. Nick indicated that he does not have a religious affiliatio.
Developmental/Medical
Several attempts were made to reach his mother, Carol Osborne, to obtain developmental and collateral information. His mother could not be reached directly, but she did leave a message reporting that "he has always been a problem." His aunt, Joyce, did not recall any problems during his mother's pregnancy or his delivery. She did not recall that he had any developmental delays and commented that "he was always pretty smart." There is no indication that Nick ever received any early intervention services. By his own report, he was able to read prior to entering kindergarten.
Medically, Nick reported that he does not have a primary care physician. He denied any history of seizures, head trauma, unusual illness, or medical hospitalizations. He is not aware of any allergies to medications or environmental agents. He is not being treated for any medical problems. He did report concern about a chronic cough, but reported that he was told by a physician that it was likely due to allergies. He is presently prescribed Viibryd for anxiety and depression and he also has a PRN prescription for Ativan which he reportedly uses two times per month when he goes grocery shopping. He reported that he takes his medication as prescribed and follows with Dr. Biever, his psychiatrist, on a regular basis.
Trauma History
With regard to trauma, Nick denied any history of sexual, physical, or emotional abuse. He denied any history of neglect. Nick's aunt, Joyce, reported that when he was young and his parents were still married and living together, his father would frequently come home intoxicated and would be verbally abusive and destructive to property. His aunt also recalled an incident where Nick's father spanked him at school and "somebody checked into that." Nick's parents divorced sometime during his elementary school years, although he could not recall what age. He continued to live with his mother and visited with his father on a regular basis. Nick has not been involved in any human-made or natural disasters.
School/Vocational
Nick attended Penn Manor School District and paperwork from this district indicated that he was placed in full-time emotional support in 4th grade, although a copy of his psych-educational evaluation is not available for review. His present educational levels during the 2001-2002 school year noted the following: "Nick is usually very quiet in class and at times cooperative in class. He works well in 1:1 situations with staff and in small groups. He receives 48 to 52 points per day on his point sheet (52 possible points). Nick loses the most points in the area of respect and class rules. He continues to exhibit difficulty with peer relationships which is demonstrated by his inappropriate behaviors to peers. Until recently, Nick did not interact with others on the playground and often chose to remain in the classroom during recess. He is unable to accept consequences for his inappropriate actions, and repeatedly states, 'I didn't do anything.' Nick is extremely emotional and takes everything to heart."
His strengths were noted to be superior intelligence, creative talents, visual sequencing, wide vocabulary skills, verbal reasoning skills, abstract reasoning abilities, academic abilities. His needs were described as increase compliance with school rules/expectations, increase appropriate social interaction with peers, specifically to lessen physical aggression toward peers, increase ability to seek help when needed and to develop strategies to deal with anxiety and withdrawal.
There is no other school information available until he returned to Penn Manor High School as a junior. Nick was homeschooled during his 7th, 8th, 9th, and 10th grade years. When Nick returned to the public high school, he was enrolled in full-time emotional support. Information from his IEP that year noted, "since enrolling in Penn Manor School District as a junior, Nick has been doing very well academically and behaviorally." Observations indicated that "his teachers describe Nick as quiet, intelligent, and funny. In class, Nick will sit quietly and rarely offer answers or participate in class discussion without teaching prompting." It is also noted that, "Nick needs to improve his social skills. Nick avoids high social areas such as the cafeteria and hallways, even with peer prompting to join. Nick sometimes makes comments or acts in ways that has a tendency to draw negative attention to himself - such as sucking on his hair or moaning for no apparent reason."
Nick reported that when he was younger, he would frequently get into fights with his peers at school. He could not recall if he initiated the fights. When he returned to school as a junior, Nick reported that he spent most of his time sitting at a desk drawing and peers would approach him to talk and/or comment on his drawings. He described these peers as his friends but reported that he never had contact with them outside of school by his choice.
Transition planning indicated that Nick's future goal was "to be a househusband and Nick has given little thought to other options, even with prompting from the teachers and the job trainer."
Nick graduated high school, although he cannot recall the exact year. He thinks it was 2008 or 2009.
Vocationally, Nick has helped his mother at her flea market stand a couple times, but other than this he has no employment history. He is presently receiving social security disability based on his diagnosis of major depression.
Community/Peer Relationships
Nick does not have any peer relationships in the community. He has a strained relationship with his family members. He developed a relationship with some individuals online when he was a teenager. One individual is "Anna" and she has blocked all contact with him, although he continues to make attempts to contact her electronically. Nick firmly believes that he and Anna will eventually marry and he continues to ignore her request to not contact her, and the more recent request of the police, to stop all contact with her. He believes that she resides in California, but stated that he has no plans to go to California to find her "because I would need an escort because I wouldn't know how to go about getting there." He also reported that he will continue to try to contact her, although "I wouldn't commit a major crime to reach her, but probably a misdemeanor." He continues to have frequent contact with a young woman, "Jessa," and Jessa's fiancé, "William." Nick refers to Jessa as his mother, but reported that he does not really like William, but maintains contact with him because of Jessa. Reportedly Jessa is his age. He commented how he had gotten her some coupons for Mother's Day. There is another individual, "Thom" who Nick met online and Nick refers to his as his father.
With regard to intimate relationships, Nick reported that he has never had a girlfriend that he has met in person and he reported that the only girlfriend he has ever had is "Anna", although he has only had electronic communication with her and it is not clear if she ever reciprocated his feelings. Nick has never been sexually active with a female or male and he reported that he regards himself as heterosexual. He reported that he has crossdressed since he has been a teen, but he does not currently have access to women's clothes. He reported that he frequently masturbates and that he feels his sex drive is "more active than most people." He enjoys pornography that involves feces and he reported that he frequently fantasizes about having anal sex, consensually and forcibly with females. He also reported that his sexual fantasies include young girls who "can talk in full sentences and are house-trained, but not yet like real women." He denied that he has ever approached or had any sexual contact with a minor. He admitted that he tried to find female child pornography online in the past, but he was reportedly unsuccessful. When this evaluator told him that this type of activity is illegal, he indicated that he did not understand why that would be.
Nick is not involved in any community activites and reportedly only leaves his apartment to go to appointments and to grocery shop two times monthly. He spends the majority of his time at home alone, communicating with the above individuals electronically. Nick reported that he does not recaqll ever engaging in any community or school activites.
Drug & Alcohol/Legal
In terms of substance abuse history, Nick reported that he used alcohol one time several years ago while with his father. He consumed one "Jell-O shot". Nick reported that he used marijuana approximately 20-30 times with his father when he was a young teen. He reported that he has not used marijuana in at least 4 years. He denied any history of using any other type of substance. He denied any history of abusing prescription or over-the-counter medication and he does not take any herbal supplements.
In the legal sphere, Nick reported that he was arrested twice as a juvenile. His memory of the exact indicents is not clear, but he believes both incidentes may have been related to aggression and/or threats to his mother. He stated that he was on probation for these incidents. He denied any arrests as an adult. He was aware that the police had recently contacted his aunt related to his attempts to contact a female via the Internet, but he reported that "they did not approach me directly." He reported that he has continued to try to contact a female, "Anna", despite her direct request that he not contact her and she has blocked all communication from him.
Service History
Nick received inpatient psychiatric treatment at age 15 for 11 days at Brooke Glen Behavioral Hospital. He was involuntarily committed after he became physically aggressive with his mother. A discharge summary from this facility indicated the following diagnoses: major depression, social phobia, avoidant personality traits. It further stated that, "psychological testing was completed which supports the above diagnoses, it did not support psychosis." During his hospitalization, anti-depressant medication was recommended but "mother did not indicate that she would follow through with this option for aftercare."
Other than school interventions and his current treatment, it appears that Nick's hospitalization represents the extent of his previous formal psychiatric treatment. Nick reported that his mother does not believe in mental illness and, therefore, she did not initiate or support treatment.
Evaluation Procedures
Review of the following records:
Clinical interview with Nick Stoutzenberger
Consult with Tara Tumility and Chad Wickenheiser
Brief phone interview with his maternal aunt, Joyce
Behavioral observations
Wechsler Abbreviated Scale of Intelligence (WASI-II)
Wechsler Individual Achievement Test, Second Edition Abbreviated (WIAT-II)
Thematic Apperception Test (TAT)
Minnesota Multiphasic Personality Inventory-2 (MMPI-2)
Delis Kaplan Executive Function System (D-K EFS)
Interview/Test Results
Behavioral Observations
Nick was brought to the appointment by his case manager, who dropped him at the office. Nick is tall and he has a large build. He was dressed casually and appropriately, although he was malodorous. He had a beard and his hair was slightly unkempt. Nick reported that he generally only showers once a week. His eye contact was fleeting and he appeared to try to avoid eye contact, often looking down. His activity level was within normal limits. He was able to initiate and sustain attention for all tasks and his concentration was adequate. He did not require any repetition of directions. He demonstrated good manners, never interrupted and was able to engage in a reciprocal conversation. He answered all questions, at times offering relevant spontaneous information. He was able to complete the entire evaluation in one day, taking a 20 minute break for lunch. After he completed the evaluation, he thanked the evaluator.
Mental Status Exam
In terms of mental status, Nick was alert and was oriented to person, day of the week, month, year, and situation. His affect was constricted. He described his mood as "depressed, scared, and bored." Stream of thought appeared to be organized, relevant, and goal-directed with content of thought focused on providing information as requested and completing the tasks required. His responses were relevant to the questions. Nick did not exhibit any overt indications of an underlying thought disturbance, in the form of auditory or visual hallucinations, and he denied that presence of both, in the present or past. He denied present suicidal ideation. He reported that he has experienced suicidal thoughts in the past, "but I would never do it." Nick reported that he constantly has homicidal ideation toward his mother, step-father, and aunt; however, he stated adamantly that he has no intent to act on these thoughts because "I do not want to go to jail." He indicated that he frequently has "videos" playing in his mind that involve killing his family in multiple ways, indicating that sometimes he is portrayed as a superhero in these "videos." Nick reported that he has been violent with his mother in the past and has left bruises on her. When he was fifteen, he was psychiatrically hospitalized after he assaulted his mother because she would not allow him to use the computer. Nick denied any history of cruelty to animals, vandalism, or fireplay, adding that he is very close to his cat and wondered what life would be like if he could communicate with his cat by speaking "cat language." His insight was fair as he indicated that he has pursued therapy, psychiatric treatment, and psychologcal testing "because I want to know what's wrong with me." His judgment is extremely impaired as he reported that he does not understand why anyone would be concerned with his constant attempts to contact a female that does not want contact as well as his claims that he will certainly marry this female. Additionally, he showed this evaluator, as well as his therapist, conversations that he has had online with others that contain graphic sexual and violent comments and he does not understand why this is considered inappropriate or unusual.
Validity Considerations
The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) yielded an invalid profile based on Nick's endorsement of far more symptoms than would be typical even for an individual being treated on an inpatient psychiatric unit. High scores on most scales as evidenced by Nick's profile suggests that an individual may be overly endorsing problems in order to appear pathological or, as likely in Nick's case, it is an indication that an individual is experiencing a myriad of symptoms in several domains, frequently and intensely, and that the symptoms are causing a significant amount of stress and impairment.
Intellectual Functioning
The Wechsler Abbreviated Scale of Intelligence, 2nd Edition (WASI-II) administered in order to assess Nick's cognitive functioning and to obtain and understanding of his level of intellectual functioning. The WASI-II is designed as a screening tool to quickly and accurately estimate an individual's intellectual functioning. Assessment of Nick's present level of cognitive abilities indicates overall intellectual functioning in the superior range (WASI-II IQ = 129). Nick's IQ places him in the 97th percentile, indicating that he did as well or better than 97% of similarly aged individuals. Nick's verbal skills are significantly more developed than his nonverbal skills, although his nonverbal abilties, as evidenced by his performance on the Perceptual Reasoning Index, are solidly within the average range.
WASI-II SUMMARY SCALES (Mean = 100, SD = 15)
Scale - Composite Score - Percentile - Confidence Interval (95%) - Description
Verbal - 143 - 99.8 - 135-147 - Very Superior
Perceptual Reasoning - 108 - 70 - 101-114 - Average
Full Scale (Four subtests) - 129 - 97 - 123-133 - Superior
WASI-II SUBTEST T-SCORES (Mean = 50, SD = 10)
Vocabulary: 77
Similarities: 75
Block Design: 58
Matrix Reasoning: 52
With regard to specific subtests, Nick demonstrated abilities above the norm on all subtests. His best performance was on the Vocabulary subtest, as his score fell well above the norm. This subtest assesses an individual's expressive vocabulary, verbal knowledge, and fund of information. His performance on the Similarities subtest was equally as strong as his performance on the Vocabulary subtest. The Similarities subtest measures abstract verbal reasoning and conceptualization. Nick's performance on the Block Design subtest was above the norm. This subtest measures spatial visualization, visual-motor coordination, and abstract conceptualization. Nick also performed in the average range on the Matrix Reasoning subtest, which measures nonverbal fluid reasoning.
Achievement
In order to assess Nick's level of academic achievement, the Wechsler Individual Achievement Test - Abbreviated, Second Edition (WIAT-II Abr.) was administered. Nick's performance on the Word Reading subtest was in the high average range of scores (SS = 112). He was able to read all the words on the list with the exception of "ethereal" which he slightly mispronounced. His performance on this subtest correlates to a 12.8 grade equivalent. His score on the Numerical Operations subtest was in the average range (SS = 103). This score corresponds to an 11.9 grade level. His performance on the Spelling subtest was in the high average range (SS = 114) and corresponds to a 12.8 grade level.
Neuropsychological Functioning
In order to further measure Nick's executive functioning abilities and his higher level cognitive skills, various tests were administered to obtain a clearer picture of his strengths and weaknesses in these areas. The Delis-Kaplan Exsecutive Functioning System (D-KEFS) is a measure of high order cognitive, executive functioning. The subtests were designed to assess complex multifactorial domains of cognition in a comprehensive manner. The D-KEFS subtests administered include Trail Making, Verbal Fluency, Sorting Test, Twenty Questions, and Proverb Test.
Trail Making Test - Scaled Score - Classification
Visual Scanning - 12 - At Expected Level
Number Sequencing - 13 - Above Expected Level
Letter Sequencing - 12 - At Expected Level
Number-Letter Switching - 11 - At Expected Level
Motor Speed - 13 - Above Expected Level
Nick's performance on Trail Making, which involved visual cancellation and connecting circles tasks, demonstrated average to above average abilities in cognitive flexibility, a classic executive function that is essential for higher-level skills such as mulititasking, simultaneous processing, and divided attention. His motor speed was faster than would be expected and his ability to visually scan information was at the expected level. His ability to sequence numbers was above the expected level and his ability to sequence letters was average. His ability to shift between numbers and letters, requiring cognitive flexibility and divided attention, is in the average range.
Verbal Fluency - Scaled Score - Classification
Letter Fluency - 7 - Borderline
Category Fluency - 7 - Borderline
Category Switch - 8 - At Expected Level
Category Switching Accuracy - 9 - At Expected Level
The Verbal Fluency Test requires word generation based on letter and category, with a switching task also presented. Nick's ability to generate words starting with a specific letter is slightly below what would be expected. He appeared to be anxious during this task and some of the words were associated with sexual activity such as "fornication" and "syphilis." His ability to generate words that fit into a specific category is slightly below the expected level; however, his ability to cognitive shift between categories is at the expected level with his accuracy on this task at the expected level as well.
Sorting Test - Scaled Score - Classification
Confirmed Correct Sorts - 14 - Above Expected Level
Free Sorting Description - 15 - Above Expected Level
Sort Recognition - 16 - Well Above Expected Level
On the Sorting Test which measures concept-formation and verbal and nonverbal problem solving abilities, Nick performed in the range above what would be expected for an individual his age. His performance on this measure suggests that his ability to think abstractly and solve problems is very well developed.
Twenty Questions - Scaled Score - Classification
Initial Abstraction Score - 9 - At Expected Level
Total Questions Asked - 13 - Above Expected Level
Total Weighted Achievement - 19 - Well Above Expected Level
The Twenty Questions Test measures abstract thinking and problem solving strategies. The executive functions assesed include the perception of various categories and subcategories represented; the ability to formulate dichtomous questions, and incorporate feedback to formulate more efficient questions. Nick was shown a page of various common items and objects and he has to ask yes/no questions to determine the target object. The goal was to ask as few questions as possible in order to identify the target object. Nick's performance on this measure is consistent with his performance on all other measures of abstract thinking and problem solving, suggesting that these higher level thinking skills are very well developed in this young man.
The Proverb Test evaluates the abstract interpretation, understanding of word meanings, as well as abstract principles and concepts. Nick's ability to verbally describe proverbs was in the expected range and when provided with a proverb and multiple choice answers, he correctly answered 100% of the questions.
Emotional and Behavioral Functioning
While Nick's cognitive, achievement, and higher level executive functioning abilities are impressive, his emotional and behavioral functioning is concerning. In the clinical interview, Nick reported that he has "videos" playing in his head where he is able to view himself killing his mother, step-father and aunt in various ways. He reported that at times it is him in his natural state killing them and other times, he becomes a superhero with superpowers and kills them. Nick casually described how he feels they deserve to die because they are very conservative and not tolerant of other races and homosexuals. He stated that they don't like him because he likes sex, violence, and cursing. Nick clearly stated that he has no intent to kill his family, "because I don't want to go to jail," but he further stated that if no laws prohibited murder, he is sure he would do it.
Nick also reported having sexual fantasies that involve him having anal sex with women and young girls. He reported that his fantasies include both rape and consensual sex. His sexual fantasies involve feces as he reported that he becomes sexually aroused by fantasizing about women defecating and that he has used feces when he masturbates. He does frequently view pornographic tapes that involve the above, although he reported he has not been able to access child pornography. He stated that he has never been sexually intimate with anyone. His only sexual encounter was around the age of thirteen when he and a female teen cousin touched each other and this was reported to be consensual. Nick shared his journals with this evaluator which included numerous writings about sex and violence. He had written about being angry with his aunt and described how he would like to anally rape her. He reported that he does not necessarily fantasize about his aunt and that he wrote that statement out of anger. At one point, he wrote how something was falling from the sky and he thought it was semen, but later realized that it was rain. On the MMPI-2, Nick's responses on the Schizophrenia scale were quite high (T = 112). Specifically, his high score on the social alienation subscale (T = 105) suggests that he perceives that he is mistreated and misunderstood. His emotional alienation score (T = 98) indicated that he has a significant amount of fears, depression, and apathy. Additionally, the high T scores on the Lack of Ego Mastery, Cognitive (T = 90) and Conative (T = 92) scales are consistent with someone who fears losing control, feels as though life is unreal and likely responds to stress by retreating into a fantasy world. His responses on the Thematic Apperception Test (TAT) suggested some problems with reality orientation. He described one picture as a house in a snowstorm with "eyes" in the background "that's like a ghost or something." On another card, he saw a figure in the background and stated, "that's like a dog wearing a hood" but later added that he did not know why a dog would be walking upright, wearing a hooded jacket.
With regard to his impulse control, Nick reported that he feels he can control his impulses but attributed part of that to his fear to leave his home. He did state that he has some concerns about decreasing his social anxiety because "If I'm cured and go out, I fear what I would do." While Nick's explosive anger score is elevated (T = 71) his score on the inhibition of aggression score is average (T = 48), which supports Nick's assertion that at the present time he is successfully controlling his angry impulses.
Nick described a significant level of social anxiety, which he has experienced for several years. He reported that he did not want to go to school and that is why he was homeschooled from 7th to 10th grade. When he did return to public school, he reported that his attendance was good, but he did not like to leave the classroom. He reported that he does not like to be in the community because he is worried about being harmed or shot. He does not feel safe in his home, "I'm afraid of everything, I feel like I can't defend myself and I don't know what I would do if someone broke in." He also reported that he does not like to take showers because he becomes increasingly fearful during this task. He reported that he has difficulty talking to others in the community and that he has signigicant problems making decisions, "I have trouble placing an order at McDonald's." Nick was able to describe appropriate social behavior and described being socially avoidant because he becomes so anxious around others that he cannot function or communicate. He indicated that he is aware that some of his anxiety resolves around his fear of what he may do to others if he cannot control his impulses. Nick's overall score on the paranoia scale on the MMPI-2 was extremely elevated (T = 101) with responses that corresponded to a signigicant amount of persecutory ideas (T = 112). His responses on the TAT also include some persecutory ideation. He described story about a picture with a young boy and broken violin as "it's broken at the neck; someone probably did it on purpose." Another card showed a little boy sitting alone and he described the boy as "upset" and that "maybe his parents punished him and he's in trouble." Another picture he described as "a bunch of dudes huddled together for safety or warmth" noting that one man is "probably the watch, they probably sleep in shifts."
With regard to his mood, Nick stated that he is generally depressed. He often feels hopeless, but indicated there are times when he is hopeful; mainly when he fantasizes about "Anna." He described feeling worthless, "I'm not really good at anything, I can't contribute to society." He indicated that he never cries, "but I feel like I need to, I just don't." His personal hygiene is very poor, he showers once per week with prompting and does not attend to his personal care consistently. He described his sleep as "random" but indicated that he is working on trying to establish better sleep habits by going to bed at 10 or 11 and then he typically sleeps until 9 AM. He reported that his appetite is good. He denied present suicidal ideation, but noted that he has had these thoughts in the past, but has never made a suicide attempt. Nick's score on the MMPI-2 depression scale is elevated (T = 91) with elevated scores on scales that assess subjection depression, psychomotor retardation, physical symptoms, mental dullness, and brooding. Nick has previously been diagnosed with major depression and he is currently being treated for anxiety and depression with therapy and medication.
Discussion
One of the purposes of this evaluation was to assess Nick's cognitive functioning as he demonstrates extremely poor judgment and decision making skills and his adaptive functioning is marginal. However, Nick's intellectual ability is in the superior range, with very superior verbal skills. His verbal skills are significantly more developed than his nonverbal skills; which is sometimes the case in individuals with Asperger's disorder; however, Nick does not demonstrate any deficiencies in academic achievement as if often co-morbid in inidividuals with Asperger's disorder, nor does he show any deficits in his higher level thinking skills. Quite the contrary, Nick demonstrated well developed abstract thinking, problem solving, cognitive flexibility, and the ability to sustain divided attention. Typically, individuals with Asperger's disorder demonstrate areas of relative weakness in some areas of higher level thinking.
Although limited past information was available for review, the information from his school and from his inpatient stay at age 15, does not mention any consideration of a diagnosis of Asperger's disorder and reported his problems with socialization to be primarily related to his social avoidance and social phobic behaviors. Presently, Nick demonstrates a marked fear of all social situations because he feels he does not know how to communicate and behave in these situations. When he is required to attend certain places, such as the grocery store, he reported that he needs to take Ativan to avoid a panic attack. Nick understands that his anxiety is well beyond what is typical and acknowledged that he is in no more danger than anyone else. His anxiety has significantly negatively impacted his ability to function in all domains including social, occupational, academic and interpersonal. Based on these symptoms that have been present for several years, a diagnosis of social phobia will be assigned.
Nick has demonstrated a pervasive pattern of social interpersonal deficits evidenced by his extreme discomfort with social interactions and his inability to develop close relationships. In addition, he also has cognitive distortions. He believes his family should be murdered because of his perception that they are "too conservative." He continues to be obsessed with a female, "Anna" that he met on the Internet and firmly believes she will be his wife despite her consistent refusal to have contact with him and police involvement. The relationships that he has developed on the Internet, based on his journal writings and the dialogue, appear to revolve around his expression of sexual and violent desires. These relationships seem to have a surreal quality to them as he described one female as his mother and another individual as his father and looks to them for parental advice. He demonstrates obsessive ruminations with explicit sexual and aggressive content and does not seem to understand that this is atypical, especially his focus on discussing his intense dislike for vaginas. His speech, although well developed, can be circumstantial and odd as when he described young girls as "being house-trained and able to speak in complete sentences." His affect is constricted and he demonstrates little to no emotion, he lacks close friends, and his social anxiety is pervasive and seems to be more associated with fears of being harmed rather than on negative judgments about himself. Based on records from the school and his previous hospitalization, as well as his report and his aunt's collateral information, these behaviors have been longstanding and likely represent a maladaptive personality disorganization. Based on these symptoms, Nick meets criteria for schizotypal personality disorder. While some of his behaviors are consistent with avoidant personality disorder, his social anxiety does not primarily seem to be the result of the fear of rejection. Additionally, his cognitive distortions and odd beliefs are more consistent with a schizotypal personality organization.
While Nick reported that his "friends" from the Internet have suggested to him that he has Asperger's disorder and he also feels this may be the case, there is limited historical information to support this diagnosis. Additionally, his performance on tests of higher level thinking skills indicated that his abstract reasoning, problem solving skills, and cognitive flexibility are very well developed, which is not typical. His problems with socialization appear to be more related to social anxiety and fears, rather than an inability to understand social cues or a lack of understanding about appropriate social behavior.
Nick has previously been diagnosed with major depression and he clearly meets criteria for this disorder at this time. He described that he has a pervasive depressed mood and finds little enjoyment in any activities. His functioning in all domains is impaired and he has great difficulty making simple decisions. His self-care is marginal, although he understands what activities of daily living should be completed, knows how to do them, and can functionally perform these tasks; he does not. He feels hopeless and worthless most of the time and has little motivation and energy. It appears that he has had several episodes of depression since at least his teen years, with few periods of remission. He reported that he feels little benefit from the medication.
With regard to his perported sexual arousal related to touching or viewing feces, he will be given a diagnosis of paraphilia, specifically coprophilia. While Nick describes wearing female clothes, it is not clear that this is related to sexual arousal as he described he specifically likes female clothes because they are "smooth and soft," and did not relate the activity to sexual arousal. While he has violent sexual fantasies and fantasizes about sexual activity with young girls, he denied that he has ever acted on these impulses.
Diagnosis
Axis I: 300.23 Social phobia
296.33 Major depression, recurrent, severe without psychotic features
302.9 Paraphilia not otherwise specified, coprophilia
Axis II: 301.22 schizotypal personality disorder
Axis III: none reported
Axis IV: Psychosocial stressors: problems with primary supports; occupational problems; other psychosocial and environmental problems
Axis V: Current GAF: 30
Highest GAF in the past year: 30
Recommendations
1. Nick is an individual who is suffering from several depressive symptoms that appear to be minimally responsive to medication and therapy at this time. In addition, Nick appears to have significant problems with cognitive distortions and his orientation to reality is tenuous. It is likely that his social isolation, which allows him to spend most of his day fantasizing, is contributing to his overall impairment. While Nick has not acted on any of his impulses, based on the level of specific violent details involved in his fantasies and his grossly impaired judgment, it is strongly recommended that Nick be referred to a partial hospitalization program where he can be supervised and treated on a daily basis. This type of environment will also be able to provide him with a safe environment with structure to work on decreasing his anxiety related to interpersonal contact. If Nick is unwilling to attend a partial hospitalization program, his status should be monitored frequently by his intensive case manager to determine if inpatient treatment may be necessary.
2. With regard to his violent sexual fantasies that involve both adults and minors, it is recommended that a comprehensive psycho-sexual evaluation be conducted as soon as possible. It is recommended that a residential treatment center be considered due to the violent nature of his thoughts.
3. With regard to his housing situation, Nick has questioned his ability to live independently. Presently, his judgment and decision making abilities are impaired and it is questionable whether he would be able to function appropriately if faced with an emergency in his home. Based on this, it is recommended that a residential program be considered.
NICKALAUS STOUTZENBERGER
MAY 10, 2013
Identifying Information
Birth Date: 09/01/91
Gender: Male
Age: 21 years, 8 months
Race: Caucasian
Community Systems Involved:
TEAMCare Behavioral Health, LLC: Therapist - Tara Tumility; Psychiatrist - Dr. Biever
Community Services Group, Intensive Case Management - Chad Wickenheiser
Reason for Referral
Nick was referred for a comprehensive psychological evaluation by his outpatient therapist, Tara Tumility, to clarify diagnosis and to determine if Nick's demonstrated social weaknesses may be related to cognitive defects, personality factors, and/or a developmental disability.
Relevant Information
Background History
Strengths
Nick is a 21 year, 8 month-old Caucasian male, with self-reported strengths that include an interest in music, writing and drawing. Family strengths include a supportive maternal aunt who provides housing and money management for Nick. She has also arranged for a variety of services for him. These areas of individual and family strengths represent domains that can be further developed for use as a foundation for a strength-based plan.
Family
Nick is presently living alone in an apartment in Columbia, PA which is owned by his maternal aunt, Joyce. He has never married and he has no children. His parents are divorced; his mother is remarried and his father resides with his girlfriend. Both his parents live locally, but Nick reported that he does not see them often. He reported that his mother and step-father will not allow him to come to their house although Nick reported that he does not know what prompted that decision. When he inquired about this to his step-father, Nick indicated that his step-father said, "You know why." Nick reported that he does not like his mother or step-father because "they are very conservative and not very tolerant." He acknowledged that his aunt, Joyce, is his primary social support, but he reported that he does not have a good relationship with her. His main source of conflict with her is that she controls his money and will not allow him discretion with his purchases; specifically she will not allow him to purchase women's clothing for himself. Nick did report that he was in agreement with her being his representative payee because he feels that he would not be capable of managing his own money.
Nick does have a 10-year-old maternal step-sister and he reported that he has a good relationship with her, but he is not allowed to see her without a parent present. He denied any past violence or inappropriate behavior towards her.
Nick lived with his biological parents until they divorced when he was a young child. Nick reported that he does not recall much about his childhood, although his aunt reported that his father was alcoholic, abusive, and unpredictable. His aunt could not recall any specific incidents. Nick remained living with his mother when his parents divorced and after his mother's second marriage. Nick was homeschooled for a period of a couple years in high school. His aunt, Joyce, was his primary instructor. After Nick completed high school, his aunt assisted him in applying for social security disability, helped him to get connected with a mental health case manager, and allowed him to live in an apartment that she owns.
With regard to his living situation, Nick has concerns about his ability to live independently. At one point, his voice became loud and he appeared to be in distress and stated, "Why would these people even think I could live alone?" He reported that he is fearful to leave his house or to answer his door. He acknowledged that his decision-making skills are poor at this time. When asked what he would do if there were a fire on his stovetop, he responded, "I would have to text my aunt." When further prompted, he said maybe he could put something over the fire because he did not think you could throw water on a stove, but at no point did he mention calling 911 or using a fire extinguisher.
In terms of family psychiatric history, his aunt reported that his maternal grandmother was diagnosed with dementia recently and may have previously been diagnosed with bipolar disorder. Some extended cousins are reported to have been diagnosed with bipolar disorder. Family substance abuse is significant in that Nick's father was reportedly an alcoholic and according to Nick, his father also abused marijuana, allowing Nick to smoke with him.
Cultural Considerations
Nick's family composition is Caucasian. There is no report of any adverse impact as a result of cultural factors. There is no report of any negative impact due to environmental factors. Nick reported some concerns with his finances as he is currently receiving Social Security Income. Nick indicated that he does not have a religious affiliatio.
Developmental/Medical
Several attempts were made to reach his mother, Carol Osborne, to obtain developmental and collateral information. His mother could not be reached directly, but she did leave a message reporting that "he has always been a problem." His aunt, Joyce, did not recall any problems during his mother's pregnancy or his delivery. She did not recall that he had any developmental delays and commented that "he was always pretty smart." There is no indication that Nick ever received any early intervention services. By his own report, he was able to read prior to entering kindergarten.
Medically, Nick reported that he does not have a primary care physician. He denied any history of seizures, head trauma, unusual illness, or medical hospitalizations. He is not aware of any allergies to medications or environmental agents. He is not being treated for any medical problems. He did report concern about a chronic cough, but reported that he was told by a physician that it was likely due to allergies. He is presently prescribed Viibryd for anxiety and depression and he also has a PRN prescription for Ativan which he reportedly uses two times per month when he goes grocery shopping. He reported that he takes his medication as prescribed and follows with Dr. Biever, his psychiatrist, on a regular basis.
Trauma History
With regard to trauma, Nick denied any history of sexual, physical, or emotional abuse. He denied any history of neglect. Nick's aunt, Joyce, reported that when he was young and his parents were still married and living together, his father would frequently come home intoxicated and would be verbally abusive and destructive to property. His aunt also recalled an incident where Nick's father spanked him at school and "somebody checked into that." Nick's parents divorced sometime during his elementary school years, although he could not recall what age. He continued to live with his mother and visited with his father on a regular basis. Nick has not been involved in any human-made or natural disasters.
School/Vocational
Nick attended Penn Manor School District and paperwork from this district indicated that he was placed in full-time emotional support in 4th grade, although a copy of his psych-educational evaluation is not available for review. His present educational levels during the 2001-2002 school year noted the following: "Nick is usually very quiet in class and at times cooperative in class. He works well in 1:1 situations with staff and in small groups. He receives 48 to 52 points per day on his point sheet (52 possible points). Nick loses the most points in the area of respect and class rules. He continues to exhibit difficulty with peer relationships which is demonstrated by his inappropriate behaviors to peers. Until recently, Nick did not interact with others on the playground and often chose to remain in the classroom during recess. He is unable to accept consequences for his inappropriate actions, and repeatedly states, 'I didn't do anything.' Nick is extremely emotional and takes everything to heart."
His strengths were noted to be superior intelligence, creative talents, visual sequencing, wide vocabulary skills, verbal reasoning skills, abstract reasoning abilities, academic abilities. His needs were described as increase compliance with school rules/expectations, increase appropriate social interaction with peers, specifically to lessen physical aggression toward peers, increase ability to seek help when needed and to develop strategies to deal with anxiety and withdrawal.
There is no other school information available until he returned to Penn Manor High School as a junior. Nick was homeschooled during his 7th, 8th, 9th, and 10th grade years. When Nick returned to the public high school, he was enrolled in full-time emotional support. Information from his IEP that year noted, "since enrolling in Penn Manor School District as a junior, Nick has been doing very well academically and behaviorally." Observations indicated that "his teachers describe Nick as quiet, intelligent, and funny. In class, Nick will sit quietly and rarely offer answers or participate in class discussion without teaching prompting." It is also noted that, "Nick needs to improve his social skills. Nick avoids high social areas such as the cafeteria and hallways, even with peer prompting to join. Nick sometimes makes comments or acts in ways that has a tendency to draw negative attention to himself - such as sucking on his hair or moaning for no apparent reason."
Nick reported that when he was younger, he would frequently get into fights with his peers at school. He could not recall if he initiated the fights. When he returned to school as a junior, Nick reported that he spent most of his time sitting at a desk drawing and peers would approach him to talk and/or comment on his drawings. He described these peers as his friends but reported that he never had contact with them outside of school by his choice.
Transition planning indicated that Nick's future goal was "to be a househusband and Nick has given little thought to other options, even with prompting from the teachers and the job trainer."
Nick graduated high school, although he cannot recall the exact year. He thinks it was 2008 or 2009.
Vocationally, Nick has helped his mother at her flea market stand a couple times, but other than this he has no employment history. He is presently receiving social security disability based on his diagnosis of major depression.
Community/Peer Relationships
Nick does not have any peer relationships in the community. He has a strained relationship with his family members. He developed a relationship with some individuals online when he was a teenager. One individual is "Anna" and she has blocked all contact with him, although he continues to make attempts to contact her electronically. Nick firmly believes that he and Anna will eventually marry and he continues to ignore her request to not contact her, and the more recent request of the police, to stop all contact with her. He believes that she resides in California, but stated that he has no plans to go to California to find her "because I would need an escort because I wouldn't know how to go about getting there." He also reported that he will continue to try to contact her, although "I wouldn't commit a major crime to reach her, but probably a misdemeanor." He continues to have frequent contact with a young woman, "Jessa," and Jessa's fiancé, "William." Nick refers to Jessa as his mother, but reported that he does not really like William, but maintains contact with him because of Jessa. Reportedly Jessa is his age. He commented how he had gotten her some coupons for Mother's Day. There is another individual, "Thom" who Nick met online and Nick refers to his as his father.
With regard to intimate relationships, Nick reported that he has never had a girlfriend that he has met in person and he reported that the only girlfriend he has ever had is "Anna", although he has only had electronic communication with her and it is not clear if she ever reciprocated his feelings. Nick has never been sexually active with a female or male and he reported that he regards himself as heterosexual. He reported that he has crossdressed since he has been a teen, but he does not currently have access to women's clothes. He reported that he frequently masturbates and that he feels his sex drive is "more active than most people." He enjoys pornography that involves feces and he reported that he frequently fantasizes about having anal sex, consensually and forcibly with females. He also reported that his sexual fantasies include young girls who "can talk in full sentences and are house-trained, but not yet like real women." He denied that he has ever approached or had any sexual contact with a minor. He admitted that he tried to find female child pornography online in the past, but he was reportedly unsuccessful. When this evaluator told him that this type of activity is illegal, he indicated that he did not understand why that would be.
Nick is not involved in any community activites and reportedly only leaves his apartment to go to appointments and to grocery shop two times monthly. He spends the majority of his time at home alone, communicating with the above individuals electronically. Nick reported that he does not recaqll ever engaging in any community or school activites.
Drug & Alcohol/Legal
In terms of substance abuse history, Nick reported that he used alcohol one time several years ago while with his father. He consumed one "Jell-O shot". Nick reported that he used marijuana approximately 20-30 times with his father when he was a young teen. He reported that he has not used marijuana in at least 4 years. He denied any history of using any other type of substance. He denied any history of abusing prescription or over-the-counter medication and he does not take any herbal supplements.
In the legal sphere, Nick reported that he was arrested twice as a juvenile. His memory of the exact indicents is not clear, but he believes both incidentes may have been related to aggression and/or threats to his mother. He stated that he was on probation for these incidents. He denied any arrests as an adult. He was aware that the police had recently contacted his aunt related to his attempts to contact a female via the Internet, but he reported that "they did not approach me directly." He reported that he has continued to try to contact a female, "Anna", despite her direct request that he not contact her and she has blocked all communication from him.
Service History
Nick received inpatient psychiatric treatment at age 15 for 11 days at Brooke Glen Behavioral Hospital. He was involuntarily committed after he became physically aggressive with his mother. A discharge summary from this facility indicated the following diagnoses: major depression, social phobia, avoidant personality traits. It further stated that, "psychological testing was completed which supports the above diagnoses, it did not support psychosis." During his hospitalization, anti-depressant medication was recommended but "mother did not indicate that she would follow through with this option for aftercare."
Other than school interventions and his current treatment, it appears that Nick's hospitalization represents the extent of his previous formal psychiatric treatment. Nick reported that his mother does not believe in mental illness and, therefore, she did not initiate or support treatment.
Evaluation Procedures
Review of the following records:
Clinical interview with Nick Stoutzenberger
Consult with Tara Tumility and Chad Wickenheiser
Brief phone interview with his maternal aunt, Joyce
Behavioral observations
Wechsler Abbreviated Scale of Intelligence (WASI-II)
Wechsler Individual Achievement Test, Second Edition Abbreviated (WIAT-II)
Thematic Apperception Test (TAT)
Minnesota Multiphasic Personality Inventory-2 (MMPI-2)
Delis Kaplan Executive Function System (D-K EFS)
Interview/Test Results
Behavioral Observations
Nick was brought to the appointment by his case manager, who dropped him at the office. Nick is tall and he has a large build. He was dressed casually and appropriately, although he was malodorous. He had a beard and his hair was slightly unkempt. Nick reported that he generally only showers once a week. His eye contact was fleeting and he appeared to try to avoid eye contact, often looking down. His activity level was within normal limits. He was able to initiate and sustain attention for all tasks and his concentration was adequate. He did not require any repetition of directions. He demonstrated good manners, never interrupted and was able to engage in a reciprocal conversation. He answered all questions, at times offering relevant spontaneous information. He was able to complete the entire evaluation in one day, taking a 20 minute break for lunch. After he completed the evaluation, he thanked the evaluator.
Mental Status Exam
In terms of mental status, Nick was alert and was oriented to person, day of the week, month, year, and situation. His affect was constricted. He described his mood as "depressed, scared, and bored." Stream of thought appeared to be organized, relevant, and goal-directed with content of thought focused on providing information as requested and completing the tasks required. His responses were relevant to the questions. Nick did not exhibit any overt indications of an underlying thought disturbance, in the form of auditory or visual hallucinations, and he denied that presence of both, in the present or past. He denied present suicidal ideation. He reported that he has experienced suicidal thoughts in the past, "but I would never do it." Nick reported that he constantly has homicidal ideation toward his mother, step-father, and aunt; however, he stated adamantly that he has no intent to act on these thoughts because "I do not want to go to jail." He indicated that he frequently has "videos" playing in his mind that involve killing his family in multiple ways, indicating that sometimes he is portrayed as a superhero in these "videos." Nick reported that he has been violent with his mother in the past and has left bruises on her. When he was fifteen, he was psychiatrically hospitalized after he assaulted his mother because she would not allow him to use the computer. Nick denied any history of cruelty to animals, vandalism, or fireplay, adding that he is very close to his cat and wondered what life would be like if he could communicate with his cat by speaking "cat language." His insight was fair as he indicated that he has pursued therapy, psychiatric treatment, and psychologcal testing "because I want to know what's wrong with me." His judgment is extremely impaired as he reported that he does not understand why anyone would be concerned with his constant attempts to contact a female that does not want contact as well as his claims that he will certainly marry this female. Additionally, he showed this evaluator, as well as his therapist, conversations that he has had online with others that contain graphic sexual and violent comments and he does not understand why this is considered inappropriate or unusual.
Validity Considerations
The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) yielded an invalid profile based on Nick's endorsement of far more symptoms than would be typical even for an individual being treated on an inpatient psychiatric unit. High scores on most scales as evidenced by Nick's profile suggests that an individual may be overly endorsing problems in order to appear pathological or, as likely in Nick's case, it is an indication that an individual is experiencing a myriad of symptoms in several domains, frequently and intensely, and that the symptoms are causing a significant amount of stress and impairment.
Intellectual Functioning
The Wechsler Abbreviated Scale of Intelligence, 2nd Edition (WASI-II) administered in order to assess Nick's cognitive functioning and to obtain and understanding of his level of intellectual functioning. The WASI-II is designed as a screening tool to quickly and accurately estimate an individual's intellectual functioning. Assessment of Nick's present level of cognitive abilities indicates overall intellectual functioning in the superior range (WASI-II IQ = 129). Nick's IQ places him in the 97th percentile, indicating that he did as well or better than 97% of similarly aged individuals. Nick's verbal skills are significantly more developed than his nonverbal skills, although his nonverbal abilties, as evidenced by his performance on the Perceptual Reasoning Index, are solidly within the average range.
WASI-II SUMMARY SCALES (Mean = 100, SD = 15)
Scale - Composite Score - Percentile - Confidence Interval (95%) - Description
Verbal - 143 - 99.8 - 135-147 - Very Superior
Perceptual Reasoning - 108 - 70 - 101-114 - Average
Full Scale (Four subtests) - 129 - 97 - 123-133 - Superior
WASI-II SUBTEST T-SCORES (Mean = 50, SD = 10)
Vocabulary: 77
Similarities: 75
Block Design: 58
Matrix Reasoning: 52
With regard to specific subtests, Nick demonstrated abilities above the norm on all subtests. His best performance was on the Vocabulary subtest, as his score fell well above the norm. This subtest assesses an individual's expressive vocabulary, verbal knowledge, and fund of information. His performance on the Similarities subtest was equally as strong as his performance on the Vocabulary subtest. The Similarities subtest measures abstract verbal reasoning and conceptualization. Nick's performance on the Block Design subtest was above the norm. This subtest measures spatial visualization, visual-motor coordination, and abstract conceptualization. Nick also performed in the average range on the Matrix Reasoning subtest, which measures nonverbal fluid reasoning.
Achievement
In order to assess Nick's level of academic achievement, the Wechsler Individual Achievement Test - Abbreviated, Second Edition (WIAT-II Abr.) was administered. Nick's performance on the Word Reading subtest was in the high average range of scores (SS = 112). He was able to read all the words on the list with the exception of "ethereal" which he slightly mispronounced. His performance on this subtest correlates to a 12.8 grade equivalent. His score on the Numerical Operations subtest was in the average range (SS = 103). This score corresponds to an 11.9 grade level. His performance on the Spelling subtest was in the high average range (SS = 114) and corresponds to a 12.8 grade level.
Neuropsychological Functioning
In order to further measure Nick's executive functioning abilities and his higher level cognitive skills, various tests were administered to obtain a clearer picture of his strengths and weaknesses in these areas. The Delis-Kaplan Exsecutive Functioning System (D-KEFS) is a measure of high order cognitive, executive functioning. The subtests were designed to assess complex multifactorial domains of cognition in a comprehensive manner. The D-KEFS subtests administered include Trail Making, Verbal Fluency, Sorting Test, Twenty Questions, and Proverb Test.
Trail Making Test - Scaled Score - Classification
Visual Scanning - 12 - At Expected Level
Number Sequencing - 13 - Above Expected Level
Letter Sequencing - 12 - At Expected Level
Number-Letter Switching - 11 - At Expected Level
Motor Speed - 13 - Above Expected Level
Nick's performance on Trail Making, which involved visual cancellation and connecting circles tasks, demonstrated average to above average abilities in cognitive flexibility, a classic executive function that is essential for higher-level skills such as mulititasking, simultaneous processing, and divided attention. His motor speed was faster than would be expected and his ability to visually scan information was at the expected level. His ability to sequence numbers was above the expected level and his ability to sequence letters was average. His ability to shift between numbers and letters, requiring cognitive flexibility and divided attention, is in the average range.
Verbal Fluency - Scaled Score - Classification
Letter Fluency - 7 - Borderline
Category Fluency - 7 - Borderline
Category Switch - 8 - At Expected Level
Category Switching Accuracy - 9 - At Expected Level
The Verbal Fluency Test requires word generation based on letter and category, with a switching task also presented. Nick's ability to generate words starting with a specific letter is slightly below what would be expected. He appeared to be anxious during this task and some of the words were associated with sexual activity such as "fornication" and "syphilis." His ability to generate words that fit into a specific category is slightly below the expected level; however, his ability to cognitive shift between categories is at the expected level with his accuracy on this task at the expected level as well.
Sorting Test - Scaled Score - Classification
Confirmed Correct Sorts - 14 - Above Expected Level
Free Sorting Description - 15 - Above Expected Level
Sort Recognition - 16 - Well Above Expected Level
On the Sorting Test which measures concept-formation and verbal and nonverbal problem solving abilities, Nick performed in the range above what would be expected for an individual his age. His performance on this measure suggests that his ability to think abstractly and solve problems is very well developed.
Twenty Questions - Scaled Score - Classification
Initial Abstraction Score - 9 - At Expected Level
Total Questions Asked - 13 - Above Expected Level
Total Weighted Achievement - 19 - Well Above Expected Level
The Twenty Questions Test measures abstract thinking and problem solving strategies. The executive functions assesed include the perception of various categories and subcategories represented; the ability to formulate dichtomous questions, and incorporate feedback to formulate more efficient questions. Nick was shown a page of various common items and objects and he has to ask yes/no questions to determine the target object. The goal was to ask as few questions as possible in order to identify the target object. Nick's performance on this measure is consistent with his performance on all other measures of abstract thinking and problem solving, suggesting that these higher level thinking skills are very well developed in this young man.
The Proverb Test evaluates the abstract interpretation, understanding of word meanings, as well as abstract principles and concepts. Nick's ability to verbally describe proverbs was in the expected range and when provided with a proverb and multiple choice answers, he correctly answered 100% of the questions.
Emotional and Behavioral Functioning
While Nick's cognitive, achievement, and higher level executive functioning abilities are impressive, his emotional and behavioral functioning is concerning. In the clinical interview, Nick reported that he has "videos" playing in his head where he is able to view himself killing his mother, step-father and aunt in various ways. He reported that at times it is him in his natural state killing them and other times, he becomes a superhero with superpowers and kills them. Nick casually described how he feels they deserve to die because they are very conservative and not tolerant of other races and homosexuals. He stated that they don't like him because he likes sex, violence, and cursing. Nick clearly stated that he has no intent to kill his family, "because I don't want to go to jail," but he further stated that if no laws prohibited murder, he is sure he would do it.
Nick also reported having sexual fantasies that involve him having anal sex with women and young girls. He reported that his fantasies include both rape and consensual sex. His sexual fantasies involve feces as he reported that he becomes sexually aroused by fantasizing about women defecating and that he has used feces when he masturbates. He does frequently view pornographic tapes that involve the above, although he reported he has not been able to access child pornography. He stated that he has never been sexually intimate with anyone. His only sexual encounter was around the age of thirteen when he and a female teen cousin touched each other and this was reported to be consensual. Nick shared his journals with this evaluator which included numerous writings about sex and violence. He had written about being angry with his aunt and described how he would like to anally rape her. He reported that he does not necessarily fantasize about his aunt and that he wrote that statement out of anger. At one point, he wrote how something was falling from the sky and he thought it was semen, but later realized that it was rain. On the MMPI-2, Nick's responses on the Schizophrenia scale were quite high (T = 112). Specifically, his high score on the social alienation subscale (T = 105) suggests that he perceives that he is mistreated and misunderstood. His emotional alienation score (T = 98) indicated that he has a significant amount of fears, depression, and apathy. Additionally, the high T scores on the Lack of Ego Mastery, Cognitive (T = 90) and Conative (T = 92) scales are consistent with someone who fears losing control, feels as though life is unreal and likely responds to stress by retreating into a fantasy world. His responses on the Thematic Apperception Test (TAT) suggested some problems with reality orientation. He described one picture as a house in a snowstorm with "eyes" in the background "that's like a ghost or something." On another card, he saw a figure in the background and stated, "that's like a dog wearing a hood" but later added that he did not know why a dog would be walking upright, wearing a hooded jacket.
With regard to his impulse control, Nick reported that he feels he can control his impulses but attributed part of that to his fear to leave his home. He did state that he has some concerns about decreasing his social anxiety because "If I'm cured and go out, I fear what I would do." While Nick's explosive anger score is elevated (T = 71) his score on the inhibition of aggression score is average (T = 48), which supports Nick's assertion that at the present time he is successfully controlling his angry impulses.
Nick described a significant level of social anxiety, which he has experienced for several years. He reported that he did not want to go to school and that is why he was homeschooled from 7th to 10th grade. When he did return to public school, he reported that his attendance was good, but he did not like to leave the classroom. He reported that he does not like to be in the community because he is worried about being harmed or shot. He does not feel safe in his home, "I'm afraid of everything, I feel like I can't defend myself and I don't know what I would do if someone broke in." He also reported that he does not like to take showers because he becomes increasingly fearful during this task. He reported that he has difficulty talking to others in the community and that he has signigicant problems making decisions, "I have trouble placing an order at McDonald's." Nick was able to describe appropriate social behavior and described being socially avoidant because he becomes so anxious around others that he cannot function or communicate. He indicated that he is aware that some of his anxiety resolves around his fear of what he may do to others if he cannot control his impulses. Nick's overall score on the paranoia scale on the MMPI-2 was extremely elevated (T = 101) with responses that corresponded to a signigicant amount of persecutory ideas (T = 112). His responses on the TAT also include some persecutory ideation. He described story about a picture with a young boy and broken violin as "it's broken at the neck; someone probably did it on purpose." Another card showed a little boy sitting alone and he described the boy as "upset" and that "maybe his parents punished him and he's in trouble." Another picture he described as "a bunch of dudes huddled together for safety or warmth" noting that one man is "probably the watch, they probably sleep in shifts."
With regard to his mood, Nick stated that he is generally depressed. He often feels hopeless, but indicated there are times when he is hopeful; mainly when he fantasizes about "Anna." He described feeling worthless, "I'm not really good at anything, I can't contribute to society." He indicated that he never cries, "but I feel like I need to, I just don't." His personal hygiene is very poor, he showers once per week with prompting and does not attend to his personal care consistently. He described his sleep as "random" but indicated that he is working on trying to establish better sleep habits by going to bed at 10 or 11 and then he typically sleeps until 9 AM. He reported that his appetite is good. He denied present suicidal ideation, but noted that he has had these thoughts in the past, but has never made a suicide attempt. Nick's score on the MMPI-2 depression scale is elevated (T = 91) with elevated scores on scales that assess subjection depression, psychomotor retardation, physical symptoms, mental dullness, and brooding. Nick has previously been diagnosed with major depression and he is currently being treated for anxiety and depression with therapy and medication.
Discussion
One of the purposes of this evaluation was to assess Nick's cognitive functioning as he demonstrates extremely poor judgment and decision making skills and his adaptive functioning is marginal. However, Nick's intellectual ability is in the superior range, with very superior verbal skills. His verbal skills are significantly more developed than his nonverbal skills; which is sometimes the case in individuals with Asperger's disorder; however, Nick does not demonstrate any deficiencies in academic achievement as if often co-morbid in inidividuals with Asperger's disorder, nor does he show any deficits in his higher level thinking skills. Quite the contrary, Nick demonstrated well developed abstract thinking, problem solving, cognitive flexibility, and the ability to sustain divided attention. Typically, individuals with Asperger's disorder demonstrate areas of relative weakness in some areas of higher level thinking.
Although limited past information was available for review, the information from his school and from his inpatient stay at age 15, does not mention any consideration of a diagnosis of Asperger's disorder and reported his problems with socialization to be primarily related to his social avoidance and social phobic behaviors. Presently, Nick demonstrates a marked fear of all social situations because he feels he does not know how to communicate and behave in these situations. When he is required to attend certain places, such as the grocery store, he reported that he needs to take Ativan to avoid a panic attack. Nick understands that his anxiety is well beyond what is typical and acknowledged that he is in no more danger than anyone else. His anxiety has significantly negatively impacted his ability to function in all domains including social, occupational, academic and interpersonal. Based on these symptoms that have been present for several years, a diagnosis of social phobia will be assigned.
Nick has demonstrated a pervasive pattern of social interpersonal deficits evidenced by his extreme discomfort with social interactions and his inability to develop close relationships. In addition, he also has cognitive distortions. He believes his family should be murdered because of his perception that they are "too conservative." He continues to be obsessed with a female, "Anna" that he met on the Internet and firmly believes she will be his wife despite her consistent refusal to have contact with him and police involvement. The relationships that he has developed on the Internet, based on his journal writings and the dialogue, appear to revolve around his expression of sexual and violent desires. These relationships seem to have a surreal quality to them as he described one female as his mother and another individual as his father and looks to them for parental advice. He demonstrates obsessive ruminations with explicit sexual and aggressive content and does not seem to understand that this is atypical, especially his focus on discussing his intense dislike for vaginas. His speech, although well developed, can be circumstantial and odd as when he described young girls as "being house-trained and able to speak in complete sentences." His affect is constricted and he demonstrates little to no emotion, he lacks close friends, and his social anxiety is pervasive and seems to be more associated with fears of being harmed rather than on negative judgments about himself. Based on records from the school and his previous hospitalization, as well as his report and his aunt's collateral information, these behaviors have been longstanding and likely represent a maladaptive personality disorganization. Based on these symptoms, Nick meets criteria for schizotypal personality disorder. While some of his behaviors are consistent with avoidant personality disorder, his social anxiety does not primarily seem to be the result of the fear of rejection. Additionally, his cognitive distortions and odd beliefs are more consistent with a schizotypal personality organization.
While Nick reported that his "friends" from the Internet have suggested to him that he has Asperger's disorder and he also feels this may be the case, there is limited historical information to support this diagnosis. Additionally, his performance on tests of higher level thinking skills indicated that his abstract reasoning, problem solving skills, and cognitive flexibility are very well developed, which is not typical. His problems with socialization appear to be more related to social anxiety and fears, rather than an inability to understand social cues or a lack of understanding about appropriate social behavior.
Nick has previously been diagnosed with major depression and he clearly meets criteria for this disorder at this time. He described that he has a pervasive depressed mood and finds little enjoyment in any activities. His functioning in all domains is impaired and he has great difficulty making simple decisions. His self-care is marginal, although he understands what activities of daily living should be completed, knows how to do them, and can functionally perform these tasks; he does not. He feels hopeless and worthless most of the time and has little motivation and energy. It appears that he has had several episodes of depression since at least his teen years, with few periods of remission. He reported that he feels little benefit from the medication.
With regard to his perported sexual arousal related to touching or viewing feces, he will be given a diagnosis of paraphilia, specifically coprophilia. While Nick describes wearing female clothes, it is not clear that this is related to sexual arousal as he described he specifically likes female clothes because they are "smooth and soft," and did not relate the activity to sexual arousal. While he has violent sexual fantasies and fantasizes about sexual activity with young girls, he denied that he has ever acted on these impulses.
Diagnosis
Axis I: 300.23 Social phobia
296.33 Major depression, recurrent, severe without psychotic features
302.9 Paraphilia not otherwise specified, coprophilia
Axis II: 301.22 schizotypal personality disorder
Axis III: none reported
Axis IV: Psychosocial stressors: problems with primary supports; occupational problems; other psychosocial and environmental problems
Axis V: Current GAF: 30
Highest GAF in the past year: 30
Recommendations
1. Nick is an individual who is suffering from several depressive symptoms that appear to be minimally responsive to medication and therapy at this time. In addition, Nick appears to have significant problems with cognitive distortions and his orientation to reality is tenuous. It is likely that his social isolation, which allows him to spend most of his day fantasizing, is contributing to his overall impairment. While Nick has not acted on any of his impulses, based on the level of specific violent details involved in his fantasies and his grossly impaired judgment, it is strongly recommended that Nick be referred to a partial hospitalization program where he can be supervised and treated on a daily basis. This type of environment will also be able to provide him with a safe environment with structure to work on decreasing his anxiety related to interpersonal contact. If Nick is unwilling to attend a partial hospitalization program, his status should be monitored frequently by his intensive case manager to determine if inpatient treatment may be necessary.
2. With regard to his violent sexual fantasies that involve both adults and minors, it is recommended that a comprehensive psycho-sexual evaluation be conducted as soon as possible. It is recommended that a residential treatment center be considered due to the violent nature of his thoughts.
3. With regard to his housing situation, Nick has questioned his ability to live independently. Presently, his judgment and decision making abilities are impaired and it is questionable whether he would be able to function appropriately if faced with an emergency in his home. Based on this, it is recommended that a residential program be considered.
Thursday, June 23, 2011
Thursday, June 16, 2011
UGH.
I've been trying to keep Anna things off of my LJ but I no longer have access to the place I was channeling it all into because of the jerk channers taking over most of my accounts, so I kinda have to put it here. Sorry. If you're one of the people trying to stay out of it, just ignore this post.
EDIT: UGH WHY IS LJ CUT NOT WORKING
The Anna Quest is going horribly at the moment. A few weeks ago, one of my friends decided to post a thread aboot me on an imageboard for some reason. A bunch of douchebag chantards hate me now and hacked most of my accounts and called my mom telling her I molested my half-sister (which I didn't, of course), but this isn't aboot all that. Apparently the thread attracted the attention of Anna and Jessa somehow, and for whatever reason they posted in it that Anna had sex with her jerk boyfriend Jeremy (whom I like to call Jerkemy). I have oodles of evidence that they're most likely lying just to upset me, but nothing concrete.
Their plan is sure as hell working. I don't know exactly why the thought of her having sex with someone upsets me so much (although I do know a lot of other bad repercussions), but it does. A lot. Anna having sex is constantly on my mind, traumatizing me. Literally, constantly. I can't even distract myself with video games or TV or music or whatever as I usually do when shit upsets me. "In Fact" (by They Might Be Giants), it kinda adds on to it. Every time I try to listen to TMBG now, it reminds me of how obsessive and energetic and nerdy Anna is. She's like a sweet, innocent little girl. And I love that aboot her. But if it's true that she's had sex, then, well, she's not innocent anymore.
Also, I keep uncontrollably having mental videos of all the horrible repercussions Anna having sex would have. For one, I'd continue to be all depressed like this forever, and I could never be happy and I'd never get any enjoyment out of anything anymore. And I imagine it'd be a huge buzzkill for Anna to be married to someone who couldn't enjoy their marriage. Plus, sex is supposed to be a really special thing shared by soul mates... if she has sex with someone else, well, yeah, it ruins sex for us when we finally do end up together. I've always wanted to make her first time especially special and romantic. I'll kiss her and caress her while we make passionate love, and maybe even throw around some rose petals and light candles, if I can ever figure out where you get those things from. I dunno if she's into mood music or not but I'll do that too if she is. Personally it creeps me out to do anything sexual when music's playing because it feels like the singer's watching me. Hell, I even take off my t-shirts and throw them somewhere face-down when I jack off. But whatev, it's all aboot what Anna wants. I bet stupid Jerkemy just wants to put his penis in and jackhammer and have horrible porn sex. :/
What follows now is all the evidence why I suspect they're lying. Enjoy.
When Maddi first read me the post, I already had my doubts that it was true. She then asked Jessa, who "confirmed" by saying Anna told her she had sex a few days after it happened. Right there's a red flag. A few days? Dude, this is Anna we're talking aboot. She would've told everyone immediately, especially her best friend. Why on earth would she wait that long unless her computer was fucked up or something?
I exchanged posts with Jessa in the thread for a while. When I told her I didn't believe it, she then pulled another story out of her presumably hot ass, saying she and Myrrh licked eachother's boobs and engaged in heavy petting. Problem is, I was still Anna's friend when she met Myrrh irl. She told me all aboot it but never mentioned any of that. All they did was make out and look at each other's boobs. Look, not touch. I even told Jessa this, but she tried to cover by saying Anna was trying to avoid hurting my feelings. Um, no she wasn't... If she wanted to avoid hurting my feelings, she wouldn't have even told me what she did tell me. The making out hurt quite a lot for quite a while, and she knew it would. I mean, yeah, it didn't hurt as much as Anna doing anything sexual would, but at that point I hadn't yet told her my thoughts on her doing anything sexual. She would've assumed sex would be the same amount of hurt that making out would be.
Also, Anna's really shy and socially awkward. I doubt she'd be able to get nekkid in front of a dude let alone have sex. Even if she did, she wouldn't know what to do. She'd most likely just lay there motionless. I mean, she'll most likely pick up on the kissing once I start, but it'll probably take her longer to figure out what to do with her hands. Hell, she doesn't know what to do with them when she's sleeping, even. Neither do I, actually. But I digress.
She was with her last boyfriend, Paul, way longer than she's been with Jeremy and nothing happened between them either. Apparently Paul didn't even like kissing. Let's hope Jeremy shares the sentiment as well.
I recently heard Anna's in college now (which also upsets me, but that's a discussion for another day), so how would she even find the time and place to have sex? She lives in a dorm, presumably with a roommate, on a college campus.
I also highly doubt that Anna and Jeremy's relationship is even all that serious. As far as I can tell, they went to prom (as friends), and sometimes hang out. Pretty much just the same shit she did with Paul. Which is basically just friend things. It's painfully obvious to me that Anna doesn't even understand love. She's mistaking intense crushes for love, and that can be extremely dangerous. I mean yeah, seems like everyone goes through that phase at some point. I know I did, up until I met Anna and fell in love for real. Once it clicked for me, I started noticing other people being really stupid with relationships too, mainly in high school and on the Internet. People toss the word "love" around way too casually, when they don't really mean it. Anna's been doing just that her whole life. She "loved" Myrrh, Paul, and apparently Jeremy now, but if she actually took the time to compare the former two to Jeremy, she'd realize nothing's any different from her first two "loves". It's sad, really. Anna's so big on shipping yet doesn't know what love's all aboot.
As far as I can tell, Anna hasn't posted aboot having sex on deviantART, LiveJournal, or anywhere else but in the thread. I did hear that Scott and Jessa posted on Facebook aboot it, but Anna's parents have Facebook accounts and I'd assume they have Anna friended, so they would've seen it. Unless Anna told them aboot the plan or something, idk. My assumption is that she and her friends took advantage of the Nick thread, which they knew I would read at some point, and posted a lie aboot having sex in it to either upset me or make me stop loving her. Or both. But the joke's on them, 'cause even if it were true that still wouldn't make me stop loving her. It would ruin her lives, but not make me stop loving her.
Hopefully nobody but me would even want to have sex with her, because I heard third- or maybe fourth-hand that she has BO. I dunno who it came from, but my guess is Jessa since she's the only one who's met Anna irl who would be talking to my friends. Everyone lost contact with Myrrh once Anna decided to hate her, and I don't think anyone talks to Sean or Kate either. Except maybe Scott. I guess it's possible one of them told Scott, who told another person, who told me. Idk. I'm still thinking Jessa. Jessa's p nice though, so if it was her I'm sure she didn't mean it as an insult, just as a fact. Seems like something that'd be true. She seems to have not-great hygience. It would also explain the photo of her holding deodorant. Although I find it odd that she changed brands. She used to use Teen Spirit (strawberry scented, to be exact) because of the Nirvana song.
Touching back on the shyness thing, how would the subject of sex even come up? I mean, can you imagine it? It'd be awkward as fuck.
And finally, I once saw one of Anna's friends talking to her on Twitter and I suspect they were talking aboot telling me she had sex to get me to kill myself. The exact words were something along the lines of "Yeah, and then right before he dies, say 'Oh yeah, I lied'." Yes, it's p vague, but they were definitely discussing telling someone a lie that would somehow cause their death. Seems to fit.
Looking back one all the evidence makes me feel a little better, but as I said before none of it's concrete. In any case, I hope the truth comes out soon. I also hope that the truth is that she lied. Because if not her lives are irreversibly ruined forever. I would hope she'd have more sense than to do that to herself. I guess we'll find oot...
EDIT: UGH WHY IS LJ CUT NOT WORKING
The Anna Quest is going horribly at the moment. A few weeks ago, one of my friends decided to post a thread aboot me on an imageboard for some reason. A bunch of douchebag chantards hate me now and hacked most of my accounts and called my mom telling her I molested my half-sister (which I didn't, of course), but this isn't aboot all that. Apparently the thread attracted the attention of Anna and Jessa somehow, and for whatever reason they posted in it that Anna had sex with her jerk boyfriend Jeremy (whom I like to call Jerkemy). I have oodles of evidence that they're most likely lying just to upset me, but nothing concrete.
Their plan is sure as hell working. I don't know exactly why the thought of her having sex with someone upsets me so much (although I do know a lot of other bad repercussions), but it does. A lot. Anna having sex is constantly on my mind, traumatizing me. Literally, constantly. I can't even distract myself with video games or TV or music or whatever as I usually do when shit upsets me. "In Fact" (by They Might Be Giants), it kinda adds on to it. Every time I try to listen to TMBG now, it reminds me of how obsessive and energetic and nerdy Anna is. She's like a sweet, innocent little girl. And I love that aboot her. But if it's true that she's had sex, then, well, she's not innocent anymore.
Also, I keep uncontrollably having mental videos of all the horrible repercussions Anna having sex would have. For one, I'd continue to be all depressed like this forever, and I could never be happy and I'd never get any enjoyment out of anything anymore. And I imagine it'd be a huge buzzkill for Anna to be married to someone who couldn't enjoy their marriage. Plus, sex is supposed to be a really special thing shared by soul mates... if she has sex with someone else, well, yeah, it ruins sex for us when we finally do end up together. I've always wanted to make her first time especially special and romantic. I'll kiss her and caress her while we make passionate love, and maybe even throw around some rose petals and light candles, if I can ever figure out where you get those things from. I dunno if she's into mood music or not but I'll do that too if she is. Personally it creeps me out to do anything sexual when music's playing because it feels like the singer's watching me. Hell, I even take off my t-shirts and throw them somewhere face-down when I jack off. But whatev, it's all aboot what Anna wants. I bet stupid Jerkemy just wants to put his penis in and jackhammer and have horrible porn sex. :/
What follows now is all the evidence why I suspect they're lying. Enjoy.
When Maddi first read me the post, I already had my doubts that it was true. She then asked Jessa, who "confirmed" by saying Anna told her she had sex a few days after it happened. Right there's a red flag. A few days? Dude, this is Anna we're talking aboot. She would've told everyone immediately, especially her best friend. Why on earth would she wait that long unless her computer was fucked up or something?
I exchanged posts with Jessa in the thread for a while. When I told her I didn't believe it, she then pulled another story out of her presumably hot ass, saying she and Myrrh licked eachother's boobs and engaged in heavy petting. Problem is, I was still Anna's friend when she met Myrrh irl. She told me all aboot it but never mentioned any of that. All they did was make out and look at each other's boobs. Look, not touch. I even told Jessa this, but she tried to cover by saying Anna was trying to avoid hurting my feelings. Um, no she wasn't... If she wanted to avoid hurting my feelings, she wouldn't have even told me what she did tell me. The making out hurt quite a lot for quite a while, and she knew it would. I mean, yeah, it didn't hurt as much as Anna doing anything sexual would, but at that point I hadn't yet told her my thoughts on her doing anything sexual. She would've assumed sex would be the same amount of hurt that making out would be.
Also, Anna's really shy and socially awkward. I doubt she'd be able to get nekkid in front of a dude let alone have sex. Even if she did, she wouldn't know what to do. She'd most likely just lay there motionless. I mean, she'll most likely pick up on the kissing once I start, but it'll probably take her longer to figure out what to do with her hands. Hell, she doesn't know what to do with them when she's sleeping, even. Neither do I, actually. But I digress.
She was with her last boyfriend, Paul, way longer than she's been with Jeremy and nothing happened between them either. Apparently Paul didn't even like kissing. Let's hope Jeremy shares the sentiment as well.
I recently heard Anna's in college now (which also upsets me, but that's a discussion for another day), so how would she even find the time and place to have sex? She lives in a dorm, presumably with a roommate, on a college campus.
I also highly doubt that Anna and Jeremy's relationship is even all that serious. As far as I can tell, they went to prom (as friends), and sometimes hang out. Pretty much just the same shit she did with Paul. Which is basically just friend things. It's painfully obvious to me that Anna doesn't even understand love. She's mistaking intense crushes for love, and that can be extremely dangerous. I mean yeah, seems like everyone goes through that phase at some point. I know I did, up until I met Anna and fell in love for real. Once it clicked for me, I started noticing other people being really stupid with relationships too, mainly in high school and on the Internet. People toss the word "love" around way too casually, when they don't really mean it. Anna's been doing just that her whole life. She "loved" Myrrh, Paul, and apparently Jeremy now, but if she actually took the time to compare the former two to Jeremy, she'd realize nothing's any different from her first two "loves". It's sad, really. Anna's so big on shipping yet doesn't know what love's all aboot.
As far as I can tell, Anna hasn't posted aboot having sex on deviantART, LiveJournal, or anywhere else but in the thread. I did hear that Scott and Jessa posted on Facebook aboot it, but Anna's parents have Facebook accounts and I'd assume they have Anna friended, so they would've seen it. Unless Anna told them aboot the plan or something, idk. My assumption is that she and her friends took advantage of the Nick thread, which they knew I would read at some point, and posted a lie aboot having sex in it to either upset me or make me stop loving her. Or both. But the joke's on them, 'cause even if it were true that still wouldn't make me stop loving her. It would ruin her lives, but not make me stop loving her.
Hopefully nobody but me would even want to have sex with her, because I heard third- or maybe fourth-hand that she has BO. I dunno who it came from, but my guess is Jessa since she's the only one who's met Anna irl who would be talking to my friends. Everyone lost contact with Myrrh once Anna decided to hate her, and I don't think anyone talks to Sean or Kate either. Except maybe Scott. I guess it's possible one of them told Scott, who told another person, who told me. Idk. I'm still thinking Jessa. Jessa's p nice though, so if it was her I'm sure she didn't mean it as an insult, just as a fact. Seems like something that'd be true. She seems to have not-great hygience. It would also explain the photo of her holding deodorant. Although I find it odd that she changed brands. She used to use Teen Spirit (strawberry scented, to be exact) because of the Nirvana song.
Touching back on the shyness thing, how would the subject of sex even come up? I mean, can you imagine it? It'd be awkward as fuck.
And finally, I once saw one of Anna's friends talking to her on Twitter and I suspect they were talking aboot telling me she had sex to get me to kill myself. The exact words were something along the lines of "Yeah, and then right before he dies, say 'Oh yeah, I lied'." Yes, it's p vague, but they were definitely discussing telling someone a lie that would somehow cause their death. Seems to fit.
Looking back one all the evidence makes me feel a little better, but as I said before none of it's concrete. In any case, I hope the truth comes out soon. I also hope that the truth is that she lied. Because if not her lives are irreversibly ruined forever. I would hope she'd have more sense than to do that to herself. I guess we'll find oot...
Sunday, November 18, 2007
A FEW PROBLEMS SOLVED.
I got some non-cancer deodorant. I do not smell bad anymore.
Also, major drama has been resolved, I think. I'd rather not go into detail.
I just bought a live show by TMBG, y'know, the ones from their wedsite. I'm enjoying it! ^_^
I'm also reading *GASP* ...A BOOK!
Over the weekend, I tried converting Bonus Stage episodes to a different format so I can watch 'em on my laptop back home. So far I'm only up to episode 50, so I probably won't get it done before I go home. Especially since episode 48 is giving me problems. I skipped it temporarily.
I'm addicted to the Dial-A-Song demo of Ant. I don't know why. I've listened to it at least ten times just yesterday.
Also, major drama has been resolved, I think. I'd rather not go into detail.
I just bought a live show by TMBG, y'know, the ones from their wedsite. I'm enjoying it! ^_^
I'm also reading *GASP* ...A BOOK!
Over the weekend, I tried converting Bonus Stage episodes to a different format so I can watch 'em on my laptop back home. So far I'm only up to episode 50, so I probably won't get it done before I go home. Especially since episode 48 is giving me problems. I skipped it temporarily.
I'm addicted to the Dial-A-Song demo of Ant. I don't know why. I've listened to it at least ten times just yesterday.
Sunday, November 11, 2007
I DON'T KNOW, MAN...
Nothing interesting happened this week. I mean, not like anything interesting ever happens anyway. Figured I'd make an entry anyway. =/
I finally managed to get a book for the literature circle thing we do, and also apparently my teacher's going to bring in some non-cancer deodorant for me, because I don't think it's normal to still smell bad RIGHT AFTER taking a shower (especially when I used multiple soaps).
We also recently started this new thing in math where we have to do math problems out of a textbook, and I fucking hate it. Oh, but I got out of it one day went we went on a field trip to some sort of job faire. Ironic, eh? Oh, but then I had to make up the work the next day anyway. That's almost as ironic, which isn't cool.
I finally managed to get a book for the literature circle thing we do, and also apparently my teacher's going to bring in some non-cancer deodorant for me, because I don't think it's normal to still smell bad RIGHT AFTER taking a shower (especially when I used multiple soaps).
We also recently started this new thing in math where we have to do math problems out of a textbook, and I fucking hate it. Oh, but I got out of it one day went we went on a field trip to some sort of job faire. Ironic, eh? Oh, but then I had to make up the work the next day anyway. That's almost as ironic, which isn't cool.
Sunday, November 4, 2007
WEEKEND UPDATE
location: In the fucking shower =/
mood: irritated irritated
music: Where is My Mind? - Pixies
This weekend was mostly unproductive, but I burned some CDs of things to bring to my laptop, continued my roleplay, and actually attempted making a game in Flash. This was the result: a Nick Bate dress-up game.
http://img106.imageshack.us/img106/8948/dressupex8.swf
It's not on the site yet but eventually it shall be. Really it sucks, but that's okay because it's just an experiment to get used to Flash a little better.
In unrelated news, I've taken a shower two days in a row and I'm not happy about it. B|
Ed Note: Link Broken
mood: irritated irritated
music: Where is My Mind? - Pixies
This weekend was mostly unproductive, but I burned some CDs of things to bring to my laptop, continued my roleplay, and actually attempted making a game in Flash. This was the result: a Nick Bate dress-up game.
http://img106.imageshack.us/img106/8948/dressupex8.swf
It's not on the site yet but eventually it shall be. Really it sucks, but that's okay because it's just an experiment to get used to Flash a little better.
In unrelated news, I've taken a shower two days in a row and I'm not happy about it. B|
Ed Note: Link Broken
Friday, November 2, 2007
I HUNG OUT WITH A DEAD GUY.
Week ten, and Friday was definitely the best day this week. We did a few minutes of our regular first period, but from then on the whole day was a field trip to Edgar Allen Poe's house and gravesite in Baltimore. Also I found out Baltimore's in Maryland, and not Pennsylvania as I previously presumed. The whole day was mostly riding in the car (but it was fun because it was only five kids going, and many lolz occured in the van) and we were really only at the place for like an hour, if that. But we took a photo of us standing in front of the headstone. Someone apparently leaves a bottle of alchohol there every year on Poe's birthday, so that's in the photo too. I'll see if I can get a copy to scan. And now a list of what the hell was going on in the van.
Nick (me) mostly sat there staring blankly out the window and being antisocial, like always. At first he listened to Miscellaneous T, and after that he decided to listen in on what everyone else was doing, occasionally chiming in with "I don't understand y'alls" or "What the f-". But he was in the front seat with the teacher (due to everyone else always going to great lengths to avoid sitting with him) so he probably missed a lot. Dillon, being the class clown that he is, bugged everyone the whole time. Whether it was pulling Nick's hair or grabbing Jess' tits, he did indeed bug people. Kyle, the resident goth kid who acts nothing like a goth kid, pretty much just went along with whatever everyone else was doing. Jess slept the whole way to Baltimore. Bethany was apparently letting people sleep on her, and also stroking their hair. o_O
So then once we got to Baltimore, we stopped for some food. But instead of getting anything, I waited until everyone was done eating and devoured their leftovers. I have problems. Anyway, then we entered Poe's house. They had displays and stuff set up, like a museum. There was even a portrait of Poe's wife's dead body, which was kinda creepy. We weren't there for very long, but then we went to the gravesite, which was pretty cool. We even walked into some sort of cemetery... INSIDE A BUILDING. I can't quite comprehend how they managed to bury someone INSIDE A BUILDING. But yeah. The van ride back was interesting, as halfway back while everyone else was taking a bathroom break, I quickly hopped into the middle seat, forcing Jess to have to sit with me. She tried to hardest to get someone in another seat to let her sit with them but failed. My ultimate goal was for her to fall asleep on my lap like she just did with Dillon shortly before, but it didn't work. At all. Then I tried to get her to hug me, which she also didn't agree to. But hey, she sat with me, so that's a start, I guess. We also missed the buses, so the teachers dropped us off. I was the first to be dropped off. Everyone saw one of my kitties.
All week, though, everyone was trying to get me to take a shower. Apparently I smelled bad. They even sprayed some perfume on me during class. Eventually I DID take the shower, because the teachers told my mom, who then began bitching as usual.
Outside of school, I've been listening to music on my now-fixed laptop. It's a bit slow, but whatever. I also never did try for teh Internet access, but I DID get to go to the mall today. I tried looking for theSTART's Initiation album, but they didn't have it. So instead I picked up Nevermind (by Nirvana, duh) and Wave of Mutilation: Best of the Pixies. Also I got two video games, my first new games in years. FFXII, BITCH!
Nick (me) mostly sat there staring blankly out the window and being antisocial, like always. At first he listened to Miscellaneous T, and after that he decided to listen in on what everyone else was doing, occasionally chiming in with "I don't understand y'alls" or "What the f-". But he was in the front seat with the teacher (due to everyone else always going to great lengths to avoid sitting with him) so he probably missed a lot. Dillon, being the class clown that he is, bugged everyone the whole time. Whether it was pulling Nick's hair or grabbing Jess' tits, he did indeed bug people. Kyle, the resident goth kid who acts nothing like a goth kid, pretty much just went along with whatever everyone else was doing. Jess slept the whole way to Baltimore. Bethany was apparently letting people sleep on her, and also stroking their hair. o_O
So then once we got to Baltimore, we stopped for some food. But instead of getting anything, I waited until everyone was done eating and devoured their leftovers. I have problems. Anyway, then we entered Poe's house. They had displays and stuff set up, like a museum. There was even a portrait of Poe's wife's dead body, which was kinda creepy. We weren't there for very long, but then we went to the gravesite, which was pretty cool. We even walked into some sort of cemetery... INSIDE A BUILDING. I can't quite comprehend how they managed to bury someone INSIDE A BUILDING. But yeah. The van ride back was interesting, as halfway back while everyone else was taking a bathroom break, I quickly hopped into the middle seat, forcing Jess to have to sit with me. She tried to hardest to get someone in another seat to let her sit with them but failed. My ultimate goal was for her to fall asleep on my lap like she just did with Dillon shortly before, but it didn't work. At all. Then I tried to get her to hug me, which she also didn't agree to. But hey, she sat with me, so that's a start, I guess. We also missed the buses, so the teachers dropped us off. I was the first to be dropped off. Everyone saw one of my kitties.
All week, though, everyone was trying to get me to take a shower. Apparently I smelled bad. They even sprayed some perfume on me during class. Eventually I DID take the shower, because the teachers told my mom, who then began bitching as usual.
Outside of school, I've been listening to music on my now-fixed laptop. It's a bit slow, but whatever. I also never did try for teh Internet access, but I DID get to go to the mall today. I tried looking for theSTART's Initiation album, but they didn't have it. So instead I picked up Nevermind (by Nirvana, duh) and Wave of Mutilation: Best of the Pixies. Also I got two video games, my first new games in years. FFXII, BITCH!
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