CLINICAL INTERNSHIP REPORT

DAR-UL-HIKMAT NEUROPSYCHIATRY CLINIC

3 June-24 August

MAHNOOR SHAFIQ

ADP-23-15

ADP IN APPLIED PYCHOLOGY

SESSION 2023-25

DEPARTMENT OF APPLIED PSYCHOLOGY

BAHAUDDIN ZAKARIYA UNIVERSITY

MULTAN
 CERTIFICATE

It is certified that Miss Mahnoor Shafiq student of ADP in

Applied Psychology Bahauddin Zakariya University Multan completed this report

under Supervision.

Dr.Ruqia Safdar Bajwa

 APPROVED BY

_____________________________________________

Supervisor

_____________________________________________

Chairperson

__________________________________________________
 Table of Content

Introduction

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Introduction to the Case Study Method

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Introduction to the Psychological Assessment Process

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Introduction to the Disorders

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Case No 1.

Depression

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Case No 2.

Anxiety

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Case No 3.

Schizophrenia

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Case No 4.

Personality Disorder

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Case No 5.

Obsessive Compulsive Disorder

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References
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Introduction To The Case Study Method

Case Study Method is a research approach that involves an in-depth investigation of a particular
individual, group, organization, or event to explore its complexities in real-world contexts. This
method focuses on detailed analysis and can be used in various fields, such as social sciences,
education, business, and medicine.
1.Contextual Exploration:

Studies the subject within its real-world context to capture complexities and dynamics.

2.Qualitative and Quantitative:

Can use both qualitative and quantitative data through interviews, observations, and document
reviews.

3.Qualitative and Quantitative:

Can use both qualitative and quantitative data through interviews, observations, and document
reviews.

4.Interdisciplinary Application:

Commonly used in fields like social sciences, education, business, and healthcare.

5.Theory Development:

Can contribute to theory-building by testing existing theories or generating new ones based on
real-life situations.

6.Time-Consuming:

Often requires a significant amount of time for data collection, analysis, and interpretation.

7.Subjective Interpretation:

Results may involve researcher bias or subjectivity, as interpretation can vary based on personal
or theoretical perspectives.

Methodology:
1.Case Selection: Choose a case that is unique, rare, or offers educational value, highlighting
novel aspects of diagnosis, treatment, or outcomes.

2.Patient Consent: Obtain informed consent from the patient for publication. Check if ethics
approval is required.

3.Report Structure:

 Title: Clearly reflect the case's key aspect.

 Abstract: Provide a brief overview of the case and its significance.
 Introduction: Explain why the case is important.
 Case Presentation: Include patient demographics, symptoms, diagnostic tests, treatment,
and follow-up.
 Discussion: Compare findings with the literature and highlight clinical lessons.
 Conclusion: Summarize key takeaways.
 Introduction to the Psychological Assessment Process

The introduction of the psychological assessment process provides a brief overview of the
purpose, scope, and goals of the assessment. It outlines the reason for the evaluation, typically
related to diagnosing mental health conditions, understanding cognitive functioning, personality
traits, or emotional well-being.

The Psychological Assessment Process

The psychological assessment process is a systematic evaluation of an individual's psychological

functioning, which typically includes the following key components:

1.Referral and Background Information:

 Referral Source: Understanding who referred the individual (e.g., a physician, educator,
or legal authority) and why.
 History: Gathering relevant background information, including the individual’s personal,
medical, and psychological history.

2.Clinical Interview: Structured or Semi-Structured Interviews: Engaging in conversations with

the individual (and sometimes family members) to explore their concerns, symptoms, and
functioning.

 Gathering Data: Collecting information about current issues, past experiences, and
contextual factors affecting the individual.

3. Selection of Assessment Tools:

 Standardized Tests: Choosing appropriate psychological tests based on the referral

question and the individual’s needs, which may include:
 Personality Assessments: Such as the MMPI (Minnesota Multiphasic Personality
Inventory) or the Big Five Inventory.
 Cognitive Tests: Like IQ tests (e.g., WAIS) to evaluate cognitive abilities.
  Behavioral Assessments: Observations or rating scales for specific behaviors or
emotional states.

4. Administration of Tests:

 Testing Environment: Conducting assessments in a controlled, comfortable setting to

ensure accurate results.
 Following Protocols: Administering tests according to standardized procedures to
maintain reliability and validity.

5. Scoring and Interpretation:

 Scoring: Calculating scores according to standardized guidelines for each assessment

tool.
 Interpretation: Analyzing results in the context of the individual’s history, current
functioning, and the specific referral question.

6. Integration of Findings:

 Synthesis of Data: Combining information from interviews, assessments, and

observations to form a comprehensive understanding of the individual.
 Identifying Patterns: Looking for patterns in the data that can inform diagnosis and
treatment.

7. Reporting:

 Written Report: Preparing a formal report that includes findings, interpretations, and
recommendations for treatment or intervention.
 Feedback Session: Providing feedback to the individual (and possibly their family) to
discuss results, clarify questions, and suggest next steps.

8. Recommendations and Follow-Up

 Treatment Planning: Offering recommendations for therapeutic interventions, support

services, or further evaluations.
 Monitoring Progress: Discussing how to monitor changes in the individual’s
functioning over time, if applicable.
 Introduction to Disorders

1. Anxiety Disorders

 Symptoms: Excessive worry, restlessness, fatigue, difficulty concentrating, irritability,

muscle tension, sleep disturbances, and physical symptoms like a racing heart or
sweating.
 Causes: A combination of genetic, environmental, psychological, and developmental
factors. Stressful life events can trigger symptoms.
 Treatment: Cognitive-behavioral therapy (CBT), medication (such as SSRIs or
benzodiazepines), lifestyle changes, and mindfulness practices.

2. Schizophrenia

 Symptoms: Delusions, hallucinations, disorganized thinking and speech, negative

symptoms (such as lack of motivation or emotional expression), and cognitive issues.
 Causes: Genetics, brain chemistry and structure, and environmental factors (such as
prenatal exposure to infections or stress).
 Treatment: Antipsychotic medications, psychotherapy, social skills training, and support
services.

3. Obsessive-Compulsive Disorder (OCD)

 Symptoms: Obsessions (recurrent, intrusive thoughts) and compulsions (repetitive

behaviors or mental acts performed to reduce anxiety). Common obsessions include fears
of contamination, while compulsions may include excessive cleaning or checking.
 Causes: Genetic predisposition, brain structure differences, and environmental factors,
including traumatic experiences.
 Treatment: CBT (especially exposure and response prevention), medications (such as
SSRIs), and mindfulness strategies.

4. Personality Disorders

Personality disorders are characterized by enduring patterns of behavior, cognition, and inner
experience that deviate markedly from the expectations of the individual’s culture.

 Borderline Personality Disorder (BPD)

Symptoms: Intense and unstable emotions, impulsive behaviors, and difficulty in maintaining
relationships. Individuals may also experience a distorted self-image and fear of abandonment.
Causes: Genetic factors, brain abnormalities, and traumatic life events.

Treatment: Dialectical behavior therapy (DBT), medications, and psychotherapy.

 Antisocial Personality Disorder (ASPD)

Symptoms: Disregard for the rights of others, deceitfulness, impulsivity, irritability, and lack of
remorse after harming others.

Causes: Genetic predisposition, environmental factors, and childhood trauma.

Treatment: Psychotherapy, particularly cognitive-behavioral approaches, and sometimes

medications to manage symptoms.

 Narcissistic Personality Disorder (NPD)

Symptoms: Grandiosity, need for admiration, and lack of empathy. Individuals often have

an inflated sense of their own importance and a deep need for excessive attention and admiration.

Causes: Genetic and environmental factors, including early childhood experiences.

Treatment: Psychotherapy, particularly cognitive-behavioral therapy.

5. Depressive Disorders

 Symptoms: Persistent sadness, loss of interest in activities, changes in appetite or weight,

sleep disturbances, fatigue, feelings of worthlessness or guilt, and difficulty
concentrating. Suicidal thoughts may also be present.
 Causes: Genetic factors, biochemical imbalances, environmental stressors, and
psychological factors such as negative thinking patterns.
 Treatment: Antidepressant medications (such as SSRIs or SNRIs), psychotherapy (such
as CBT or interpersonal therapy), lifestyle changes, and support groups.
 Case No 1

Depression

Case History

2.1 Introduction

Name: ZK

Age: 33

Marital Status: Married

Occupation: Software Engineer

Referral Details: Referred by a psychiatrist for worsening depressive symptoms despite initial
treatment.

Central Problem: Severe depression with persistent low mood, loss of interest, and suicidal
thoughts.

2.2 History of Presenting Complaint: Zain reports a prolonged period (6 months) of depressed
mood, feelings of worthlessness, fatigue, and sleep disturbances. He has lost interest in work and
family activities. The symptoms were exacerbated following a recent job demotion, which
triggered increased stress and isolation. He has experienced passive suicidal ideation without
intent or plan.

2.3 Past Psychiatric History

Zain was diagnosed with major depressive disorder two years ago and was initially treated with
SSRIs, with partial remission. He stopped medication due to side effects.

2.4 Past Medical History

No significant medical history, no history of major surgeries or hospitalizations.

2.5 Family History

Family history of depression in his father. No known history of other psychiatric or medical
conditions.

2.6 Personal History

Stable upbringing, completed higher education, currently employed in a stable job. Married with
two children but reports increasing tension in his relationship due to his symptoms.
3. Mental State Examination (MSE)

 General Appearance and Behavior: Appears tired, with poor grooming, maintains
minimal eye contact, and shows psychomotor retardation.
 Speech: Soft, slow, and monotonous.
 Affect and Mood: Flat affect with a pervasive depressed mood.
 Depersonalization and Derealization: Not present.
 Thought (Stream, Form, Content): Thoughts of hopelessness, worthlessness, and guilt;
denies active suicidal intent but has passive ideation.
 Perception: No hallucinations or delusions.
 Cognition: Oriented to time, place, and person; memory intact, but attention is impaired.
 Judgment: Impaired, as he is unable to make decisions about work and family matters.
 Insight: Partial, recognizes symptoms but reluctant to accept the need for ongoing
treatment.
 Rapport: Poor, difficulty engaging in the session.

4. Psychological Testing and Assessment

 Tests Administered: Beck Depression Inventory-II (BDI-II), Hamilton Depression

Rating Scale (HDRS).
 Rationale for Test Selection: To quantify the severity of depressive symptoms and track
changes over time.
 Test Results and Interpretation: BDI-II score: 35 (severe depression); HDRS score: 24
(severe depression). Both indicate significant depressive symptoms.
 Assessment Summary: Results confirm the diagnosis of severe major depressive
disorder with significant impairments in daily functioning.

5. Physical Examination

Physical health is generally stable, with no major findings that impact psychological well-being.
Minor weight loss reported due to reduced appetite.

6. Summary and Diagnosis

 Summary: Zain presents with a worsening case of major depressive disorder,

characterized by persistent low mood, fatigue, suicidal ideation, and significant
impairment in both personal and occupational life. His symptoms are exacerbated by
recent job-related stress.
 Diagnosis: Major Depressive Disorder, Severe (DSM-5-TR).

7. Formulation
  Predisposing Factors: Family history of depression, previous episode of major
depressive disorder.
 Precipitating Factors: Job demotion leading to increased stress and a sense of failure.

8. Management

 Short-term Management Plan: Reintroduce antidepressant therapy (SSRIs with close

monitoring), initiate cognitive-behavioral therapy (CBT), and consider adding a mood
stabilizer.
 Long-term Management Plan: Continue psychotherapy, regular psychiatric reviews,
and family therapy to support the patient.
 Prognosis: Moderate, with the potential for recovery with proper treatment adherence,
though challenges remain due to family stress and job insecurity.
 Case No 2

Anxiety

2. Case History

2.1 Introduction

Name: MR

Age: 30

Marital Status: Married

Occupation: Housewife

Referral Details: Referred by family physician due to severe anxiety symptoms

Central Problem: Marital conflict causing severe anxiety and distress

2.2 History of Presenting Complaint

Rubab reports continuous worry and tension, poor sleep, irritability, and physical symptoms like
chest tightness. Symptoms have persisted for six months, worsening after increased marital
conflicts.

2.3 Past Psychiatric History

Rubab has no previous history of psychiatric illness, though she reported mild anxiety during
periods of significant life stress.

2.4 Past Medical History

No significant medical history.

2.5 Family History

Family history of depression and anxiety.

2.6 Personal History

 Development: Normal childhood and adolescence

 Education: High school
 Employment: Housewife
 Relationships: Married for 8 years, strained marital relationship.
 Significant Life Events: Increased conflicts with her husband over the past year.
3. Mental State Examination

3.1 General Appearance and Behavior

Rubab appears anxious and restless. She maintains good hygiene but is often fidgeting and tense.

3.2 Speech

Normal rate and volume, but often halting due to distress.

3.3 Affect and Mood

Affect is restricted; mood is anxious and worried.

3.4 Thought Process

Her thoughts are coherent but dominated by worries about her marriage.

3.5 Cognition

Fully oriented, good memory and attention.

3.6 Judgment and Insight

Judgment is intact; insight into her condition is fair.

4. Psychological Testing and Assessment

4.1 Tests Administered

Beck Anxiety Inventory (BAI): Score 34 Indicate severe anxiety.

Hamilton Anxiety Rating Scale (HAM-A): Scores 10 consistent with generalized anxiety
disorder.

4.2 Rationale for Test Selection

The BAI and HAM-A were chosen for their effectiveness in assessing anxiety severity and
frequency.

4.3 Test Results and Interpretation

Both tests confirm severe anxiety, especially in response to interpersonal stress.

4.4 Assessment Summary

Rubab's anxiety is primarily triggered by marital stress, consistent with GAD.

5. Physical Examination

No physical health concerns directly impacting her mental health.

6. Summary and Diagnosis

6.1 Summary

Rubab presents with symptoms of GAD, exacerbated by ongoing marital conflicts.

6.2 Diagnosis

DSM-5-TR Diagnosis: Generalized Anxiety Disorder (GAD)

7. Formulation

7.1 Predisposing Factors

Family history of anxiety, long-term marital dissatisfaction.

7.2 Precipitating Factors

Increased marital conflict over the past year.

7.3 Perpetuating Factors

Ongoing unresolved issues in her marriage.

7.4 Protective Factors

Strong support system through her extended family.

8. Management

8.1 Short-term Management Plan

 Cognitive Behavioral Therapy (CBT) to address anxiety.

 Marital counseling with the husband.
 Prescription of low-dose anxiolytics.

8.2 Long-term Management Plan

 Continued individual therapy for anxiety management.

 Ongoing marital therapy for conflict resolution.

8.3 Prognosis

 Good, provided both individual and marital therapy are pursued consistently
 Case No 3

Schizophrenia

Case History

1.1 Introduction

Name: MM

Age: 28

Marital Status: Single.

Occupation: Unemployed.

Referral Details: Referred by the family due to erratic behavior and social withdrawal.
Central Problem: Hallucinations, disorganized speech, and paranoia.

1.2 History of Presenting Complaint

Maqsood has been exhibiting auditory hallucinations for the past six months, accompanied by
delusions and poor self-care. The onset was gradual, worsening over time.

1.3 Past Psychiatric History

No previous formal psychiatric treatment but a history of occasional erratic behavior.

1.4 Past Medical History

Unremarkable, with no significant physical illnesses or hospitalizations.

1.5 Family History

A family history of mental illness, with a paternal uncle diagnosed with schizophrenia.

1.6 Personal History

 Developmental History: Normal childhood development.

 Educational Background: Completed high school but struggled academically.
 Employment History: Brief employment history, currently unemployed.
 Relationships: Limited social relationships, mainly with family.

3. Mental State Examination (MSE)

 General Appearance and Behavior: Unkempt appearance, poor hygiene, limited eye
contact.
 Speech: Disorganized, tangential, and at times incoherent.
 Affect and Mood: Blunted affect, with flat emotional expression.
  Thought Process: Presence of persecutory delusions and thought bloc 4. Psychological
Testing and Assessment.
 Perception: Auditory hallucinations, mainly voices commenting on his actions.
 Cognition: Poor concentration and orientation to time and place.
 Judgment: Severely impaired.
 Insight: Lacks insight into his condition.

4. Psychological Testing and Assessment

 Tests Administered: MMPI (Minnesota Multiphasic Personality Inventory), PANSS

(Positive and Negative Syndrome Scale).
 Rationale for Test Selection: To assess the severity of psychotic symptoms and
personality structure.
 Test Results and Interpretation: Elevated scores on PANSS indicating severe positive
symptoms (hallucinations, delusions).

5. Physical Examination

Normal physical findings. No neurological deficits observed.

6. Summary and Diagnosis

 Summary: Maqsood presents with auditory hallucinations, persecutory delusions, and

disorganized speech, with a family history of schizophrenia.
 Diagnosis: Schizophrenia (DSM-5-TR criteria), predominantly paranoid type.

7. Formulation

 Predisposing Factors: Family history of schizophrenia.

 Precipitating Factors: Recent job loss and social isolation.
 Perpetuating Factors: Poor insight, lack of treatment compliance.
 Protective Factors: Supportive family.

8. Management

 Short-term Plan: Initiation of antipsychotic medication (e.g., Risperidone) and

immediate psychiatric care.
 Long-term Plan: Cognitive-behavioral therapy (CBT), social skills training, and family
therapy.
 Prognosis: Fair, dependent on medication adherence and supportive car
 Case No 4

Personality Disorder

Case History

1.1 Introduction

Name: MA

Age: 36

Marital Status: Single

Occupation: Office worker

Referral Details: Referred by a friend due to interpersonal conflicts and chronic instability

Central Problem: Difficulty maintaining relationships, frequent mood swings, and impulsive
behavior.

1.2 History of Presenting Complaint

Ammar has a history of unstable relationships, intense emotional reactions, and impulsive
behaviors, such as spending sprees and substance use. These issues have persisted for several
years but have worsened in the past six months following a breakup.

1.3 Past Psychiatric History

Previous diagnosis of anxiety and depression but never engaged in long-term treatment.

1.4 Past Medical History

No significant medical conditions.

1.5 Family History

History of substance abuse in the father; no psychiatric history.

Mental State Examination (MSE)

2.1 General Appearance and Behavior: Appears anxious and restless

2.2 Speech: Rapid and pressured at times

2.3 Affect and Mood: Labile affect, fluctuating between anger and sadness

2.4 Depersonalization and Derealization: Occasionally feels detached from reality

2.5 Thought (Stream, Form, Content): Thought content revolves around self-worth issues and
abandonment fears

2.6 Perception: No hallucinations

2.7 Cognition: Intact, oriented to time, place, and person

2.8 Judgment: Poor; engages in impulsive decision-making

2.9 Insight: Limited; often blames others for his problems

2.10 Rapport: Engaging but easily frustrated.

Psychological Testing and Assessment

 Tests Administered: Minnesota Multiphasic Personality Inventory (MMPI), Personality

Assessment Inventory (PAI)
 Rationale for Test Selection: These tests help in understanding personality structure and
traits.
 Test Results and Interpretation: Ammar's results indicate traits consistent with
Borderline Personality Disorder (BPD).
 Assessment Summary: The pattern of instability in relationships, mood, and behavior
aligns with the diagnosis of BPD.
 Physical Examination

No significant physical findings.

Summary and Diagnosis

 Summary: Ammar's history, mental state examination, and psychological testing suggest
chronic personality issues, particularly related to emotional regulation and interpersonal
relationships.
 Diagnosis: Borderline Personality Disorder (DSM-5 Criteria).

Formulation

 Predisposing Factors: Family history of substance abuse, childhood trauma

 Precipitating Factors: Recent relationship breakup
 Perpetuating Factors: Emotional dysregulation and lack of stable relationships
 Protective Factors: Interest in creative work, support from friends

Management

 Short-term Management Plan: Dialectical Behavior Therapy (DBT), mood stabilizers

to manage emotional swings
 Long-term Management Plan: Continued DBT, substance abuse counseling, focus on
building stable relationships
 Prognosis: Guarded, with challenges related to emotional regulation and interpersonal
conflicts.

Case No 5
 Obsessive Compulsive disorder

Introduction

Name : MS

Age: 25

Marital Status: Married

Occupation: Accountant

Referral Details: Referred by a psychiatrist for persistent anxiety, obsessions, and compulsions.

Central Problem: Obsessive-Compulsive Disorder (OCD) with Panic disorder.

1.2 History of Presenting Complaint

 Current Symptoms: Samreen reports recurrent intrusive thoughts about contamination
and compulsive washing rituals. She also experiences sudden, intense episodes of panic,
characterized by palpitations, sweating, and fear of losing control.
 Duration: Symptoms have been present for the past year, with a significant increase in
frequency and intensity over the last three months.
 Relevant Triggers or Stressors: Increased workload and family pressure have been
significant stressors contributing to her symptoms.

1.3 Past Psychiatric History

 Previous Diagnoses: None. Occasional anxiety episodes in the past but not clinically
significant.
 Treatments Received: None prior to the current episode.

1.4 Past Medical History

 Medical Conditions: No significant medical conditions or surgeries.

1.5 Family History

 Psychiatric Conditions: Her father has a history of generalized anxiety disorder.

 Medical Conditions: No significant medical conditions reported.

1.6 Personal History

 Developmental History: Normal developmental milestones.

 Educational Background: Bachelor’s degree in Mathematics.
 Employment History: Employed as an accountant for six years.
 Relationships: Married with no children.
 Significant Life Events: High academic pressure during college years.
3. Mental State Examination (MSE)

3.1 General Appearance and Behavior

 Appearance: Well-groomed but appears tense and restless.

 Behavior: Frequently washes hands during the interview.

3.2 Speech

 Characteristics: Rapid and pressured speech.

3.3 Affect and Mood

 Affect: Anxious and labile.

 Mood: Reports feeling "overwhelmed" and "fearful."
3.4 Depersonalization and Derealization

 Experience: Denies experiencing depersonalization or derealization.

3.5 Thought (Stream, Form, Content)

 Process: Logical but obsessional content.

 Content: Recurrent thoughts of contamination and fear of germs.

3.6 Perception

 Hallucinations or Delusions: None reported.

3.7 Cognition

Orientation: Oriented to person, place, and time.

 Memory: Intact.
 Attention: Impaired by obsessive thoughts.

3.8 Judgment

 Decision-making: Impaired by anxiety and compulsions.

3.9 Insight

 Awareness: Acknowledges having a problem and is seeking help.

3.10 Rapport

Interaction: Initially hesitant but becomes more cooperative as the session progresses.

4. Psychological Testing and Assessment

Tests Administered
  Obsessive-Compulsive Inventory (OCI)
 Panic Disorder Severity Scale (PDSS)

Rationale for Test Selection

 OCI: To quantify the severity of obsessive-compulsive symptoms.

 PDSS: To assess the severity and impact of panic disorder.

Test Results and Interpretation

 OCI: Score 43 indicate severe obsessive-compulsive symptoms.

 PDSS: Scores 15 confirm moderate to severe panic disorder.

5. Physical Examination

 Findings: No significant physical health issues noted.

6. Summary and Diagnosis

Summary

Samreen is a 25-year-old married Accountant presenting with severe symptoms of OCD and
panic disorder. Her OCD symptoms include intrusive thoughts about contamination and
compulsive washing, exacerbated by work and family stress. She also experiences intense panic
attacks.

Diagnosis

 Primary Diagnosis: Obsessive-Compulsive Disorder (DSM-5-TR criteria)

 Secondary Diagnosis: Panic Disorder (DSM-5-TR criteria)

7. Formulation

Predisposing Factors

 Genetic Predisposition: Family history of anxiety disorder.

 Significant Life Events: High academic pressure in the past.

Precipitating Factors

 Recent Stressors: Increased workload and family pressure.

Perpetuating Factors

 Behavioral Patterns: Compulsive rituals maintaining anxiety.

Cognitive Patterns: Persistent negative and obsessional thoughts.

8. Management

Short-term Management Plan

 Medication: Initiate SSRI for OCD and panic symptoms.

 Therapy: Begin cognitive-behavioral therapy (CBT) focusing on exposure and response
prevention (ERP).

Long-term Management Plan

 Ongoing Therapy: Continue CBT with ERP.

 Support Systems: Encourage family support and involvement.
 Relapse Prevention: Develop strategies to manage stress and prevent symptom
recurrence.
Prognosis

 Expected Outcome: With adherence to treatment, significant improvement in symptoms

is expected.
 Challenges: Managing ongoing stressors and ensuring consistent therapy attendance.

References for the Case Report

  American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental
Disorders (5th ed., text rev.). Washington, DC: American Psychiatric Association
Publishing.
 American Psychological Association. (2020). Publication Manual of the American
Psychological Association (7th ed.). Washington, DC: American Psychological
Association.
 American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental
Disorders (5th ed., text rev.). Washington, DC: American Psychiatric Association
Publishing.
 American Psychological Association. (2020). Publication Manual of the American
Psychological Association (7th ed.). Washington, DC: American Psychological
Association.
References for the Scales Used

 Lesieur, H. R., & Blume, S. B. (1987). South Oaks Gambling Screen (SOGS). American
Journal of Psychiatry, 144(9), 1184–1188.
 Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck Depression
Inventory-II (BDI-II). San Antonio, TX: Psychological Corporation.
 Beck, A. T., & Steer, R. A. (1990). Manual for the Beck Anxiety Inventory (BAI). San
Antonio, TX: Psychological Corporation.
 Hathaway, S. R., & McKinley, J. C. (1983). Minnesota Multiphasic Personality Inventory
(MMPI). University of Minnesota Press.
 Morey, L. C. (1991). Personality Assessment Inventory (PAI) Manual. Odessa, FL:
Psychological Assessment Resources, Inc.