Referral Source: Tyrone was referred by his family physician because of his report of chronic neck and back pain for which medical tests failed to confirm an organic cause.

Referral Question and Statement of Purpose: The evaluation was intended to gain greater understanding of the psychosocial origins of Tyrone's report of chronic pain and generate recommendations for nonmedical treatment.

Evaluation Procedures: Minnesota Multiphasic Personality Inventory - Revised (MMPI-2)

Test Behavior and Observations: Tyrone required approximately 1.5 hours to complete the MMPI-2.  He did not ask any questions while taking the test.  He arrive exactly on time, was well-groomed, and interacted very respectfully with the examiner.  Every so often, Tyrone rotated his head and arched his back while seated, slightly grimacing when stretching.  When doing so, he glanced at the examiner.

Background Information: Tyrone was in a minor car accident six months before being referred for evaluation.  Various medical tests failed to identify an organic basis for his pain.  He reports no other health problems.  Tyrone stated that he never had psychological problems before and nor did he ever receive mental-health services.  Tyrone reported using alcohol on occasion, but denied abuse of chemical substances.  Tyrone graduated from college with a degree in political science and is currently enrolled as a first-year law student with average grades.  Tyrone, who has never been married, lives alone in an apartment near campus.  Although he dates occasionally, he has never had a serious, lasting relationship.  Tyrone's father sells insurance and his mother is employed as a receptionist.  Tyrone stated that he is quite popular and enjoys spending time with friends and planning interesting things to do when not studying (e.g., attending sporting events).  Tyrone is a practicing Christian.

Results and Interpretation: The results of the MMPI-2 are as follows:

?  =  0
L  =  52
F  =  48
K  =  58
Hs  =  70
D  =  43
Hy  =  73
Pd  =  42
Mf  =  34
Pa  =  50
Pt   =  58
Sc  =  56
Ma  =  60
Si  =  40

Tyrone's scores on the validity scales indicate that the test results are valid.  However, his score on scale L is somewhat high for a college student, reflecting, perhaps, modest rigidity and limited psychological sophistication.  On the F scale, Tyrone did not respond in a noticeably deviant manner or produce the slight elevation that might be expected of African-American respondents (nor, for that matter are his scores on Pa and Sc elevated as is typically seen in profiles produced by African Americans).  Scale K shows moderate elevation, suggesting that Tyrone was motivated to present himself in a favorable light.

Tyrone produced clinically significant elevations on scales Hs and Hy.  Coupled with his moderately low score on scale D, this clinical configuration suggests a tendency to convert psychological discomfort into bodily complaints.  It is possible that Tyrone transforms ongoing and intense turmoil related to law school into somatic symptoms.  His elevation on scale Hs also suggests a general preference for medical explanations for life difficulties and for others to assume responsibility when he is taxed by life events.  His elevation on scale Hy further supports the notion that he may have limited insight into his problems, is uncomfortable acknowledging and expressing conflict, uses denial as a coping strategy, and has a need to be affirmed by others.  Tyrone's need for affirmation is further evidenced by his moderately low score on scale Si; he appears to prefer the company of others, albeit superficially, and may use social interaction to distract himself from his problems.  His avoidant style of coping is also suggested by a moderately high score on scale Ma, which reflects a tendency to cope by keeping busy, and by a moderately high score on scale Pt, which implies a preference for nonemotional processing of information and a need for control through being methodical and organized.  Tyrone's low score on scale Mf shows that he holds traditional masculine sex-role attitudes and engages in stereotypic masculine activities, both of which suggest a dislike of acknowledging personal distress.  Likewise, his moderately low score on scale Pd suggests that Tyrone may be somewhat conventional, concerned about his image, and emotionally constricted.

In summary, Tyrone's MMPI-2 profile strongly points to the possibility that his back pain may be psychological in origin.  He shows a tendency to somatize emotional distress.  This tendency is underscored by a generally avoidant style of coping in which he remains unaware of his internal experience, distracts himself from problems through activity and socializing, isolates emotion from thinking, and maintains illusory control via attempts to self-regulate.  He is rather naive psychologically and is concerned with how he is viewed by others.

Recommendations:  Tyrone is unlikely to benefit from insight-oriented psychotherapy.  However, cognitive-behavioral interventions might help Tyrone to acquire more adaptive and responsible ways of coping with the emotional discomfort emanating from challenging life circumstances (e.g., the demands of law school, parental expectations for success).  Given his active, cognitive style, Tyrone is likely to be receptive to procedures such as relaxation training / biofeedback to regulate his distress, the rational restructuring of beliefs which contribute to or exacerbate his physical complaints, and the modification of his lifestyle .  It is important to note that Tyrone will be particularly responsive to a therapist who expresses encouragement for his efforts and prizes his accomplishments.