Bob’s behavioral reaction was immobile and exacerbated his current crisis. Bob’s wandering throughout the day without contacting anyone who might be able to provide him support suggested he was paralyzed and unable to make decisions for himself. This situation is not unusual and is expected, given the circumstances. Bob could not think beyond the immediacy of his inability to provide financial support for his family. Although Bob expressed suicidal ideations, the clinician determined these were not at a level of immediate danger. Bob’s inability to perform routine personal grooming was also an indication of the severity of Bob’s behavioral reaction. The severity of Bob’s reactions was certainly elevated beyond moderate impairment; that is, his coping behav- iors exacerbated the situation, and his ability to perform daily tasks was markedly com- promised. Thus, Bob’s behavioral reactions to the crisis fell within the marked impairment range, a score of 9.
Cognitive Reaction. Bob’s primary cognitive reaction was threat in the area of phys- ical dimension. He also was perceiving a loss in social relationships and to a degree a threat to his psychological well being. Bob’s neglect of some aspects of his routine living (wandering, disheveled appearance, etc.), though behavioral indicators, also demon- strated a lapse in cognitive functioning. He was able to recall personal information but needed prompting to do so. However, his perceptions of his financial status and the impending crisis were also critical factors in determining the severity of his cognitive reaction. These thoughts were intrusive and Bob seemed to have no control over them. Because more than half of the descriptors for marked impairment in the severity scale were met, Bob was evaluated with a score of 9.