Appearance and Behavior

First in the mental status exam we describe what we observe – the patient’s appearance and behavior. Imagine yourself looking at the patient through a one-way mirror, and describe all that you can see without asking or hearing anything. We see that Mrs. Dempsey looks as though she doesn’t care much about her appearance, her clothes are wrinkled and her hair isn’t combed. During the interview she exhibited low level of energy and an effort to avoid direct eye contact with me. She is cooperative, but depleted and a bit wary of telling me what is going on. Throughout the interview, we also need to pay attention to her attitude. This is an effort to capture both her manner of regarding her illness, as well as how she regards the interviewer. In more psychological terms, we might think of attitude as related to defenses. Defenses are those mechanisms that mediate between the inner and the outer world, the methods by which people cope with impinging stresses. Mrs. Dempsey focuses on somatic issues, “can’t sleep, can’t eat, nauseous,” and external pressures, such as work. In general she blames difficulties on outside forces and pushes herself to overide her emotions.