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In mental status examinations, interviewers take note of their client's general appearance. Observations are limited primarily to physical characteristics, but some demographic information is also included in this domain.

Physical characteristics commonly noted on a mental status exam include grooming, dress, pupil dilation/contraction, facial expression, perspiration, make-up, presence of body piercing or tattoos, height, weight, and nutritional status. Interviewers should closely observe not only how clients look, but also how they physically react or interact with the interviewer. Morrison (1993) recommends: "When you shake hands during your introductions, notice whether the patient's palms are dry or damp" (p. 106). Similarly, Shea (1998) states: "The experienced clinician may note whether he or she en counters the iron fingers of a Hercules bent upon establishing control or the dampened palm of a Charlie Brown expecting imminent rejection" (p. 9).

A client's physical appearance may be a manifestation of mental state. Further, physical appearance may be indicative of particular psychiatric diagnoses. For example, dilated pupils are sometimes associated with drug intoxication and pinpoint pupils, with drug withdrawal. Of course, dilated pupils should not be considered conclusive evidence of drug intoxication; this is only one piece of the puzzle and would require further evidence before you could legitimately reach such a conclusion.

Client sex, age, race, and ethnic background are also concrete variables noted during a mental status exam. Each of these factors can be related to psychiatric diagnosis and treatment planning. For example, base rates of various DSM diagnoses vary with regard to sex. Also, as Othmer and Othmer (1994) note, the relationship between appearance and biological age may have significance: "A patient who appears older than his stated age may have a history of drug or alcohol abuse, organic mental disorder, depression, or physical illness" (p. 114).

In a mental status report, a client's appearance might be described with the following narrative:

Maxine Kane, a 41-year-old Australian American female, appeared much younger than her stated age. She arrived for the evaluation wearing a miniskirt, spike heels, excessive makeup, and a contemporary bleached-blonde hairstyle.

A client's physical appearance may also be a manifestation of his or her environment or situation (Paniagua, 2001). In the preceding example, it would be important to know that Ms. Kane came to her evaluation appointment directly from her place of employment—the set of a television soap opera.

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