EFTA01076507

Name: 
Date: November 17, 2009 
Epstein. She noted that she has started locking her doors at this time. (This is in contrast to Dr. Klima's 
report, where she notes she had been locking her doors for some period of time, as this is one ofherOCD-type 
symptoms and related to her stepbrother ill) 
allininotes that Mr. Epstein's face was "pressed into [her] memory." She thought she saw him in a 
parking lot. She "freaked out" and had a period when her heart raced and she was short of breath. This 
sensation lasted for 10-20 seconds. She notes that she has had other periods of "panic attacks," which last for 
an equally long period of time and are set off by "fear," or fear of a person, but she did not identify any person 
in particular (more description of an anxiety attack than a true panic attack). She reports that she never went 
back to Mr. Epstein's house, but stated that she did drive a girlfriend near it and pointed down the road where 
it is. 
notes she is fearful that somebody may do something bad to her. She had one particular episode 
right after she talked to the FBI, where a stranger came up and asked her if she knew where to buy dnigs.6 She 
was concerned that this individual might somehow be related to Epstein, since it occurred in close proximity to 
when she had spoken to the FBI and it was a strange interaction. She notes that many of her symptoms have 
improved with time, but that they are not fully gone. Things are better and she is a little less tense. She 
believes she is still having symptoms such as worrying more than most people do. She notes that in high school 
she worried about what the other students thought of her.°
did not endorse having any paranoid symptoms. She never experienced hallucinations, received 
messages from the TV, or had concerns that others could have inserted or removed thoughts from her head. 
6 Because I thought that was kind of awkward after I just talked to the FBI agents, somebody was corning around 
asking me a question, questions like that. Seemed not like a daily thing that most people would ask me where I could 
find drugs, and I don't even know somebody, the person that would be asking me. And then he didn't even go in the 
direction that I told him to go to. He went the opposite way, and he like sped out of the parking lot. And I was, like, 
wow, I need to get in my car, lock my doors. Like, I was big at locking my doors after that happened. I, I wanted to 
make sure no one was following me. I just felt like I was being followed, and I didn't — I was, was scared that 
somebody was going to come up behind me, hie, put a bag over my head or something. And that was just another 
thing. 
7 Worrying about — it might have been when I, when I got into high school, just worrying a little bit, not worrying so 
much about how I looked. But then as time went on I started thinking about how other people started looking at me 
and how other people started thinking about the things that I am wearing, and the way that I do certain things. And 
the way that I was, I started worrying about what they thought about me. I was worried about what everybody 
thought about me. 
41 
EFTA01076547

Name: 
Date: November 17, 2009 
MI"notes she is not currently in treatment. However, she saw a psychologist named allill
one 
time in Richmond. 
PAST MEDICAL HISTORY: 
Primary Care Physician None currently. She reports she saw two different doctors in Virginia. She could not 
remember the name of the first one, but states the other physician was 
who saw her "a couple" of 
times. Both physicians worked at the Midlothian Family Practice. 
Medical Disorders AIM 
was diagnosed with a ruptured ovarian cyst and a kidney stone at age 16, 
neither of which required surgical correction. She believed she developed the kidney stone due to not drinking 
enough water. She notes that she was in a hospital for a couple of hours and had either a CT scan or an MR'. 
also reported having an inguinal hernia, which has not been surgically corrected. 
Past Surgery — 
had tubes placed in her ears, an adenoidectomy, wisdom teeth removed, and an 
abortion. Prior to having her adenoids removed when she was in middle school, she had "ear infections all the 
time." 
Allergic reaction to medications: 
reports she had an allergic reaction to Zoloft (antidepressant) at 
around age 19. She developed a facial rash after taking the medication for two weeks. She believed she was 
placed on the medication to treat both obsessive-compulsive disorder and depression. 
Transfusions - None. 
Loss of Consciousness - 
initially reported that she "possibly" had periods where she lost 
consciousness while drinking in high school. Later, she stated that she had not actually had any periods of loss 
of consciousness. She reports no traumatic brain injuries or seizures. She had a fall as a child, which required 
stitches to her scalp. 
Accidents -- Fractured pelvis and sacrum, which have not required surgical repair. 
states she has 
been doing yoga to help with her back and spine pain. 
42 
EFTA01076548

Name: 
Date: November 17, 2009 
Current Medications -No current medications. allilreports 
that she was "sick quite often" and 
frequently required antibiotics, such as amoxicillin, for strep throat. Past medications included hydrocodone 
(narcotic pain medication) following removal of her wisdom teeth. After a car accident, she received 
OxyContin (narcotic pain medication), oxycodone (narcotic pain medication), Senecot (laxative), and docusate 
(stool softener). 
REVIEW OF SYSTEMS: 
clogs] - No fever, chills, sweats or night sweats. No recent weight gain or loss. 
HEENT — She notes that her eyes become red and dry and her mouth becomes dry when she smokes 
marijuana. She notes that she had a bloody nose after the car accident She reports lymphadenopathy when ill 
with viral infections. She notes that prior to having her adenoids removed, she had "ear infections all the 
time." She notes that initially after the car accident, she had limited mobility of her neck, but "[it is] fine now." 
No headaches, nausea, vomiting, dizziness, or vertigo. No nasal polyps, obstructions, septa! deviations, or 
history ofrecurrent sinusitis. No recent loss of teeth; bleeding from the lips, gum or tongue; swelling inside the 
mouth; or pain or tenderness of the tongue. No difficulty swallowing. 
Cardioresoiratory - No history of asthma, cough or recurrent bronchitis or pneumonia. No history of elevated 
blood pressure. No cardiac irregularities. No history of myocardial infarction, angina, or cardiac or pulmonary 
disease. 
Gastrointestinal - She notes that when she is sick (with viral illnesses) she has periods of diarrhea. She gets the 
"beer shits" after she drinks too much. No dysphagia, hematemesis, melena, heartburn, history of peptic ulcer 
disease, constipation, or rectal bleeding. 
Genitourinary — She noted her menstrual periods began at age 14, when she was in the 8ih grade, and that she 
frequently has irregular and heavy periods. She was evaluated for an ovarian cyst and was told that she had 
"extra hormones." At times, she has burning on urination, often post coitus. She has had recurrent yeast 
infections. She denied vaginismus, dyspareunia or current anorgasmia. She notes past episodes of anorgastnia 
Musculoskeletal -No calor, rubor or dolor of joints. No swelling, alterations in muscle mass, weakness, pain, 
or tenderness. 
Hematorioietic - No history of hematopoietic diseases such as chronic anemia, leukemia or increased 
bruisability. No history of any allergic drug reactions producing bone marrow suppression or other 
hematological side effects. 
43 
EFTA01076549

Name: 
Date: November 17, 2009 
Neurological - No history of seizures, no motor or vocal tics. History, of alcohol-induced blackouts. 
SUMMARY OF TYPICAL DAY/SOCIAL ACTIVITIES: 
IIIIIStports that she hangs out with friends and family on a typical day. She usually awakens at around 
10:30 am. She goes to work, comes home, and watches some TV, such as Flash Forward. She reports that she 
can keep track of a TV show. She usually goes to bed "early" at "11, 12 or sometimes 1 am." 
able to clean. She makes her bed everyday and helps her parents clean their restaurant. She is 
able and enjoys shopping with her stepfather because he is able to help her pick out healthy foods. She is 
trying to learn to cook. She reports that she has learned how to make egg sandwiches. She does not see why 
she would have a problem using public transportation and believes that she would be able to figure out 
schedules and use it if she needed to. She reports no fear of leaving her house. She is able to travel and can 
"get on a plane and get off pretty well." (Of note, when seen by Dr. Kliman, she reported that she had 
problems with planes.) She reports that she pays bills on time because she does not want to ruin her credit, that 
she is able to maintain a residence, and if she needs something fixed in an apartment complex, she can call for 
maintenance. 
When asked about caring for herself, 
explain that she is no longer shaving her legs because 
"People see my hairy legs and think, oh, she's a girl, she's supposed to shave her legs. You know. I'm like, you 
know, women aren't made out to be what everybody tells them, but they are supposed to be like lady-like... I 
have a boyfriend and I don't want to feel the need to attract anybody." When asked if this was some sort of 
statement about feminism or just her own personal concern, she reports this is her own issue and that her 
boyfriend does not care if she shaves her legs or not. She is maintaining other areas of her hygiene such as 
brushing her teeth and showering. She reports she washes her hair approximately twice a week. She notes that 
in the past, when she was a "neat freak," she washed her hair daily and shaved "everything" such as arms, 
hands, fingers, and toes. 
believes she can use a telephone directory and the Internet if she needs to look something up. She 
states she has never used a post office, but she thinks she can figure out what she needs to do if she needs to 
buy stamps or mail a package. She notes that her current back pain affects her sleep. She reports that her 
44 
EFTA01076550

Name: 
Date: November 17, 2009 
sexual activity is decreasing because she is intentionally trying to be less sexual. However, she notes that when 
she is with her boyfriend, she i er
gLjjoffSmonte„
ce 
aff
i
t " 
When asked about social activities, estates 
she is not "hiding in [her] room," and she still goes 
"out." When asked how she gets along with family members, friends, and neighbors, she reports "normal." 
When asked for her to define that, she reports that she is "still learning how to talk to people without upsetting 
people." 
IIIIMInotes that she has problems with her attention and concentration, persistence, and pace and that it 
is easy for her to become sidetrackcd. 
When asked how she does reacting to stress, MINEreports she gets flustered, does not know quite what 
to say, and sometimes "freaks out" and says "I don't know what you want" when she is talking to people. She 
notes that she has a difficult time making decisions and "goes with what somebody else fsuggestsl, I ask my 
friend. you know, like, what would you do." She says that she is able to maintain attendance and show up 
when she needs to. When asked how she does with schedules, talked about how she used to have day-planners 
in high school, but now she cannot find her day-planners and that she cannot plan anything. She states that she 
has difficulty with task completion. When asked about road rage, 
noted that when she lived in 
Florida, if someone was driving slow, she would get angry and frequently honk and swerve around the other 
driver. 
reports no problems with supervisors. Interaction with peers are reported as "okay." However, she 
stated, "I worked in restaurants most of my life and there is always just drama with girls, because most of the 
servers that I worked with were girls. It was always about their friends and relationships, and I was a gossip. I 
was a gossip girl with my girlfriends and we would talk. And, you know, some people didn't like us talking 
about them." 
When asked about her attitude toward the future, 
states she would like to have a family and sees 
herself going to school in order to get a "good [job]." 
45 
EFTA01076551

Name: 
Date: November 17, 2009 
ADDITIONAL COMMENTS 
When given the opportunity to provide additional informationkcatunents,Mat discussed how the 
manager at Glory Days Restaurant did not like her. She states this was because she did not share her personal 
life with him and that he ended up firing her "because [she] made [him] feel uncomfortable in [his] own 
restaurant. She reports this occurred when she was around 18-19 years old. 
PSYCHOLOGICAL TESTING/SCALES: 
Psychological testing constitutes but one facet of a comprehensive psychiatric evaluation. Psychological 
testing can provide useful data and offer potential diagnostic possibilities, but psychological testing should not 
be viewed in isolation. There needs to be clinical correlation to see what is applicable and what is not. 
MCM/-/H: 
The test shows the examinee to be a 21-year-old single white female with 13 years of education, who is 
experiencing problems involving her sex life and moodiness. 
Profile Severity: The test suggests that the client is experiencing a moderately severe mental disorder. 
Possible Diagnoses: Axis 11: Dependent Personality Disorder, with Depressive Personality Traits, Borderline 
Personality Features, and Histrionic Personality Features. Axis 1 clinical syndromes suggested include: 
Generalized Anxiety Disorder, Bipolar Disorder (manic, severe, without psychotic features), and Psychoactive 
Substance Abuse, NOS, 
Therapeutic Considerations: The test suggests that she is amiable and dependent, yet anxious and depressed, 
and inclined to lean on others for support Under stress, she may claim that even the simplest of 
responsibilities are too demanding. 
Profile scores above the 75t° percentile include Depressive (97), Histrionic (75), and Dependent (109) in 
Clinical Personality Patterns; Borderline (79) under Severe Personality Pathology; and Anxiety (87), Bipolar: 
Manic (85), Alcohol Dependence (75), Drug Dependence (79), and Post-traumatic Stress (77) under Clinical 
Syndromes. Dependent scales show Interpersonally Submissive at 93 and Immature Representations at 92. 
46 
EFTA01076552

Name: 
Date: November 17, 2009 
The Depressive scale shows Cognitively Fatalistic at 83. Borderline shows Temperamentally Labile at 92 and 
Uncertain Self-Image at 79. 
Axis II Personality Patterns: A moderate level of pathology characterizes the overall personality organization of 
this woman. Defective psychic structures suggest a failure to develop adequate internal cohesion and a less 
than satisfactory hierarc y of coping strategies. There is ineffective intrapsychic regulation and socially 
acceptable interpersonal conduct appears deficient or incompetent She is subject to the flux of her own 
attitudes and contradictory behavior and her sense of psychic coherence is often precarious. She is likely to 
have a history of disappointments in her personal and family relationships and deficits in social attainments, as 
well as a tendency to precioitate self-defeating vicious circles. She is usual y able to function on a satisfactory 
basis, but may experience periods of marked emotional, cognitive, or behavioral dysfunction. 
The profile suggests that she is sad at
kagnimt, docile, self-effacing. and  ineffectual. She appears 
both dejected and tense. She feels helpless to overcome her fate, prefers a passively dependent role in 
relationships, and seeks to evoke nurturant and protective attitudes from others. She may be unable to function 
autonomously and is especially vulnerable to separation anxieties and fears of desertion. There are well-hidden 
resentments toward those on whom she must depend because they arc often critical and disapproving of her. 
Venting resentment would endanger her security and the support she desperately nods. She does not trust 
others and does not believe she will get the nurturance and protection she needs. As a result, she is 
apprehensive, withdrawn from personal involvements, overly self-critical, and punishes herself for what she 
sees as her inadequacies and failures, perhaps through self-damaging acts and suicidal gestures. There is a wall 
of indifference around her to deaden her excessive sensitivity. There are deep feelings of loneliness and 
isolation and a disturbing mixture of anxiety, sadness, anger, and guilt 
Fears of abandonment may underlie her efforts to place herself in an obviously bad light and account for her 
Pollyanna-ish attitude toward mild rebuff and deprecation. Except for an occasional impulsive, angry outburst, 
she tries to be conciliatory, placating, ingratiating, and self-sacrificing. She tries to submerge all traces of 
independence and self-assertion, subordinates her personal desires, and submits at times to abuse and 
intimidation to avoid abandonment. She has a desire to submit and comply, through which she hopes to elicit 
nurturance and protection. 
47 
EFTA01076553

Name: 
Date: November 17, 2009 
At times of withdrawal and self-deprecation, she is not likely to depend on whatever realistic capacities she 
possesses; instead, depending on physical weakness and fatigability. At these times, simple responsibilities 
call for more energy than she can muster and she experiences life as empty but draining, with a persistent 
feeling of weariness and worthlessness. 
Grossman Personality Facet Scales: Most notable is her inclination to subordinate her own wishes to a stronger 
and (she hopes) nurturing person, resulting in the habit of being conciliatory, deferential, and self-sacrificing. 
She feels it is best to abdicate responsibility, leave matters to others, and place her fate in others' hands. She 
sees other people as being better equipped to shoulder responsibility, navigate the intricacies of a complex 
world, and discover and achieve the pleasures to be found in the competitions of life. 
Also salient is her pattern of rapidly changing moods that shift erratically from normality to depression to 
excitement, with chronic feelings of dejection and apathy interspersed with brief spells of anger, euphoria, and 
anxiety. The intensity of her affect and the changeability of her actions are striking. She generally fails to 
accord her unstable mood levels with external reality. She may exhibit a single, dominant outlook or 
temperament, such as a self-ingratiating depressive tone, which periodically gives way to anxious agitation or 
impulsive outbursts of anger or resentment. She may engage in self-destructive behavior, but she usually 
realizes later that her behavior was irrational and foolish. 
Also worthy of attention is the presence of unsophisticated ideas and rudimentary memories, simple if not 
childlike impulses and expectations, and immature competencies. She has probably learned through parental 
models how to behave affectionately and admiringly. She has learned the "inferior" role well and is able to 
provide a "superior" partner with the feeling of being useful, sympathetic, and competent. 
Axis I Clinical Syndromes: She experiences a state of disquietude and social discomfort and symptoms are 
indicative of an anxiety disorder. She has a growing apprehensiveness over trivial matters, an increase in a 
variety of psychosomatic signs (e.g., exhaustion, insomnia, gastrointestinal pains), and psychological symptoms 
(e.g., restlessness, diffuse fears, catastrophic anticipations, and distractibility). She is especially sensitive to 
social humiliation yet lacks sufficient self-worth to act with equanimity. She may express her disappointments 
and resentments inadvertently and now fears or is experiencing distressful repercussions. (NB. Often are drug 
related.) 
48 
EFTA01076554

Name: MINEll 
Date: November 17, 2009 
The test suggests that she may be undergoing a mild to moderately severe manic episode with internal pressure 
of a troubling affective nature welling up within her. She has recently been unable to cope with upsetting 
thoughts and feelings in her characteristic way. Hypomanic symptoms and behavior are being exhibited in 
extreme form (e.g., expansive mood, restless activity, talkativeness, decreased sleep), which is a marked, if 
temporary, reversal of her habitual style. (NB. Often are drug related.) 
The test suggests that she either has abused or is currently abusing legal medications or street drugs to the point 
oliAgerjencjabotkeggenalimamilyzeklems. These substances are primarily employed to moderate her 
psychic pain, helping her overcome her interpersonal fears and anxieties and to provide a respite from her 
travails. They also facilitate fantasies that replace the loneliness and anguish that characterize her daily life. 
She appears to have been confronted with an event or events in which she was exposed to a severe threat to her 
life that precipitated intense fear or horror on her part. She may be persistently reexperiencing residuals with 
recurrent and distressing recollections, which she attempts to avoid. Where they cannot be anticipated or 
actively avoided, as in dreams or nightmares, she may become terrified and exhibit a number of symptoms of 
intense anxiety. Other symptoms that she experiences that may be associated with this or other conditions 
include difficulty falling asleep, outbursts of anger, panic attacks, hypervigilance, exaggerated startle response, 
or a subjective sense of numbing and detachment. 
The test further suggests that she is subject to alcoholic indulgences. Feeling anxious, lonely, and mistreated, 
she is likely to turn to alcohol to facilitate psychological needs that are difficult for her to achieve otherwise. 
Alcohol may moderate her social anxieties and fears, enhance her self-confidence, and enable her to relate 
easily to others. It also serves, briefly, to bolster her depleted feelings of self-esteem and well-being. She is 
likely to recognize the detrimental consequences of her drinking; however, alcohol has become an effective 
antidote to her omnipresent psychic pain. 
Axis I Clinical Syndromes suggested in the order of clinical significance and salience: 300.02 Generalized 
Anxiety Disorder, 296.43 Bipolar Disorder (manic, severe, without psychotic features), and 305.90 
Psychoactive Substance Abuse, NOS. Axis II Personality Disorders representing deeply ingrained and 
pervasive patterns of maladaptive functioning reflecting long-term or chronic traits that arc likely to have 
49 
EFTA01076555

Name: 
Date: November 17, 2009 
persisted for several years prior to the present assessment include: 301.60 Dependent Personality Disorder 
with Depressive Personality Traits, Borderline Personals y Features, and Histrionic Personality Features. Axis 
IV Psychosocial and Environmental Problems: Sex life: Moodiness. 
The treatment guide suggests short-term treatment techniques are the most appropriate, with the first step being 
the implementing of psychopharmacological and therapeutic methodsto ameliorate her current state of clinical 
anxiety, depressive hopelessness, or pathological personality functioning. Psychopharmacological treatment 
should be considered a short-term technique to promote alertness and vigor and counter fatigue, lethargy, 
dejection, and anxiety. Therapy should be directed toward enhancing environmental changes and minimizing 
dependency. A cognitive behavioral therapy aoproach is recommended. Qarefid attention to her substance 
abuse is indicated. 
Rescored MMPI-2 of Dr. KlIman: 
The test was taken on 12/04/08 when she was 20. It showed the profile to be valid. The test suggested that 
individuals with this profile tend to be blunt and may openly complain to others about their psychological 
problems. The client was quite self-critical and may appear to have low self-esteem and inadequate 
psychological defense mechanisms. She may be presenting a picture of one who feels that things arc out of 
control and unmanageable. The scales that predominated were Paranoia and Psychasthenia. 
She reported experiencing many psychological problems at the time of the test. She appears to ruminate a 
great deal and may manifest obsessional and compulsive behavior. She holds beliefs that others are not likely 
to accept and tends to obsess about them to the point of alienating others. She appears to be quite intense, 
anxious and distracted. Individuals with this profile may be overreacting to environmental situations with 
intense anxiety, suspicion, and concern. She feels insecure and inadequate when dealing with her problems. 
She may feel very angry with herself and others. She may feel very guilty about her fantasies or beliefs. She is 
often rather rigid and may have problems controlling and directly expressing her anger. 
The test suggests she is experiencing low morale and a depressed mood. Thought processes are characterized 
by obsessiveness and indecision and she reflects a high degree of anger. She has a high potential for explosive 
behavior at times. She feels somewhat self-alienated and expresses some personal misgivings or a vague sense 
of remorse about past acts. She feels that life is unrewarding and dull and may find it hard to settle down. She 
50 
EFTA01076556

Name: MEI 
Date: November 17, 2009 
views the world as a threatening place, sees herself as being unjustly blamed for others' problems, and feels 
that she is getting a raw deal from life. She is rather high strung and believes that she feels things more intently 
than others do. She feels quite lonely and misunderstood at times. 
She endorsed a number of extreme and bizarre thoughts, suggesting the presence of delusions and/or 
hallucinations. She apparently believes that she has special mystical powers or a special mission in life that 
others do not understand or accept. The possibility that she could act out in an aggressive manner on her 
delusional ideas should be further evaluated. The client's response content suggests that she feels intently 
fearful about many objects and activities. This hypersensitivity and fearfulness appears to be generalized at 
this point and may be debilitating in social and work situations. She endorsed statements that indicate some 
inability to control her anger. She may physically or verbally attack others when she is angry. 
Her MMPI-2 two-point profile 6-7/74 is very rare in samples of normals, occurring in less than 1% of the 
MMPI-2 normative sample of women. The high-point paranoia score occurs in 6.9% of the Pearson 
Assessment medical sample, with only 2.9% having well-defined paranoid peak in the high range that hers 
occurred. This elevated two-point profile, 6-7O-6, occurs in less than 1% of women in the Pearson medical 
sample and only 2% of women with chronic pain high-peak scores on the paranoia scale occur with moderate 
frequency, 13.4%, among individuals involved in personal injury litigation, with 6.4% having well-defined 
scores at a T-score of 65 or above. 
Profile stability suggests that her profile is not well defined. Changes in profile might show increased 
emotional alienation, unusual thinking, bizarre perceptions, or a strong tendency to engage in extreme fantasy. 
Interpersonal relations: People with this profile tend to experience interpersonal distress. The test suggests she 
is somewhat shy and may have excessively high moral standards by which she judges others. There is an 
inflexibility in interpersonal situations that is likely to put a great strain on close relationships because she 
seems to test other people to reassure herself. She appears rather touchy or hostile interpersonally and may 
brood over what she imagines others have done. She tends to feel insecure in interpersonal relationships, is 
hypersensitive to rejection, and may become jealous at times. She tends to need a great deal of reassurance. 
She approaches relationships with some caution and skepticism. She feels intensely amity. hostile, and 
resentful of others. and she would like to get back at them. She is competitive and uncooperative and tends to 
51 
EFTA01076557

Name: 
Date: November 17, 2009 
be very critical of others. 
Mental health considerations: The test suggests that excessive anxiety and obsessional behavior should be 
considered. It suggests the possibility of a paranoid disorder or paranoid personality. Unusual thought 
processes and bizarre ideas should be taken into consideration. The test notes that there are a number of 
personality characteristics associated with substance abuse or substance use problems and her scores on 
addiction proneness indicators suggest the possibility of an addictive disorder. The test suggests farther 
evaluation for substance use or abuse disorder and notes that she acknowledged problems with excessive use or 
abuse of addictive substances. The test suggests that psychological treatment should focus on her anxiety and 
self-doubts and provide relief for intense tension. Therapists should keep in mind the presence of suspicious 
and paranoid ideas when dealing with her. She may have trouble forming a therapeutic relationship. She is 
quite rigid and intellectualizes a great deal; therapeutic progress is likely to be slow. 
People with this profile tend to have unrealistic expectations of themselves and perfectionistic ideals that may 
require some challenge if their personal vulnerability is to be diminished. The test suggests she has low 
potential for change, may feel that her problems are not addressable through therapy, and that she is not likely 
to benefit from psychological treatment at this time. Her negative treatment attitude should be explored early 
in therapy. In addition, responses suggest family conflicts are causing her considerable concern. She feels 
unhappy about her life and resents having an unpleasant home life. The test shows negative work attitudes, 
which could become an important problem for her to overcome in that she has a number of attitudes and 
feelings that could interfere with work adjustment. In addition, her acknowledged problems with alcohol and 
drug use need to be addressed in therapy. 
Personal injury considerations: The test notes that she presented a large number of unusual symptoms and 
responded in a very open manner. These types of reports are relatively common in personal injury litigation in 
which the litigant is claiming a broad range of mental health problems. Her approach suggests a tendency to 
exaggerate symptoms a situation that the assessor should consider. The test suggests her psychological 
adjustment is poor and that her interpersonal relationships are likely to be strained. They note that individuals 
involved in personal injury litigation have heightened states of interpersonal sensitivity and anger toward 
others, which may be reflected as a moderate elevation in the paranoia scale. They felt, however, that her 
scores are too extreme to be accounted for by a transitory state of anger. Individuals like her, who score in the 
52 
EFTA01076558

Name: 
Date: November 17, 2009 
extremely high range on the paranoia scale, usually have frankly bizarre behavior, disturbed thinking, delusions 
of persecution or grandeur, or ideas of reference. 
The test suggests that she appears not to be thinking rationally and tends to feel mistreated and picked on by 
others. She is apparently very angry and resentful and may harbor grudges against other people. Her extreme 
mistrust and suspicious probably result from her tendency to use projection as a defense. Her extreme paranoid 
thinking could result in her viewing others as working against her. She may not be open to changing her 
thinking in response to others. The possibility that she is extremely litigious in her dealings with others should 
be considered. 
In addition, she acknowledges numerous family problems, anxiety, depression, fear, obsessive thinking, 
concerns about health, and unusual thoughts. She has low self-esteem and an ineffective manner of 
approaching new tasks. There is a basic insecurity and lack of self-confidence, which may make it difficult for 
her to implement change-oriented plans. Anger control problems are likely to interfere with interpersonal 
relationships and her substance abuse problems require ongoing evaluation. 
Restored SCL-90-R (Symptom Checklist-90-Revised) of Dr. 'Inman: 
The SCL-90-R, taken on 12/04/08 at age 20, notes that the test results should be considered in the clinical 
range and suggests that a more intensive evaluation of mental status is called for. The test shows distress of an 
extremely high level and that she endorsed a large number of clinical symptoms in multiple primary areas and 
dimensions. The test notes that with the extremely large number of syndrome elevated, such as in this case, it 
is very difficult to interpret score patterns unless one or more dimension scores are unusually high. 
She endorsed being "extremely" distressed by the following: nervousness or shakiness inside, feeling critical 
of others, the idea that someone else can control her thoughts, worried about sloppiness or carelessness, feeling 
easily annoyed or irritated, feeling afraid in open spaces or on the street, feeling that most people cannot be 
trusted, crying easily, feelings of being trapped or caught, temper outbursts that she could not control, feeling 
afraid to go out of her house alone, blaming herself for things, worrying too much about things, and feeling 
fearful. In addition, endorsed "extremely" for feeling easily hurt; other people being aware of her private 
thoughts; feeling others do not understand her or are unsympathetic; having to do things slowly to ensure 
correctness; feeling inferior to others; feeling that she is watched or talked about by others; feeling afraid to 
53 
EFTA01076559

Name: 
Date: November 17, 2009 
travel on buses, subways or trains; feeling uneasy when people arc watching or talking about her, having 
thoughts that are not her own; feeling nervous when she is left alone; others not giving her proper credit for her 
achievements; feeling that something bad is going to happen to her; feeling that people will take advantage of 
her, and the idea that something is wrong with her mind. 
Mini Mental State Examination: 
On orientation, she got the year and date correct. For location, she knew she was in West Palm Beach in 
Florida and that she was in a conference center. However, she didn't know the name of the building, streets 
nearby, or the floor that she was on. She was able to register three common words. She was able to spell the 
word "world" forward and backward. She had difficulty engaging in the math task of subtracting seven from 
100 serially because her mind went "blank." She could recall three items. She could identify a pen and a pair 
of glasses. She was able to repeat the phrase "no ifs, ands, or buts." She was able to follow a three-step 
command of folding a piece of paper in half and setting it on the floor on her left side. She was able to read 
and obey "close your eyes." She was able to write a sentence, which was "my favorite color is blue." She 
could copy a design. Her total score was 28/30. 
MENTAL STATUS EXAMINATION: 
appeared her stated age. Affect was slightly restricted. She was able to smile. Sometimes she did 
have periods of tearfulness, which occurred while discussing the Epstein event, as well as discussing the death 
of her friend 
. She notes that she has three tattoos — 
. She notes she got her first tattoo at age 18. 
She had good hygiene. She maintained good eye contact. She was of slim build. She appeared well 
developed, well nourished, and had a normal body habitus without deformity. She was well groomed. She had 
no noticeable mannerisms or tics. She did not appear to have any nervous tendencies or mannerisms, which 
was different from her videotaped interview with Dr. Kliman, where she was continually cracking her 
knuckles. 
notes that her mood during the evaluation was 3 on a 1 — I 0 scale, with 5 being normal, one being 
the worst and 10 being the best. She notes that for the past month her average mood was approximately 5 or 
normal. She rates her anxiety during the course of the interview at 8 on a 1-10 scale, with 1 being no anxiety 
54 
EFTA01076560

Name: 
Date: November 17, 2009 
and 10 being the highest level. Over the last month, she has averaged about a 5 for anxiety (normal levels). 
She believes an average person would have an anxiety level of 3. 
There was no autism, ambivalence, loosening of associations, thought control, insertion or broadcasting. 
Associations were intact. There were no abnormal or psychotic thoughts, specifically no hallucinations, 
delusions or preoccupation with violence. Language functions were intact. Gait and station were normal. She 
sat and rose from a chair without difficulty. Muscle strength and tone appeared intact. 
Her thought process was concrete and goal oriented. She had no word-finding difficulties and she did not 
demonstrate any formal thought disorder. She reports no suicidal or homicidal ideation, plan or intent. She 
demonstrated periods of concrete thinking. She had good attention, doing five numbers forward and backward. 
She could spell the word "world" forward and backward. She had difficulty doing the serial 7 subtraction task, 
getting only two items right. She had mixed performance with similarities, stating that an apple and a pear 
were both fruit, but was not able to describe how a boat and a bike are similar. When asked about a mouse and 
a tree, she initially said, "I don't know" and then stated that a mouse has big upper ears and a tree has large, 
billowy branches. When asked to interpret proverbs, she reported that people in glass houses shouldn't throw 
stones because it will break the windows. With "don't cry over spilled milk," she reported "don't get upset 
over something that has already happened." She had difficulty remembering past presidents and only 
remembered Obama, Bush, and Clinton. She was able to identify that the United States is actively at war in 
Iraq and Afghanistan. She notes that we should refrigerate food to stop bacteria from growing. 
Her mood and affect were congruent without apparent depression, anxiety, agitation, hypomania or lability, 
other than the two episodes of tearfulness noted above. Her insight was fair. Judgment was fair. Impulse 
control was fair. Intelligence was low average to average. 
DIAGNOSTIC IMPRESSION: 
305.90 Psychoactive substance abuse, NOS. (Percocet, age 19; Adderall, age 20; nitrous oxide 
whippets, age 20; Xanax, act 19; alcohol, age 17; marijuana, age 17; cocaine, age 21; 
LSD, age 19; hallucinogenic mushrooms, age 21) 
296.90 Mood Disorder, NOS. Rule out Substance-Induced vs. Bipolar Disorder. 
55 
EFTA01076561

Name: Min 
Date: November 17, 2009 
305.0 Alcohol Abuse with frequent symptoms of severe alcohol intoxication, vomiting, and 
blackouts. 
300.3 Obsessive-Compulsive Disorder, by history, accompanied by significant anxiety, age IS. 
Rule out PANDA Syndrome. 
311 
Chronic Depression, by history, diagnosed age 18, Dr. Agresti. 
MULTIAXIAL EVALUATION REPORT 
AXIS 1. 
Clinical Disorders: 305.90 Psychoactive substance abuse, NOS. (Pacocet, age 19; 
Adderall, age 20; nitrous oxide whippets, age 20; Xanax, act 19; alcohol, age 17; 
marijuana, age 17; cocaine, age 21; LSD, age 19; hallucinogenic mushrooms, age 21); 
296.90 Mood Disorder, NOS. Rule out Substance-Induced vs. Bipolar Disorder; 305.00 
Alcohol Abuse with frequent symptoms of severe alcohol intoxication, vomiting, and 
blackouts. 300.3 Obsessive-Compulsive Disorder, by history, accompanied by significant 
anxiety, age 18. Rule out PANDA Syndrome. 311 Chronic Depression, by history, 
diagnosed age 18, Dr. Agresti. 
AXIS II: 
Personality Disorders: 301.60 Dependent Personality Disorder, with Depressive 
Personality Traits, Borderline Personality Features, and Histrionic Personality Features, 
per the MCMI-111. 
AXIS Ill• 
General Medical Conditions: Rule out PANDA Syndrome, history of recurrent ear 
infections as a child with bilateral myTingotom ies and adenoidectomy. 
AMIN: 
Psychosocial and Environmental Problems: Moderate 
_X_ 
Problems with primary support group: Parents divorced, problems with merged families 
after mother remarried. 
Problems related to the social environment: FIypersexual, problems with substance 
abuse and intoxication. 
Educational problems: 
Occupational problems: 
Housing problems: 
56 
EFTA01076562

Name: 
Date: November 17, 2009 
X 
Economic problems: 
Problems with access to health care services: 
Problems related to interaction with the legal system/crime: Currently involved in 
lawsuit. 
Other psychosocial and environmental problems: 
AXIS V: Global Assessment of Functioning Scale 
Score: 
75 
If symptoms are present, they are transient and expectable reactions to psychosocial stressors; no more than 
slight impairment in social, occupational, or school functioning. 
DISCUSSION: 
The amended complaint filed by Miss MEM 
(lane Doe 2) against Mr. Jeffrey Epstein makes 
sensitive allegations of sexual assault and abuse on a minor and seeks damages in excess of $50-million. It 
alleges that 
was recruited to give Mr. Epstein a massage for monetary compensation and was 
brought to his mansion in Palm Beach for that purpose. Once in the home, she was introduced to 
his assistant, who led her up a flight of stairs to the room with a massage table. In this room, Mr. Epstein told 
NMI to take off her clothes and give him a massage. She kept her panties and brassiere on and 
complied with his instructions. He wore only a towel around his waist After a short period of time, he 
removed the towel and rolled over to expose his penis. He then began to masturbate and he sexually assaulted 
IMINI 
After he had completed the assault, 
was able to get dressed, leave the room, and go 
back downstairs. She was paid $200 by Epstein. The girl who recruited her was paid $100 by Epstein. 
The complaint alleges that as a result of this encounter she experienced confusion, shame, humiliation, and 
embarrassment and has suffered severe psychological and emotional injuries. The complaint further alleges 
that because of Epstein's intentional offensive sexual conduct, he created an unreasonable fear of imminent 
peril. As a result, she has suffered and will continue to suffer severe and permanent traumatic injuries, 
including mental, psychological, and emotional damages. In Count II, the intentional infliction of emotional 
distress, 
alleges that Mr. Epstein's behavior caused her mental or emotional health to be 
significantly impaired and that he caused severe emotional distress to her. As a result of his behavior, she 
alleges that she will continue to suffer "severe mental anguish and pain." 
57 
EFTA01076563

Name: MM. 
Date: November 17, 2009 
In Count III, coercion and enticement to sexual activity, IMIllt 
contends that Mr. Epstein knowingly 
attempted to persuade, induce or entice her, when she was under the age of 18, to engage in prostitution or 
sexual activity for which any person can be charged with a criminal offense. As a result of this, she alleges she 
has suffered personal injury, including mental, psychological and emotional damage. 
When evaluating an examinee for these types of complaints, it is essential to look at their medical, social, 
academic, psychological, and psychiatric condition and state prior to any alleged act of victimization and to 
see, as well, if there are specific changes that occur that had not been present prior to the time of the alleged 
incident. 
Psychiatric literature shows that there are a number of variables that combine to determine the effects of such 
alleged victimization. The type and character of the alleged assault and key victim variables such as 
demographics, psychological reactions at the time of the alleged trauma, previous psychiatric and psychological 
history, previous victimization history, current or previous psychological difficulties, and general personality 
dynamics and coping style are important. Sociocultural factors are also important and include such things are 
drug use/abuse; poverty; social inequity and/or inadequate social support; previous history of abuse within or 
outside the family; whether individuals were abused by strangers, acquaintances or family members; and 
whether there was any history of indiscriminate behavior that may have placed them at increased risk. 
It is also important to know whether there has been any history of previous sexual conduct, contact with police 
or welfare agencies, alcohol or drug use or abuse, voluntary sexual activity, contraceptive use, genital 
infections, or apparent indifference to previous abuse. 
One must also understand family interactions and the level of emotional support available to the plaintiff and 
whether any significant psychiatric illnesses were present in family members or others with whom they lived 
and resided. One must know if they were taking medications, prescribed or nonprescribed, and if there had 
been any previous or subsequent suicide attempts, thoughts, plans; hospitalizations (voluntary or involuntary); 
or interactions with the legal system. 
58 
EFTA01076564

Name: Min 
Date: November 17, 2009 
Key to understanding the long-term impact of these types of allegations is to understand those factors, which 
determine personality, life expectations, and future performance. These factors include socioeconomic status, 
social disadvantage, intrauterine exposure to toxic substances such as alcohol or cocaine, family instability, 
impaired child/parent relationships, and parental adjustment difficulties that cause stress or strife within the 
family. 
ANALYSIS OF VARIABLES AFFECTING
1. Type and character of assault. MIMS 
reports that she was either 16 or 17 and in the I l a grade 
when she had her one and only contact with Mr. Jeffrey Epstein. (Complaint states approximately age 
16.) She reports that her friend 
asked her before Christmas if she wanted to make some 
additional money and that she could do so by giving an older man a massage. She was instructed not 
to tell anyone about this bat 
and if she did, "I will beat your ass." She was advised she would 
be paid $200 for her services. After being invited, she reports that a couple of weeks passed before 
she agreed to go. She was told prior to seeing Mr. Epstein that she would be asked to take off 
clothing. She felt that was okay because it would be "like being in a bathing suit." She reports that 
she didn't think that he would touch her. She notes that her friend 
told her to lie about her 
age and to report that she was over 18. She notes that she was worried that she might be stranded at 
Mr. Epstein's residence. She did not think that anything "bad" was going to happen to her by going 
there. 
When she arrived at Mr. Epstein's home, she provided her name and phone number to a tall, blond, 
nice-looking assistant of Mr. Epstein. She was taken upstairs to the massage room. Shortly thereafter, 
Mr. Epstein entered the room draped in a towel and advised her to take off her clothes. 
reports that she complied, but was uncomfortable because she was shy. (She notes, however, that she 
was told by her friend 
before going to the home that she would be asked to take off her 
clothes.) 
She began the massage by rubbing Mr. Epstein's feet, legs, back, and shoulders and then the area 
around his buttocks. He was talking on the telephone. When he got off the phone, he began asking 
her personal questions about her relationship with boys and complimenting her on her appearance. 
She notes that he then rolled from his stomach to his back, began masturbating, and put his hand "flat" 
59 
EFTA01076565

Name: 
Date: November 17, 2009 
on her crotch area on the outside of her underwear. She notes that this "terrified" her. She reports that 
she didn't think of leaving because she felt he might kidnap her or shoot her with a gun. She reports 
that he was never threatening, there were no weapons, he never raised his voice, nor did he make any 
threatening gestures. She reports that she did not see his penis, as she looked only at his eyes. She 
notes that after he ejaculated, he went into the steam shower. At that time, he told her to take the $200 
and to give the other $100 that was on a counter to her friends. 
She went downstairs. She and 
left. In the car, she told 
that he tried to "finger" her. NM 
said that he had tried 
to do that to one of her other friends last week. MIS 
reports that she was upset, put on her 
sunglasses, and "cried my way home." She used the $200 to buy Christmas gifts. 
She told her friendilliallt 
what had occurred. The friend suggested that she call the police. 
She reports she didn't because she didn't want anyone to find out or to have anyone coming after her. 
She reports, "I kept my mouth shut" until the FBI came to her. She notes that she knew four of the 
girls who had gone to Mr. Epstein's home AMMIll,a1 
ands. 
She notes that she 
told her current boyfriend,a, about the episode and told her mother about it after the FBI came to 
interrogate her. She reports that the consequences of having seen Mr. Epstein were that she began 
having "a lot of sex" and that her friends and family thought that she was a "slut/whore." 
She categorically denied that she had any problems prior to meeting Mr. Epstein, other than perhaps 
ADD, which was never officially diagnosed. She states that she had never had any periods of 
depression prior to meeting Epstein and that, after she met Epstein, she had a "sexual extravaganza." 
In a police report of 12/13/05, she reported that Mr. Epstein told her to rub his nipples, that he tried to 
rub her breasts after snapping off her brassiere, and that he grabbed her thighs while he was 
masturbating. She notes that he didn't take off her panties, but he pushed them to the side, felt her in 
the vaginal area, and talked dirty. 
reports that she backed away and told him "well, I 
don't know if 1 should do that" She reports that she "got really hesitant" and so scared that she didn't 
know what to do. She reports that he actually stuck a finger into her vagina at that time and that she 
backed away. He then rubbed her on the outside of her genital area while masturbating, then wrapped 
in a towel, and told her to take the money and leave. She reports that she saw him only one time. She 
notes that her friend 
split the money for bringing another girl with a mutual friend, 
60 
EFTA01076566