P O LY T E C H N I C U N I V E R S I T Y O F T H E P H I L I P P I N E S

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Seminar in Abnormal
Psychology
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Critical Analysis: Nim's Island

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Submitted by
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Nuez, Edsel L
MP - IP

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August 2016

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MENTAL STATUS EXAMINATION
The character, Alexandra "Alex" Rover is from San Francisco New York,
around thirty (30) to forty (40) years old and single. Physically, she has an average
body type and exercise regularly. She stands around 5'4" to 5'6".
Culturally, the movie wasn't able to discuss the cultural background of
Alexandra but can be said that her current location depicts that she shares cultural
domain of Western culture.
Though the movie wasn't able to capture the educational background of
Alexandra, her field of work, a well-known writer, suggests her high educational
attainment.
Cognitively, Alexandra demonstrates high verbal comprehension basing this
assumption from being a prominent writer. Though absence of actual measurement
of verbal comprehension, the movie depicts her high verbal comprehension.
The movie however, failed to present her family roots as well as her religious
background. Thus, further checking is necessary which will be helpful in using the
psychosexual approach.
Behaviorally, when facing pressure, she demonstrates lip biting, nail biting,
shaking of hands (though there is a need to check medical condition to identify if
there is medical history for tremors) and stuttering. She also presents extreme
concern over sanitation (over the phone, she ordered all the available sanitizers).
Alexandra sees the world as unsanitary and hostile. She also presents extreme
obsession in symmetry as she aligns her stuff like pens position and right angle of
her keyboard before she can work. When in panic, her eyeballs dilate and she
consistently makes faces. Heavily breathing can also be observed during such
situation.
Socially, Alexandra doesn't leave her home for the last 16 months. She avoids
personal contact; when the delivery man delivered the sanitizers she ordered over
the phone, she refuses to receive it personally and requested the delivery man to

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leave it on her doorsteps. Right after the man leaves, she slightly opened the door to
pick up the goods. There was a time as well when a messenger delivered her mails
and she requested to put it near the door instead of the putting it on the mailbox.
Unfortunately, the mail man cannot hear her. She attempted to get the mails but she
was too afraid to open the door and walk few steps outside her house. She ended up
not getting the mails, reasoning out that it is not important after all.
Diagnoses
A. Obsessive Compulsive Disorder (OCD)
Evidently, Alexandra presented symptoms of OCD. She is obsess in ensuring
that things are in place triggering compulsions to secure her things are in place
before she can work. Pens must be positioned upward and must be beside each
other. The keyboard must be on the right angle before she can starts typing.
According to DSM V, obsessions are recurrent and persistent thoughts, urges, or
images that are experienced as intrusive and unwanted, whereas compulsions are
repetitive behaviors or mental acts that an individual feels driven to perform in
response to an obsession or according to rules that must be applied rigidly. Definition
applies to Alexandra's case.
Based on the diagnostic criteria of DSM V for this disorder, presence of
obsessions, compulsion or both are basis for this diagnosis. In obsessions, (2) the
individual attempts to ignore or suppress such thoughts, urges, or images, or to
neutralize them with some other thought or action (i.e., by performing a compulsion).
Compulsions are (1) repetitive behaviors (e.g., hand washing, ordering, checking) or
mental acts (e.g., praying, counting, repeating words silently) that the individual feels
driven to perform in response to an obsession or according to rules that must be
applied rigidly. Her OCD was triggered by the presence of a spider. As a result, after
getting rid of the spider, she kept on putting sanitizer, she fixed the misplaced pens
and keyboard and repetitively saying that it is just a spider. However, due to absence
of further questioning, it cannot be specified whether the OCD is with good or fair

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insight, with poor insight or with absent insight/delusional beliefs. Thus, needs further
clarification.
As an additional features to support the diagnosis, DSM V indicates that
common current themes or dimensions for OCD includes those of cleaning
(contamination obsessions and cleaning compulsions); symmetry (symmetry
obsessions and repeating ordering and counting compulsions), forbidden or taboo
thoughts (e.g., aggressive, sexual, or religious obsessions and related compulsions);
and harm (e.g., fears of harm to oneself or others and checking compulsions).
Alexandra

met

the

qualifications

for

the

theme

of

her

obsessions

(contamination/cleanliness) and compulsions (symmetry obsessions).

B. Specific Phobia
Initial Diagnosis:
300.29 (F40.218) Animal (spiders)
300.29 (F40.228) Natural environment (e.g., heights, storms, water)
300.2 (F40.248) Situational (e.g., airplanes, elevators, enclosed places)
Narrative:
Contrary to the fictional character she is well known of, Alex Rover, an
adventurist, Alexandra has fear of spiders. She is also afraid of riding in an airplane
and of heights.
Using DSM V, Alexandra met Criterion A - marked fear or anxiety about a
specific object or situation

(e.g., flying, heights, animals, receiving an injection,

seeing blood). Additionally, Criterion B surface as well as the phobic object or

situation almost always provokes immediate fear or anxiety.
However, Criterion G indicates that the disturbance is not better explained by
the symptoms of another mental disorder, including fear, anxiety, and avoidance of
situations associated with panic-like symptoms or other incapacitating symptoms (as
in agoraphobia): objects or situations related to obsessions (as in obsessive-

P O LY T E C H N I C U N I V E R S I T Y O F T H E P H I L I P P I N E S
compulsive disorder); reminders of traumatic events (as in posttraumatic stress
disorder); separation from home or attachment figures (as in separation anxiety
disorder); or social situations (as in social anxiety disorder).
Alexandra's fear of airplane, heights, water and storm can be ruled out with
this criterion since the anxiety was triggered by Alexandra's fear of going outside her
house. But nevertheless, the fear of spiders 300.29 (F40.218) cannot be ruled out
since the fear was stimulated outside of the defined conditions above.
C. On Agoraphobia
Searching for movies that portrays agoraphobia, Nim's Island is one of the
movies that will show up. But there are several questions that arise whether
Alexandra's case is indeed agoraphobia. Though there was a scene in the movie
when she admittedly confess that she is suffering from agoraphobia. Using DSM V to
diagnose the case, below are some questions to consider to confirm whether the
case is agoraphobia or a different disorder.
To put in to context, according to Abnormal Psychology, 7 th Edition (2007)
written by Thomas E. Ottmanns and Robert E. Emery, agoraphobia refers to an
exaggerated fear of being in situations from which escape might be difficult. It is often
associated with a pervasive avoidance of many different kinds of situations, rather
than one specific feared object or situation (as in other phobias). Typical situations
that are feared include crowded streets and shops, enclosed places like theaters and
churches, travelling on public transportation, and driving an automobile on bridges, in
tunnels, or on crowded expressways. In the most extreme form of the disorder,
agoraphobic patients are unable to venture away from their own homes.
The definition applies to Alexandra's case for the reason of her fear to venture
away from her home. Avoidance of situation such as going outside the house to get
her mail or to receive the sanitizers she ordered were present in the movie. But for
full diagnosis, certain criterions must be met in accordance to DSM V.

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From DSM V, Criterion A says that agoraphobia is marked with fear or anxiety
about two or more of the following situations;
1. Using public transportation (e.g., automobiles, buses, trains, ships, planes).
2. Being in open spaces (e.g., parking lots, marketplaces, bridges).
3. Being in enclosed places (e.g., shops, theaters, cinemas).
4. Standing in line or being in a crowd.
5. Being outside of the home alone.
Criterion A 1, 4 and 5 are the all present in Alexandra's case. Initial
appearance of Alexandra in the movie, showed her fear of going outside her house.
She also showed discomfort when she was falling in line entering the airport. She
was looking around checking if people are looking at her. Same fear was shown
when she was in the ship after being rescued. Fear of using public transportation was
shown towards the mid part of the movie when she finally went out of her house and
she rides a cab, planes, ships and boats.
Criterion C states the agoraphobic situations almost always provoke fear or
anxiety. Criterion D states that the agoraphobic situations are actively avoided,
require the presence of a companion, or are endured with intense fear or anxiety.
These Criterions were showed in the movie. Alexandra showed fear and
anxiety just the thought of being outside of the house. She avoids being outside. The
time when she was left of no choice but to go out of her house (to save Nim), she
requires the presence of companion through the presence of her fictional character
Alex Rover. Consistently, Alex Rover appears in the movie which shows Alexandra's
case of having visual hallucination. Visual hallucination is not part of the diagnostic
criteria for this disorder. (Further discussion below)
Criterion E states that the fear or anxiety is out of proportion to the actual
danger posed by the agoraphobic situations and to the sociocultural context.
Alexandra's fear to go out of her house is due to her belief that the world is
unsanitary and hostile.

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Criterion F states that the fear, anxiety or avoidance is persistent, typically
lasting for 6 months or more. In Alexandra's case, she never step out of her house for
the last 16 weeks or equivalent to 4mos. Thus, can be said that there is a tendency to
achieve severe agoraphobia should reach 6mos.
Lastly, Criterion G states that the fear, anxiety, or avoidance causes clinically
significant distress or impairment in social, occupational, or other important areas of
functioning. In Alexandra's case, impairment is observable in her social functioning as
she avoids having personal contact. Her job though doesn't require physical contact
as she can work from home and submit her manuscripts on-line thus doesn't affect
her occupational functioning. However, should her work demands being out of her
home, tendency of occupation malfunction is high.
Though Alexandra's case met many of the criterion for the diagnosis, the
visual hallucination makes it quite challenging to totally claim that the situation is
indeed agoraphobia. However, on personal note, the context of Alexandra's nature of
work should not be discredit. Alexandra is a writer. The presence of her fictional
character can be a manifestation of her attachment to her character. Taking in to
consideration as well the time devoted to write a fictional work, it is not impossible
that such attachment can happen. It is not impossible as well that the writer would
think that the character is real. I believe it is part of an artist's emancipation of
thoughts that can trigger creativity. Alexandra's genre - fictional novel, requires high
creativity. Having said this, this artist's mechanism should not be easily judge as
mental disorder and would require additional battery of psychological test and
interview before fully diagnosing as part of psychopathy.
IV. References
Books:
Ottmann, THomas F. and Emery, Robert E. (2007). Abnormal Psychology 7th
Edition. United States of America; Pearson Education Inc

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American Psychiatric Association, Diagnostic and Statistical Manual of Mental

Disorders, 5th Edition, (2013). American Psychiatric Publishing, Arlington
Virginia.