The mental status examination in the age of the internet

The Internet has grown increasingly relevant in the practice of forensic psychiatry. To a psychiatrist conducting a forensic evaluation, the evaluee's Internet use can be relevant in nearly all aspects of the analysis. An evaluee's Internet presence may help to confirm, corroborate, refute, or elaborate on the psychiatrist's general impression of the person. Questions about the individual's choice of screen names, activities, images, and phrases can be valuable conversational tools to increase candor and self-disclosure, even among less cooperative evaluees. Difficulties in mood or affect regulation, problems with thought process or content, and impaired impulse control may be apparent in the evaluee's behavior in various Internet forums-for example, hostile or provocative behavior in social forums or excessive use of gaming or shopping websites. Discussions about the evaluee's behavior on the Internet can help the psychiatrist to assess for impaired insight and judgment. Perceptual disturbances, such as derealization and depersonalization, may be related to an evaluee's overidentification with the virtual world to the neglect of real-life needs and responsibilities. Furthermore, digital evidence can be especially useful in assessments of impairment, credibility, and dangerousness or risk, particularly when the evaluee is uncooperative or unreliable in the face-to-face psychiatric examination. This discussion will provide illustrative examples and suggestions for questions and topics the forensic psychiatrist may find helpful in conducting a thorough evaluation in this new age of the Internet.