Cognitive Dynamics

1–2 (Hs–D)

Snapshot.
Living inside a 1–2 codetype means your body feels like a constant battleground. You notice aches, pains, fatigue, or dizziness before you notice the weather. The mind locks onto these signals and interprets them as danger — proof that something is wrong. Layered on top is depression: low energy, guilt, hopelessness. The cycle is brutal: feeling unwell fuels despair, despair heightens vigilance to the body, and the whole loop confirms a sense of being trapped in an unfair life.

Data & demographics.
You are not alone. Large primary-care studies show that 20–25% of all doctor visits are driven by medically unexplained symptoms, and depressive disorders co-occur in about half of those patients (Kroenke, 2003). In MMPI research, the 1–2 profile is one of the most frequent elevations among chronic pain patients, often predicting higher health-care use and more doctor-shopping (Waldman et al., 2015). Women appear with this codetype more than men, though men often underreport until disability forces attention.

Internal dynamics.
Inside, the narrative feels like:

“If I feel this tired, something must be broken.”
“Doctors don’t see what I feel — maybe they’re missing it.”
“I can’t keep up with others. I must be defective.”

This isn’t malingering. It’s the nervous system on high alert, scanning and interpreting every signal as serious. Depression adds the sense that there’s no way out. That combination explains why many with this code type cycle endlessly between medical reassurance and emotional collapse.

Clinical prognosis.
The prognosis depends on which part dominates. When depression is primary, outcomes improve with antidepressants or structured therapies. But when health-preoccupation drives the picture, studies show high persistence: one follow-up found that 70% of somatizing patients were still impaired 10 years later (Noyes et al., 1999). These patients average 2–3 times more medical visits than matched controls (Barsky et al., 2005).

Evolving dynamic.
Over 4–10 years, most 1–2s don’t resolve fully. Some slide deeper into withdrawal, becoming 1–2–0, where social isolation compounds the despair. Others recruit anxiety into the mix, shifting into 1–2–7. Litigation or secondary gain hardens the code type, making symptoms not only identity-defining but economically reinforced. A minority, however, with validating yet firm relationships, can loosen the body-depression loop, learning to reinterpret symptoms as non-threatening.

1–3 (Hs–Hy)

Snapshot.
Living as a 1–3 feels like carrying symptoms that arrive and vanish like storms. One week it’s numbness, the next a fainting spell, later sudden paralysis of a hand. The body becomes the stage where conflict plays out. On the surface, you might look lively, even dramatic, but inside there’s a feeling of being overwhelmed by emotions you can’t name — so they pour into the body. Unlike the 1–2’s resignation, the 1–3 often feels charged, theatrical, and confusing even to themselves: “Why does this keep happening to me?”

Data & demographics.
Functional neurological disorders (conversion symptoms) appear in 10–15% of neurology clinic referrals (Stone et al., 2009), making this one of the most common nonepileptic presentations. Historically, conversion symptoms have shown female:male ratios of 2–3:1 (Stone et al., 2005). The age of onset clusters in adolescence to young adulthood. Socioeconomic stress, limited access to mental health resources, and cultures that stigmatize emotional expression all raise the likelihood of bodily conversion of conflict.

Internal dynamics.
The lived truth of the 1–3 is that the body speaks the pain the mind cannot voice.

“I can’t admit my anger, but my legs collapse under it.”
“I shouldn’t want to avoid responsibility — but I faint instead.”
“They’ll take my suffering seriously if it’s physical.”

This is not faking. It’s the psyche finding a channel. But because the body’s signals are so dramatic, doctors chase endless tests, and patients are often left labeled “mystery case” or “psychosomatic.” The mistrust that grows in this loop makes sufferers feel invalidated and abandoned.

Clinical prognosis.
Short-term remissions occur spontaneously: some symptoms fade within weeks, only to return in altered form. Long-term data show that 70% of conversion patients remain symptomatic after 7 years (Stone et al., 2009). Psychotherapy can help if framed as collaborative (not dismissive), but dropout rates are high if the patient senses they’re being told “it’s all in your head.” Treatments work best when both medical and psychological validation are combined.

Evolving dynamic.
Over 4–10 years, many 1–3s evolve into 1–2–3 patterns: somatic symptoms remain but depressive resignation deepens. In others, anxiety overlays, creating 1–3–7, where worry fuels symptom recurrence. A minority “burn out” into 1–0 patterns, living with chronic pain and fatigue rather than acute conversion events. For many, the dynamic remains circular: emotional conflict → bodily symptom → medical invalidation → further distress.

1–4 (Hs–Pd)

Snapshot.
The 1–4 codetype feels like illness weaponized against betrayal. Pain or fatigue is not just suffering — it is proof of mistreatment, injustice, or institutional failure. These individuals often voice bitterness toward doctors (“quacks”), employers (“they ruined my back”), or insurance systems (“they’re denying the obvious”). Unlike the depressive heaviness of 1–2 or the theatrical crises of 1–3, this codetype channels its energy into adversarial stance.

Data & demographics.
This codetype is less common in routine clinical settings but disproportionately seen in forensic and occupational injury evaluations (Archer & Krishnamurthy, 2013). Men outnumber women here, particularly those with histories of externalizing behavior, legal disputes, or institutional mistrust. In compensation-seeking populations, 1–4 profiles can reach up to 15–20% of claimants, a much higher rate than in general outpatient samples.

Internal dynamics.
The inside voice of 1–4 is combative and mistrustful:

“They did this to me.”
“My pain proves their guilt.”
“I won’t be tricked — they’re out to deny me.”

The body’s symptoms become not just suffering but evidence in a personal trial against authority. Unlike 1–2, which craves sympathy, 1–4 demands recognition and redress.

Clinical prognosis.
Poor. Providers become adversaries; treatment plans are challenged or dismissed. Somatic complaints worsen with non-adherence. Psychiatric referral is often rejected as offensive, interpreted as “you’re saying I’m crazy.” In compensation contexts, the adversarial loop entrenches: symptoms harden as they become currency in disputes.

Evolving dynamic.
Over years, the bitterness escalates. Some evolve into 1–4–6, where paranoia fuses with grievance (“they’re conspiring against me”). Others, when the external battle is lost, sink into 1–2–4, layering depression over anger. Rarely does spontaneous remission occur: the narrative of betrayal keeps the system alive.

Reference.

Archer, R. P., & Krishnamurthy, R. (2013). MMPI-2: Assessing personality and psychopathology. Routledge.

1–5 (Hs–Mf)

Snapshot.
The 1–5 profile reflects conflict between somatic complaints and gender identity or role expectations. The body becomes the arena where doubts about masculinity or femininity take form. In men, vague weakness or fatigue may symbolize unconscious fears of inadequacy. In women, illness may stand in for tensions around sexuality, caregiving, or restrictive gender roles.

Data & demographics.
Historically, this pattern appeared more in men, especially those from rigidly gendered cultures. Modern cohorts show less distinctiveness due to shifting norms. Prevalence is low overall, but when present, it often co-occurs with identity tension and repression.

Internal dynamics.
The internal voice is conflicted:

“I can’t show weakness, but my body does it for me.”
“I’m trapped between what’s expected and what I feel.”

Somatic symptoms symbolically protect against openly confronting gender or sexual conflict.

Clinical prognosis.
Prognosis improves when identity is supported. If conflicts remain repressed, complaints become chronic. Few randomized outcome studies exist, but case series suggest partial resolution when psychotherapy addresses self-acceptance.

Evolving dynamic.
In supportive environments, the codetype may dissolve. In unsupportive ones, it often mutates into 1–5–0, where isolation and bodily preoccupation coexist with alienation.

1–6 (Hs–Pa)

Snapshot.
The 1–6 codetype feels like living in a hostile world conspiring to deny or worsen one’s illness. The sufferer is convinced: “They know I’m sick, but they’re covering it up.” Every doctor’s reassurance feels like deliberate deceit. Every test result is suspect.

Data & demographics.
Prevalence is low in general populations but spikes in forensic and compensation contexts. Men, particularly those from working-class or adversarial occupational backgrounds, predominate. This codetype overlaps with somatic delusional disorder and paranoid personality features.

Internal dynamics.

“The truth is being hidden from me.”
“They want me to look crazy so they don’t have to pay.”

This mindset makes trust nearly impossible. Every provider becomes an enemy.

Clinical prognosis.
Very poor. Dropout is nearly universal. Violence and litigation risk are elevated. Therapeutic progress requires extraordinary trust-building, often unsuccessful.

Evolving dynamic.
Over 5–10 years, many escalate into 1–6–8, with full somatic delusions. Others remain fixed in grievance identities, bitter and combative. Remission is extremely rare.

1–7 (Hs–Pt)

Snapshot.
The 1–7 codetype lives in worry: “What if this ache means cancer? What if the doctors missed something?” Unlike 1–2, which collapses into resignation, the 1–7 spirals in anxious loops, checking, scanning, asking, and seeking reassurance — yet never feeling reassured.

Data & demographics.
Health anxiety affects 4–6% of the population (Sunderland et al., 2013), with higher prevalence in women. On the MMPI, 1–7s are common among patients with generalized anxiety disorder and OCD-spectrum traits. Age of onset is often early adulthood.

Internal dynamics.

“If I ignore this, I could die.”
“Doctors miss things all the time.”
“I have to check again.”

The drive is vigilance, not malingering. Anxiety is the fuel.

Clinical prognosis.
Moderate. CBT and SSRIs show strong evidence of benefit, but reassurance-seeking undermines progress. Engagement is usually steady, unlike 1–6 or 1–4, but progress is slow.

Evolving dynamic.
Over years, 1–7s often accumulate depressive features, becoming 1–2–7. Others, worn down by social withdrawal, drift into 1–0. Anxiety rarely disappears entirely; the evolving dynamic is one of chronic but manageable worry.

References.

Sunderland, M., et al. (2013). Health anxiety prevalence and correlates in the Australian general population. Journal of Psychosomatic Research, 75(6), 546–552).
Abramowitz, J. S., & Braddock, A. E. (2008). Hypochondriasis and Health Anxiety: A Guide for Clinicians. Oxford University Press.

1–8 (Hs–Sc)

Snapshot.
The 1–8 codetype feels like being caught between physical suffering and a collapsing reality. Somatic complaints — pain, fatigue, dizziness — dominate daily life, but they are interwoven with distorted perceptions, suspiciousness, or outright psychotic features. The body becomes a canvas for delusional ideas: “My organs are being poisoned,” “The doctors implanted something in me,” or “They’re experimenting on me.” Unlike the anxious vigilance of 1–7, the 1–8 lives in a world where body and mind are targets of imagined persecution.

Data & demographics.

In inpatient psychiatric settings, somatic delusions are frequent, with estimates that 20–40% of psychotic patients present somatic themes (Stompe et al., 1995).
1–8 profiles are overrepresented among schizoaffective and paranoid schizophrenia patients, particularly those with poor insight.
Men and women appear at similar rates, but onset is typically earlier in men (late teens to early 20s) and slightly later in women (late 20s to early 30s), consistent with broader schizophrenia onset patterns (Häfner, 2003).

Internal dynamics.
The inner voice of 1–8 is fearful, suspicious, and often fragmented:

“The pain isn’t natural — someone caused it.”
“They won’t tell me the truth because they’re in on it.”
“This is proof that I’m being controlled.”

This codetype often feels profoundly alienated. Medical reassurance does nothing, because the “illness” is woven into a persecutory system of belief.

Clinical prognosis.
Prognosis is poor without antipsychotic intervention. Somatic delusions are often treatment-resistant, requiring long-term pharmacological management (González-Rodríguez et al., 2020). Functional outcomes are typically low: unemployment, social isolation, and recurrent hospitalization are common.

Evolving dynamic.
Over 5–10 years, the codetype tends to harden, especially if left untreated. 1–8 can evolve into 1–6–8 (where paranoid distrust predominates) or 1–8–9 (where grandiosity mixes with somatic delusions). Spontaneous remission is rare. Long-term trajectories are shaped by access to treatment and family support; without both, chronic psychosis dominates.

1–9 (Hs–Ma)

Snapshot.
The 1–9 codetype feels like being pulled between hyperarousal and hypochondria. These individuals experience bursts of energy, pressured speech, and racing thoughts, alongside dramatic health complaints. Somatic worries can become expansive and flamboyant: “I can work 20 hours a day despite my heart problem,” or “I know I’m sick but I’m too strong to be stopped.” The profile oscillates between denial of limits and obsessive focus on the body.

Data & demographics.

This codetype appears in bipolar disorder presentations, especially mixed states with somatic preoccupation. Studies show that around 20–25% of bipolar patients present with significant somatic concerns during acute episodes (Stubbs et al., 2016).
Men are more likely to show this codetype than women, particularly those with externalizing histories.
Younger adults (late teens to 30s) dominate prevalence due to manic onset timing.

Internal dynamics.

“Nothing can stop me, but something might kill me.”
“I’m too full of energy to be sick, but what if my body fails?”
“Doctors can’t keep up with me — they underestimate how serious this is.”

The oscillation is between inflated confidence and hypochondriacal dread — the body becomes both invincible and dangerously fragile.

Clinical prognosis.
Highly unstable. Prognosis depends on mood stabilization: with treatment, somatic concerns often remit; without it, the codetype can lead to reckless overexertion, repeated ER visits, and financial/legal trouble. In one large cohort, over 60% of untreated bipolar patients had recurrent somatic ER presentations over 5 years (Carvalho et al., 2014).

Evolving dynamic.
Across years, untreated 1–9s frequently evolve into 1–9–4 (somatic + mania + antisocial features) or 1–9–8 (grandiosity + somatic paranoia). With treatment, however, many stabilize, and the 1–9 pattern fades into baseline 1–2 mild somatic concerns.

1–0 (Hs–Si)

Snapshot.
The 1–0 codetype is heavy with withdrawal. The person lives in their body, cataloguing symptoms, while retreating from social life. Unlike the anxious checking of 1–7 or the angry grievance of 1–4, the 1–0 simply resigns: “I am broken, and I don’t belong anywhere.” Social contact is avoided, not from paranoia, but from exhaustion and fear of being a burden.

Data & demographics.

This codetype is common among older adults, where chronic illness, pain, and isolation interact. Prevalence of depressive–somatic syndromes increases sharply after 60, particularly in widowed or retired populations (Blazer, 2003).
Women report higher somatic preoccupation; men are more likely to silently withdraw, leading to under-detection.
In medical–psychiatric liaison samples, 1–0 codetypes are associated with high rates of late-life depression and institutionalization.

Internal dynamics.

“My body is falling apart, and there’s no one to help.”
“I don’t fit in anymore.”
“If I stay alone, at least I won’t be judged.”

The combination of somatic distress and social retreat creates a profound sense of futility.

Clinical prognosis.
Prognosis is guarded. Social isolation is a major risk factor for morbidity and mortality — one meta-analysis showed isolation carries a 26% increased risk of early death (Holt-Lunstad et al., 2015). For 1–0s, untreated withdrawal often leads to functional decline. Treatment can work, but requires not just symptom relief, but re-engagement with social networks, often resisted.

Evolving dynamic.
Over 5–10 years, this codetype tends to entrench. Some evolve into 1–2–0 (adding depression) or 1–6–0 (adding suspiciousness to withdrawal). Others fade into chronic institutional care, their world shrinking to symptom monitoring and minimal social exchange. Rarely does a 1–0 spontaneously improve; improvement almost always requires outside intervention.

At its essence, this is the profile of withdrawal into the body. The individual no longer fights, doubts, argues, or constructs elaborate theories. What remains is pain and solitude. Life is lived at the level of sensations: joints aching, stomach unsettled, breath shallow, fatigue endless. Relationships thin out. Work, if it continues, is done mechanically, without vitality.

In population studies, social withdrawal combined with health complaints is one of the strongest predictors of early mortality in older adults—loneliness doubles risk of death (Holt-Lunstad et al., 2015). Yet this codetype is not only an aging phenomenon; young adults with 1–0 profiles often present as “invisible” patients: multiple absences, little disclosure, living as if life has already narrowed before it began.

The long-term trajectory is one of entrenchment. Without interruption, years slip by with little change except the slow intensification of isolation. Sometimes depressive features add (sliding into 1–2–0), sometimes paranoid suspicion (1–6–0), but the central fact is contraction. A life reduced to symptoms and silence.

1–2–3 (Hs–D–Hy)

Snapshot.
Living with 1–2–3 is like being locked in a cycle of exhaustion, despair, and bodily drama. The body hurts or malfunctions (1), the mood is persistently low and hopeless (2), and symptoms escalate or shift into dramatic presentations (3). This is one of the “classic neurotic triad” code types, long recognized as a marker of heavy psychological distress expressed through physical channels. To the sufferer, it feels like: “I am sick, I am hopeless, and no one takes it seriously unless my symptoms overwhelm the room.”

Data & demographics.

The neurotic triad (1–2–3) is among the most common MMPI profiles in chronic pain and somatoform populations (Butcher, Graham, Ben-Porath, 1990).
Studies in medical clinics show that 15–25% of frequent attenders endorse this configuration, often with long treatment histories and poor satisfaction (Barsky et al., 2005).
Gender: women outnumber men, though in compensation and military populations, men appear more often.
Age: peaks in early–mid adulthood, with persistence into older age if untreated.

Internal dynamics.
The narrative is circular and punishing:

“My body betrays me.”
“I can’t get better, nothing works.”
“The only way to be seen is if I collapse or break down.”

The depression (2) prevents hope. The somatic focus (1) convinces the person they are medically ill. The hysteria component (3) pushes symptoms into exaggerated or shifting forms, sometimes winning temporary attention but ultimately invalidation. This cycle is profoundly invalidating — every attempt to get help risks reinforcing the sense of being dismissed.

Clinical prognosis.
Prognosis is guarded. These individuals are heavy healthcare utilizers — one study found over double the average number of physician visits annually (Kroenke, 2003). Depression worsens disability and increases risk of chronicity. Treatments that confront the psychological origin of symptoms often trigger resistance, as patients perceive them as minimizing real suffering. Long-term follow-ups show many remain symptomatic for decades, though subsets improve with integrated biopsychosocial interventions.

Evolving dynamic.
Over 5–10 years, the 1–2–3 pattern can entrench into identity: “being ill” becomes the central organizing fact of life. Some evolve toward 1–2–0, with full social withdrawal. Others harden into adversarial patterns such as 1–2–4, where bitterness toward providers dominates. A minority resolve partially when supportive medical alliances are built, but even then residual somatic complaints often remain.

1–2–4 (Hs–D–Pd)

Snapshot.
Here the body’s suffering (1) and depression (2) join with anger and rule-breaking tendencies (4). This codetype often feels like a story of grievance and injustice: “I’ve been wronged, my body proves it, and I won’t be quiet about it.” Compared to the resigned 1–2–3, the 1–2–4 is louder, angrier, and more likely to accuse institutions or individuals of mistreatment.

Data & demographics.

Prominent in forensic, worker’s compensation, and disability populations. Rates up to 20% among litigants with chronic pain (Archer & Krishnamurthy, 2013).
More common among men, especially those with histories of oppositional behavior or legal conflict.
Age: middle adulthood predominates, often following occupational injury.

Internal dynamics.

“I suffer, and someone caused it.”
“Doctors and employers don’t care; they’re against me.”
“My pain is proof of my mistreatment.”

This is less about hopeless collapse (1–2–3) and more about anger, external blame, and demand for recognition. The depressive element fuels bitterness, while the antisocial Pd (4) colors the stance as combative.

Clinical prognosis.
Prognosis is generally poor unless legal/compensation contexts are resolved. Adherence to treatment is low; medical providers are often viewed as adversaries. Psychiatric referral is resisted or weaponized (“See, they think I’m crazy — proof of the conspiracy”). Healthcare costs are high, outcomes poor.

Evolving dynamic.
Over 5–10 years, 1–2–4 often evolves into 1–4–6 if paranoia deepens, or into 1–2–0 if energy for the fight collapses into isolation. In some, anger gives way to depressive resignation, resembling the 1–2–3. Litigation and compensation dynamics strongly reinforce chronicity.

1–2–5 (Hs–D–Mf)

Snapshot.
This codetype reflects the entanglement of bodily complaints, depression, and conflicts around gender/identity roles. Internally, it feels like: “I’m sick, I’m tired, and maybe I don’t measure up as a man/woman/partner.” The depressive element adds shame; the somatic complaints create “evidence” of weakness.

Data & demographics.

Historically more frequent in men raised in rigid gendered roles, where weakness was equated with failure.
Modern prevalence is low, but still appears in clinical samples dealing with identity stress.
Depression is near-universal in this codetype; suicidal ideation rates are elevated.

Internal dynamics.

“I can’t meet expectations.”
“My body exposes my flaws.”
“I feel alien in my role.”

Somatic complaints and fatigue act as protective barriers, allowing withdrawal without openly confronting identity struggles.

Clinical prognosis.
Prognosis depends heavily on cultural context. In restrictive settings, symptoms persist for years, often worsening depression. In supportive contexts, especially where identity expression is validated, symptoms can remit.

Evolving dynamic.
Over time, these individuals risk slipping into 1–2–0 if isolation deepens, or evolving into 1–5–0 if gender/role conflict dominates. With acceptance and support, however, the code type may dissolve entirely, leaving behind only mild depressive residuals.

1–2–6 (Hs–D–Pa)

Snapshot.
This codetype feels like a prison of distrust. The body aches and fails (1), mood is low and hopeless (2), and suspicion (6) insists: “Doctors are hiding the truth, people are against me, and I’m not safe.” Unlike the grief of 1–2–3 or the anger of 1–2–4, here paranoia locks the person into a solitary struggle against a hostile world.

Data & demographics.

Common in forensic samples, disability claimants, and psychotic-spectrum disorders.
Prevalence in general outpatient populations is low but significant in chronic somatization.
Both men and women are affected; men are more likely to escalate into combative confrontation.

Internal dynamics.

“They know something they’re not telling me.”
“My suffering proves the cover-up.”
“The system is against me.”

Depression fuels despair, somatic focus justifies suffering, and paranoia explains it as persecution.

Clinical prognosis.
Prognosis is very poor. These individuals often refuse psychiatric treatment, sabotage medical alliances, and become adversarial. Some present litigation or even violence risk. Long-term functional outcomes are low.

Evolving dynamic.
Over years, this codetype often evolves into 1–6–8, with overt delusions, or collapses into 1–2–0, complete withdrawal. Rarely does spontaneous improvement occur.

1–2–7 (Hs–D–Pt)

Snapshot.
This codetype feels like “I’m sick, I’m sad, and I can’t stop worrying about it.” Somatic distress (1) fuels despair (2), while obsessive checking and ruminations (7) drive endless scanning. These are the chronic worriers: symptom preoccupation plus guilt plus unending mental loops.

Data & demographics.

Health anxiety + depression co-occur in over 40% of patients with medically unexplained symptoms (Sunderland et al., 2013).
Prevalence is higher in women, and onset often in young adulthood.
Cognitive style is ruminative, with high healthcare utilization.

Internal dynamics.

“I’m doomed, but maybe I missed something.”
“What if I have a disease? What if it’s my fault?”
“Checking doesn’t help, but not checking feels impossible.”

This codetype lives in circular self-torture: somatic → hopeless → obsessive → somatic.

Clinical prognosis.
Prognosis is moderate. CBT for health anxiety and depression can work, but requires sustained effort. These individuals are often compliant but slow to improve. Without treatment, chronicity is high.

Evolving dynamic.
Over years, many evolve into 1–2–0 if isolation increases. Others slip toward 1–7–0 if rumination fuels withdrawal. In rare cases, successful therapy yields significant remission, though health vigilance often lingers.

1–2–8 (Hs–D–Sc)

Snapshot.
Living with 1–2–8 is like walking through fog inside your own body while the world tilts away from you. Somatic distress (1) is constant—pain, fatigue, odd bodily sensations—then depression (2) drains momentum, and finally psychotic coloring (8) reframes the whole experience: “This isn’t just illness; something (or someone) is doing this to me.” Reassurance doesn’t land. Ordinary coincidences feel like patterns; tests feel rigged; the body becomes a contested site where reality itself is in doubt.

Data & demographics.
Psychotic disorders frequently include somatic delusions or bodily passivity phenomena; older inpatient series estimate 20–40% of psychotic patients report prominent somatic themes (Stompe et al., 1995). Onset follows broader schizophrenia patterns—earlier in men on average, later in women (Häfner, 2003). Clinical reviews note that somatic delusions often show lower insight and poorer response than non-somatic delusions, requiring sustained antipsychotic strategies (González-Rodríguez et al., 2020).

Internal dynamics (from the inside).

“This pain is not random. It’s placed.”
“My sadness proves how serious this is; their calm proves they’re lying.”
“If I can find the pattern, I can stop it.”
The depressive layer pushes toward hopeless certainty; the psychotic layer supplies an external persecutor; the somatic layer provides “evidence.” Together they create a closed explanatory loop impervious to ordinary reassurance.

Clinical prognosis.
Without antipsychotic treatment and a stable, non-argumentative alliance, outcomes are poor. Somatic delusions are comparatively treatment-resistant, and comorbid depression predicts worse functioning and higher relapse risk (González-Rodríguez et al., 2020). Engagement improves when clinicians validate suffering while sidestepping head-on battles over delusional content.

Evolving dynamic (4–10 years).
The profile often hardens: 1–2–8 can evolve to 1–6–8 (persecutory mistrust becomes dominant) or to 1–8–9 (energized, irritable psychosis). When depressive load lifts, somatic delusions may persist as a fixed belief system. Best long-term outcomes occur with consistent medication adherence, family psychoeducation, and low-expressed-emotion environments.

1–2–9 (Hs–D–Ma)

Snapshot.
Inside 1–2–9, the body complains (1), mood falls (2), yet the mind revs (9). It feels like depressed speed: racing thoughts, irritability, restlessness, bursts of productivity—then crashes—while health fears hum in the background. You can argue passionately about your symptoms at 2 a.m., research them for hours, then feel ashamed and exhausted by noon.

Data & demographics.
This triad often mirrors mixed-features states in bipolar spectrum conditions—depressive mood with “manic” activation (racing thoughts, agitation). Mixed features are common and impairing in bipolar disorders (Vieta et al., 2018). Somatic burden is high in bipolar patients (pain, sleep disruption, cardiometabolic issues), and during mixed/depressed phases health anxiety and utilization spike (Carvalho et al., 2014).

Internal dynamics.

“I’m exhausted and doomed—also I must act now.”
“My symptoms are serious—and everyone is too slow or careless.”
“If I push hard enough, I can outrun the illness.”
The 9-energy fuels vigilance and argumentation; the 2-depression colors interpretations as catastrophic; the 1-somatic channel supplies an ever-replenishing focus.

Clinical prognosis.
Unstable. When the 9-component goes untreated, people overexert, ignore limits, and bounce between ER reassurance and burnout; depressive weight then deepens hopelessness. With mood stabilization (lithium/atypicals) and sleep regulation, somatic preoccupation usually shrinks in volume, and decision-making improves (Vieta et al., 2018; Carvalho et al., 2014).

Evolving dynamic (4–10 years).
Without stabilization, trajectories bend toward irritable externalization (e.g., 1–9–4) or paranoid coloring (1–9–8). With consistent treatment, many settle into lower-amplitude patterns (e.g., a more manageable 1–2 baseline), with fewer crisis visits and less health-related impulsivity.

1–2–0 (Hs–D–Si)

Snapshot.
This codetype feels like quiet collapse. The body hurts (1); mood is low (2); social life narrows (0). You cancel plans because you’re “not up to it,” then feel lonelier and more certain that something is wrong with you. The world recedes to appointments, pills, and symptom diaries.

Data & demographics.
Prominent in older adults and in anyone living with chronic pain or medical illness. Social withdrawal and loneliness are independent risk factors for morbidity; meta-analytic data link social isolation to a 26% increase in all-cause mortality (Holt-Lunstad et al., 2015). In primary care, medically unexplained symptoms frequently co-occur with depression and produce frequent-attender patterns (Kroenke, 2003).

Internal dynamics.

“I’ll spare everyone by staying home.”
“I can’t keep pretending I’m okay.”
“Tracking symptoms is the only thing I can still do right.”
The loop is self-sealing: isolation reduces corrective experiences, and the absence of social feedback amplifies bodily focus.

Clinical prognosis.
Guarded if isolation continues. Even effective depression care underperforms when social reconnection is absent. Behavioral activation and graded social re-entry correlate with functional improvements, but the first steps feel punishing. Medical alliances that include practical re-engagement goals (day structure, micro-commitments) have the best yield.

Evolving dynamic (4–10 years).
The pattern entrenches unless interrupted. Common endpoints: 1–2–0 → institutional dependence; or drift toward 1–6–0 if bitterness/suspicion grows. Reversal requires outsiders (family, peers, community) plus predictable, non-catastrophizing medical care.

1–3–4 (Hs–Hy–Pd)

Snapshot.
Illness is the argument here. Somatic drama (1–3) meets oppositional, rule-testing energy (4). Symptoms may be flamboyant or shifting, and the tone is adversarial: “Believe me now?” The body becomes both megaphone and shield in battles with authority—clinicians, employers, family.

Data & demographics.
Over-represented in forensic/compensation contexts and some emergency and neurology settings where functional symptoms are common. Functional neurological disorder accounts for ~10–15% of neurology referrals (Stone et al., 2009). Externalizing traits predict lower adherence and higher conflict with providers (clinical/forensic syntheses in Archer & Krishnamurthy, 2013).

Internal dynamics.

“You only listen when it’s dramatic.”
“Rules aren’t for people who are suffering.”
“If I back down, I’ll be erased.”
Hy channels conflict into symptoms; Pd supplies the fight; Hs keeps attention anchored to the body.

Clinical prognosis.
Fragile. Confrontation escalates symptoms; invalidation escalates conflict. Best outcomes come from clear boundaries + high validation: acknowledge suffering, avoid power struggles, and offer structured choices. Adherence improves when the patient retains agency without controlling the frame.

Evolving dynamic (4–10 years).
Paths diverge: toward 1–4–6 if distrust consolidates, toward 1–2–3 if energy collapses into resignation, or toward lower-amplitude functional symptoms if a stable alliance forms and non-contingent support replaces symptom-contingent attention.

1–3–5 (Hs–Hy–Mf)

Snapshot.
Somatic expression (1–3) is braided with identity tension (5). Illness “speaks” conflicts around gender roles, sexuality, or belonging. Symptoms can flare around milestones—marriage, parenthood, role shifts—and soften when identity fits better.

Data & demographics.
Historically noted in men from rigid gender-norm environments; now rarer as norms broaden. Appears in cross-cultural settings where direct discussion of identity is constrained.

Internal dynamics.

“If my body fails, I won’t be forced into that role.”
“Being sick explains why I can’t be who they expect.”
Hysteria converts conflict to symptoms; Mf marks the latent role-strain; Hs supplies the somatic stage.

Clinical prognosis.
Improves when identity is named and supported. Where repression is mandatory (family, culture, institution), symptoms persist or migrate. Psychoeducation with a non-pathologizing stance is pivotal.

Evolving dynamic (4–10 years).
With acceptance, intensity fades (sometimes down to mild 1–0). Without it, isolation grows (→ 1–5–0) or bitterness accrues (→ 1–4–5 flavor).

1–3–6 (Hs–Hy–Pa)

Snapshot.
Dramatic, shifting symptoms meet suspicious interpretation. A fainting episode becomes “evidence” of poisoning; sensory anomalies become proof of tampering. Unlike 1–2–8, psychosis is not required—here the style is suspicious rather than frankly delusional.

Data & demographics.
Seen in high-conflict medical settings, malingering-suspected contexts, and cultures where distrust of institutions is normative. Prevalence is low in general clinics but salient in neurology/ER when symptoms recur with inconsistent findings.

Internal dynamics.

“Something is being done to me.”
“Doctors hide things.”
“Only dramatic symptoms cut through the lies.”
Hy provides theatrical signal; Pa supplies the lens of mistrust; Hs keeps attention fixed on the body.

Clinical prognosis.
Difficult. Direct challenges backfire. The leverage is process transparency (what you will and won’t do, and why), repeated, with calm affect. Limited, predictable testing; focus on function rather than proof-seeking.

Evolving dynamic (4–10 years).
Often drifts toward 1–6–8 if suspicious style escalates, or toward 1–2–3 if energy wanes and depressive resignation grows.

1–3–7 (Hs–Hy–Pt)

Snapshot.
This is a cycle of alarm: bodily oddities (1) spark dramatic episodes (3), which ignite obsessive checking and rumination (7). Day-to-day life swings between showy crises and quiet hours of searching symptoms online, re-enacting episodes, or rehearsing explanations.

Data & demographics.
Health anxiety affects 4–6% of the population and often co-occurs with functional symptoms (Sunderland et al., 2013). In specialized neurology clinics, functional presentations are common, and repetitive reassurance-seeking predicts persistence (Stone et al., 2009).

Internal dynamics.

“If I don’t dramatize it, they’ll miss it.”
“If I don’t check it, I’ll die of it.”
Hy demands visibility; Pt demands certainty; Hs supplies the stream of bodily inputs.

Clinical prognosis.
Fair with exposure-based approaches that reduce checking and re-enactment, paired with neutral medical containment (clear parameters for testing). Progress is slow; relapse risk is tied to stress and unstructured time.

Evolving dynamic (4–10 years).
Common end-states: 1–2–7 (depressive overlay as life constricts) or 1–7–0 (retreat and quiet preoccupation). With durable habit change, intensity can ratchet down to mild vigilance without theatrics.

1–3–8 (Hs–Hy–Sc)

Snapshot.
Functional/somatic drama merges with psychotic coloration. Episodes may look theatrical to observers, but for the sufferer they are anchored by bizarre certainties: “Something is inside me,” “They switched my blood,” “An implant controls the spasms.”

Data & demographics.
Somatic delusions/dysmorphic experiences occur across psychotic spectra (Stompe et al., 1995). When Hy is high, symptom form can be spectacular, complicating assessment and fueling iatrogenic testing.

Internal dynamics.
Hy broadcasts; Sc rewrites reality; Hs feeds the signal. The person oscillates between seeking witnesses and hiding for fear of disbelief.

Clinical prognosis.
Requires antipsychotic treatment plus behavioral containment of reenactment. Without both, revolving-door utilization is common.

Evolving dynamic (4–10 years).
Stabilization can shift to a lower-amplitude somatic preoccupation; otherwise, the course parallels 1–2–8 with entrenched belief systems.

1–3–9 (Hs–Hy–Ma)

Snapshot.
High energy, high drama, high somatic focus. Symptoms arrive big; explanations arrive bigger. There’s charisma, urgency, and a tendency to overpromise and overextend, then crash.

Data & demographics.
Tracks with hypomanic/affective temperaments; over-represented in younger adults in high-intensity environments (sales, startups, performing arts). Health-care use spikes during high-activation phases (sleep loss, stimulants, stress loads).

Internal dynamics.

“I’ll prove it convincingly—watch.”
“I feel terrible, but I can still outwork this.”
Hy seeks audience; Ma supplies drive; Hs sustains the topic.

Clinical prognosis.
Improves with sleep regularization, throttle control on stimulation, and limits on medical “show and tell.” Without pacing, burnout and credibility erosion are predictable.

Evolving dynamic (4–10 years).
Either matures into a contained, high-functioning style with residual somatic talk—or degrades into 1–9–4 conflict cycles and provider-shopping.

1–3–0 (Hs–Hy–Si)

Snapshot.
Public drama, private retreat. Episodes are visible; daily life is small. After each crisis, shame and fatigue lead to cancellations and ghosting. Over time, the outer circle learns to disengage; the inner circle shrinks.

Data & demographics.
Common endpoint for repeated functional presentations that wear out social capital. Loneliness then amplifies symptom focus (see mortality/health-risk links in Holt-Lunstad et al., 2015).

Internal dynamics.

“They’ll only believe me if it’s big.”
“After it’s big, I can’t face anyone.”
Hy demands spectacle; Si demands distance; Hs fills the silence.

Clinical prognosis.
Shifts only when attention becomes non-contingent (connection not tied to crises) and daily structure grows independently of symptoms.

Evolving dynamic (4–10 years).
Often settles into 1–0 or 1–2–0 unless the social feedback loop is rebuilt.

1–4–5 (Hs–Pd–Mf)

Snapshot.
Somatic complaint harnessed to defiance (4) and role conflict (5). The body is both evidence (of grievance) and alibi (for not conforming to role demands). Tone: sharp, proud, resistant to pathologizing.

Data & demographics.
Seen in rigid role settings (military, heavy industry, conservative communities). Higher in men; often post-injury or post-conflict.

Internal dynamics.

“My body proves I’m right—and that I won’t play their part.”
Pd externalizes blame; Mf resists the assigned identity; Hs keeps the case file open.

Clinical prognosis.
Alliance is possible only with respectful autonomy: spell out choices, consequences, and limits. Attempts to moralize or cajole backfire.

Evolving dynamic (4–10 years).
Trajectory splits: reconciliation and role renegotiation → symptom thaw; or bitterness and isolation → 1–5–0/1–2–4 grooves.

1–4–6 (Hs–Pd–Pa)

Snapshot.
The grievance becomes a system. Somatic suffering, defiance, and suspicion cohere into a worldview of persecuted righteousness. Interactions are legalistic, recorded, and mined for “proof.”

Data & demographics.
Overrepresented in litigated injury, long-running employer disputes, and compensation denials. Escalation risk (threats, complaints) is non-trivial.

Internal dynamics.

“They harmed me, they’re hiding it, and I will expose them.”
“Doctors are part of the machine.”
Pd fuels the fight; Pa supplies conspiracy; Hs provides the exhibits.

Clinical prognosis.
Poor. Only structured, boundaries-forward care avoids entanglement. Focus on function and safety; do not bargain over reality.

Evolving dynamic (4–10 years).
Often consolidates into 1–6–8. Rare de-escalations occur when the external conflict ends decisively and a new identity replaces “the wronged patient.”

1–4–7 (Hs–Pd–Pt)

Snapshot.
Combative vigilance. Body complaints, oppositional stance, and obsessive rumination produce a relentless audit of slights and symptoms.

Data & demographics.
Common in high-control workplaces and after contentious supervision histories. Documentation behavior (logs, recordings, emails) is heavy.

Internal dynamics.

“If I track everything, they can’t get away with it.”
“If I relax, I’ll be exploited.”
Pt supplies the audit; Pd the fight; Hs the content.

Clinical prognosis.
Moderate only if energy can be redirected toward personally valued goals with transparent guardrails. Otherwise, endless grievance cycles.

Evolving dynamic (4–10 years).
Drifts toward 1–2–4 if energy burns out; toward 1–4–6 if suspicion hardens.

1–4–8 (Hs–Pd–Sc)

Snapshot.
From grievance to grand conspiracy. Bodily symptoms prove the plot; inconsistent tests prove the cover-up. Interactions are accusatory and theatrical; stakes feel existential.

Data & demographics.
Low base rate but high impact in systems (hospitals, insurers). Safety planning may be required if volatility rises.

Internal dynamics.

“My case reveals the whole system.”
“Anyone calm is complicit.”
Sc enlarges meaning; Pd enforces conflict; Hs anchors the “evidence.”

Clinical prognosis.
Requires risk-aware, minimally reactive teams; antipsychotic trials if delusionality is clear.

Evolving dynamic (4–10 years).
Often stabilizes only after external anchors change (new environment, legal resolution, or sustained treatment adherence).

1–4–9 (Hs–Pd–Ma)

Snapshot.
High-energy grievance. Quick to mobilize, quick to confront, quick to burn bridges. Somatic claims are pursued aggressively; setbacks incite new campaigns.

Data & demographics.
Shows up in entrepreneurial and adversarial subcultures. Sleep loss, stimulants, or stress spikes can amplify cycles.

Internal dynamics.

“Push harder—prove them wrong.”
Ma adds drive; Pd adds edge; Hs provides the rallying cry.

Clinical prognosis.
Improves when activation is capped (sleep, pacing) and goals are reframed from “win” to “build.” Without that, serial provider-shopping and conflict escalation are likely.

Evolving dynamic (4–10 years).
Either evolves to 1–9–4 dominance (irritable, abrasive) or mellows into a purposeful, contained style with residual health rhetoric.

1–4–0 (Hs–Pd–Si)

Snapshot.
From battle to bunker. After years of conflict, the field narrows: the person stays home, nurses symptoms, and recounts past injustices to a shrinking audience.

Data & demographics.
Common end-state after long compensation disputes or failed reintegration attempts. Isolation now props up both identity and symptom focus (see risk data in Holt-Lunstad et al., 2015).

Internal dynamics.

“I was right—but it cost me everyone.”
“If I go out, they win.”
Si preserves dignity through withdrawal; Pd keeps the narrative sharp; Hs fills the days.

Clinical prognosis.
Movement requires grief work (mourning the lost fight/identity) and micro-reentries into valued roles. Without that, stasis.

Evolving dynamic (4–10 years).
Often settles into 1–0 or 1–2–0; rarely returns to broad social functioning unless a new, non-adversarial identity is found.

1–5–6 (Hs–Mf–Pa)

Snapshot.
Here the body (1) becomes a stage for role tension (5) and mistrust (6). The person feels out of place in their assigned gender/identity role (Mf), experiences chronic somatic complaints (Hs), and interprets the pushback or confusion of others through a suspicious lens (Pa). The lived sense is: “My body betrays me, society mislabels me, and people are hostile about it.”

Data & demographics.

Gender dysphoria and role conflict predict higher health service use and frequent somatic complaints; in one survey, 42% of trans adults reported poor physical health alongside elevated psychological distress (UCLA Williams Institute, 2017).
Minority stress research shows that mistrust (Pa) correlates with discrimination experiences: LGBTQ adults report double the rate of healthcare discrimination compared to cis/heterosexual adults (Kcomt, 2019).
Paired with Hs, this yields a strong tendency toward medical utilization plus suspicion of providers’ motives.

Internal dynamics.

“This body isn’t neutral—it’s evidence of my struggle.”
“Every encounter is a test; they’re watching, judging, misgendering.”
“If I expose my pain enough, maybe someone will validate me—but they rarely do, and then I know they’re against me.”

Mf colors everything with identity friction; Pa stiffens into vigilance; Hs ensures the conversation never leaves the body. The loop keeps personal identity and physical suffering fused, with little room for neutrality.

Clinical prognosis.
If identity affirmation is missing, prognosis is poor: mistrust grows, alliances collapse, somatic distress amplifies. With affirming care and transparent boundaries, outcomes improve—both in mental health and utilization. Suspicious interpretations soften when identity is validated and bodily complaints are not dismissed.

Evolving dynamic (4–10 years).

Positive arc: with affirming identity support, codetype relaxes toward 1–5–0 (somatic distress plus quiet retreat) or 1–0 baseline.
Negative arc: if hostility is chronic, it hardens into 1–6–8 (paranoid, persecuted stance) or 1–8–9 (energized, angry psychosis).
Data show that supportive environments halve suicide attempt rates in trans youth (The Trevor Project, 2020). The same protective effect applies longitudinally for adults.

1–5–7 (Hs–Mf–Pt)

Snapshot.
The identity/body conflict of 1–5 is compounded by obsessive rehearsal and rumination (7). The person scrutinizes every role performance, every interaction, every bodily marker for signs of judgment or failure. Anxiety is pervasive: “Did I sound too masculine? Too feminine? Did they notice my posture? Did I misstep socially?”

Data & demographics.

Obsessive–compulsive tendencies are elevated among people facing rigid role expectations; LGBTQ adolescents report twice the odds of obsessive checking and rumination compared with peers (Calzo et al., 2017).
Somatic complaints in this group are high, often tied to stress: headaches, GI issues, and fatigue are disproportionately reported (Casey et al., 2019).
Gender nonconforming individuals in conservative cultural settings show especially high 1–5–7 patterns: bodily distress + identity role stress + ruminative preoccupation.

Internal dynamics.

“Every detail counts. If I slip, I’ll be exposed.”
“My body is a constant threat to my identity—it gives me away.”
“I replay and replay until I find safety—but I never find it.”

Hs supplies endless somatic fuel; Mf directs the lens to role/gender; Pt traps the cycle in ritual and doubt.

Clinical prognosis.
Often chronic unless obsessions are addressed with exposure–response prevention and identity support. Prognosis worsens when secrecy is required (family, workplace) because rumination thrives in silence. Supportive environments shorten cycles of obsessive review.

Evolving dynamic (4–10 years).

If left untreated, 1–5–7 often collapses into 1–2–7 (depressive resignation with obsessive checking).
With support, may loosen to 1–5–0, where identity conflict is still felt but obsessive monitoring eases.
Longitudinally, persistent role/identity suppression predicts sustained high-rumination states and poorer physical health (Meyer, 2003).

1–5–8 (Hs–Mf–Sc)

Snapshot.
Identity strain (5) escalates into somatic distress (1) colored by psychotic elaboration (8). The body is experienced as tampered-with, altered, or surveilled: “They implanted something to keep me in my role,” “My body is morphing to punish me.”

Data & demographics.

Psychotic disorders are more prevalent in sexual minority groups: a meta-analysis found a 2- to 3-fold higher risk of psychosis among LGBTQ individuals, partly mediated by minority stress (Långström et al., 2016).
Somatic delusions are prominent: 20–40% of schizophrenia patients report them (Stompe et al., 1995).
These themes are especially intense when identity suppression is chronic—external persecution narratives find traction in lived experiences of stigma.

Internal dynamics.

“My body itself is controlled.”
“The world conspires to fix me into a role.”
“Even my sensations aren’t mine—they’re placed.”

This is not mere mistrust but full psychotic misattribution of bodily experience. The 5-scale ensures identity is always implicated.

Clinical prognosis.
Poor without antipsychotic intervention plus identity-affirming therapy. Standard psychoeducation about delusions is less effective because the lived experience of stigma already validates persecutory interpretations. Outcomes improve when treatment is paired with minority-stress-informed care.

Evolving dynamic (4–10 years).

Entrenched states often evolve into 1–8–9 (energized persecutory psychosis).
Milder courses can stabilize with treatment into a 1–2–5 style (depressive, identity-burdened without frank psychosis).
Protective factors: sustained medication adherence, identity-affirming environment, and strong peer supports.

1–5–9 (Hs–Mf–Ma)

Snapshot.
Here the conflict is active, driven, volatile. Somatic complaints highlight role/identity strain (5), but instead of quiet withdrawal, there’s manic or hypomanic charge (9): bursts of energy, anger, impulsivity. The narrative is: “I won’t take this silently—I’ll prove, fight, and reshape the world.”

Data & demographics.

Bipolar-spectrum conditions are strongly comorbid with somatic complaints; one study found 65% of bipolar patients reported significant somatic pain during mood episodes (Stubbs et al., 2015).
Minority stress research suggests LGBTQ individuals have higher risk of mood disorders and higher medical utilization, especially in unsupportive environments (Meyer, 2003).
Mf coding here often reflects friction between inner identity and external expectations—combined with 9, it fuels restless confrontation.

Internal dynamics.

“I’ll show them—I’ll take control, no matter the cost.”
“This body is both weapon and wound.”
“I can outwork, outfight, outlast—but the crash is brutal.”

Hs keeps distress salient; Mf frames it in identity struggle; Ma accelerates into confrontation and overextension.

Clinical prognosis.
Highly unstable. Without mood stabilization, energy crashes into depression, then surges into impulsive activism, litigation, or risky choices. Prognosis improves with bipolar-specific care (lithium, atypicals, structured sleep) and identity support, which channels energy into sustainable outlets.

Evolving dynamic (4–10 years).

If untreated: slides into 1–9–4 or 1–9–8 patterns (irritable, conflictual, sometimes psychotic).
If stabilized: energy can be harnessed into purposeful advocacy, reducing somatic distress to background noise.
Long-term studies show untreated bipolar spectrum disorders cut life expectancy by 9–20 years, primarily due to medical comorbidity and risk behaviors (Kessing et al., 2015).

1–6–7 (Hs–Pa–Pt)

Snapshot.
This codetype fuses somatic preoccupation (1) with paranoid suspicion (6) and obsessive doubt (7). The world is threatening, doctors are deceptive, and the mind runs in endless circles: “Something’s wrong, I know it, I can’t trust them, but I can’t stop checking.” Unlike 1–2–7 (hopeless rumination), the 1–6–7 is tense, suspicious, and compulsively scanning.

Data & demographics.

High in forensic settings: custody litigants with elevated Pa and Pt often present excessive medical complaints coupled with mistrust of evaluators (Archer & Krishnamurthy, 2013).
OCD and paranoia co-occur in 15–20% of psychotic patients (Poyurovsky et al., 2012), often manifesting in repeated health-checking.
Gender balance: roughly equal, but with slightly higher rates among men in forensic samples, women in clinical/medical utilization samples.

Internal dynamics.

“Doctors are hiding something—why else would they be so vague?”
“If I just check one more time, maybe I’ll catch them.”
“They think I’m crazy, but that’s because they don’t want me to know the truth.”

The somatic complaints provide proof, the paranoia provides explanation, and the obsessive doubt ensures the cycle never closes.

Clinical prognosis.
Prognosis is poor without alliance-building. Obsessions prevent closure, paranoia prevents trust, and somatic focus prevents reorientation. High risk of adversarial litigation, repeated provider-switching, and medical iatrogenesis. With long-term structured CBT/ERP for obsessions plus cautious paranoia management, slow gains are possible, but dropout rates are high.

Evolving dynamic (4–10 years).

Many devolve toward 1–6–8 (paranoid psychotic elaboration).
Some collapse into 1–2–0, retreating after repeated failed confrontations.
Rarely, with trust built, paranoia softens and the profile loosens into 1–7–0, where checking continues but adversarial stance recedes.

1–6–8 (Hs–Pa–Sc)

Snapshot.
This codetype is the archetypal persecuted somatic patient. The body is in pain (Hs), others are out to harm or deceive (Pa), and psychotic ideation (Sc) constructs elaborate persecutory narratives. Lived experience: “They tampered with me. My pain is proof. The system conspires to cover it.”

Data & demographics.

High prevalence in psychotic-spectrum disorders with somatic delusions: 20–40% of schizophrenia patients report somatic-type delusions (Stompe et al., 1995).
Legal settings: overrepresented among disability claimants with “bizarre” symptom presentations; malingering must be carefully distinguished.
Gender: slightly higher in men in forensic contexts, balanced in clinical psychosis samples.

Internal dynamics.

“The doctors are complicit.”
“My body proves I’ve been harmed by them.”
“This isn’t in my head—it’s in my flesh, in my nerves, and they planted it there.”

Pa supplies hostile attribution, Sc elaborates into delusions, Hs ensures every pain feels like evidence.

Clinical prognosis.
Very poor without antipsychotics. Insight is minimal, trust nonexistent, adherence low. Many become treatment-refractory because paranoia prevents medication compliance. Prognosis improves only when a consistent, non-coercive alliance is built.

Evolving dynamic (4–10 years).

Commonly entrenches into 1–8–9: psychotic elaboration with manic drive, sometimes violent.
Alternatively, collapses into 1–6–0: paranoid withdrawal and isolation.
Rare spontaneous remission; most remain highly impaired long term.

1–6–9 (Hs–Pa–Ma)

Snapshot.
Here, suspiciousness (6) and somatic distress (1) ignite under the manic energy of Ma (9). The result is paranoid agitation with somatic complaints: “They’re against me, my body proves it, and I won’t sit still—I’ll fight, expose, act.” Unlike 1–6–8 (delusional, withdrawn), 1–6–9 is energized, restless, often aggressive.

Data & demographics.

Seen in psychotic mood disorders and paranoid bipolar presentations.
In legal/forensic contexts, this codetype correlates with counter-suits, disruptive courtroom behavior, and aggression toward evaluators (MMPI forensic reviews: Archer & Krishnamurthy, 2013).
Men are overrepresented, especially in violent/forensic samples.

Internal dynamics.

“They’re lying—I’ll prove it.”
“Pain is my weapon; my suffering indicts them.”
“I won’t rest until they’re exposed.”

Hs ensures symptoms remain center stage, Pa attributes them to malevolence, Ma drives agitation and overaction.

Clinical prognosis.
Extremely poor without mood stabilization. High risk of violence, litigation, and chaotic treatment trajectories. Some respond to combined antipsychotic + mood stabilizer regimens, but alliance-building is difficult.

Evolving dynamic (4–10 years).

Often shifts into 1–9–4 or 1–9–8, energized conflictual states with antisocial or psychotic coloration.
If manic energy burns out, collapses toward 1–2–6, bitter depressive-paranoid stasis.
Prognosis over a decade: chronicity, institutionalization, or legal entanglements are common.

1–6–0 (Hs–Pa–Si)

Snapshot.
This is the silent paranoid somatic retreat. The body aches (Hs), trust is absent (Pa), and the person withdraws socially (Si). They interpret others as hostile, then retreat into privacy. The inner sense is: “People are dangerous. My pain proves it. I’ll stay alone and safe.”

Data & demographics.

Overrepresented in older adults, especially those with chronic medical illness plus late-onset paranoia.
Social withdrawal and suspiciousness co-occur in up to 40% of late-life psychosis cases (Howard et al., 2000).
Gender: balanced. Women present more with somatic emphasis; men more with hostile suspiciousness.

Internal dynamics.

“I’m not safe with people—they mock or exploit me.”
“My body is my excuse to stay away.”
“I’ll endure this alone; they’ll never get to me.”

The stance is avoidant rather than combative.

Clinical prognosis.
Better than 1–6–8 or 1–6–9: lower violence/agitation risk, but prognosis is still poor for quality of life. Isolation deepens, medical utilization continues but alliances are shallow. If engaged in therapy, slow progress possible via non-intrusive, validating approaches.

Evolving dynamic (4–10 years).

Entrenches into hermit-like existence with chronic somatic focus.
Sometimes drifts into 1–0, pure social withdrawal with bodily complaints as background.
Rarely expands outward into psychotic codetypes unless provoked by stress.

1–7–8 (Hs–Pt–Sc)

Snapshot.
Somatic fixation (1) collides with obsessive doubt (7) and psychotic distortion (8). The result is somatic-obsessive paranoia: checking, replaying, then crossing into delusional conviction. The experience: “Something is terribly wrong with my body. I check, I test, I research—but the more I check, the more I discover proof that it’s catastrophic. Doctors are lying or missing it.”

Data & demographics.

Health anxiety/hypochondriasis: lifetime prevalence ~5–7% in community samples, with OCD features in about 30% of cases (Salkovskis & Warwick, 2001).
Somatic delusions occur in ~20–40% of schizophrenia cases, often with themes of infestation, poisoning, or bodily manipulation (Stompe et al., 1995).
Gender balance: women more likely to present with health anxiety; men slightly more with somatic delusions.

Internal dynamics.

“If I check enough, I’ll find the hidden cause.”
“No reassurance lasts—something is being concealed.”
“This body is proof that I’m being deceived or attacked.”

The obsessive checking (Pt) keeps the system spinning; Sc provides psychotic “closure”: the cause is persecution.

Clinical prognosis.

Prognosis is poor without antipsychotic treatment for delusional elaboration.
Cognitive–behavioral interventions for health anxiety can reduce rumination but are often rejected once delusional conviction takes hold.
Prognosis worsens when litigation or disability seeking reinforces the belief.

Evolving dynamic (4–10 years).

Escalates into 1–8–9: energized persecutory psychosis.
Can collapse into 1–2–7, where despair replaces agitation but obsessions persist.
Chronic trajectory in medical utilization settings: repeated negative tests, adversarial doctor-patient relationships, and social isolation.

1–7–9 (Hs–Pt–Ma)

Snapshot.
The obsessive–somatic core (1–7) is injected with manic drive (9). Here, ruminative worry escalates into restless activity: countless doctor visits, frantic health research, impulsive “treatments” or supplements. The felt sense: “If I just act fast enough, I can outpace what’s wrong with me.”

Data & demographics.

Hypomanic energy amplifies utilization: bipolar patients report 65% somatic complaints during episodes (Stubbs et al., 2015).
“Doctor shopping” behaviors: a study of somatoform patients showed average 14.5 outpatient visits per year, far above norms (Barsky et al., 2005).
Gender: equal, but men more likely to frame as performance urgency, women as catastrophic health anxiety.

Internal dynamics.

“I can’t wait—I must act now.”
“Checking isn’t enough; I need results, movement, intervention.”
“Rest is dangerous—if I slow down, I’ll collapse.”

The Ma charge means the usual ruminative paralysis of 1–7 turns into restless, exhausting activity.

Clinical prognosis.

Unstable: burnout cycles of frantic engagement followed by collapse.
High risk of iatrogenic harm from over-testing, over-medicating, or impulsive treatments.
Prognosis improves only when energy is stabilized pharmacologically and checking is redirected behaviorally.

Evolving dynamic (4–10 years).

Escalates into 1–9–4 or 1–9–8 patterns if untreated (irritable, psychotic, or aggressive).
May collapse into 1–2–7 if manic drive burns out.
Long-term: oscillates between frenetic medical pursuit and despairing withdrawal.

1–7–0 (Hs–Pt–Si)

Snapshot.
Somatic distress (1) plus obsessive doubt (7) resolves into social retreat (0). The person withdraws, ruminating endlessly about health, replaying interactions, avoiding exposure. The experience: “If I stay away, I won’t be humiliated when my body betrays me. But in silence, my mind never stops.”

Data & demographics.

Social anxiety disorder lifetime prevalence: ~12%, often co-occurring with health anxiety and OCD traits (Kessler et al., 2005).
Isolation worsens health anxiety: isolated individuals are twice as likely to report somatic preoccupation in older-adult samples (Hawkley & Cacioppo, 2010).
Gender: women more likely to present in clinical samples; men more likely to withdraw without disclosure.

Internal dynamics.

“It’s safer alone—no one can see me fail.”
“Every symptom feels catastrophic; I keep it secret, but I obsess anyway.”
“My world shrinks, but the thoughts never stop.”

Here, the isolation prevents external conflict but worsens internal loops.

Clinical prognosis.

Somewhat better than 1–7–8 or 1–7–9: lower external disruption, but internal suffering is intense.
Prognosis is fair if isolation is interrupted with structured exposures and reassurance boundaries. Without intervention, symptoms become entrenched.

Evolving dynamic (4–10 years).

Often entrenches into chronic solitary checking, low-function lifestyle.
Can progress to 1–6–0 if suspicion colors isolation, or to 1–2–0 if despair dominates.
Positive arc possible: with engagement, can shift to 1–0, a quieter but less obsessive withdrawal.

1–8–9 (Hs–Sc–Ma)

Snapshot.
Now the body (1) is the theater for psychotic elaboration (8) with manic activation (9). Pain, sensations, and fatigue are woven into delusional conviction, pursued with restless energy. “They implanted a device in me—I’ll prove it, expose them, and show the world.” Unlike 1–6–8 (withdrawn paranoia), 1–8–9 is active, loud, and combative.

Data & demographics.

Psychotic mania prevalence: ~20% of bipolar I cases include psychotic features (Goodwin & Jamison, 2007).
Somatic delusions are common: 20–40% of schizophrenia, 25–30% of psychotic bipolar patients.
Forensic overrepresentation: violent incidents linked to psychotic somatic delusions + manic agitation.

Internal dynamics.

“This body is evidence—and I’ll make sure everyone knows it.”
“I’m unstoppable; I don’t need rest, I need to fight.”
“Every symptom is a sign I’m right.”

The manic charge makes the psychosis externalized and dangerous.

Clinical prognosis.

Very poor without strict stabilization.
High risk of violence, institutionalization, or adversarial legal entanglements.
With treatment: can partially remit, but relapse rates are high.

Evolving dynamic (4–10 years).

Commonly entrenches as chronic psychotic mania, with repeated hospitalizations.
Occasionally burns out into 1–2–8, depressive-paranoid psychosis.
Prognosis across a decade: functional decline, fractured relationships, disability dependence.

1–8–0 (Hs–Sc–Si)

The person with this profile lives in a narrowing corridor of reality. The body is never neutral: aches, fatigue, twitches, bowel shifts, all rise into awareness. Unlike ordinary discomfort, these sensations do not fade—they echo and amplify. Schizophrenic distortion (Sc) stretches these bodily experiences into something uncanny: “It isn’t just pain, it’s interference… something in me is altered.” With Si elevation, the natural response is to withdraw, and so the world contracts. Days pass in solitude, marked by an overwhelming attentiveness to bodily cues and vague but frightening suspicions.

In research on late-life psychosis, 40% report somatic themes in their delusional content (Howard et al., 2000). Chronic medical illness accelerates this drift: patients with high Hs and Sc often turn ordinary disease management into persecutory narratives, believing doctors have altered their treatment or hidden information. Social withdrawal then deepens these suspicions.

Prognosis is dominated by attrition: people do not explode outward into chaos, but rather fade into a brittle, self-contained existence. Families describe them as always alone, always tired, always talking about something “off” in the body that no one else can see. Over ten years, most stabilize into a flat, disengaged existence, sometimes housed but isolated, sometimes unvisited and forgotten. A minority progress to frank psychosis (8 dominant), others into sheer bodily hypochondriasis (1 dominant).

1–9–0 (Hs–Ma–Si)

This codetype feels like a contradiction: the body is experienced as weak, pained, failing (Hs), but inside there is a restless, irritable push to act (Ma). Social introversion (Si) channels that restless energy not into engagement but into pacing, sleeplessness, private irritability. Imagine lying in bed exhausted but unable to stop your legs from twitching, your mind from circling, your body from feeling like both victim and culprit. That is the daily rhythm.

Studies of bipolar patients show that somatic preoccupation and sleep disturbance are among the earliest and most persistent prodromes (Stubbs et al., 2015). When Si is high, these patients are far less likely to present with flamboyant mania, and far more likely to cycle in silence—overactive internally, inert externally.

Over years, this code often leads to health neglect. The body becomes the enemy, but social isolation ensures no corrective feedback interrupts the cycle. Prognosis depends on whether medical or psychiatric stabilization can enter the closed circle. If not, the dynamic usually burns down into sheer 1–0 patterns: life organized entirely around fatigue, discomfort, and absence from others.

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Codetypes: A Do-It-Yourself Guide to Analyzing Your Own MMPI-2 Results (All Scale 1 Code Types: Hypochondriasis)

1–2 (Hs–D)

1–3 (Hs–Hy)

1–4 (Hs–Pd)

1–5 (Hs–Mf)

1–6 (Hs–Pa)

1–7 (Hs–Pt)

1–8 (Hs–Sc)

1–9 (Hs–Ma)

1–0 (Hs–Si)

1–2–3 (Hs–D–Hy)

1–2–4 (Hs–D–Pd)

1–2–5 (Hs–D–Mf)

1–2–6 (Hs–D–Pa)

1–2–7 (Hs–D–Pt)

1–2–8 (Hs–D–Sc)

1–2–9 (Hs–D–Ma)

1–2–0 (Hs–D–Si)

1–3–4 (Hs–Hy–Pd)

1–3–5 (Hs–Hy–Mf)

1–3–6 (Hs–Hy–Pa)

1–3–7 (Hs–Hy–Pt)

1–3–8 (Hs–Hy–Sc)

1–3–9 (Hs–Hy–Ma)

1–3–0 (Hs–Hy–Si)

1–4–5 (Hs–Pd–Mf)

1–4–6 (Hs–Pd–Pa)

1–4–7 (Hs–Pd–Pt)

1–4–8 (Hs–Pd–Sc)

1–4–9 (Hs–Pd–Ma)

1–4–0 (Hs–Pd–Si)

1–5–6 (Hs–Mf–Pa)

1–5–7 (Hs–Mf–Pt)

1–5–8 (Hs–Mf–Sc)

1–5–9 (Hs–Mf–Ma)

1–6–7 (Hs–Pa–Pt)

1–6–8 (Hs–Pa–Sc)

1–6–9 (Hs–Pa–Ma)

1–6–0 (Hs–Pa–Si)

1–7–8 (Hs–Pt–Sc)

1–7–9 (Hs–Pt–Ma)

1–7–0 (Hs–Pt–Si)

1–8–9 (Hs–Sc–Ma)

1–8–0 (Hs–Sc–Si)

1–9–0 (Hs–Ma–Si)

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