Examiners do not perform formal or complete psychiatric
Examiner is expected to form a general impression of the emotional stability and
mental state of the applicant.
There is a need for discretion in
the Examiner / airman relationship consistent with the FAA's aviation
safety mission and privacy.
Review of an airman applicant's history as provided on the application form may
alert the Examiner to gather further important factual information.
Information about the applicant may be found in items related to age,
pilot time, and class of certificate for which applied. Information about
the present occupation and employer also may be helpful. If any
psychotropic drugs are or have been used, the examiner will defer the
decision to the FAA who will in-turn investigate. Previous medical denials or aircraft accidents
are also considered as they may be related
to psychiatric problems.
Psychiatric information can be derived from the individual items in
medical history (FAA FORM 8500-8, Item 18). Any affirmative answers to
Item 18.m., " Mental disorders of any sort; depression, anxiety, etc.," or
Item 18.p., "Suicide attempt," are significant. Any disclosure of current
or previous alcohol or drug problems requires further clarification.
record of traffic violations may reflect certain personality problems or
indicate an alcohol problem. Affirmative answers related to rejection by
military service or a military medical discharge require elaboration.
Reporting symptoms such as headaches or dizziness, or even heart or
stomach trouble, may reflect a history of anxiety rather than a primary
medical problem in these areas.
Sometimes, the information applicants give
about their previous diagnoses is incorrect, either because the applicant
is unsure of the correct information or because the applicant chooses to
minimize past difficulties. If there was a hospital admission for any
emotionally related problem, it will be necessary to obtain the entire
Valuable information is often derived from the casual conversation that
occurs during the physical examination. Some of this conversation may
reveal information about the family, the job, and special interests. Even
some personal troubles may be revealed at this time. The Examiner is
discouraged from questions which are stilted or follow a regular pattern;
instead, they are encouraged to inquire in a manner that is a natural
extension of the Examiner's curiosity.
Information about the motivation for medical certification and interest in
flying may be revealing. While a formal Mental Status Examination may not
be necessary. While an examiner may not ask about time, place, or
person to discover whether the applicant is oriented, information about
the flow of associations, mood, and memory, is generally available from
the usual interactions during the examination. Indication of cognitive
problems may become apparent during the examination. Such problems with
concentration, attention, or confusion during the examination or slower,
vague responses will noted and may be cause for deferral.
The examiner typically makes observations about the following specific
elements and will note any gross or notable deviations from
1. Appearance (abnormal if dirty, disheveled, odoriferous, or unkempt).
2. Behavior (abnormal if uncooperative, bizarre, or inexplicable).
3. Mood (abnormal if excessively angry, sad, euphoric, or labile).
4. Communication (abnormal if incomprehensible, does not answer questions
5. Memory (abnormal if unable to recall recent events).
6. Cognition (abnormal if unable to engage in abstract thought, or if
delusional or hallucinating).
Significant observations during this part of the medical examination will
be recorded in Item 60 of the application form. The Examiner, upon
identifying any significant problems, will defer issuance of the medical
certificate and report findings to the FAA.
It must be pointed out that considerations for safety, which in the
"mental" area are related to a compromise of judgment and emotional
control or to diminished mental capacity with loss of behavioral control,
are not the same as concerns for emotional health in everyday life. Some
problems may have only a slight impact on an individual's overall
capacities and the quality of life but may nevertheless have a great
impact on safety. Conversely, many emotional problems that are of
therapeutic and clinical concern have no impact on safety.
The reasons that an applicant has seen a mental health professional must be revealed, but may be found not to have significance for medical
certification. For instance, growth and adjustment problems requiring
psychotherapy are usually not considered significant for safety when there
have been no vocational disruptions and medications have not been used.
This might include marital counseling or psychotherapy for identity
problems or issues of growth and personal fulfillment. A history of brief
situational problems secondary to such life events as marital disruption,
business problems, and the death of loved ones may likewise not be
significant. Also, sexual behavior that does not reflect upon overall
judgment and self-control is not a concern for safety.
The FAA has concluded that certain psychiatric conditions are such that
their presence or a past history of their presence is sufficient to
suggest a significant potential threat to safety. Examiners, once aware of
any indications of these conditions currently, or in the past, will deny or defer issuance of the
medical certificate to an applicant who has a history of these conditions.
An applicant who has a current diagnosis or history of these conditions
(listed below) may request the FAA to grant an Authorization under the
special issuance section of Part 67 (14 CFR 67.401) and, based upon
individual considerations, the FAA may grant such an issuance.
The use of a psychotropic drug is generally considered disqualifying. This includes
all sedatives, tranquilizers, antipsychotic drugs, antidepressant drugs
(including SSRI's), analeptics, anxiolytics, and hallucinogens. The
Examiner will defer issuance and forward the medical records to the FAA.
1. The category of personality disorder severe enough to have repeatedly
manifested itself by overt acts refers to diagnosed personality disorders
that involve what is called "acting out" behavior. These personality
problems relate to poor social judgment, impulsivity, and disregard or
antagonism toward authority, especially rules and regulations. A history
of long-standing behavioral problems, whether major (criminal) or
relatively minor (truancy, military misbehavior, petty criminal and civil
indiscretions, and social instability), usually occurs with these
disorders. Driving infractions and previous failures to follow aviation
regulations are critical examples of these acts.
2. The category of psychosis includes schizophenia and some bipolar and
major depression, as well as some other rarer conditions. In addition,
some conditions such as schizotypal and borderline personality disorders
that include psychotic symptoms at some time in their course may also be
3. A bipolar disorder may not reach the level of psychosis but can be so
disruptive of judgment and functioning (especially mania) so as to
interfere with aviation safety. All applicants with such a diagnosis must
be denied or deferred. However, a number of these applicants, so
diagnosed, may be favorably considered for an Authorization when the
symptoms do not constitute a threat to safe aviation operations.
4. Certain personality disorders and other mental disorders that include
conditions of limited duration and/or widely varying severity may be
disqualifying. Under this category, the FAA is especially concerned with
significant depressive episodes requiring treatment, even outpatient
therapy. If these episodes have been severe enough to cause some
disruption of vocational or educational activity, or if they have required
medication or involved suicidal ideation, the application should be
deferred or denied issuance.
Some personality disorders and situational dysphorias may be considered
disqualifying for a limited time. These include such conditions as gross
immaturity and some personality disorders not involving or manifested by
Although they may be rare in occurrence, severe anxiety problems,
especially anxiety and phobias associated with some aspect of flying, are
considered significant. Organic mental disorders that cause a cognitive
defect, even if the applicant is not psychotic, are considered
disqualifying whether they are due to trauma, toxic exposure, or
arteriosclerotic or other degenerative changes.
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