Psychological Signs and Symptoms
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The first encounter between psychiatrist or therapist and
patient (or client) is multi-phased. The mental health practitioner notes the
patient's history and administers or prescribes a physical examination to rule
out certain medical conditions. Armed with the results, the diagnostician now
observes the patient carefully and compiles lists of signs and symptoms, grouped
into syndromes.
Symptoms are the patient's complaints. They are highly subjective and amenable
to suggestion and to alterations in the patient's mood and other mental
processes. Symptoms are no more than mere indications. Signs, on the other hand,
are objective and measurable. Signs are evidence of the existence, stage, and
extent of a pathological state. Headache is a symptom - short-sightedness (which
may well be the cause of the headache) is a sign.
Here is a partial list of the most important signs and symptoms in alphabetical
order:
Affect
We all experience emotions, but each and every one of us expresses them
differently. Affect is HOW we express our innermost feelings and how other
people observe and interpret our expressions. Affect is characterized by the
type of emotion involved (sadness, happiness, anger, etc.) and by the intensity
of its expression. Some people have flat affect: they maintain "poker faces",
monotonous, immobile, apparently unmoved. This is typical of the Schizoid
Personality Disorder Others have blunted, constricted, or broad (healthy)
affect. Patients with the dramatic (Cluster B) personality disorders -
especially the Histrionic and the Borderline - have exaggerate and labile
(changeable) affect. They are "drama queens".
In certain mental health disorders, the affect is inappropriate. For instance:
such people laugh when they recount a sad or horrifying event or when they find
themselves is morbid settings (e.g., in a funeral). Also see:
Mood.
Read about inappropriate
affect in narcissists
Ambivalence
We have all come across situations and dilemmas which evoked equipotent - but
opposing and conflicting - emotions or ideas. Now, imagine someone with a
permanent state of inner turmoil: her emotions come in mutually exclusive pairs,
her thoughts and conclusions arrayed in contradictory dyads. The result is, of
course, extreme indecision, to the point of utter paralysis and inaction.
Sufferers of Obsessive-Compulsive Disorders and the Obsessive-Compulsive
Personality Disorder are highly ambivalent.
Anhedonia
When we lose the urge to seek pleasure and to prefer it to nothingness or even
pain, we become anhedonic. Depression inevitably involves anhedonia. the
depressed are unable to conjure sufficient mental energy to get off the couch
and do something because they find everything equally boring and unattractive.
(continued below)
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Anorexia
Diminished appetite to the point of refraining from eating. Whether it is part
of a depressive illness or a body dysmorphic disorder (erroneous perception of
one's body as too fat) is still debated. Anorexia is one of a family of eating
disorders which also includes bulimia (compulsive gorging on food and then its
forced purging, usually by vomiting).
Learn more about comorbidity of
eating disorders and personality disorders
Anxiety
A kind of unpleasant (dysphoric), mild fear, with no apparent external reason.
Anxiety is akin to dread, or apprehension, or fearful anticipation of some
imminent but diffuse and unspecified danger. The mental state of anxiety (and
the concomitant hypervigilance) has physiological complements: tensed muscle
tone, elevated blood pressure, tachycardia, and sweating (arousal).
Generalized Anxiety Disorder is sometimes
misdiagnosed as a personality
disorder
Autism
More precisely: autistic thinking and inter-relating (relating to other people).
Fantasy-infused thoughts. The patient's cognitions derive from an overarching
and all-pervasive fantasy life. Moreover, the patient infuses people and events
around him or her with fantastic and completely subjective meanings. The patient
regards the external world as an extension or projection of the internal one.
He, thus, often withdraws completely and retreats into his inner, private realm,
unavailable to communicate and interact with others.
Asperger's Disorder, one of the spectrum of autistic disorders, is sometimes
misdiagnosed as
Narcissistic Personality Disorder (NPD)
Automatic obeisance or obedience
Automatic, unquestioning, and immediate obeisance of all commands, even the most
manifestly absurd and dangerous ones. This suspension of critical judgment is
sometimes an indication of incipient catatonia.
Blocking
Halted, frequently interrupted speech to the point of incoherence indicates a
parallel disruption of thought processes. The patient appears to try hard to
remember what it was that he or she were saying or thinking (as if they "lost
the thread" of conversation).
(continued below)
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Catalepsy
"Human sculptures" are patients who freeze in any posture and position that
they are placed, no matter how painful and unusual. Typical of catatonics.
Catatonia
A syndrome comprised of various signs, amongst which are: catalepsy, mutism,
stereotypy, negativism, stupor, automatic obedience, echolalia, and
echopraxia. Until recently it was thought to be related to schizophrenia,
but this view has been discredited when the biochemical basis for
schizophrenia had been discovered. The current thinking is that catatonia is
an exaggerated form of mania (in other words: an affective disorder). It is
a feature of catatonic schizophrenia, though, and also appears in certain
psychotic states and mental disorders that have organic (medical) roots.
Cerea Flexibilitas
Literally: wax-like flexibility. In the common form of catalepsy, the
patient offers no resistance to the re-arrangement of his limbs or to the
re-alignment of her posture. In Cerea Flexibilitas, there is some
resistance, though it is very mild, much like the resistance a sculpture
made of soft wax would offer.
Circumstantiality
When the train of thought and speech is often derailed by unrelated
digressions, based on chaotic associations. The patient finally succeeds to
express his or her main idea but only after much effort and wandering. In
extreme cases considered to be a communication disorder.
Clang Associations
Rhyming or punning associations of words with no logical connection or any
discernible relationship between them. Typical of manic episodes, psychotic
states, and schizophrenia.
Clouding
(Also: Clouding of Consciousness)
The patient is wide awake but his or her awareness of the environment is
partial, distorted, or impaired. Clouding also occurs when one gradually
loses consciousness (for instance, as a result of intense pain or lack of
oxygen).
(continued below)
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Compulsion
Involuntary repetition of a stereotyped and ritualistic action or movement,
usually in connection with a wish or a fear. The patient is aware of the
irrationality of the compulsive act (in other words: she knows that there is
no real connection between her fears and wishes and what she is repeatedly
compelled to do). Most compulsive patients find their compulsions tedious,
bothersome, distressing, and unpleasant - but resisting the urge results in
mounting anxiety from which only the compulsive act provides much needed
relief. Compulsions are common in obsessive-compulsive disorders, the
Obsessive-Compulsive Personality Disorder (OCPD), and in certain types of
schizophrenia.
Concrete Thinking
Inability or diminished capacity to form abstractions or to think using
abstract categories. The patient is unable to consider and formulate
hypotheses or to grasp and apply metaphors. Only one layer of meaning is
attributed to each word or phrase and figures of speech are taken literally.
Consequently, nuances are not detected or appreciated. A common feature of
schizophrenia, autism spectrum disorders, and certain organic disorders.
The constant and unnecessary fabrication of information or events to fill in
gaps in the patient's memory, biography or knowledge, or to substitute for
unacceptable reality. Common in the Cluster B personality disorders
(narcissistic, histrionic, borderline, and antisocial) and in organic memory
impairment or the amnestic syndrome (amnesia).
Confusion
Complete (though often momentary) loss of orientation in relation to one's
location, time, and to other people. Usually the result of impaired memory
(often occurs in dementia) or attention deficit (for instance, in delirium).
Also see:
Disorientation.
(continued below)
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Delirium
Delirium is a syndrome which involves clouding, confusion,
restlessness, psychomotor disorders (retardation or, on the opposite
pole, agitation), and mood and affective disturbances (lability).
Delirium is not a constant state. It waxes and wanes and its onset is
sudden, usually the result of some organic affliction of the brain.
A belief, idea, or conviction firmly held despite abundant information
to the contrary. The partial or complete loss of reality test is the
first indication of a psychotic state or episode. Beliefs, ideas, or
convictions shared by other people, members of the same collective,
are not, strictly speaking, delusions, although they may be hallmarks
of shared psychosis. There are many types of delusions:
I. Paranoid
The belief that one is being controlled or persecuted by stealth
powers and conspiracies.
2. Grandiose-magical
The conviction that one is important, omnipotent, possessed of occult
powers, or a historic figure.
3. Referential (ideas of reference)
The belief that external, objective events carry hidden or coded
messages or that one is the subject of discussion, derision, or
opprobrium, even by total strangers.
Dementia
Simultaneous impairment of various mental faculties, especially the
intellect, memory, judgment, abstract thinking, and impulse control
due to brain damage, usually as an outcome of organic illness.
Dementia ultimately leads to the transformation of the patient's whole
personality. Dementia does not involve clouding and can have acute or
slow (insidious) onset. Some dementia states are reversible.
(continued below)
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Depersonalization
Feeling that one's body has changed shape or that specific organs
have become elastic and are not under one's control. Usually coupled
with "out of body" experiences. Common in a variety of mental health
and physiological disorders: depression, anxiety, epilepsy,
schizophrenia, and hypnagogic states. Often observed in adolescents.
See:
Derealization.
DerailmentA
loosening of associations. A pattern of speech in which unrelated or
loosely-related ideas are expressed hurriedly and forcefully, with
frequent topical shifts and with no apparent internal logic or
reason. See: Incoherence.
Feeling that one's immediate environment is unreal, dream-like, or
somehow altered. See: Depersonalization.
Warped Reality
Dereistic Thinking
Inability to incorporate reality-based facts and logical
inference into one's thinking. Fantasy-based thoughts.
Not knowing what year, month, or day it is or not knowing one's
location (country, state, city, street, or building one is in).
Also: not knowing who one is, one's identity. One of the signs
of delirium.
Imitation by way of exactly repeating another person's
speech. Involuntary, semiautomatic, uncontrollable, and repeated
imitation of the speech of others. Observed in organic mental
disorders, pervasive developmental disorders, psychosis, and
catatonia. See:
Echopraxia.
Imitation by way or
exactly repeating another person's movements. Involuntary,
semiautomatic, uncontrollable, and repeated imitation of the
movements of others. Observed in organic mental disorders,
pervasive developmental disorders, psychosis, and catatonia.
See: Echolalia.
Rapidly verbalized train of unrelated thoughts or of
thoughts related only via relatively-coherent
associations. Still, in its extreme forms, flight of
ideas involves cognitive incoherence and
disorganization. Appears as a sign of mania, certain
organic mental health disorders, schizophrenia, and
psychotic states. Also see:
Pressure of Speech
and
Loosening of
Associations.
Folie a Deux (Madness in Twosome, Shared
Psychosis)
The sharing of delusional (often persecutory) ideas and
beliefs by two or more (folie a plusieurs) persons who
cohabitate or form a social unit (e.g., a family, a
cult, or an organization). One of the members in each
of these groups is dominant and is the source of the
delusional content and the instigator of the
idiosyncratic behaviors that accompany the delusions.
Read more about Shared Psychosis and cults - click
on these links:
Fugue
Vanishing act. A sudden flight or wandering away and disappearance from
home or work, followed by the assumption of a new identity and the
commencement of a new life in a new place. The previous life is
completely erased from memory (amnesia). When the fugue is over, it is
also forgotten as is the new life adopted by the patient.
False perceptions based on false sensa (sensory input) not triggered by
any external event or entity. The patient is usually not psychotic - he
is aware that he what he sees, smells, feels, or hears is not there.
Still, some psychotic states are accompanied by hallucinations (e.g.,
formication - the feeling that bugs are crawling over or under one's
skin).
There are a few classes of hallucinations:
Auditory - The false perception of voices and sounds (such as
buzzing, humming, radio transmissions, whispering, motor noises, and so
on).
Gustatory - The false perception of tastes
Olfactory - The false perception of smells and scents (e.g.,
burning flesh, candles)
Somatic - The false perception of processes and events that are
happening inside the body or to the body (e.g., piercing objects,
electricity running through one's extremities). Usually supported by an
appropriate and relevant delusional content.
Tactile - The false sensation of being touched, or crawled upon
or that events and processes are taking place under one's skin. Usually
supported by an appropriate and relevant delusional content.
Visual - The false perception of objects, people, or events in
broad daylight or in an illuminated environment with eyes wide open.
Hypnagogic and Hypnopompic - Images and trains of events
experienced while falling asleep or when waking up. Not hallucinations
in the strict sense of the word.
Hallucinations are common in schizophrenia, affective disorders, and
mental health disorders with organic origins. Hallucinations are also
common in drug and alcohol withdrawal and among substance abusers.
(continued below)
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Ideas of Reference
Weak delusions of reference, devoid of inner conviction and with a
stronger reality test. See:
Delusion.
Illusion
The misperception or misinterpretation of real external - visual
or auditory - stimuli, attributing them to non-existent events
and actions. Incorrect perception of a material object. See:
Hallucination.
Incomprehensible speech, rife with severely loose associations,
distorted grammar, tortured syntax, and idiosyncratic
definitions of the words used by the patient ("private
language"). A loosening of associations. A pattern of speech in
which unrelated or loosely-related ideas are expressed hurriedly
and forcefully, using broken, ungrammatical, non-syntactical
sentences, an idiosyncratic vocabulary ("private language"),
topical shifts, and inane juxtapositions ("word salad"). See:
Loosening of Associations;
Flight of Ideas;
Tangentiality.
Insomnia
Sleep disorder or disturbance involving difficulties to either
fall asleep ("initial insomnia") or to remain asleep ("middle
insomnia"). Waking up early and being unable to resume sleep is
also a form of insomnia ("terminal insomnia").
Thought and speech
disorder which involves the translocation of the focus of
attention from one subject to another for no apparent reason.
The patient is usually unaware of the fact that his train of
thoughts and his speech are incongruous and incoherent. A sign
of schizophrenia and some psychotic states. See: Incoherence;
Flight of Ideas;
Tangentiality.
Pervasive and sustained feelings and emotions as subjectively
described by the patient. The same phenomena observed by the
clinician are called affect. Mood can be either dysphoric
(unpleasant) or euphoric (elevated, expansive, "good mood").
Dysphoric moods are characterized by a reduced sense of
well-being, depleted energy, and negative self-regard or sense
of self-worth. Euphoric moods typically involve an increased
sense of well-being, ample energy, and a stable sense of
self-worth and self-esteem. Also see:
Affect.
Mood Congruence and Incongruence
The contents of mood-congruent hallucinations and
delusions are consistent and compatible with the patient's
mood. During the manic phase of the Bipolar Disorder, for
instance, such hallucinations and delusions involve
grandiosity, omnipotence, personal identification with
great personalities in history or with deities, and
magical thinking. In depression, mood-congruent
hallucinations and delusions revolve around themes like
the patient's self-misperceived faults, shortcomings,
failures, worthlessness, guilt - or the patient's
impending doom, death, and "well-deserved" sadistic
punishment.
The contents of mood-incongruent hallucinations and
delusions are inconsistent and incompatible with the
patient's mood. Most persecutory delusions and delusions
and ideas of reference, as well as phenomena such as
control "freakery" and Schneiderian First-rank Symptoms
are mood-incongruent. Mood incongruence is especially
prevalent in schizophrenia, psychosis, mania, and
depression.
Misdiagnosing the Bipolar Disorder as Narcissistic
Personality Disorder
Depression and Cluster B Personality Disorders - click
on these links:
Mutism
Abstention from
speech or refusal to speak. Common in catatonia.
In catatonia, complete opposition and resistance to suggestion.
Neologism
In schizophrenia and other psychotic disorders, the invention of
new "words" which are meaningful to the patient but meaningless
to everyone else. To form the neologisms, the patient fuses
together and combines syllables or other elements from existing
words.
Obsession
Recurring and intrusive images, thoughts, ideas, or wishes that
dominate and exclude other cognitions. The patient often finds
the contents of his obsessions unacceptable or even repulsive
and actively resists them, but to no avail. Common in
schizophrenia and obsessive-compulsive disorder.
Panic Attack
A form of severe
anxiety attack accompanied by a sense of losing control and
of an impending and imminent life-threatening danger (where
there is none). Physiological markers of panic attacks
include palpitation, sweating, tachycardia (rapid heart
beats), dyspnea or apnoea (chest tightening and difficulties
breathing), hyperventilation, light-headedness or dizziness,
nausea, and peripheral paresthesias (an abnormal sensation
of burning, prickling, tingling, or tickling). In normal
people it is a reaction to sustained and extreme stress.
Common in many mental health disorders.
Sudden,
overpowering feelings of imminent threat and apprehension,
bordering on fear and terror. There usually is no external
cause for alarm (the attacks are uncued or unexpected, with
no situational trigger) - though some panic attacks are
situationally-bound (reactive) and follow exposure to "cues"
(potentially or actually dangerous events or circumstances).
Most patients display a mixture of both types of attacks
(they are situationally predisposed).
Bodily
manifestations include shortness of breath, sweating,
pounding heart and increased pulse as well as palpitations,
chest pain, overall discomfort, and choking. Sufferers often
describe their experience as being smothered or suffocated.
They are afraid that they may be going crazy or about to
lose control.
Misdiagnosing General Anxiety Disorder (GAD) as
Narcissistic Personality Disorder
Paranoia
Psychotic grandiose and persecutory delusions.
Paranoids are characterized by a paranoid style: they
are rigid, sullen, suspicious, hypervigilant,
hypersensitive, envious, guarded, resentful, humorless,
and litigious. Paranoids often suffer from paranoid
ideation - they believe (though not firmly) that they
are being stalked or followed, plotted against, or
maliciously slandered. They constantly gather
information to prove their "case" that they are the
objects of conspiracies against them. Paranoia is not
the same as Paranoid Schizophrenia, which is a subtype
of schizophrenia.
Paranoid Personality Disorder
(continued below)
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Repeating the same gesture, behavior, concept,
idea, phrase, or word in speech. Common in
schizophrenia, organic mental disorders, and
psychotic disorders.
Phobia
Dread of a particular object or situation,
acknowledged by the patient to be irrational or
excessive. Leads to all-pervasive avoidance
behavior (attempts to avoid the feared object or
situation).
A persistent, unfounded, and
irrational fear or dread of one or more classes
of objects, activities, situations, or locations
(the phobic stimuli) and the resulting
overwhelming and compulsive desire to avoid
them. See:
Anxiety.
Posturing
Assuming and remaining in abnormal and contorted
bodily positions for prolonged periods of time.
Typical of catatonic states.
Poverty of Content (of Speech)
Persistently vague, overly abstract or concrete,
repetitive, or stereotyped speech.
Poverty of Speech
Reactive, non-spontaneous, extremely brief,
intermittent, and halting speech. Such patients
often remain silent for days on end unless and
until spoken to.
Rapid, condensed, unstoppable and "driven"
speech. The patient dominates the conversation,
speaks loudly and emphatically, ignores
attempted interruptions, and doesn't care if
anyone is listening or responding to him or her.
Seen in manic states, psychotic or organic
mental disorders, and conditions associated with
stress. See: Flight
of Ideas.
Mounting internal
tension associated with excessive, non-productive
(not goal orientated), and repeated motor
activity (hand wringing, fidgeting, and similar
gestures). Hyperactivity and motor restlessness
which co-occur with anxiety and irritability.
Psychomotor Retardation
Visible slowing of speech or movements or both.
Usually affects the entire range of performance
(entire repertory). Typically involves poverty of
speech, delayed response time (subjects answer
questions after an inordinately long silence),
monotonous and flat voice tone, and constant
feelings of overwhelming fatigue.
Psychosis
Chaotic thinking that is the result of a
severely impaired reality test ( the patient
cannot tell inner fantasy from outside reality).
Some psychotic states are short-lived and
transient (microepisodes). These last from a few
hours to a few days and are sometimes reactions to
stress. Persistent psychoses are a fixture of the
patient's mental life and manifest for months or
years.
Psychotics are fully aware of events and people
"out there". They cannot, however separate data
and experiences originating in the outside world
from information generated by internal mental
processes. They confuse the external universe with
their inner emotions, cognitions, preconceptions,
fears, expectations, and representations.
Consequently, psychotics have a distorted view
of reality and are not rational. No amount of
objective evidence can cause them to doubt or
reject their hypotheses and convictions.
Full-fledged psychosis involves complex and ever
more bizarre delusions and the unwillingness to
confront and consider contrary data and
information (preoccupation with the subjective
rather than the objective). Thought becomes
utterly disorganized and fantastic.
There is a thin line separating nonpsychotic
from psychotic perception and ideation. On this
spectrum we also find the schizotypal personality
disorder.
Narcissism, Psychosis, and Delusions
Reality Sense
The way one thinks about, perceives, and feels reality.
Reality Testing
Comparing one's reality sense and one's hypotheses about the way things are and how things operate to objective, external cues from the environment.
A list of symptoms compiled by Kurt Schneider, a German psychiatrist, in 1957 and indicative of the presence of schizophrenia. Includes:
Auditory hallucinations
Hearing conversations between a few imaginary "interlocutors", or one's thoughts spoken out loud, or a running background commentary on one's actions and thoughts.
Somatic hallucinations
Experiencing imagined sexual acts couple with delusions attributed to forces, "energy", or hypnotic suggestion.
Thought withdrawal
The delusion that one's thoughts are taken over and controlled by others and then "drained" from one's brain.
Thought insertion
The delusion that thoughts are being implanted or inserted into one's mind involuntarily.
Thought broadcasting
The delusion that everyone can read one's mind, as though one's thoughts were being broadcast.
Delusional perception
Attaching unusual meanings and significance to genuine perceptions, usually with some kind of (paranoid or narcissistic) self-reference.
Delusion of control
The delusion that one's acts, thoughts, feelings, perceptions, and impulses are directed or influenced by other people.
Stereotyping or Stereotyped movement (or motion)
Repetitive, urgent, compulsive, purposeless, and non-functional movements, such as head banging, waving, rocking, biting, or picking at one's nose or skin. Common in catatonia, amphetamine poisoning, and schizophrenia.
(continued below)
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Stupor
Restricted and constricted consciousness akin in some respects to coma. Activity, both mental and physical, is limited. Some patients in stupor are unresponsive and seem to be unaware of the environment. Others sit motionless and frozen but are clearly cognizant of their surroundings. Often the result of an organic impairment. Common in catatonia, schizophrenia, and extreme depressive states.
Inability or unwillingness to focus on an idea, issue, question, or theme of conversation. The patient "takes off on a tangent" and hops from one topic to another in accordance with his own coherent inner agenda, frequently changing subjects, and ignoring any attempts to restore "discipline" to the communication. Often co-occurs with speech derailment. As distinct from loosening of associations, tangential thinking and speech are coherent and logical but they seek to evade the issue, problem, question, or theme raised by the other interlocutor.
Thought Broadcasting, Though Insertion, Thought Withdrawal
Thought Disorder
A consistent disturbance that affects the process or content of thinking, the use of language, and, consequently, the ability to communicate effectively. An all-pervasive failure to observe semantic, logical, or even syntactical rules and forms. A fundamental feature of schizophrenia.
Vegetative Signs
A set of signs in depression which includes loss of appetite, sleep disorder, loss of sexual drive, loss of weight, and constipation. May also indicate an eating disorder.
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Malignant
Self Love - Narcissism Revisited
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