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.
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,Guest Posting 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:
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
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.
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.
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
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
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.
BlockingHalted, 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).
“Human sculptures” are patients who freeze in any posture and position that they are placed, no matter how painful and unusual. Typical of catatonics.
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.
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.
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.
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).
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.
Obsessive-Compulsive Personality Disorder (OCPD) Read about the compulsive acts of the narcissist 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.
Read about narcissism and Asperger’s Disorder
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).
Read about the Narcissist’s Confabulated Life
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.
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:
The belief that one is being controlled or persecuted by stealth powers and conspiracies.
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.
The Delusional Way Out Psychosis and Delusions Ideas of Reference
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.
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.
A 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.
Feeling that one’s immediate environment is unreal, dream-like, or somehow altered. See: Depersonalization.
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.
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.
Flight of Ideas
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.
More about the manic phase of the Bipolar disorder
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.