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.
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).
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).
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.
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
Confabulation
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
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.
Many additional Frequently Asked Questions (FAQs) about Personality Disorders - click HERE!
Psychological Defense Mechanisms
Psychological Tests and Interviews
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