AFFECT. A pattern of
observable behaviors that is the expression
of a subjectively experienced feeling state
(emotion). Common examples of affect are
euphoria, anger, and sadness. Affect is
variable over time, in response to changing
emotional states, whereas mood refers to a
pervasive and sustained emotion.
A range of affect may be described as broad
(normal), restricted (constricted), blunted,
or flat. What is considered the normal range
of the expression of affect varies
considerably, both within and among different
cultures The normal expression of affect
involves variability in facial expression,
pitch of voice, and hand and body movements.
Restricted affect is characterized by a clear
reduction in the expressive range and
intensity of affects. Blunted affect is
marked by a severe reduction in the intensity
of affective expression. In flat affect there
is virtually no affective expression;
generally the voice is monotonous and the
face, immobile
Affect is inappropriate when it is clearly
discordant with the content of the person's
speech or ideation. Example: A patient smiled
and laughed while discussing demons who were
persecuting him.
Affect is labile when it is characterized by
repeated, rapid, and abrupt shifts. Examples:
An elderly man is tearful one moment and
combative the next; a young woman is observed
by her friends to be friendly, gregarious,
and happy one moment and angry and abusive
the next, without apparent reason.
AGITATION. See
psychomotor agitation.
ANXIETY. Apprehension,
tension, or uneasiness that stems from the
anticipation of danger, which may be internal
or external. Some definitions of anxiety
distinguish it from fear by limiting it to
anticipation of a danger whose source is
largely unknown, whereas fear is the response
to a consciously recognized and usually
external threat or danger. The manifestations
of anxiety and fear are the same and include
motor tension, autonomic hyperactivity,
apprehensive expectation, and vigilance and
scanning.
Anxiety may be focused on an object,
situation, or activity, which is avoided
(phobia), or may be unfocused (free-floating
anxiety). It may be experienced in discrete
periods of sudden onset and be accompanied by
physical symptoms (panic attacks). When
anxiety is focused on physical signs or
symptoms and causes preoccupation with the
fear or belief of having a disease, it is
termed hypochondria’s.
ATTENTION. The ability to
focus in a sustained manner on one activity.
A disturbance in attention may be manifested
by difficulty in finishing tasks that have
been started, easy distractibility, or
difficulty in concentrating on work.
BLOCKING. Interruption of
a train of speech before a thought or idea
has been completed. After a period of
silence, which may last from a few seconds to
minutes, the person indicates that he or she
cannot recall what he or she has been saying
or meant to say. Blocking should be judged to
be present only if the person spontaneously
describes losing his or her train of thought
or if, upon questioning by an interviewer,
gives that as the reason for pausing.
CATATONIC BEHAVIOR. Marked
motor anomalies, generally limited to
disturbances within the context of a
diagnosis of a nonorganic psychotic disorder.
Catatonic excitement. Excited
motor activity, apparently purposeless and
not Influenced by external stimuli.
Catatonic negativism. An
apparently motiveless resistance to all
instructions or attempts to be moved. When
passive, the person may resist any effort to
be moved; when active, he or she may do the
opposite of what is asked-for example, firmly
clench jaws when asked to open mouth.
Catatonic posturing.
Voluntary assumption of an inappropriate or
bizarre posture, usually held for a long
period of time. Example: A patient may stand
with arms out-stretched as if he were Jesus
on the cross.
Catatonic rigidity. Maintenance
of a rigid posture against all efforts to be
moved.
Catatonic stupor. Marked
decrease in reactivity to the environment and
reduction in spontaneous movements and
activity, sometimes to the point of appearing
to be unaware of one's surroundings.
Catatonic waxy flexibility.
the person's limbs can be "molded"
into any position, which is then maintained.
When the limb is being moved, it feels to the
examiner as if it were made of pliable wax.
CIRCUMSTANTIALITY. A term
used to describe speech that is indirect and
delayed in reaching the point because of
unnecessary, tedious details and
parenthetical remarks. Circumstantial replies
or statements may be prolonged for many
minutes if the speaker is not interrupted and
urged to get to the point. Interviewers often
respond to circumstantiality by interrupting
the speaker in order to complete the process
of history-taking within an allotted time
This may make it difficult to distinguish
loosening of associations from
circumstantiality. In the former there is a
lack of connection between clauses, but in
the latter the clauses always retain a
meaningful connection. In loosening of
associations, the original point is lost,
whereas in circurustautiality, the speaker is
always aware of the original point, goal, or
topic.
Circumstantiality is common in an Obsessive
Compulsive Personality Disorder and in many
people without mental disorder.
CLANGING. Speech in which
sounds, rather than meaningful, conceptual
relationships govern word choice; it may
include rhyming and punning. The term is
generally applied only when it is a
manifestation of a pathological condition;
thus, it would not be used to describe the
rhyming word play of children. Example.
“Im not trying to make noise. I'm trying
to make sense. If you can make sense out of
nonsense, well, have fun. I’m trying to
make sense out of sense. I'm not making sense
(cents) anymore. I have to make
dollars."
Clanging is observed most commonly in
Schizophrenia and Manic Episodes.
COMPULSION. Repetitive
and seemingly purposeful behavior that is in
response to an obsession, or performed
according to certain rules or in a
stereotyped fashion. The behavior is not an
end in itself, but is designed to produce or
prevent some future state of affairs; the
activity, however, either is not connected in
a realistic way with the state of affairs it
is designed to produce or prevent, or may be
clearly excessive. The act is performed with
a sense of subjective compulsion coupled with
a desire to resist it (at least initially);
performing the particular act is not
pleasurable, although it may afford some
relief of tension. Example: A person feels
compelled to wash her hands every time she
shakes hands because of a fear of
contamination, which she recognizes as
excessive.
Compulsions are characteristic of Obsessive
Compulsive Disorder.
CONFABULATION.
Fabrication of facts or events in response to
questions about situations or events that are
not recalled because of memory impairment. It
differs from lying in that the person is not
consciously attempting to deceive.
Confabulation is common in Amnesic Disorder.
CONVERSlON SYMPTOM. A
loss or alteration of physical functioning
that suggests a physical disorder, but that
is actually a direct expression of a
psychological conflict or need. The
disturbance is not under voluntary control,
and is not explained by any physical disorder
(this possibility having been excluded by
appropriate examinations).
Conversion symptoms are observed in
Conversion Disorder, and may occur in
Schizophrenia.
DEFENSE MECHANISMS.
Patterns of feelings, thoughts, or behaviors
that are relatively involuntary and arise in
response to perceptions of psychic danger.
They are designed to hide or to alleviate the
conflicts or stressors that give rise to
anxiety. Some defense mechanisms, such as
projection, splitting, and acting out, are
almost invariably maladaptive. Others, such
as suppression and denial, may be either
maladaptive or adaptive, depending on their
severity, their inflexibility, and the
context in which they occur. Defense
mechanisms that are usually adaptive, such as
sublimation and humor, are not included here.
Acting-out. A mechanism in
which the person acts without reflection or
apparent regard for negative consequences.
Autistic fantasy. A
mechanism in which the person substitutes
excessive daydreaming for the pursuit of
human relationships, more direct and
effective action, or problem solving.
Denial. A mechanism in which
the person fails to acknowledge some aspect
of external reality that would be apparent to
others.
Devaluation. A mechanism in
which the person attributes exaggeratedly
negative qualities to self or others.
Displacement. A mechanism in
which the person generalizes or redirects a
feeling about an object or a response to an
object onto another, usually less
threatening, object.
Dissociation. A mechanism in
which the person sustains a temporary
alteration in the integrative functions of
consciousness or identity.
Idealization. A mechanism in
which the person attributes exaggeratedly
positive qualities to self or others.
Intellectualization. A
mechanism in which the person engages in
excessive abstract thinking to avoid
experiencing disturbing feelings.
Isolation. A mechanism in
which the person is unable to experience
simultaneously the cognitive and affective
components of an experience because the
affect is kept from consciousness.
Passive aggression. A
mechanism in which the person indirectly and
inassertively expresses aggression toward
others.
Projection. A mechanism in
which the person falsely attributes his or
her own unacknowledged feelings, impulses, or
thoughts to others.
Rationalization. A mechanism
in which the person devises reassuring or
self-serving, but incorrect, explanations for
his or her own or others' behavior.
Reaction formation. A
mechanism in which the person substitutes
behavior, thoughts, or feelings that are
diametrically opposed to his or her own
unacceptable ones.
Repression. A mechanism in
which the person is unable to remember or to
be cognitively aware of disturbing wishes,
feelings, thoughts, or experiences.
Somatization. A mechanism in
which the person becomes preoccupied with
physical symptoms disproportionate to any
actual physical disturbance.
Splitting. A mechanism in
which the person views himself or herself or
others as all good or all bad, failing to
integrate the positive and the negative
qualities of self and others into cohesive
images; often the person alternately
idealizes and devalues the same person.
Suppression. A mechanism in
which the person intentionally avoids
thinking about disturbing problems, desires,
feelings, or experiences.
Undoing. A mechanism in
which the person engages in behavior designed
to symbolically make amends for or negate
previous thoughts, feelings, or actions.
DELUSION. A false
personal belief based on incorrect inference
about external reality and firmly sustained
in spite of what almost everyone else
believes and in spite of what constitutes
incontrovertible and obvious proof or
evidence to the contrary. The belief is not
one ordinarily accepted by other members of
the person's culture or subculture (i.e., it
is not an article of religious faith).
When a false belief involves an extreme value
judgment, it is regarded as a delusion only
when the judgment is so extreme as to defy
credibility. Example: if someone claims he or
she is terrible and has disappointed his or
her family, this is generally not regarded as
a delusion even if an objective assessment of
the situation would lead observers to think
otherwise; but if someone claims he or she is
the worst sinner in the world, this would
generally be considered a delusional
conviction. Similarly, a person judged by
most people to he moderately underweight who
asserts that he or she is fat would not be
regarded as delusional; but one with Anorexia
Nervosa who, at the point of extreme
emaciation, insists he or she is fat could
rightly be considered delusional.
A delusion should be distinguished from a
hallucination, which is a false sensory
perception (although a hallucination may give
rise to the delusion that the perception is
true). A delusion is also to be distinguished
from an overvalued idea, in which an
unreasonable belief or idea is not as firmly
held as is the case with a delusion.
Delusions are subdivided according to their
content. Some of the more common types are
listed below.
Delusion of being controlled. A
delusion in which feelings, impulses,
thoughts, or actions are experienced as being
not one's own, as being imposed by some
external force. This does not include the
mere conviction that one is acting as an
agent of God, has had a curse placed on him
or her, is the victim of fate, or is not
sufficiently assertive. The symptom should be
judged present only when the subject
experiences his or her will, thoughts, or
feelings as operating under some external
force. Examples: A man claimed that his words
were not his own, but those of his father; a
student believed that his actions were under
the control of a yogi; a housewife believed
that sexual feelings were being put into her
body from without.
Delusion, bizarre. A false
belief that involves a phenomenon that the
person's culture would regard as totally
implausible. example: A man believed that
when his adenoids had been removed in
childhood, a box had been inserted into his
head. and that wires had been placed in his
head so that the voice he heard was that of
the governor.
Delusion, grandiose. A delusion whose content
involves an exaggerated sense of one's
importance power, knowledge, or identity. It
may have religious, somatic, or other theme.
Delusion, mood-congruent. See
mood-congruent psychotic features.
Delusion, mood-incongruent. See
mood-incongruent psychotic features.
Delusion, nihilistic. A
delusion involving the theme of nonexistence
of the self or part of the self, others, or
the world. examples: "The world is
finished"; "I no longer have a
brain"; "There is no need to eat,
because I have no insides." A somatic
delusion may also be a nihilistic delusion if
the emphasis is on nonexistence of the body
or a part of the body.
Delusion, persecutory. A
delusion in which the central theme is that a
person or group is being attacked, harassed,
cheated, persecuted, or conspired against.
Usually the subject or someone or some group
or institution close to him or her is singled
out as the object of the persecution.
It is recommended that the term paranoid
delusion not be used, because its meanings
are multiple, confusing, and contradictory.
lt has often been employed to refer to both
persecutory and grandiose delusions because
of their presence in the Paranoid Type of
Schizophrenia.
Delusion of poverty. A
delusion that the person is, or will be,
bereft of all, or virtually all, material
possessions.
Delusion of reference. A
delusion whose theme is that events, objects,
or other people in the person's immediate
environment have a particular and unusual
significance, usually of a negative or
pejorative nature. This differs from an idea
of reference, in which the false belief is
not as firmly held as in a delusion. If the
delusion of reference involves a persecutory
theme, then a delusion of persecution is
present as well. exampIes: A woman was
convinced that programs on the radio were
directed especially to her: when recipes were
broadcast, it was to tell her to prepare
wholesome food for her child and stop feeding
her candy; when dance music was broadcast, it
was to tell her to stop what she was doing
and start dancing, and perhaps even to resume
ballet lessons. A patient noted that the room
number of his therapist's office was the same
as the number of the hospital room in which
his father died and believed that this meant
there was a plot to kill him.
Delusion, somatic. A
delusion whose main content pertains to the
functioning of one's body. Examples: One's
brain is rotting; one is pregnant despite
being postmenopausal.
Extreme value judgments about the body may,
under certain circumstances, also be
considered somatic delusions. Example; A
person insists that his nose is grossly
misshapen despite lack of confirmation of
this by observers.
Hypochondriacal delusions are also somatic
delusions when they involve specific changes
in the functioning or structure of the body
rather than merely an insistent belief that
one has a disease.
Delusion, systematized. A
single delusion with multiple
elaboration’s or a group of delusions
that are all related by the person to a
single even! or theme. Example. A man who
failed his bar examination developed the
delusion that this occurred because of a
conspiracy involving the university and the
bar association. He then attributed all other
difficulties in his social and occupational
life to this continuing conspiracy.
Delusional jealousy. The
delusion that one's sexual partner is
unfaithful.
Page
18
Back to Special Needs
Index
