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Mental health

A glossary of key terms related to mental health and psychosocial problems that teachers (and parents) may detect in their students:

A

abnormality

In psychological terms, any mental, emotional, or behavioral activity that deviates from culturally or scientifically accepted norms.

abreaction

Emotional release or discharge after recalling a painful experience that has been repressed because it was not consciously tolerable (see conscious). A therapeutic effect sometimes occurs through partial or repeated discharge of the painful affect. See also systematic desensitization.

abstinence

Foregoing some kind of gratification; in the area of alcohol or drug dependence, being without the substance on which the subject had been dependent.

abuse, substance

Impairment in social and occupational functioning resulting from the pathological and “compulsive” use of a substance. The concept is closely related to the definition of substance dependence, which has similar symptoms of impairment but may include evidence of physiological tolerance or withdrawal. Typical symptoms of abuse include failure to fulfill major role obligations at work, school, or home; recurrent use of the substance in situations where such use is physically hazardous; substance-related legal problems; and continued use even though it causes or exaggerates interpersonal problems. See also dependence, substance.

abused child

A child or infant who has suffered repeated injuries, which may include bone fractures, neurologic and psychological damage, or sexual abuse at the hands of a parent, parents, or parent surrogate(s). The abuse takes place repeatedly and is often precipitated, in the case of physical abuse, by the child’s minor and normally irritating behavior. Child abuse also includes child neglect.

academic problem

School difficulty that is not due to a mental disorder.Examples are failing grades or significant underachievement in a person with adequate intellectual capacity.

academic disorders

In DSM-IV, this is a major group of infancy, childhood, and adolescence disorders that includes reading disorder, mathematics disorder, and disorder of written expression.

accident-proneness

Susceptibility to accidents based on psychological causes or motivations, usually unconscious.

acculturation difficulty

A problem in adapting to or finding an appropriate way to adapt to a different culture or environment. The problem is not based on any coexisting mental disorder.

acting out

Expressions of unconscious emotional conflicts or feelings in actions rather than words. The person is not consciously aware of the meaning of such acts (see conscious). Acting out may be harmful or, in controlled situations, therapeutic (e.g., children’s play therapy).

adaptation

Fitting one’s behavior to meet the needs of one’s environment, which often involves a modification of impulses, emotions, or attitudes.

addiction

Dependence on a chemical substance to the extent that a physiological and/or psychological need is established. This may be manifested by any combination of the following symptoms: tolerance, preoccupation with obtaining and using the substance, use of the substance despite anticipation of probable adverse consequences, repeated efforts to cut down or control substance use, and withdrawal symptomswhen the substance is unavailable or not used.

ADHD

See attention-deficit/hyperactivity disorder.

adjustment

Often transitory functional alteration or accommodation by which one can better adapt oneself to the immediate environment and to one’s inner self. See also adaptation.

adjustment disorder

An imprecise term referring to emotional or behavioral symptoms that develop in response to an identifiable stressor. The symptoms, which may include anxiety, depressed mood, and disturbance of conduct, are clinically significant in that the distress exceeds what would be expected under the circumstances, or significant impairment in social or occupational functioning is produced. Duration of symptoms tends to be self-limited, not persisting more than 6 months after termination of the stressor or its consequences. Sometimes the disorder is designated as “acute” if duration is 6 months or less, and as “persistent” or “chronic” if symptoms endure beyond 6 months.

affect

Behavior that expresses a subjectively experienced feeling state (emotion); affect is responsive to changing emotional states, whereas mood refers to a pervasive and sustained emotion. Common affects are euphoria, anger, and sadness. Some types of affect disturbance are:

blunted

Severe reduction in the intensity of affective expression.

flat

Absence or near absence of any signs of affective expression such as a monotonous voice and an immobile face.

inappropriate

Discordance of voice and movements with the content of the person’s speech or ideation.

labile

Abnormal variability, with repeated, rapid, and abrupt shifts in affective expression.

restricted or constricted

Reduction in the expressive range and intensity of affects.

affective disorder

A disorder in which mood change or disturbance is the primary manifestation. Now referred to as mood disorder. See depression.

aggression

Forceful physical, verbal, or symbolic action. May be appropriate and self- protective, including healthy self-assertiveness, or inappropriate as in hostile or destructive behavior. May also be directed toward the environment, toward another person or personality, or toward the self, as in depression.

agitation

Excessive motor activity, usually nonpurposeful and associated with internal tension. Examples include inability to sit still, fidgeting, pacing, wringing of hands, and pulling of clothes. See psychomotor agitation.

agoraphobia

Anxiety about being in places or situations in which escape might be difficult or embarrassing or in which help may not be available should a panic attack occur. The fears typically relate to venturing into the open, of leaving the familiar setting of one’s home, or of being in a crowd, standing in line, or traveling in a car or train. Although agoraphobia usually occurs as a part of panic disorder, agoraphobia without a history of panic disorder has been described.

alcohol dependence

Dependence on alcohol characterized by either tolerance to the agent or development of withdrawal phenomena on cessation of, or reduction in, intake. Other aspects of the syndrome are psychological dependence and impairment in social and/or vocational functioning. This is also called alcoholism.

Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA)

An agency in the U.S. Department of Health and Human Services that was replaced in 1992 by the Substance Abuse and Mental Health Services Administration (SAMHSA). In reorganizing ADAMHA into SAMHSA, the three ADAMHA research institutes, the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National institute on Drug Abuse (NIDA), and the National Institute of Mental Health (NIMH), were moved to the National Institutes of Health. What remain in SAMHSA are the substance abuse and mental health services programs.

alcohol hallucinosis

An organic mental disorder consisting of auditory hallucinations occurring in a clear sensorium, developing shortly after the reduction or cessation of drinking, usually within 48 hours. The disorder commonly follows prolonged and heavy alcohol use.

alcohol psychosis

A group of major mental disorders associated with organic brain dysfunction due to alcohol; in DSM-IV, categorized as alcohol-induced psychotic disorder. Includes delirium tremens and alcohol hallucinosis.

alcohol use disorders

In DSM-IV, this group includes alcohol dependence, alcohol abuse, alcohol intoxication, alcohol withdrawal, alcohol delirium, alcohol persisting dementia, alcohol persisting amnestic disorder, alcohol psychotic disorder, alcohol mood disorder, alcohol anxiety disorder, alcohol sleep disorder, and alcohol sexual dysfunction. See abuse, substance; dependence, substance; intoxication, alcohol; withdrawal symptoms, alcohol.

ambivalence

The coexistence of contradictory emotions, attitudes, ideas, or desires with respect to a particular person, object, or situation. Ordinarily, the ambivalence is not fully conscious and suggests psychopathology only when present in an extreme form.

amnesia

Pathologic loss of memory; a phenomenon in which an area of experience becomes inaccessible to conscious recall. The loss in memory may be organic, emotional, dissociative, or of mixed origin, and may be permanent or limited to a sharply circumscribed period of time. Two types are distinguished:

anterograde

Inability to form new memories of events following such as condition(s).

retrograde

Loss of memory for events preceding the amnesia proper and the condition(s) presumed to be responsible for it.

amphetamine use disorders

In DSM-IV, this group includes amphetamine (or related substance) dependence, amphetamine abuse, amphetamine intoxication, amphetamine withdrawal, amphetamine delirium, amphetamine psychotic disorder, amphetamine mood disorder, amphetamine anxiety disorder, amphetamine sexual dysfunction, and amphetamine sleep disorder.

amphetamines

A group of chemicals that stimulate dopamine release in the central nervous system; often misused by adults and adolescents to control normal fatigue and to induce euphoria. Used clinically to treat hyperkinetic disorder and narcolepsy.

androgyny

A combination of male and female characteristics in one person.

anhedonia

Inability to experience pleasure from activities that usually produce pleasurable feelings. Contrast with hedonism.

anniversary reaction

An emotional response to a previous event occurring at the same time of year. Often the event involved a loss and the reaction involves a depressed state. The reaction can range from mild to severe and may occur at any time after the event.

anomie

Apathy, alienation, and personal distress resulting from the loss of goals previously valued. Emile Durkheim popularized this term when he listed it as a principal reason for suicide.

anorexia nervosa

An eating disorder characterized by refusal or inability to maintain minimum normal weight for age and height combined with intense fear of gaining weight, denial of the seriousness of current low weight, undue influence of body weight or shape on self-evaluation, and, in females, amenorrhea or failure to menstruate. Weight is typically 15% or more below normal, and it may decrease to life-threatening extremes. In the restricting subtype, the person does not engage regularly in binge eating. In the binge eating/purging, or bulimic, subtype, the person engages in recurrent episodes of binge eating or purging during the episode of anorexia nervosa. See also bulimia nervosa.

Antabuse (disulfiram)

A drug used in treatment of alcohol dependence to create an aversive response to alcohol. It blocks the normal metabolism of alcohol and produces increased blood concentrations of acetaldehyde that induce distressing symptoms such as flushing of the skin, pounding of the heart, shortness of breath, nausea, and vomiting. With more severe reactions, hypertension, cardiovascular collapse, and, sometimes, convulsions may occur.

antisocial behavior

Conduct indicating indifference to another’s person or property; criminal behavior, dishonesty, or abuse are examples. In DSM-IV, childhood or adolescent antisocial behavior and adult antisocial behavior (in contrast to antisocial personality disorder, etc.) are included as “other conditions that may be a focus of clinical attention.”

anxiety

Apprehension, tension, or uneasiness from anticipation of danger, the source of which is largely unknown or unrecognized. Primarily of intrapsychic origin, in distinction to fear, which is the emotional response to a consciously recognized and usually external threat or danger. May be regarded as pathologic when it interferes with effectiveness in living, achievement of desired goals or satisfaction, or reasonable emotional comfort.

anxiety disorders

In DSM-IV, this category includes panic disorder without agoraphobia, panic disorder with agoraphobia, agoraphobia without history of panic disorder, specific (simple) phobia, social phobia (social anxiety disorder), obsessive-compulsive disorder, posttraumatic stress disorder, acute stress disorder, generalized anxiety disorder (includes overanxious disorder of childhood), anxiety disorder due to a general medical condition, and substance-induced anxiety disorder. (The inclusion of mixed anxiety-depressive disorder into this category awaits further study.) See agoraphobia; generalized anxiety disorder; mixed anxiety-depressive disorder; obsessive-compulsive disorder; panic disorder; phobia; posttraumatic stress disorder.

apathy

Lack of feeling, emotion, interest, or concern.

apperception

Perception as modified and enhanced by one’s own emotions, memories, and biases.

Asperger’s disorder

A disorder of development characterized by gross and sustained impairment in social interaction and restricted, repetitive, and stereotyped patterns of behavior, interests, and activities occurring in the context of preserved cognitive and language development.

Attachment disorder, reactive

A disorder of infancy or early childhood, beginning before the child is 5 years old, characterized by markedly disturbed and developmentally inappropriate social relatedness. In the inhibited type of reactive attachment disorder, failure to respond predominates, and responses are hypervigilant, avoidant, or highly ambivalent and contradictory. Frozen watchfulness maybe present. In the disinhibited type, indiscriminate sociability is characteristic, such as excessive familiarity with relative strangers or lack of selectivity in choice of attachment figures. The majority of children who develop this disorder (either type) are from a setting in which care has been grossly pathogenic. Either the caregivers have continually disregarded the child’s basic physical and emotional needs, or repeated changes of the primary caregiver have prevented the formation of stable attachments.

attention-deficit/hyperactivity disorder (ADHD)

A child whose inattention and hyperactivity-impulsivity cause problems may have this disorder. Symptomsappear before the age of 7 years and are inconsistent with the subject’s developmental level and severe enough to impair social or academic functioning.

In the predominantly

inattentive type

, characteristic symptoms include distractibility, difficulty in sustaining attention or following through on instructions in the absence of close supervision, avoidance of tasks that require sustained mental effort, failure to pay close attention to details in schoolwork or other activities, difficulty in organizing activities, not listening to what is being said to him or her, loss of things that are necessary for assignments, and forgetfulness in daily activities.

In the predominantly hyperactive-impulsive type, characteristic symptoms are that the person inappropriately leaves his or her seat in classroom or runs about, fidgets or squirms, has difficulty in engaging in leisure activities quietly, has difficulty in awaiting turn in games, and blurts out answers to questions before they are completed.

The two types may be combined.

autistic disorder

A disorder of development consisting of gross and sustained impairment in social interaction and communication; restricted and stereotyped patterns of behavior, interest, and activities; and abnormal development prior to age 3 manifested by delays or abnormal functioning in social development, language communication, or play. Specific symptoms may include impaired awareness of others, lack of social or emotional reciprocity, failure to develop peer relationships appropriate to developmental level, delay or absence of spoken language and abnormal nonverbal communication, stereotyped and repetitive language, idiosyncratic language, impaired imaginative play, insistence on sameness (e.g., nonfunctional routines or rituals), and stereotyped and repetitive motor mannerisms.

aversion therapy

A behavior therapy procedure in which associated with undesirable behavior are paired with a painful or unpleasant stimulus, resulting in the suppression of the undesirable behavior.

B

biofeedback

The use of instrumentation to provide information (i.e. feedback) about variations in one or more of the subject’s own physiological processes not ordinarily perceived (e.g., brain wave activity, muscle tension, blood pressure). Such feedback over a period of time can help the subject learn to control certain physiological processes even though he or she is unable to articulate how the learning was achieved.

bipolar disorders

In DSM-IV, a group of mood disorders that includes bipolar disorder, single episode; bipolar disorder, recurrent; and cyclothymic disorder.

A bipolar disorder includes a manic episode at some time during its course. In any

particular patient, the bipolar disorder may take the form of a single manic episode (rare), or it may consist of recurrent episodes that are either manic or depressive in nature (but at least one must have been predominantly manic).

bisexuality

Originally a concept of Freud, indicating a belief that components of both sexes could be found in each person. Today the term is often used to refer to persons who are capable of achieving orgasm with a partner of either sex. See also gender role; homosexuality.

blocking

A sudden obstruction or interruption in spontaneous flow of thinking or speaking, perceived as an absence or deprivation of thought.

bonding

The unity of two people whose identities are significantly affected by their mutual interactions. Bonding often refers to the an attachment between a mother and her child.

brief psychotherapy

Any form of psycbotberapy whose end point is defined either in terms of the number of sessions (generally not more than 15) or in terms of specified objectives; usually goal-oriented, circumscribed, active, focused, and directed toward a specific problem or symptom.

bulimia nervosa

An eating disorder characterized by recurrent episodes of binge eatingfollowed by compensatory behavior such as purging (i.e., self-induced vomiting or the use of diuretics and laxatives) or other methods to control weight (e.g., strict dieting, fasting, or vigorous exercise).

burnout

A stress reaction developing in persons working in an area of unrelenting occupational demands. Symptoms include impaired work performance, fatigue, insomnia, depression, increased susceptibility to physical illness, and reliance on alcohol or other drugs of abuse for temporary relief.

C

catatonia

Immobility with muscular rigidity or inflexibility and at times excitability. See also schizophrenia.

catharsis

The healthful (therapeutic) release of ideas through “talking out” conscious material accompanied by an appropriate emotional reaction. Also, the release into awareness of repressed (“forgotten”) material from the unconscious. See also repression.

character disorder (character neurosis)

A personality disorder manifested by a chronic, habitual, maladaptive pattern of reaction that is relatively inflexible, limits the optimal use of potentialities, and often provokes the responses from the environment that the person wants to avoid. In contrast to symptoms of neurosis, character traits are typically ego-syntonic. See also personality.

circumstantiality

Pattern of speech that is indirect and delayed in reaching its goal because of excessive or irrelevant detail or parenthetical remarks. The speaker does not lose the point, as is characteristic of loosening of associations, and clauses remain logically connected, but to the listener it seems that the end will never be reached. Compare with tangentiality.

clanging

A type of thinking in which the sound of a word, rather than its meaning, gives the direction to subsequent associations. Punning and rhyming may substitute for logic, and language may become increasingly a senseless compulsion to associate and decreasingly a vehicle for communication. For example, in response to the statement “That will probably remain a mystery,” a patient said, “History is one of my strong points.”

cluster suicides

Multiple suicides, usually among adolescents, in a circumscribed period of time and area. Thought to have an element of contagion.

cocaine use disorders

In DSM-IV, this group includes cocaine dependence, cocaine abuse, cocaine intoxication, cocaine withdrawal, cocaine delirium, cocaine psychotic disorder with delusions or hallucinations, cocaine mood disorder, cocaine anxiety disorder, cocaine sexual dysfunction, and cocaine sleep disorder.

codependency

A popular term referring to all the effects that people who are dependent on alcohol or other substances have on those around them, including the attempts of those people to affect the dependent person. The term implies that codependence is a psychiatric disorder and hypothesizes that the family’s actions tend to perpetuate (enable) the person’s dependence. Empirical studies, however, support a stress and coping model for explanation of the family behavior.

cognitive

Refers to the mental process of comprehension, judgment, memory, and reasoning, in contrast to emotional and volitional processes. Contrast with conative.

cognitive-behavioral psychotherapy

Cognitive therapy; a short-term psychotherapy directed at specific target conditions or symptoms. (Depression has been the most intensively investigated to date.) The symptoms themselves are clues to the patient’s verbal thoughts, images, and assumptions that account for both the symptomatic state and the psychological vulnerability to that state. Initial treatment is aimed at symptom reduction. The patient is taught to recognize the negative cognitions that contribute significantly to the development or maintenance of symptoms and to evaluate and modify such thinking patterns. The second phase of treatment concerns the underlying problem.

comorbidity

The simultaneous appearance of two or more illnesses, such as the co-occurrence of schizophrenia and substance abuse or of alcohol dependence and depression. The association may reflect a causal relationship between one disorder and another or an underlying vulnerability to both disorders. Also, the appearance of the illnesses may be unrelated to any common etiology or vulnerability.

compensation A defense mechanism, operating unconsciously (see unconscious), by which one attempts to make up for real or fancied deficiencies. Also a conscious process in which one tries to make up for real or imagined defects of physique, performance skills, or psychological attributes. The two types frequently merge. See also Adler; individual psychology; overcompensation.

complex

A group of associated ideas having a common, strong emotional tone. These ideas are largely unconscious and significantly influence attitudes and associations. See also Oedipus complex.

compulsion

Repetitive ritualistic behavior such as hand washing or ordering or a mental act such as praying or repeating words silently that aims to prevent or reduce distress or prevent some dreaded event or situation. The person feels driven to perform such actions in response to an obsessionor according to rules that must be applied rigidly, even though the behaviors are recognized to be excessive or unreasonable.

concrete thinking

Thinking characterized by immediate experience, rather than abstractions. It may occur as a primary, developmental defect, or it may develop secondary to organic brain disease or schizophrenia.

conduct disorder

A disruptive behavior disorder of childhood characterized by repetitive and persistent violation of the rights of others or of age-appropriate social norms or rules. Symptoms may include bullying others, truancy or work absences, staying out at night despite parental prohibition before the age of 13, using alcohol or other substances before the age of 13, breaking into another’s house or car, firesetting with the intent of causing serious damage, physical cruelty to people or animals, stealing, or use more than once of a weapon that could cause harm to others (e.g., brick, broken bottle, or gun).

conversion disorder

One of the somatoform disorders (but in some classifications called a dissociative disorder), characterized by a symptom suggestive of a neurologic disorder that affects sensation or voluntary motor function. The symptom is not consciously or intentionally produced, it cannot be explained fully by any known general medical condition, and it is severe enough to impair functioning or require medical attention. Commonly seen symptoms are blindness, double vision, deafness, impaired coordination, paralysis, and seizures.

coping mechanisms

Ways of adjusting to environmental stress without altering one’s goals or purposes; includes both conscious and unconsciousmechanisms.

coprophagia

Eating of filth or feces.

counterphobia Deliberately seeking out and exposing oneself to, rather than avoiding, the object or situation that is consciously or unconsciously feared.

countertransference

The therapist’s emotional reactions to the patient that are based on the therapist’s unconscious needs and conflicts, as distinguished from his or her conscious responses to the patient’s behavior. Countertransference may interfere with the therapist’s ability to understand the patient and may adversely affect the therapeutic technique. Currently, there is emphasis on the positive aspects of countertransference and its use as a guide to a more empathic understanding of the patient.

crack

Freebase or alkaloidal cocaine that is named for the cracking sound it makes when heated. Also known as “rock” for its crystallized appearance. It is ingested by inhalation of vapors produced by heating the “rock.”

cyclothymic disorder

In DSM-IV, one of the bipolar disorders characterized by numerous hypomanic episodes and frequent periods of depressed mood or loss of interest or pleasure. These episodes do not meet the criteria for a full manic episode or major depressive disorder.

D

decompensation

The deterioration of existing defenses (see defense mechanism), leading to an exacerbation of pathological behavior.

defense mechanism Unconscious intrapsychic processes serving to provide relief from emotional conflict and anxiety. Conscious efforts are frequently made for the same reasons, but true defense mechanisms are unconscious. Some of the common defense mechanisms defined in this glossary are compensation, conversion, denial, displacement, dissociation, idealization, identification, incorporation, introjection, projection, rationalization, reaction formation, regression, sublimation, substitution, symbolization, and undoing.

deja vu

A paramnesia consisting of the sensation or illusion that one is seeing what one has seen before.

delusion

A false belief based on an incorrect inference about external reality and firmly sustained despite clear evidence to the contrary. The belief is not part of a cultural tradition such as an article of religious faith. Among the more frequently reported delusions are the following:

delusion of control

The belief that one’s feelings, impulses, thoughts, or actions are not one’s own but have been imposed by some external force.

delusion of poverty

The conviction that one is, or will be, bereft of all material possessions.

delusion of reference

The conviction that events, objects, or other people in the immediate environment have a particular and unusual significance (usually negative).

delusional jealousy

The false belief that one’s sexual partner is unfaithful; also called the Othello delusion.

grandiose delusion

An exaggerated belief of one’s importance, power, knowledge, or identity.

nihilisitic delusion

A conviction of nonexistence of the self, part of the self, or others, or of the world. “I no longer have a brain” is an example.

persecutory delusion

The conviction that one (or a group or institution close to one) is being harassed, attacked, persecuted, or conspired against.

somatic delusion

A false belief involving the functioning of one’s body, such as the conviction of a postmenopausal woman that she is pregnant, or a person’s conviction that his nose is misshapen and ugly when there is nothing wrong with it.

systematized delusion

A single false belief with multiple elaborations or a group of false beliefs that the person relates to a single event or theme. This event is believed to have caused every problem in life that the person experiences.

denial

A defense mechanism, operating unconsciously, used to resolve emotional conflict and allay anxiety by disavowing thoughts, feelings, wishes, needs, or external reality factors that are consciously intolerable.

depersonalization

Feelings of unreality or strangeness concerning either the environment, the self, or both. This is characteristic of depersonalization disorder and may also occur in schizotypal personality disorder, schizophrenia, and in those persons experiencing overwhelming anxiety, stress, or fatigue.

depression

When used to describe a mood, depression refers to feelings of sadness, despair, and discouragement. As such, depression may be a normal feeling state. The overt manifestations are highly variable and may be culture specific. Depression may be a symptom seen in a variety of mental or physical disorders, a syndrome of associated symptoms secondary to an underlying disorder, or a specific mental disorder. Slowed thinking, decreased pleasure, decreased purposeful physical activity, guilt and hopelessness, and disorders of eating and sleeping may be seen in the depressive syndrome. DSM-IV classifies depression by severity, recurrence, and association with hypomania or mania. Other categorizations divide depression into reactive and endogenous depressions on the basis of precipitants or symptom clusters. Depression in children may be indicated by refusal to go to school, anxiety, excessive reaction to separation from parental figures, antisocial behavior, and somatic complaints.

disruptive behavior disorder

A disturbance of conduct severe enough to produce significant impairment in social, occupational, or academic functioning because of symptoms that range from oppositional defiant to moderate and severe conduct disturbances.

oppositional defiant

symptoms may include losing temper; arguing with adults and actively refusing their requests; deliberately annoying others; blaming others for one’s mistakes; being easily annoyed, resentful, or spiteful; and physically fighting with other members of the household.

conduct disturbance (moderate)

symptoms may include truancy or work absences, alcohol or other substance use before the age of 13, stealing with confrontation, destruction of others’ property, firesetting with intent of causing serious damage, initiating fights outside of home, and being physically cruel to animals.

conduct disturbance (severe)

symptoms may include running away from home overnight at least twice, breaking into another’s property, being physically cruel to people, stealing with confrontation, repeatedly using a dangerous weapon, and forcing someone into sexual activity.

dissociation

The splitting off of clusters of mental contents from conscious awareness, a mechanism central to hysterical conversion and dissociative disorder; the separation of an idea from its emotional significance and affect as seen in the inappropriate affect of schizophrenic patients.

dysphoria

Unpleasant mood.

dysthymic disorder

One of the depressive disorders, characterized by a chronic course (i.e.,. seldom without symptoms) with lowered mood tone and a range of other symptoms that may include feelings of inadequacy, loss of self-esteem, or self-deprecation: feelings of hopelessness or despair; feelings of guilt, brooding about past events, or self-pity; low energy and chronic tiredness; being less active or talkative than usual; poor concentration and indecisiveness; and inability to enjoy pleasurable activities.

E

eating disorder

Marked disturbance in eating behavior. In DSM-IV, this category includes anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified.

echolalia

Parrot-like repetition of overheard words or fragments of speech. It may be part of a developmental disorder, a neurologic disorder, or schizophrenia. Echolalia tends to be repetitive and persistent and is often uttered with a mocking, mumbling, or staccato intonation.

empathy

Insightful awareness, including the meaning and significance of the feelings, emotions, and behavior of another person. Contrast with sympathy.

encopresis, functional

An elimination disorder in a child who is at least 4 years of age, consisting of repeated passage of feces into inappropriate places (clothing, floor, etc.) and not due to a general medical condition.

enuresis, functional

An elimination disorder in a child who is at least 5 years of age, consisting of repeated voiding of urine into bed or clothing, and not due to any general medical condition.

F

fetal alcohol syndrome

A congenital disorder resulting from alcohol teratogenicity (i.e., the production, actual or potential, of pathological changes in the fetus, most frequently in the form of normal development of one or more organ systems; commonly referred to as birth defects), with the following possible dysmorphic categories: central nervous systemdysfunction, birth deficiencies (such as low birth weight), facial abnormalities, and variable major and minor malformations. A safe level of alcohol use during pregnancy has not been established, and it is generally advisable for women to refrain from alcohol use during pregnancy.

fetishism One of the paraphilias, characterized by marked distress over, or acting on, sexual urges involving the use of nonliving objects (fetishes), such as underclothing, stockings, or boots.

flashback

Hallucinogen persisting perception disorder or posthallucinogen perception disorder; reexperiencing, after ceasing the use of a hallucinogen, one or more of the perceptual symptoms that had been part of the hallucinatory experience while using the drug.

flight of ideas

An early continuous flow of accelerated speech with abrupt changes from one topic to another, usually based on understandable associations, distracting stimuli, or playing on words. When severe, however, this may lead to disorganized and incoherent speech. Flight of ideas is characteristic of manic episodes, but it may occur also in organic mental disorders, schizophrenia, other psychoses, and, rarely, acute reactions to stress.

flooding(implosion)

A behavior therapy procedure for phobias and other problems involving maladaptive anxiety, in which anxiety producers are presented in intense forms, either in imagination or in real life. The presentations, which act as desensitizers, are continued until the stimuli no longer produce disabling anxiety.

G

gender identity disorder

One of the major groups of sexual and gender identity disorders, characterized by a strong and persistent identification with the opposite sex (cross-gender identification) and discomfort with one’s assigned sex or a sense of inappropriateness in that gender role. Although onset is usually in childhood or adolescence, the disorder may not be presented clinically until adulthood. Manifestations include a repeated desire to be of the opposite sex, insistence that one has the typical feelings and reactions of the opposite sex, a belief that one was born the wrong sex, and transsexualism or preoccupation with one’s primary and secondary sex characteristics in order to simulate the opposite sex.

H

hallucination

A sensory perception in the absence of an actual external stimulus; to be distinguished from an illusion, which is a misperception or misinterpretation of an external stimulus. Hallucinations may involve any of the senses.

auditory hallucination

Perception of sound, most frequently of voices but sometimes of clicks or other noises.

olfactory hallucination

Perception of odor such as of burning rubber or decaying fish.

somatic

Perception of a physical sensation within the body such as a feeling of electricity running through one’s body.

visual hallucination

Perception of being touched or of something being under one’s skin such as the sensation of pins being stuck into one’s finger. The sensation of something crawling under one’s skin is called

formication;

it occurs most frequently in

alcohol withdrawalsyndrome

and in

cocaine

withdrawal.

visual hallucination

Perception of an image such as people (formed) or a flash of light (unformed).

hyperactivity

Excessive motor activity that may be purposeful or aimless; movements and utterances are usually more rapid than normal. Hyperactivity is a prominent feature of attention-deficit disorder, so much so that in DSM-IV the latter is called attention- deficit/hyperactivity disorder (ADHD).

hyperventilation

Overbreathing sometimes associated with anxietyand marked by a reduction of blood carbon dioxide, producing complaints of light-headedness, faintness, tingling of the extremities, palpitations, and respiratory distress.

hypomania

A psychopathological state and abnormality of mood falling somewhere between normal euphoria and mania. It is characterized by unrealistic optimism, pressure of speech and activity, and a decreased need for sleep. Some people show increased creativity during hypomanic states, whereas others show poor judgment, irritability and irascibility.

I

identity crisis

A loss of the sense of the sameness and historical continuity of one’s self and an inability to accept or adopt the role one perceives as being expected by society. This is often expressed by isolation, withdrawal, extremism, rebelliousness, and negativity, and is typically triggered by a sudden increase in the strength of instructional drivesin a milieu of rapid social evolution and technological change.

impulse control disorders

Failing to resist an impulse, drive, or temptation to perform some act that is harmful to oneself or to others. The impulse may be resisted consciously, but it is consonant with the person’, immediate, conscious wish. The act may be premeditated or unplanned. The person may display regret or guilt for the action or its consequences.

In DSM-IV, this category includes pathological gambling, kleptomania, pyromania, intermittent explosive disorder, and trichotillomania.

inhalant use disorders

In DSM-IV, this group includes inhalant dependence, inhalant abuse, inhalant intoxication, inhalant delirium, inhalant persisting dementia, inhalant psychotic disorder with delusions or hallucinations, inhalant mood disorder, and inhalant anxiety disorder.

L

labile

Rapidly shifting (as applied to emotions); unstable.

M

mania

Bipolar disorder; a mood disorder characterized by excessive elation, inflated self-esteem and grandiosity, hyperactivity, agitation, and accelerated thinking and speaking. Flight of ideas may be present. A manic syndrome may also occur in organic mental disorder,.

-mania

Formerly used as a nonspecific term for any type of “madness.” Currently used as a suffix to indicate a morbid preoccupation with some kind of idea or activity, and/or a compulsive need to behave in some deviant way. Some examples are as follows:

egomania

Pathological preoccupation with self.

erotomania

The

delusion

that one is loved by a particular person.

kleptomania

Compulsion to steal.

megalomania

Grandiose

delusions

of power, wealth, or fame.

monomania

Pathological preoccupation with one subject.

necromania

Pathological preoccupation with dead bodies.

nymphomania

Abnormal and excessive need or desire in the woman for sexual intercourse; see satyriasis.

pyromania

Compulsion to set fires; an

impulse control disorder.

trichotillomania

Compulsion to pull one’s own hair out; an

impulse disorder.

manic episode

A distinct period of time (usually lasting at least 1 week) of abnormally and persistently elevated, expansive, or irritable mood accompanied by such symptoms as inflated self-esteem or grandiosity, decreased need for sleep, overtalkativeness or pressured speech, flight of ideas or feeling that thoughts are racing, inattentiveness and distractibility, increased goal-directed activity (e.g., at work or school, socially or sexually), and involvement in pleasurable activities with high potential for painful consequences (e.g., buying sprees, sexual indiscretions, foolish business ventures). See bipolar disorders.

manic-depressive illness

A term often used synonymously with bipolar disorder, as defined in DSM-IV.

mental health

A state of being that is relative rather than absolute. The best indices of mental health are simultaneous success at working, loving, and creating, with the capacity for mature and flexible resolution of conflicts between instincts, conscience, important other people, and reality.

mental status examination

The process of estimating psychological and behavioral function by observing the patient, eliciting his or her self-description, and using formal questioning. Included in the examination are 1) evaluation and assessment of any psychiatric condition present, including provisional diagnosis and prognosis, determination of degree of impairment, suitability for treatment, and indications for particular types of therapeutic intervention; 2) formulation of the personality structure of the subject, which may suggest the historical and developmental antecedents of whatever psychiatric condition exists; and 3) estimation of the subject’s ability and willingness to participate appropriately in treatment. The mental status is reported in a series of narrative statements describing such things as affect, speech, thought content, perception, and cognitive functions. The mental status examination is part of the general examination of all patients, although it may be markedly abbreviated in the absence of psychopathology.

mood disorders

In DSM-IV, this category includes depressive disorders, bipolar disorders, mood disorder due to a general medical condition, and substance-induced (intoxication/withdrawal) mood disorder.

mood swing

Fluctuation of a person’s emotional tone between periods of elation and periods of depression.

mutism, selective

Elective mutism; a disorder of infancy, childhood, or adolescence characterized by persistent failure to speak in specific social situations by a child with demonstrated ability to speak. The mutism is not due to lack of fluency in the language being spoken or embarrassment about a speech problem.

N

negativistic personality disorder

A type of passive-aggressive personality disordercharacterized by passive resistance to demands for adequate social and occupational performance and a negative attitude. Typical manifestations include inefficiency, procrastination, complaints of being victimized and unappreciated, irritability, criticism of and scorn for authority, and personal discontent. The person with this disorder alternates between hostile assertions of independence and contrite, dependent behavior.

nitrites

“Poppers” or nitrite inhalants, including amyl, butyl, and isobutyl nitrite, that produce an intoxication characterized by a feeling of fullness in the head, mild euphoria, a change in the perception of time, relaxation of smooth muscles, and possibly an increase in sexual feelings. The nitrites may produce psychological dependence and may impair immune functioning, irritate the respiratory system, and induce a toxic reaction involving vomiting, severe headache, and dizziness.

obsessive-compulsive disorder

An anxiety disorder characterized by obsessions, compulsions, or both, that are time-consuming and interfere significantly with normal routine, occupational functioning, usual social activities, or relationships with others. See compulsion; obsession.

oppositional defiant order

A patten of negativistic and hostile behavior in a child that lasts at least 6 months. Symptoms may include losing one’s temper; arguing with adults or actively refusing their requests; deliberately annoying others; being easily annoyed, angry, and resentful; and being spiteful or vindictive.

overanxious disorder

An anxiety disorder of childhood and adolescence, sometimes considered equivalent to the adult diagnosis of generalized anxiety disorder. Symptoms include multiple, unrealistic anxieties concerning the quality of one’s performance in school and in sports; hobbies; money matters; punctuality; health; or appearance. The patient is tense and unable to relax and has recurrent somatic complaints for which no physical cause can be found.

P

panic attack

A period of intense fear or discomfort, with the abrupt development of a variety of symptoms and fears of dying, going crazy, or losing control that reach a crescendo within 10 minutes. The symptoms may include shortness of breath or smothering sensations; dizziness, faintness, or feelings of unsteadiness; trembling or shaking; sweating; choking; nausea or abdominal distress; flushes or chills; and chest pain or discomfort. Panic attacks occur in several anxiety disorders. In panic disorder they are typically unexpected and happen “out of the blue.” In social phobia and simple phobia they are cued and occur when exposed to or in anticipation of a situational trigger. These attacks occur also in posttraumatic stress disorder.

phobia

Fear cued by the presence or anticipation of a specific object or situation, exposure to which almost invariably provokes an immediate anxiety response or panic attack even though the subject recognizes that the fear is excessive or unreasonable. The phobic stimulus is avoided or endured with marked distress. In earlier psychoanalytic literature, phobia was called anxiety hysteria.

Two types of phobia have been differentiated: specific phobia (simple phobia) and social phobia. Specific phobia is subtyped on the basis of the object feared. The natural environment (animals, insects, storms, water, etc.); blood, injection, or injury; situations (cars, airplanes, heights, tunnels, etc.); and other situations that may lead to choking, vomiting, or contracting an illness are all specific phobias.

In social phobia (social anxiety disorder), the persistent fear is of social situations that might expose one to scrutiny by others and induce one to act in a way or show anxiety symptoms that will be humiliating or embarrassing. Avoidance may be limited to one or only a few situations, or it may occur in most social situations. Performing in front of others or social interactions may be the focus of concern. It is sometimes difficult to distinguish between social phobia and agoraphobia when social avoidance accompanies panic attacks. Avoidant disorder has been used to refer to social phobia occurring in childhood and adolescence.

Some of the common phobias are (add “abnormal fear of” to each entry):

achluophobia — Darkness

acrophobia — Heights

agoraphobia — Open spaces or leaving the familiar setting of the home

ailurophobia — Cats

algophobia — Pain

androphobia — Men

autophobia — Being alone or solitude

bathophobia — Depths

claustrophobia — Closed spaces

cynophobia — Dogs

demophobia — Crowds

erhthrophobia — Blushing; sometimes used to refer to the blushing itself

gynophobia — Women

hypnophobia — Sleep

mysophobia — Dirt and germs

panphobia — Everything

pedophobia — Children

xenophobia — Strangers

posttraumatic stress disorder (PTSD)

An anxiety disorder in which exposure to an exceptional mental or physical stressor is followed, sometimes immediately and sometimes not until 3 months or more after the stress, by persistent reexperiencing of the event, avoidance of stimuli associated with the trauma or numbing of general responsiveness, and manifestations of increased arousal. The trauma typically includes experiencing, witnessing, or confronting an event that involves actual or threatened death or injury, or a threat to the physical integrity of oneself or others, with an immediate reaction of intense fear, helplessness, or horror.

Reexperiencing the trauma may take several forms: recurrent, intrusive, and distressing recollections (images, thoughts, or perceptions) of the event; recurrent distressing dreams of the event; sudden feeling as if the event were recurring or being relived (including dissociative flashback episodes); or intense psychological distress or physiological reactivity if exposed to internal or external cues that symbolize or resemble some part of the event.

The affected person tries to avoid thoughts or feelings associated with the event and

anything that might arouse recollection of it. There may be amnesia for an important aspect of the trauma. The person may lose interest in significant activities, feel detached or estranged from others, or have a sense of a foreshortened future.

The person may have difficulty failing or staying asleep, be irritable or have angry outbursts, experience problems concentrating, and have an exaggerated startle response.

S

schizophrenia

A group of idiopathic psychotic disorders characterized by both positive and negative symptoms associated with disturbance in one or more major areas of functioning such as work, academic development or achievement, interpersonal relations, and self-care. Positive symptoms include delusions, which may be bizarre in nature; hallucinations, especially auditory; disorganized speech; inappropriate affect; and disorganized behavior. Negative symptoms include flat affect, avolition, alogia, and anbedonia. Duration is variable: ICD-10 requires that continuous signs of the disturbance persist for at least 1 month; DSM-IV requires a minimum of 6 months.

separation anxiety disorder

A disorder with onset before the age of 18 consisting of inappropriate anxiety concerning separation from home or from persons to whom the child is attached. Among the symptoms that may be seen are unrealistic concern about harm befalling or loss of major attachment figures; refusal to go to school (school phobia) in order to stay at home and maintain contact with this figure; refusal to go to sleep unless close to this person; clinging; nightmares about the theme of separation; and development of physical symptoms or mood changes (apathy, depression) when separation occurs or is anticipated.

sleep terror disorder

One of the parasomnias characterized by panic and confusion when abruptly awakening from sleep. This usually begins with a scream and is accompanied by intense anxiety. The person is often confused and disoriented after awakening. No detailed dream is recalled, and there is amnesia for the episode. Sleep terrors typically occur during the first third of the major sleep episode. Contrast with nightmare disorder.

steroids, anabolic

Synthetic derivatives of testosterone used medically to promote protein anabolism. They can be drugs of abuse used to aid in body building. They sometimes produce an initial sense of well-being replaced after repeated use by lack of energy, irritability, and unhappiness. Continued use may lead to such serious complications as severe depression, outbursts of violence, and liver disease.

systematic desensitization

A behavior therapy procedure widely used to modify behaviors associated with phobias. The procedure involves the construction of a hierarchy of anxiety-producing stimuli by the subject, and gradual presentation of the stimuli until they no longer produce anxiety. Also called desensitization. See also reciprocal inhibition.

T

tarasoff decision

A California court decision that essentially imposes a duty on the therapist to warn the appropriate person or persons when the therapist becomes aware that the patient may present a risk of harm to a specific person or persons.

thought disorder

A disturbance of speech, communication, or content of thought, such as delusions, ideas of reference, poverty of thought, flight of ideas, preservation, loosening of associations, and so forth. A thought disorder can be caused by a functional emotional disorder or an organic condition. A formal thought disorder is a disturbance in the form of thought rather than in the content of thought (e.g., loosening of associations).

tic

An involuntary, sudden, rapid, recurrent, nonrhythmic stereotyped motor movement or vocalization. A tic may be an expression of an emotional conflict, the result of neurologic disease, or an effect of a drug (especially a stimulant or other dopamine agonist).

tic disorders

In DSM-IV, this category includes Tourette’s disorder, chronic motor or vocal tic disorder, transient tic disorder, and tic disorder not otherwise specified; all beginning before the age of 18 years. Chronic tics may occur many times a day, nearly every day, or intermittently over a period of more than a year. Transient tics do not persist for longer than 12 consecutive months.

Tourette’s disorder

A tic disorder consisting of multiple motor and vocal tics that occur in bouts, either concurrently or separately, almost every day or intermittently over a period of more than 12 months.

trichotillomania

Pathological hair pulling that results in noticeable hair loss. As in other impulse control disorders, an increasing sense of tension or affective arousal immediately precedes an episode of hair pulling, which is then followed by a sense of pleasure, gratification, or relief.