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.
DEPERSONALIZATION. An alteration in the perception or experience of the self
so that the feeling of one's own reality is temporarily lost. This is manifested in a
sense of self-estrangement or unreality, which may include the feeling that one's
extremities have changed in size, or a sense of seeming to perceive oneself from
a distance (usually from above).
Depersonalization is seen in Depersonalization Disorder, and may also occur
in Schizotypal Personality Disorder and Schizophrenia. It is sometimes observed
in peopIe without any mental disorder who are experiencing overwhelming
anxiety, stress, or fatigue.
DIAGNOSIS. In general usage, this term refers to the process of identifying
specific mental or physical disorders. Some, however, use the term more broadly
to refer to a comprehensive evaluation that is not limited to identification of
specific disorders.
DISORIENTATlON. Confusion about the date or time of day, where one is
(place), or who one is (identity). Disorientation is characteristic of some Organic
Mental Disorders, such as Delirium and Dementia.
DISTRACTIBILITY. Attention drawn too frequently to unimportant or irrelevant
external stimuli. Example: While being interviewed, a subjects attention is
repeatedly drawn to noise from an adjoining office, a book that is on a shelf, or
the interviewer's school ring.
ECHOLALIA. Repetition (echoing) of the words or phrases of others. Typical
echolalia tends to be repetitive and persistent. The echo is often uttered with a
mocking, mumbling, or staccato intonation. Echolalia should not be confused with
habitual repetition of questions, apparently to clarify the question and formulate its
answer, as when a subject is asked, "When did you come to the hospital?" and
replies, "Come to the hospital? Yesterday." Example: An interviewer says to a
subject, "I'd like to talk with you for a few minutes"; and the subject responds, in a
mumbling tone, "Talk with you for a few minutes. Talk with you for a few
minutes."
Echolalia is observed in some Pervasive Developmental Disorders, Organic
Mental Disorders, and Schizophrenia.
FLIGHT OF IDEAS. A nearly continuous flow of accelerated speech with abrupt
changes from topic to topic, usually based on understandable associations,
distracting stimuli, or plays on words. When severe, speech may he disorganized
and incoherent
Flight of ideas is most frequently seen in manic episodes, but may also be
observed in some cases of Organic Mental Disorders, Schizophrenia, other
psychotic disorders, and, occasionally, acute reactions to stress
FORMAL THOUGHT DISORDER. A disturbance in the form of thought as
distinguished from the content of thought. The boundaries of the concept are not
clear, and there is no consensus as to which disturbances in speech or thought
are included in the concept. For this reason, "formal thought disorder" is not used
as a specific descriptive term. See loosening of associations, incoherence.
poverty of content of speech, neologisms, perseveration, blocking, echolalia,
clanging.
GRANDIOSITY. An inflated appraisal of one's worth, power, knowledge,
importance, or identity. When extreme, grandiosity may be of delusional
proportions. Example: A professor who frequently puts his students to sleep with
his boring lectures is convinced that he is the most dynamic and exciting teacher
at the university.
HALLUCINATION. A sensory perception without external stimulation of the
relevant sensory organ. A hallucination has the immediate sense of reality of a
true perception, although in some instances the source of the hallucination may
be perceived as within the body (e.g., an auditory hallucination may be
experienced as coming from within the head rather than through the ears). (Some
investigators limit the concept of true hallucinations to sensations whose source
is perceived as being external to the body, but the clinical significance of this
distinction has yet to be demonstrated.
There may or may not be a delusional interpretation of the hallucinatory
experience. For example, one person with auditory hallucinations may recognize
that he or she is having a false sensory experience whereas another may be
convinced that the source of the sensory experience has an independent physical
reality. Strictly speaking, hallucinations indicate a psychotic disturbance only
when they are associated with gross impairment in reality testing (see psychotic).
The term hallucination, by itself, is not ordinarily applied to the false perceptions
that occur during dreaming, while falling asleep (hypnagogic), or when awakening
(hypnopompic). Hallucinations occurring in the course of an intensely shared
religious experience generally have no pathological significance.
Hallucinations should be distinguished from illusions, in which an external
stimulus is misperceived or misinterpreted and from normal thought processes
that are exceptionally vivid. Transient hallucinatory experiences are common in
people without mental disorder.
Hallucination, auditory. A hallucination of sound, most commonly of voices,
but sometimes of clicks, rushing noises, music, etc
Hallucination, gustatory. A hallucination of taste, unpleasant tastes being
the most common.
Hallucination, mood-congruent. See mood-congruent psychotic
features.
Hallucination, mood-incongruent. See mood-incongruent psychotic
features.
Hallucination, olfactory. A hallucination involving smell. Example: A
woman complained of a persistent smell of dead bodies. Some people are
convinced they have a body odor they themselves cannot smell; this symptom is
a delusion, not an olfactory hallucination.
Hallucination, somatic. A hallucination involving the perception of a physical
experience localized within the body. Example: A feeling of electricity running
through one's body
Somatic hallucinations are to be distinguished from unexplained physical
sensations; a somatic hallucination can be identified with certainty only when a
delusional interpretation of a physical illness is present A somatic hallucination is
to be distinguished also from Hypochondriacal preoccupation with, or
exaggeration of, normal physical sensations and from a tactile hallucination, in
which the sensation is usually related to the skin.
Hallucination, tactile. A hallucination involving the sense of touch, often of
something on or under the skin. Almost invariably the symptom is associated with
a delusional interpretation of the sensation. Examples: A man said he could feel
the Devil sticking pins into his flesh; another claimed he could feel himself being
penetrated anally; still another- complained of experiencing pains, which he
attributed to the Devil, throughout his body, although there was no evidence of
any physical illness.
A particular tactile hallucination is formication, which is the sensation of
something creeping or crawling on or under the skin. Often there is a delusional
interpretatation of the sensation, as when it is attributed to insects or worms
Formication is seen in Alcohol Withdrawal Delirium and the withdrawal phase of
Cocaine Intoxication.
Tactile hallucinations of pain are to be distinguished from Somatoform Pain
Disorder, in which there is no delusional interpretation.
Hallucination, visual. A hallucination involving sight, which may consist of
formed images, such as of people, or of unformed images, such as flashes of
light. Visual hallucinations should be distinguished from illusions, which are
misperceptions of real external stimuli.
IDEAS OF REFERENCE. An idea, held less firmly than a delusion, that events,
objects, or other people in the person's immediate environment have a particular
and unusual meaning specifically for him or her. See also delusion of
reference.
IDENTITY. The sense of self, providing a unity of personality over time Prominent
disturbances in identity or the sense of self are seen In Schizophrenia, Borderline
Personality Disorder, and Identity Disorder.
ILLOGlCAL THINKING. Thinking that contains obvious internal contradictions or
in which conclusions are reached that are clearly erroneous, given the initial
premises. It may be seen in people without mental disorder, particularly in
situations in which they are distracted or fatigued. illogical thinking has
psychopathological significance only when it is marked, as in the examples noted
below, and when it is not due to cultural or religious values or to an intellectual
deficit. Markedly illogical thinking may lead to, or result from, a delusional belief,
or may be observed in the absence of a delusion
Examples: A patient explained that she gave her family IBM cards, which she
punched, in an effort to improve communication with them. Another patient
stated:
"Parents are the people that raise you. Parents can be anything-material,
vegetable, or mineral-that has taught you something. A person can look at a rock
and learn something from it, so a rock is a parent." In response to the question
"Why did you go to Kingston?" a patient replied, "Because l believe in the King
James Bible and my name is James. I went to Kingston to see the Queen."
ILLUSION. A misperception of a real external stimulus. examples: The rustling of
leaves is heard as the sound of voices; a man claims that when he looks in a
mirror, he sees his face distorted and misshapen. See also hallucination.
INCOHERENCE. Speech that, for the most part, is not understandable, owing to
any of the following: a lack of logical or meaningful connection between words,
phrases, or sentences; excessive use of incomplete sentences; excessive
irrelevancies or abrupt changes in subject matter; idiosyncratic word usage;
distorted grammar. Mildly ungrammatical constructions or idiomatic usage�s
characteristic of particular regional or ethnic backgrounds, lack of education, or
low intelligence should not be considered incoherence. The term is generally not
applied when there is evidence that the disturbance in speech is due to an
aphasia.
Example: Interviewer: "Why do you think people believe in God?" Subject. "U
m, because making a do in life. Isn't none of that stuff about evolution guiding
isn't true anymore now. It all happened a long time ago. It happened in eons and
eons and stuff they wouldn't believe in Him. The time that Jesus Christ people
believe in their thing people believed in, Jehovah God that they didn't believe in
Jesus Christ that much"
Incoherence may be seen in some Organic Mental Disorders, Schizophrenia,
and other psychotic disorders.
INSOMNIA. Difficulty falling or staying asleep. Initial insomnia is difficulty in falling
asleep. Middle insomnia involves an awakening, followed by difficulty returning to
sleep, but eventually doing so. Terminal insomnia is awakening at least two hours
before one's usual waking time and being unable to return to sleep.
LOOSENING OF ASSOCIATIONS. Thinking characterized by speech in which
Ideas shift from one subject to another that is completely unrelated or only
obliquely related to the first without the speaker's showing any awareness that the
topics are unconnected. Statements that lack a meaningful relationship may be
juxtaposed, or the person may shift idiosyncratically from one frame of reference
to another. When loosening of associations is severe, speech may be incoherent.
The term is generally not applied when abrupt shifts in topics are associated with
a nearly continuous flow of accelerated speech (as in flight of ideas).
Example: Interviewer; "What did you think of the whole Watergate affair?"
Subject: "You know I didn't tune in on that, I felt so bad about it. But it seemed to
get so murky, and everybody's reports were so negative. Huh, I thought, I don't
want any part of this, and I don't care who was in on it, and all I could figure out
was Artie had something to do with it. Artie was trying to flush the bathroom toilet
of the White House or something. She was trying to do something fairly simple.
The tour guests stuck or something. She got blamed because the water
overflowed, went down in the basement, down, to the kitchen. They had a, they
were going to have to repaint and restore the White House room, the enormous
living room. And then it was at this reunion they were having. And it's just such a
mess and I just thought, well, I'm just going to pretend like I don't even know
what's going on. So I came downstairs and 'cause I pretended like I didn't know
what was going on, I slipped on the floor of the kitchen, cracking my toe, when I
was teaching some kids how to do some double dives."
Loosening of associations may be seen in Schizophrenia, Manic Episodes,
and other psychotic disorders.
MAGICAL THINKING. The person believes that his or her thoughts, words, or
actions might, or will in some manner, cause or prevent a specific outcome in
some way that defies the normal laws of cause and effect. Example: A man
believed that if he said a specific prayer three times each night, his mothers death
might be prevented indefinitely; a mother believed that if she had an angry
thought, her child would become ill.
Magical thinking may be part of ideas of reference or may reach delusional
proportions when the person maintains a firm conviction about the belief despite
evidence to the contrary.
Magical thinking is seen in children, in people in primitive cultures, and in
Schizotypal Personality Disorder, Schizophrenia, and Obsessive Compulsive
Disorder.
Page 19
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Delusional jealousy. The delusion that one's sexual partner is unfaithful.
DEPERSONALIZATION. An alteration in the perception or experience of the self so that the feeling of one's own reality is temporarily lost. This is manifested in a sense of self-estrangement or unreality, which may include the feeling that one's extremities have changed in size, or a sense of seeming to perceive oneself from a distance (usually from above).
Depersonalization is seen in Depersonalization Disorder, and may also occur in Schizotypal Personality Disorder and Schizophrenia. It is sometimes observed in peopIe without any mental disorder who are experiencing overwhelming anxiety, stress, or fatigue.
DIAGNOSIS. In general usage, this term refers to the process of identifying specific mental or physical disorders. Some, however, use the term more broadly to refer to a comprehensive evaluation that is not limited to identification of specific disorders.
DISORIENTATlON. Confusion about the date or time of day, where one is (place), or who one is (identity). Disorientation is characteristic of some Organic Mental Disorders, such as Delirium and Dementia.
DISTRACTIBILITY. Attention drawn too frequently to unimportant or irrelevant external stimuli. Example: While being interviewed, a subjects attention is repeatedly drawn to noise from an adjoining office, a book that is on a shelf, or the interviewer's school ring.
ECHOLALIA. Repetition (echoing) of the words or phrases of others. Typical echolalia tends to be repetitive and persistent. The echo is often uttered with a mocking, mumbling, or staccato intonation. Echolalia should not be confused with habitual repetition of questions, apparently to clarify the question and formulate its answer, as when a subject is asked, "When did you come to the hospital?" and replies, "Come to the hospital? Yesterday." Example: An interviewer says to a subject, "I'd like to talk with you for a few minutes"; and the subject responds, in a mumbling tone, "Talk with you for a few minutes. Talk with you for a few minutes."
Echolalia is observed in some Pervasive Developmental Disorders, Organic Mental Disorders, and Schizophrenia.
FLIGHT OF IDEAS. A nearly continuous flow of accelerated speech with abrupt changes from topic to topic, usually based on understandable associations, distracting stimuli, or plays on words. When severe, speech may he disorganized and incoherent
Flight of ideas is most frequently seen in manic episodes, but may also be observed in some cases of Organic Mental Disorders, Schizophrenia, other psychotic disorders, and, occasionally, acute reactions to stress
FORMAL THOUGHT DISORDER. A disturbance in the form of thought as distinguished from the content of thought. The boundaries of the concept are not clear, and there is no consensus as to which disturbances in speech or thought are included in the concept. For this reason, "formal thought disorder" is not used as a specific descriptive term. See loosening of associations, incoherence. poverty of content of speech, neologisms, perseveration, blocking, echolalia, clanging.
GRANDIOSITY. An inflated appraisal of one's worth, power, knowledge, importance, or identity. When extreme, grandiosity may be of delusional proportions. Example: A professor who frequently puts his students to sleep with his boring lectures is convinced that he is the most dynamic and exciting teacher at the university.
HALLUCINATION. A sensory perception without external stimulation of the relevant sensory organ. A hallucination has the immediate sense of reality of a true perception, although in some instances the source of the hallucination may be perceived as within the body (e.g., an auditory hallucination may be experienced as coming from within the head rather than through the ears). (Some investigators limit the concept of true hallucinations to sensations whose source is perceived as being external to the body, but the clinical significance of this distinction has yet to be demonstrated.
There may or may not be a delusional interpretation of the hallucinatory experience. For example, one person with auditory hallucinations may recognize that he or she is having a false sensory experience whereas another may be convinced that the source of the sensory experience has an independent physical reality. Strictly speaking, hallucinations indicate a psychotic disturbance only when they are associated with gross impairment in reality testing (see psychotic). The term hallucination, by itself, is not ordinarily applied to the false perceptions that occur during dreaming, while falling asleep (hypnagogic), or when awakening (hypnopompic). Hallucinations occurring in the course of an intensely shared religious experience generally have no pathological significance.
Hallucinations should be distinguished from illusions, in which an external stimulus is misperceived or misinterpreted and from normal thought processes that are exceptionally vivid. Transient hallucinatory experiences are common in people without mental disorder.
Hallucination, auditory. A hallucination of sound, most commonly of voices, but sometimes of clicks, rushing noises, music, etc
Hallucination, gustatory. A hallucination of taste, unpleasant tastes being the most common.
Hallucination, mood-congruent. See mood-congruent psychotic features.
Hallucination, mood-incongruent. See mood-incongruent psychotic features.
Hallucination, olfactory. A hallucination involving smell. Example: A woman complained of a persistent smell of dead bodies. Some people are convinced they have a body odor they themselves cannot smell; this symptom is a delusion, not an olfactory hallucination.
Hallucination, somatic. A hallucination involving the perception of a physical experience localized within the body. Example: A feeling of electricity running through one's body
Somatic hallucinations are to be distinguished from unexplained physical sensations; a somatic hallucination can be identified with certainty only when a delusional interpretation of a physical illness is present A somatic hallucination is to be distinguished also from Hypochondriacal preoccupation with, or exaggeration of, normal physical sensations and from a tactile hallucination, in which the sensation is usually related to the skin.
Hallucination, tactile. A hallucination involving the sense of touch, often of something on or under the skin. Almost invariably the symptom is associated with a delusional interpretation of the sensation. Examples: A man said he could feel the Devil sticking pins into his flesh; another claimed he could feel himself being penetrated anally; still another- complained of experiencing pains, which he attributed to the Devil, throughout his body, although there was no evidence of any physical illness.
A particular tactile hallucination is formication, which is the sensation of something creeping or crawling on or under the skin. Often there is a delusional interpretatation of the sensation, as when it is attributed to insects or worms Formication is seen in Alcohol Withdrawal Delirium and the withdrawal phase of Cocaine Intoxication.
Tactile hallucinations of pain are to be distinguished from Somatoform Pain Disorder, in which there is no delusional interpretation.
Hallucination, visual. A hallucination involving sight, which may consist of formed images, such as of people, or of unformed images, such as flashes of light. Visual hallucinations should be distinguished from illusions, which are misperceptions of real external stimuli.
IDEAS OF REFERENCE. An idea, held less firmly than a delusion, that events, objects, or other people in the person's immediate environment have a particular and unusual meaning specifically for him or her. See also delusion of reference.
IDENTITY. The sense of self, providing a unity of personality over time Prominent disturbances in identity or the sense of self are seen In Schizophrenia, Borderline Personality Disorder, and Identity Disorder.
ILLOGlCAL THINKING. Thinking that contains obvious internal contradictions or in which conclusions are reached that are clearly erroneous, given the initial premises. It may be seen in people without mental disorder, particularly in situations in which they are distracted or fatigued. illogical thinking has psychopathological significance only when it is marked, as in the examples noted below, and when it is not due to cultural or religious values or to an intellectual deficit. Markedly illogical thinking may lead to, or result from, a delusional belief, or may be observed in the absence of a delusion
Examples: A patient explained that she gave her family IBM cards, which she punched, in an effort to improve communication with them. Another patient stated:
"Parents are the people that raise you. Parents can be anything-material, vegetable, or mineral-that has taught you something. A person can look at a rock and learn something from it, so a rock is a parent." In response to the question "Why did you go to Kingston?" a patient replied, "Because l believe in the King James Bible and my name is James. I went to Kingston to see the Queen."
ILLUSION. A misperception of a real external stimulus. examples: The rustling of leaves is heard as the sound of voices; a man claims that when he looks in a mirror, he sees his face distorted and misshapen. See also hallucination.
INCOHERENCE. Speech that, for the most part, is not understandable, owing to any of the following: a lack of logical or meaningful connection between words, phrases, or sentences; excessive use of incomplete sentences; excessive irrelevancies or abrupt changes in subject matter; idiosyncratic word usage; distorted grammar. Mildly ungrammatical constructions or idiomatic usage�s characteristic of particular regional or ethnic backgrounds, lack of education, or low intelligence should not be considered incoherence. The term is generally not applied when there is evidence that the disturbance in speech is due to an aphasia.
Example: Interviewer: "Why do you think people believe in God?" Subject. "U m, because making a do in life. Isn't none of that stuff about evolution guiding isn't true anymore now. It all happened a long time ago. It happened in eons and eons and stuff they wouldn't believe in Him. The time that Jesus Christ people believe in their thing people believed in, Jehovah God that they didn't believe in Jesus Christ that much" Incoherence may be seen in some Organic Mental Disorders, Schizophrenia, and other psychotic disorders.
INSOMNIA. Difficulty falling or staying asleep. Initial insomnia is difficulty in falling asleep. Middle insomnia involves an awakening, followed by difficulty returning to sleep, but eventually doing so. Terminal insomnia is awakening at least two hours before one's usual waking time and being unable to return to sleep.
LOOSENING OF ASSOCIATIONS. Thinking characterized by speech in which Ideas shift from one subject to another that is completely unrelated or only obliquely related to the first without the speaker's showing any awareness that the topics are unconnected. Statements that lack a meaningful relationship may be juxtaposed, or the person may shift idiosyncratically from one frame of reference to another. When loosening of associations is severe, speech may be incoherent. The term is generally not applied when abrupt shifts in topics are associated with a nearly continuous flow of accelerated speech (as in flight of ideas).
Example: Interviewer; "What did you think of the whole Watergate affair?" Subject: "You know I didn't tune in on that, I felt so bad about it. But it seemed to get so murky, and everybody's reports were so negative. Huh, I thought, I don't want any part of this, and I don't care who was in on it, and all I could figure out was Artie had something to do with it. Artie was trying to flush the bathroom toilet of the White House or something. She was trying to do something fairly simple. The tour guests stuck or something. She got blamed because the water overflowed, went down in the basement, down, to the kitchen. They had a, they were going to have to repaint and restore the White House room, the enormous living room. And then it was at this reunion they were having. And it's just such a mess and I just thought, well, I'm just going to pretend like I don't even know what's going on. So I came downstairs and 'cause I pretended like I didn't know what was going on, I slipped on the floor of the kitchen, cracking my toe, when I was teaching some kids how to do some double dives."
Loosening of associations may be seen in Schizophrenia, Manic Episodes, and other psychotic disorders.
MAGICAL THINKING. The person believes that his or her thoughts, words, or actions might, or will in some manner, cause or prevent a specific outcome in some way that defies the normal laws of cause and effect. Example: A man believed that if he said a specific prayer three times each night, his mothers death might be prevented indefinitely; a mother believed that if she had an angry thought, her child would become ill.
Magical thinking may be part of ideas of reference or may reach delusional proportions when the person maintains a firm conviction about the belief despite evidence to the contrary.
Magical thinking is seen in children, in people in primitive cultures, and in Schizotypal Personality Disorder, Schizophrenia, and Obsessive Compulsive Disorder.