The first encounter between psychiatrist or therapist and patient (or client) is multi-phased. The mental health practitioner notes the patient’s history and administers or prescribes a physical examination to rule out certain medical conditions. Armed with the results, the diagnostician now observes the patient carefully and compiles lists of signs and symptoms, grouped into syndromes.
Symptoms are the patient’s complaints. They are highly subjective and amenable to suggestion and to alterations in the patient’s mood and other mental processes. Symptoms are no more than mere indications. Signs, on the other hand, are objective and measurable. Signs are evidence of the existence, stage, and extent of a pathological state. Headache is a symptom – short-sightedness (which may well be the cause of the headache) is a sign.
Here is a partial list of the most important signs and symptoms in alphabetical order:
We all experience emotions, but each and every one of us expresses them differently. Affect is HOW we express our innermost feelings and how other people observe and interpret our expressions. Affect is characterized by the type of emotion involved (sadness, happiness, anger, etc.) and by the intensity of its expression. Some people have flat affect: they maintain “poker faces”, monotonous, immobile, apparently unmoved. This is typical of the Schizoid Personality Disorder Others have blunted, constricted, or broad (healthy) affect. Patients with the dramatic (Cluster B) personality disorders – especially the Histrionic and the Borderline – have exaggerate and labile (changeable) affect. They are “drama queens”.
In certain mental health disorders, the affect is inappropriate. For instance: such people laugh when they recount a sad or horrifying event or when they find themselves is morbid settings (e.g., in a funeral). Also see: Mood.
Read about inappropriate affect in narcissists
We have all come across situations and dilemmas which evoked equipotent – but opposing and conflicting – emotions or ideas. Now, imagine someone with a permanent state of inner turmoil: her emotions come in mutually exclusive pairs, her thoughts and conclusions arrayed in contradictory dyads. The result is, of course, extreme indecision, to the point of utter paralysis and inaction. Sufferers of Obsessive-Compulsive Disorders and the Obsessive-Compulsive Personality Disorder are highly ambivalent.
When we lose the urge to seek pleasure and to prefer it to nothingness or even pain, we become anhedonic. Depression inevitably involves anhedonia. the depressed are unable to conjure sufficient mental energy to get off the couch and do something because they find everything equally boring and unattractive.
Diminished appetite to the point of refraining from eating. Whether it is part of a depressive illness or a body dysmorphic disorder (erroneous perception of one’s body as too fat) is still debated. Anorexia is one of a family of eating disorders which also includes bulimia (compulsive gorging on food and then its forced purging, usually by vomiting).
Learn more about comorbidity of eating disorders and personality disorders
A kind of unpleasant (dysphoric), mild fear, with no apparent external reason. Anxiety is akin to dread, or apprehension, or fearful anticipation of some imminent but diffuse and unspecified danger. The mental state of anxiety (and the concomitant hypervigilance) has physiological complements: tensed muscle tone, elevated blood pressure, tachycardia, and sweating (arousal).
Generalized Anxiety Disorder is sometimes misdiagnosed as a personality disorder
More precisely: autistic thinking and inter-relating (relating to other people). Fantasy-infused thoughts. The patient’s cognitions derive from an overarching and all-pervasive fantasy life. Moreover, the patient infuses people and events around him or her with fantastic and completely subjective meanings. The patient regards the external world as an extension or projection of the internal one. He, thus, often withdraws completely and retreats into his inner, private realm, unavailable to communicate and interact with others.
Asperger’s Disorder, one of the spectrum of autistic disorders, is sometimes misdiagnosed as Narcissistic Personality Disorder (NPD)
Automatic obeisance or obedience
Automatic, unquestioning, and immediate obeisance of all commands, even the most manifestly absurd and dangerous ones. This suspension of critical judgment is sometimes an indication of incipient catatonia.
Halted, frequently interrupted speech to the point of incoherence indicates a parallel disruption of thought processes. The patient appears to try hard to remember what it was that he or she were saying or thinking (as if they “lost the thread” of conversation).
A loosening of associations. A pattern of speech in which unrelated or loosely-related ideas are expressed hurriedly and forcefully, with frequent topical shifts and with no apparent internal logic or reason. See: Incoherence.
Imitation by way or exactly repeating another person’s movements. Involuntary, semiautomatic, uncontrollable, and repeated imitation of the movements of others. Observed in organic mental disorders, pervasive developmental disorders, psychosis, and catatonia. See: Echolalia.
Thought and speech disorder which involves the translocation of the focus of attention from one subject to another for no apparent reason. The patient is usually unaware of the fact that his train of thoughts and his speech are incongruous and incoherent. A sign of schizophrenia and some psychotic states. See: Incoherence; Flight of Ideas; Tangentiality.
A form of severe anxiety attack accompanied by a sense of losing control and of an impending and imminent life-threatening danger (where there is none). Physiological markers of panic attacks include palpitation, sweating, tachycardia (rapid heart beats), dyspnea or apnoea (chest tightening and difficulties breathing), hyperventilation, light-headedness or dizziness, nausea, and peripheral paresthesias (an abnormal sensation of burning, prickling, tingling, or tickling). In normal people it is a reaction to sustained and extreme stress. Common in many mental health disorders.
Sudden, overpowering feelings of imminent threat and apprehension, bordering on fear and terror. There usually is no external cause for alarm (the attacks are uncued or unexpected, with no situational trigger) – though some panic attacks are situationally-bound (reactive) and follow exposure to “cues” (potentially or actually dangerous events or circumstances). Most patients display a mixture of both types of attacks (they are situationally predisposed).
Bodily manifestations include shortness of breath, sweating, pounding heart and increased pulse as well as palpitations, chest pain, overall discomfort, and choking. Sufferers often describe their experience as being smothered or suffocated. They are afraid that they may be going crazy or about to lose control.
Misdiagnosing General Anxiety Disorder (GAD) as Narcissistic Personality Disorder
Rapid, condensed, unstoppable and “driven” speech. The patient dominates the conversation, speaks loudly and emphatically, ignores attempted interruptions, and doesn’t care if anyone is listening or responding to him or her. Seen in manic states, psychotic or organic mental disorders, and conditions associated with stress. See: Flight of Ideas.
Visible slowing of speech or movements or both. Usually affects the entire range of performance (entire repertory). Typically involves poverty of speech, delayed response time (subjects answer questions after an inordinately long silence), monotonous and flat voice tone, and constant feelings of overwhelming fatigue.
Chaotic thinking that is the result of a severely impaired reality test ( the patient cannot tell inner fantasy from outside reality). Some psychotic states are short-lived and transient (microepisodes). These last from a few hours to a few days and are sometimes reactions to stress. Persistent psychoses are a fixture of the patient’s mental life and manifest for months or years.
Psychotics are fully aware of events and people “out there”. They cannot, however separate data and experiences originating in the outside world from information generated by internal mental processes. They confuse the external universe with their inner emotions, cognitions, preconceptions, fears, expectations, and representations.
Consequently, psychotics have a distorted view of reality and are not rational. No amount of objective evidence can cause them to doubt or reject their hypotheses and convictions. Full-fledged psychosis involves complex and ever more bizarre delusions and the unwillingness to confront and consider contrary data and information (preoccupation with the subjective rather than the objective). Thought becomes utterly disorganized and fantastic.
There is a thin line separating nonpsychotic from psychotic perception and ideation. On this spectrum we also find the schizotypal personality disorder.