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  An Update: from the Queen of Avoidance
by kathleen howe
I was the Queen of Avoidance. I'm better now. I'm not perfect, but I'm better. What did the trick? What keeps me at bay concerning
avoiding things? Well, I'll tell you the truth for the sake of using this as an example of the level of avoidance I had been
dealing with. I avoided things like paying the bills and doing the taxes. Yep. I told you I was the Queen of Avoidance. It
wasn't due to anything but fear and avoiding anything that had to do with that fear; although the IRS will cause you to take
notice once they start adding 0's to their late fees!
My fear was of the mail. I had been through a very traumatic custody fight.
My ex-husband would tell me that it was okay for me to make a transitional move and then once I had made arrangements to make
the transition, he would have me served with papers that said I couldn't after all make the transition. It was dreadful. Soon
he incorporated the tactic of parental alienation.
All communications then had to be between his attorney and my attorney.
When I ran out of money and had to get a public defender it was even worse. I couldn't open the mail and I couldn't send the
mail. I was frozen. I was so afraid - living in so much fear - I couldn't function.
That was the past. I had to force myself to live in the present moment
and face my fears. I had to open the envelopes and once I began doing what I feared the most - my avoidance behaviors began
to subside. They've subsided, but only because I made the commitment to myself to stop letting fear rule my life.
It's been an uphill journey, but after I simply began doing what I had
needed to do for years; opening correspondences cautiously eying their messages to me - it began to feel more comfortable
each time. I'm not sure that I'm an advocate of desensitization therapy, but after learning enough information concerning
fear - I began to understand it's patterns and it's ravaging force.
I've faced those immediate and looming fears so that I no longer
avoid to the extreme I once did, but I am still not cured. There are the issues I have with my father's prophecy of my life!
He proclaimed me only able to be a wife and mother. He told me that was what women were made for, but I'm a writer and I do
have things I need to publish to make myself feel whole. I have to stop avoiding the publishing actions that need to take
place.
Now I must look at my weaknesses and study. I have a huge problem with
processing directions. My brain wants to learn by trial and error, but I don't want to set myself up for failure. I need to
learn how to follow the directions I need to take in book publishing so that I can become able to process my fear of facing
my father and go forward with more small accomplishments until my goals are reached!
My best wishes if you're an avoider too! It's a very difficult habit to
break!
Eliminate Anxiety & Feel Safe Without Drugs
By Dr. Doris Jeanette, licensed psychologist
Can you be still for 15 minutes,
not talking, reading, or watching televsion, without jumping up to "DO" something? If not, anxiety is keeping you from relaxing & feeling peace & calm. Everyone has some degree of anxiety in his or her body.
The good news is we don't
have to live with anxiety. Joe Wolpe, MD, father of behavior therapy, was my supervisor at Temple Medical School in 1975. He is the one who taught me this, as well as the difference between
anxiety & fear.
Fear is a normal feeling that alerts us to real dangers, such as a fire raging in our home or a car rushing toward us. It propels us out of the house
or back on the curb! We don't want to eliminate fear. It's essential for our survival.
Anxiety, on the other hand, is a learned response, which is maladaptive. It interferes with our highest functioning &
delicious enjoyment of life. We do want to eliminate it because it ruins our life. And we can. Since anxiety is learned, we can unlearn it. It may require a little effort on our part, but we can definitely move beyond our conditioned
responses to a higher level of functioning. I've had great success with motivated people in eliminating anxiety out of the body & nervous system.
We know we're anxious when we get caught up in our thoughts, forgetting we have a body. We're like the static on the radio, unclear & disharmonous. No one can reach us & we can't reach
anyone. The communication lines are broken. Our radio station doesn't come in. This is when we could freak OUT & have an anxiety or panic attack.
Most people deny this nervous, static energy that's buzzing around their nervous system. They "bind" their anxiety by watching television, talking, eating, drinking, or constantly "DOING" something. i.e.,
instead of meeting his anxiety face to face, a man would work late at the office. A woman would have sex with anything & anybody. These avoidance behaviors are what push people away in relationships.
Instead of using drugs, legal or illegal, to mask the problem, we can eliminate this static out of our nervous system once & for all.
Then we can relax & feel more secure. When we deny our anxiety, our energy is drained & we're weakened. When we face our anxieties, we free up energy for creative living.
Without anxiety, we "connect." Our radio station comes in clearly because we're still, others can tune into us. Even if we're scared, hurt or upset we're in harmony because we're dealing with the truth inside of our body. As we accept ourselves where we are, the food tastes better, the love is greater & the sound is more beautiful. Others come closer.
There are many
methods for releasing the tension out of our body. My favorite is being still while breathing & feeling my body & emotions. Verbal therapy is limited; you need something that directly affects your autonomic nervous system & body. Find what works for you, all techniques have value. But be sure to choose a practitioner to help you that is more relaxed than you are.
source: selfgrowth.com
Struggle & Human Growth
By Jan Stephen
Maizler, LCSW
Let’s define struggle to mean any personal goal achievement accompanied by
discomfort & resistance. This leaves out struggles of an interpersonal kind. There are many forms of struggle, but for
simplicity’s sake, let’s divide struggle into negative, positive, inevitable & chosen.
Negative struggle is goal achievement to eliminate a deficit state. This occurs when you are attempting to get
back to the norm, such as mastering a life-limiting phobia.
Positive struggle is
goal achievement that involves transformation from your steady state into a more evolved, grown, or developed state of being.
Positive struggle, in contrast to negative struggle does not involve overcoming pathology. Examples of positive struggle are
going to graduate school or writing a book. Positive struggle may still certainly involve overcoming resistance and discomfort.
Inevitable struggle deals with the necessary losses and attendant discomfort that
are conditions of your life in this world. As your mother struggled to birth you, you struggled to adjust to a new and less
comforting world. During your life, you will struggle with sadness and loss when your friends,
parents, or partners die or go elsewhere. These struggles are an automatic condition of your life.
Chosen struggles are the product of personal choice and are not automatic conditions of life. Simple examples
of chosen struggles are climbing a mountain, going to graduate school, or becoming a body builder.
The basis of this article is that personal struggle as it has been defined has benefit, and conversely, the
avoidance of struggle is often harmful. It may be helpful to you to consider the following
ideas regarding your relationship to the active or potential struggles in your life.
1.
Struggle should be embraced, not avoided.
3. The discomfort that accompanies struggle may be neither harmful nor lasting.
4.Discomfort is often an automatic aspect of the growth process.
5. No one can struggle for you
6. You can't struggle for another person, although they may certainly want you to.
7. Struggle is often a normal part of life.
8. Avoidance of struggle often results in low self esteem and personal atrophy.
9. Embracing struggle can result in increased self esteem and personal growth.
10. Evolution as well as collective and individual development embody struggle itself.
Regarding individual development, some people start life off “ on the wrong
foot”. This can happen when well-meaning parents either do something for a child that they can do for themselves or
impede a child’s activities because of their own fears.
Both of these situations diminish the necessary struggle that the child must engage
in to grow, experience mastery, and learn that the world around them and their efforts have a relationship. A
sad but effective example of this is parents who excessively hover over, and worry over their toddler-child. The child
might even come to believe that falling is dangerous, harmful, maybe fatal. People WILL fall, but they get up as well: this is essential learning for
children and for adults with that kind of child “inside them.”
THE GOOD NEWS
We all have the innate capability to grow “new selves” at any point in our life cycle by embracing and “working” our chosen and inevitable
struggles. We can learn a great deal about this capacity from the discipline of body building. Those people that choose to
“grow” their muscles are aware of a phenomenon called the “training effect.”
This means that when our muscles are systematically and repeatedly subjected to a
lifting (resistance / struggle) effort greater than their capacity, they will grow to adapt to and meet the newly-introduced
demand. T
This involves considerable discomfort, BUT YOUR MUSCLES WILL NOT GROW UNLESS THEY
ARE SUBJECTED TO A LIFTING TASK GREATER THAN THEIR CAPACITY. The art form in this process is to keep the weight lifted slightly
more than your growing lifting capacity. This implies that optimal growth is a process, not a goal.
Muscles grow in another way: they can be stretched. The age-old discipline of
Yoga, and the newer Pilates involve retraining of the muscles into a more flexible arrangement of components that create a
body with a much bigger range of motion. The physical discomfort that accompanies this work is often referred to as “sweet
pain”, because the discomfort is a sign of growth that is occurring.
THE PARADOX
OF COMFORT
Although comfort feels good, it plays little if any role in your growth. Take the concept of routine, for example. Routine means an established
way of doing things that's repeated, because it has proved effective &/or useful.
Routine feeds on itself because comfort is self-reinforcing. The paradox of comfortable routine is that although it has proven useful, it'll eventually severely limit the scope of how you experience the world. You may drive to work & return home the same way, but stop to think of how
much you're missing & experiencing by not trying alternate paths.!
GET STARTED
NOW!
You can change your life right now by embracing struggle & discomfort. Start by making your decisions based on how you
can best grow & evolve. Spend less time basing your decisions & choices on their comfortability.
Jan Maizler MSW, LCSW, is a widely-read veteran
therapist/author.This is an excerpt from his newest book, “The Blessings of Struggle.” You can read more and/or
contact Jan at www.transformationhandbook.com, or www.relationshiphandbook.com.
Early Marital Slippage
By Dr. Joan
D. Atwood
Sal & Gloria were married for 21 years. They had two sons who were presently
away at college. They were married quite young & when Gloria initiated counseling, they were both in their early 40's.
It was already too late. Their marriage was over.
Sal had informed Gloria the week before that he was leaving her &
that he'd been involved in a long term extramarital affair for the past 6 years. Gloria was shocked! She had absolutely no
idea.
When asked if there were any signs of his distancing in the marital relationship,
she strongly replied that there weren't. He never went out in the evening. He was very predictable. Their sex life was the
same as it always had been. He was involved in family life & seemed to be concerned about her & the children.
This situation is a common one - a marriage that seems stable; a relationship that appears
committed; a spouse that tends to be predictably positively involved. Then, one day, seemingly out of the clear blue, one
of them informs the other that the marriage is over & has been for a very long time.
The other spouse is shocked - had no idea that this was about to occur. When
asked if there were signs, he or she invariably replies, "No."
Generally, when couples
come for marriage counseling, they've already experienced a great deal of pain & their marriage is often at risk. Among
some of the more typical presenting problems are alcohol or drug abuse, sexual dysfunction, spouse abuse (physical or emotional), continual conflict &/or extramarital relationships.
These aren't the kinds of situations we wish to address. Rather, the issues we wish to explore
are more insidious & generally more common in marital relationships. We're more interested in the early pre-conditions
of marital risk, those events which can act as danger signals to couples who are functioning quite well.
We're interested in marital
slippage - the manifestations, the signals (both emotional & behavioral)
& the curative strategies that couples can employ to reenergize their marriage &/or to reduce the chances of further
slippage.
Manifestations of marital slippage generally fall into 10 broad categories:
- spousal perceptual negation
- sarcastic teasing
- frequent disagreement over minor issues
- sexual and/or marital apathy
- need for validation by others
- predictable cycles or lack of romance in the marriage
- spousal irritations
- communication problems
- a "thing" coming between them
- jealousy
1. Spousal
perceptual negation occurs when spouses view an event differently and one spouse can't tolerate any viewpoint other
than his/her own.
For example, birthdays were
always important to Mary M. When she was a child, her parents lavished her with presents and she always had a big birthday
celebration.
John M., on the other
hand, came from a very large family who rarely celebrated holidays. Birthdays were considered "just another day." So
when John did not send Mary a birthday card, she felt that he didn't love her anymore.
Her marital expectations were not met and she was disappointed. He thought she was making a fuss over nothing.
Ultimately, this
problem could have the potential of becoming a major source of difficulty in the marriage. Remaining unchecked, it could even
possibly destroy the marriage because eventually the intolerance of differing viewpoints would increase.
Generally, the
need for a spouse to deny differing viewpoints occurs for 1 of 3 reasons: It represents:
(1) a learned way
of dealing with others which has been acquired through one's family of origin experiences,
(2) a power or
control issue, or
(3)
the reluctance to take responsibility for one's actions.
2. Sarcastic teasing is often a flirtation with disaster in disguise. Harmless little love pats soon
grow into little digs. The little digs, fueled by feelings of hurt and indignation, can lead to major battles.
The first time
Sally L. teased Walter L. about his cold-fish behavior in bed, he laughed it off as a minor annoyance. When she said it three
months later in front of his friends from work, he was more than mildly annoyed.
He soon started
to become sensitized to any negative remarks that she made, interpreting them as criticism. Being in a supposedly loving
and caring relationship for Walter soon became an experience based on his capacity to tolerate Sally's hostile and derogotory
remarks.
3. All couples experience minor
disagreements. In and of themselves, arguments generally are not problematic for relationships. They happen on a fairly regular
basis , are resolved and forgotten.
However,
if they begin to increase in number and/or intensity, or if the same issues keep cropping up remaining unresolved, then they
could signal a deterioration of the relationship.
Frequent arguments
could also signal what is called the pursuer-distancer theme. The couple is comfortable with a certain level of intimacy.
Once their closeness increases, they both become uncomfortable. Arguing with each other creates distance, serving to bring
them back to a more comfortable level of intimacy.
The distancing
effect of constant bickering produces a frustration and self-defeating cycle, such that, when one partner seeks greater
distance from the other, then the other is stimulated to react by seeking greater closeness with the distancing partner, who
now in turn must seek even ! greater distance.
This cycle ends
when the "cat and mouse" game exceeds the tolerance level of either partner and derails the relationship. Bruce M. constantly
sexually pursued Susan M. She rejected him on a regular basis. During therapy, it was suggested that Bruce stop approaching
Susan and that Susan would approach him sexually when she was interested.
This resulted
in a much greater response on Susan's part; however, it did not solve the problem because when Susan began approaching Bruce,
he rejected her. The real issues were fears of intimacy, vulnerability, and engulfment.
4. Sexual apathy may reflect
a spouse's fear of intimacy / rejection or may be a form of payback.
In the first case, when
a spouse fears intimacy / rejection, the lack of sexual interest may serve as a way of avoiding
closeness or being rejected in order to avoid a less than desired performance.
In the second case,
rejection of the others' sexual needs, along with one's own, often is a spouse's attempt to compensate for feeling or powerlessness
/ hurt in another area of the relationship. It is a way of paying the other one back or of gaining "bargaining chips" in an
ongoing struggle to manipulate the other's behavior.
Couples often use the
sexual arena to act out problems they are having in the non-sexual areas of their relationship.Dianne M. and Ron M.
came for therapy because Dianne would not have sex with Ron.
At first glance
it appeared that she did not like sex, receiving no gratification or pleasure. Closer examination revealed that she felt powerless
in the marriage, with Ron controlling all finances and making all major and minor decisions.
As a result she
felt unimportant and insignificant. Refusing to have sex with him was one area in their relationship that she could control.
Thus, the marital conflict expanded to the bedroom.
5. Validation
through the other in similar to problem number one in that it represents the flip side of the coin. Whereas number one involves
the consistent negation of alternate values; validation through other
involves an acceptance of all of a spouse's values.
Here one partner
continuously seeks the other's approval or help and in so doing is extremely sensitive to the other's
disapproval or lack of enthusiasm. In this situation the individual's self worth is determined by the opinions and behavior
of the other partner.
Both problems
involve identity issues in that one person's sense of identity is determined by either negating or accepting the other's frame
of reference. Collen L. was raised in a strict Catholic home. Coming from a large family, her behavior was strictly kept under
control by her parents and older siblings.
When she married Jim,
she devoted her entire life to being a good wife and mother. Her identity was determined by him in that all of her interests
and time were scheduled around his needs. The slightest hint of criticism from him devastated her. He then had to spent enormous
amounts of time consoling her, pledging his love to her before she feel calmed.
6. Predictable cycles in marriage
refer to repetitive patterns that don't have positive outcomes. They are often played out by one partner's actions producing as strong a reaction in the other, which then touches
off an even stronger reaction in the first partner.
Each reaction
is stronger than the previous one. The couple becomes stuck in this vicious cycle. The rule here is that each person must
say something a little worse than what was just said (x+1). This creates a very predictable yet escalating cycle. The process
usually does not end until they frighten each other, either by resorting to physical violence or devastating each other with
words.
When dating,
Roger and Sally H. showered each other with compliments. Each would attempt to outdo the other with gifts, cards expressing
their love, and compliments. Shortly after they were married, this pattern, each trying to outdo the other, took a negative
shift and the discussions began to escalate in a destructive manner.
7. Little irritating things refer to the small annoyances of everyday living. If they become too much of a focus, they can become big bothersome
things. Leaving the top off the toothpastes is the often used example. Representative of the little annoying things mentioned
in therapy are:
When a person consistently
finds his or her spouse's behavior irritating, it usually indicates that something else is upsetting him/her, either about
him/her self, the other partner or their relationship. The troubled partner may not be aware of what is bothering him/her,
but may focus on a symbolic minor feature of the partner's appearance or behavior.
Unless action is taken
by either partner to explore what is troubling him/her, it can mushroom into unintelligible and nonsensical blowups, leaving
both partners devastated and not knowing what is happening or why.
A person with poor communication skills has chosen or been trained to be either highly verbal or non-verbal. Two people having different communications styles may be at cross purposes while talking to each other.
When one spouse is highly
verbal, the other may hesitate becoming involved in any discussion because of the apparent verbal superiority
of the other. These problems may manifest by a reluctance to verbalize feelings or needs, leading to frustration and resentment.
This problem is
often directly related to a problem of low self esteem. In other cases, fears of rejection in retaliation may underlie the communication problem. One partner may avoid confrontations or sensitive areas
of interactions because s/he fears intimacy or feels reluctant to aggravate the other.
9. Sometimes, "things"
come between a couple. These "things" can be represented by anything or anyone. Some examples are:
- a job
- an interest / hobby
- over-functioning in a parent role
- under-functioning in the husband/wife role,
etc.
This could signal either that
the marriage is not yet established in a committed way or that it is in the process of deterioration. If this process is allowed to go unattended and unchecked, then marital
strife is sure to follow.
10. Jealousy can threaten a marriage. Jealousy is often a preexisting condition for one or both of the partners. It can either be accidentally or deliberately triggered.
Jealousy often reflects a person's lack of self concept in one of two ways. In the first situation, the partner could be expressing the need to possess the other. This is manifested by one trying to control the other's activities or by holding him/her accountable for his/her behavior.
In the second situation,
the one partner's self concept is in need of constant reassurances. The person needs to be constantly reminded through continued attention that s/he is loved and therefore okay. This condition often flares up quickly into an intolerable jailer -prisoner scenario.
Before situations get too far out of hand, there are some very immediate and effective measures that individuals
can take to address these signs of early marital slippage. Initially, individuals need to be sensitive to the appearance of these signs.
Then, partners need to alert each other to the presence of such signals and request cooperation in the exploration of them. Both partners need to talk about the situation until concerned feelings and perceptions have a favorable resolution. If these initial suggestions are not helpful, then partners need to stop interactions when they begin to deteriorate.
This may also facilitate
the resolution of early warning signals by placing the marital partners in a better frame of mind from which to approach these
issues. Below are some helpful guidelines which couples can employ to help their communications.
Don't collect trading stamps; deal with the issues immediately. When an individual
walks away from an interaction without having communicated a need or a feeling. the situation is ripe for "collecting a trading stamp."
Years ago, people
collected scores of trading stamps to cash them in later for some large prize. Some individuals save up petty annoyances, little angry feelings, insecurities, or anxieties to case them in later for some deeper feeling. The result is usually a major argument.
If the small feeling or anxiety had been communicated when it occurred, the result could have led to a resolution with closure and elimination of the negative feeling. Make attempts to reinterpret negative perceptions into more positive ones.
What we define as real is based on our past history - experiences, perceptions,
etc. All kinds of possibilities exist in any given set of circumstances, but we can chose which ones to perceive and how to perceive them. This selection process is shaped, molded, and created
by us because of our unique psychology and the society in which we live.
Sometimes,
because of various socialization factors, one may consistently choose to view himself, herself negatively. Such an individual usually chooses negative statements such as, "She doesn't love me. Why should she? I'm not a worthwhile person."
The associated emotional state
is depression. Another statement based on negative perceptions of the world in general might be, "He won't like me sexually," The thought is, "Why should he? I'm sure I don't know how to do it right." The associated emotional feeling is anxiety.
We all make such statements at one point or another; at times, they may actually
be realistic perceptions. This, however, isn't what we are referring to. Our concern here is when the negative perceptions of persons and circumstances are recurring themes or typical patterns - when the person generally chooses to see himself.herself negatively.
Gradually, you
can learn to view yourself in a more realistic, comfortable fashion. Avoid patterns of communication in which someone is a loser. Aim, instead, for two winners.
Some couples communicate in a way that results in a winner and a loser; someone gains at the expense of the other. This can be called "zero summing."
The mindset is, "If one is right, then the other must be wrong," or "If she is right, he must be selfish
and inconsiderate."
In actuality, this kind
of thinking only causes two losers. When this situation exists, the two individuals are off balance. It is always depressing to be the
loser, but in zero-summing situations, the victory of the winner is often shallow and lonely because they've won only at the expense of their partner.
To avoid
playing the zero summing game, focus on being a team where each helps the other to win but not at the expense of the
other. Free yourself from pre-programmed responses.
When new responses are made to us which we define
as negative, we generally exhibit displeasure, almost automatically- - in a preprogrammed way. Concentrate on not responding automatically;
encourage each other to bracket or suspend and examine initial reactions. Beware of transforming internal anxieties about self into critical attacks on others.
A common anti-communication technique is the "attack"
statement such as, "You're a jerk" or "You're stupid." Often, the true source of frustration with a mate originates out of a sense of failure in oneself.
Let's assume the husband comes home from work and immediately begins
yelling at his wife about the condition of the house. He may well be attacking his partner for reasons other than the messy
house. He may have performance anxieties about himself in general, and particularly with sex.
Perhaps he's concerned about
impotence but is psychologically unable to acknowledge this negative fear. It's too threatening for him. With his complaint, he creates a safe situation
for himself whereby his wife becomes angry with him and refuses him sex. Then, he doesn't have to worry about performance. His guilt and anxieties are alleviated for the moment, only to return at some later point - probably with more intensity.
She may decide that what
he's actually saying has nothing to do with impotence but rather with the fact that he no longer finds her attractive. This
makes her a mind reader, and the honest message from her husband becomes totally discounted; she substitutes what she thinks is the real reason. Now, if she verbalizes this to him, he may attempt to reassure her otherwise.
Even at that, the focus
has now shifted away from his anxiety onto his wife. He must now verbalize his fears again (Probably a painful & unpleasant admission for him) if he's
going to establish open communication. A further complication might be that he now becomes hesitant to communicate for fear that the conversation may center on whether or not he thinks his wife is attractive. Listen and look. Tune in to your partner.
One of the most difficult things for couples to do is to really listen to each other. Oftentimes, we may
be listening to someone reporting a situation, an incident, a problem, or a feeling, and we're thinking ahead for something we can say, a similar story we can share which aligns with what they're saying. We're listening, of course, but we're not really hearing what the person is saying. When we use this method of communicating, we lose much valuable information.
One reason
why this occurs is that many of us can't tolerate silence. We feel
a constant need to keep the conversation going -silence is something to avoid. What usually occurs is that
we are constantly thinking ahead to new topics to bring up while the other is talking. When we exhaust all possible topics, the conversation lapses
into what we probably would call boredom.
Enjoy the silence.
Relax. Don't feel the need to control or run the conversation. Don't keep talking when there's really nothing left to say. Start listening. You may even want to create specific periods of calm & reflection when the two of you simply spend time completely alone, undisturbed, yet not "discussing" anything. Examine & evaluate feelings of guilt & anxiety.
There are times when you feel guilty or anxious about certain interactions. Question yourself about where these feelings may be coming from. Have you provided yourself with information so that you can examine the intellectual basis of the negative emotion?
Have you communicated the guilt or anxiety in the present so that your partner can respond & thereby help to create closure on the negative emotion?
Have you communicated the feeling so that it doesn't intensify over time, so that you don't begin to collect trading stamps?
Have you
attempted to translate the negative feelings into more positive ones?
Don't be afraid to delve into yourself. Acknowledge the existence of negative perceptions within yourself so that you can take steps to transform them into positive ones.
Open communication provides the basis for married couples to trust. Once an individual begins to communicate openly, the groundwork is laid for the mate to reciprocate. When this positive cycle is begun, the couple has the potential for higher levels of satisfaction leading to rewarding
intimate awareness.
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Psychological Signs & Symptoms
By Sam
Vaknin
The first encounter between psychiatrist or therapist & patient (or client) is multi-phased. The mental health practitioner
notes the patient's history & administers or prescribes a physical examination to rule out certain medical conditions.
Armed with the results, the diagnostician now observes the patient carefully & compiles lists
of signs & symptoms, grouped into syndromes.
Symptoms are the patient's complaints.
They're highly subjective & amenable to suggestion & to alterations in the patient's mood & other mental processes.
Symptoms are no more than mere indications.
Signs, on the other hand, are objective & measurable.
Signs are evidence of the existence, stage & 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 & symptoms in alphabetical order:
Affect: We
all experience emotions, but each & every one of us expresses them differently. Affect is HOW we express our innermost feelings & how other people observe & interpret our expressions. Affect is characterized by the type of emotion involved (sadness, happiness, anger, etc.) & 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 & the Borderline - have exaggerate & labile (changeable)
affect. They're "drama queens".
In certain mental health disorders, the affect is
inappropriate. i.e.: 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.
Ambivalence: We've all come across situations
& dilemmas which evoked equipotent - but opposing & conflicting - emotions or ideas. Now, imagine someone with a permanent
state of inner turmoil: her emotions come in mutually exclusive pairs, her thoughts & conclusions arrayed in contradictory
dyads.
The result is, of course, extreme indecision, to the point of utter paralysis & inaction.
Sufferers of Obsessive-Compulsive Disorders & the Obsessive-Compulsive Personality Disorder are highly ambivalent.
Anhedonia: When we lose the urge to seek pleasure & 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 & do
something because they find everything equally boring & unattractive.
Anorexia: Diminished appetite to the point of refraining from eating. Whether it's 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 & then its forced purging, usually by vomiting).
Anxiety: A kind of unpleasant (dysphoric), mild
fear, with no apparent external reason. Anxiety is akin to dread, or apprehension, or fearful anticipation of some imminent but diffuse & unspecified danger. The mental
state of anxiety (& the concomitant hypervigilance) has physiological
complements:
- tensed
muscle tone
- elevated
blood pressure
- tachycardia
- sweating (arousal)
Autism: More precisely: autistic thinking & inter-relating
(relating to other people). Fantasy-infused thoughts. The patient's cognitions
derive from an overarching & all-pervasive fantasy life.
Moreover, the patient infuses people & events around him or her with fantastic & completely
subjective meanings. The patient regards the external world as an extension or projection of the internal one. He, thus, often
withdraws completely & retreats into his inner, private realm, unavailable to communicate & 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 & immediate
obeisance of all commands, even the most manifestly absurd & dangerous ones. This suspension of critical judgment is sometimes
an indication of incipient catatonia.
Blocking: Halted,
frequently interrupted speech to the point of incoherence indicates a parallel disruption of thought processes. The patient
appears to try hard to remember what it was that he or she were saying or thinking (as
if they "lost the thread" of conversation).
Catalepsy: "Human sculptures" are patients who freeze in any posture & position that they're placed, no matter how
painful & unusual. Typical of catatonics.
Catatonia: A
syndrome comprised of various signs, amongst which are:
- catalepsy
- mutism
- stereotypy
- negativism
- stupor
- automatic
obedience
- echolalia
- echopraxia
Until recently it was thought to be related to schizophrenia, but this view has been discredited
when the biochemical basis for schizophrenia had been discovered. The current thinking is that catatonia is an exaggerated
form of mania (in other words: an affective disorder).
It's a feature of catatonic schizophrenia, though & also appears in certain psychotic states
& mental disorders that have organic (medical) roots.
Cerea Flexibilitas: Literally: wax-like flexibility. In the
common form of catalepsy, the patient offers no resistance to the re-arrangement of his limbs or to the re-alignment of her
posture.
In Cerea Flexibilitas, there is some resistance, though it's very mild, much like the resistance
a sculpture made of soft wax would offer.
Circumstantiality: When the train of thought & speech is often derailed by unrelated digressions, based on chaotic associations. The patient finally succeeds to express his or her main idea but only after much effort & wandering.
In extreme cases considered to be a communication disorder.
Clang Associations: Rhyming or punning associations of words
with no logical connection or any discernible relationship between them. Typical of manic episodes, psychotic states &
schizophrenia.
Clouding (Also: Clouding of Consciousness):
The patient is wide awake but his or her awareness of the environment is partial, distorted,
or impaired. Clouding also occurs when one gradually loses consciousness (i.e., as a result
of intense pain or lack of oxygen).
Compulsion: Involuntary repetition of a stereotyped & ritualistic action or movement, usually in connection with a wish
or a fear. The patient is aware of the irrationality of the compulsive act (in other words:
she knows that there's no real connection between her fears & wishes & what she is repeatedly compelled to do).
Most compulsive patients find their compulsions tedious, bothersome, distressing & unpleasant
- but resisting the urge results in mounting anxiety from which only the compulsive act provides much needed relief.
Compulsions are common in obsessive-compulsive disorders, the Obsessive-Compulsive Personality
Disorder (OCPD) & in certain types of schizophrenia.
Concrete Thinking: Inability or diminished capacity to form abstractions or to think using abstract categories. The
patient is unable to consider & formulate hypotheses or to grasp & apply metaphors.
Only one layer of meaning is attributed to each word or phrase & figures of speech are taken
literally. Consequently, nuances aren't detected or appreciated. A common feature of schizophrenia, autism spectrum disorders
& certain organic disorders.
Confabulation: The constant
& unnecessary fabrication of information or events to fill in gaps in the patient's memory, biography or knowledge,
or to substitute for unacceptable reality. Common in the Cluster B personality disorders (narcissistic,
histrionic, borderline & antisocial) & in organic memory impairment or the amnestic syndrome (amnesia).
Confusion: Complete (though often momentary) loss
of orientation in relation to one's location, time & to other people. Usually the result of impaired memory (often occurs in dementia) or attention deficit (i.e., in
delirium). Also see: Disorientation.
Delirium: Delirium is a syndrome which involves clouding, confusion, restlessness, psychomotor disorders (retardation or, on the opposite pole, agitation) & mood & affective disturbances (lability). Delirium isn't a constant state. It waxes & wanes & its onset
is sudden, usually the result of some organic affliction of the brain.
Delusion: A
belief, idea, or conviction firmly held despite abundant information to the contrary. The partial or complete loss of reality
test is the first indication of a psychotic state or episode. Beliefs, ideas, or convictions shared by other people, members
of the same collective, are not, strictly speaking, delusions, although they may be hallmarks of shared psychosis.
There are many types of delusions:
I. Paranoid: The
belief that one is being controlled or persecuted by stealth powers & conspiracies.
2.
Grandiose-magical: The conviction that one is important, omnipotent, possessed of occult powers, or a historic figure.
3. Referential (ideas of reference): The belief
that external, objective events carry hidden or coded messages or that one is the subject of discussion, derision, or opprobrium,
even by total strangers.
Dementia: Simultaneous impairment of various mental faculties, especially the intellect,
memory, judgment, abstract thinking & impulse control due to brain damage, usually as an outcome of organic illness.
Dementia ultimately leads to the transformation of the patient's whole personality. Dementia doesn't
involve clouding & can have acute or slow (insidious) onset. Some dementia
states are reversible.
Depersonalization: Feeling that one's body has changed shape or that specific organs have become elastic & aren't under one's control. Usually
coupled with "out of body" experiences.
Common in a variety of mental health & physiological disorders: depression, anxiety, epilepsy,
schizophrenia & hypnagogic states. Often observed in adolescents. See: Derealization.
Derailment:
A loosening of associations. A pattern of speech in which unrelated or loosely-related
ideas are expressed hurriedly & forcefully, with frequent topical shifts & with no apparent internal logic or reason.
See: Incoherence.
Derealization: Feeling that one's immediate environment is unreal, dream-like, or somehow altered. See: Depersonalization.
Dereistic Thinking: Inability to incorporate reality-based facts & logical
inference into one's thinking. Fantasy-based thoughts.
Disorientation: Not knowing what year, month, or day it is or not knowing one's location (country,
state, city, street, or building one is in). Also: not knowing who one is, one's identity. One of the signs
of delirium.
Echolalia: Imitation by way of exactly
repeating another person's speech. Involuntary, semiautomatic, uncontrollable & repeated imitation of the speech of others.
Observed in organic mental disorders, pervasive developmental disorders, psychosis & catatonia. See: Echopraxia.
Echopraxia: Imitation by way or exactly repeating another person's
movements. Involuntary, semiautomatic, uncontrollable & repeated imitation of the movements of others. Observed in organic
mental disorders, pervasive developmental disorders, psychosis & catatonia. See: Echolalia.
Flight of Ideas: Rapidly verbalized train of unrelated thoughts or of thoughts
related only via relatively-coherent associations. Still, in its extreme forms, flight of ideas involves cognitive incoherence
& disorganization.
Appears as a sign of mania, certain organic mental health disorders, schizophrenia & psychotic
states. Also see: Pressure of Speech & Loosening of Associations.
Folie a Deux
(Madness in Twosome, Shared Psychosis)
The
sharing of delusional (often persecutory) ideas & beliefs by
two or more (folie a plusieurs) persons who cohabitate or form a social
unit (e.g., a family, a cult, or an organization).
One of the members in each of these groups is dominant & is the source of the delusional content
& the instigator of the idiosyncratic behaviors that accompany the delusions.
Fugue:
Vanishing act. A sudden flight or wandering away & disappearance from home or
work, followed by the assumption of a new identity & the commencement of a new life in a new place.
The previous life is completely erased from memory (amnesia).
When the fugue is over, it's also forgotten as is the new life adopted by the patient.
Hallucination:
False perceptions based on false sensa (sensory
input) not triggered by any external event or entity. The patient is usually not psychotic - he's aware that
he what he sees, smells, feels, or hears is not there.
Still, some psychotic states are accompanied by hallucinations
(e.g., formication - the feeling that bugs are crawling over or under one's skin).
There are a few classes of hallucinations:
Auditory - The false perception of voices and sounds
(such as buzzing, humming, radio transmissions, whispering, motor noises & so on).
Gustatory - The false perception of tastes
Olfactory
- The false perception of smells & scents (e.g., burning flesh, candles)
Somatic - The false perception of processes & events that are happening inside the body or
to the body (e.g., piercing objects, electricity running through one's extremities).
Usually supported by an appropriate & relevant delusional content.
Tactile -
The false sensation of being touched, or crawled upon or that events & processes are taking place under one's skin. Usually
supported by an appropriate & relevant delusional content.
Visual - The false
perception of objects, people, or events in broad daylight or in an illuminated environment with eyes wide open.
Hypnagogic & Hypnopompic - Images and trains of events experienced while falling asleep or
when waking up. Not hallucinations in the strict sense of the word.
Hallucinations are common in schizophrenia, affective
disorders & mental health disorders with organic origins. Hallucinations are also common in drug & alcohol withdrawal
& among substance abusers.
Ideas of Reference: Weak
delusions of reference, devoid of inner conviction & with a stronger reality test. See: Delusion.
Illusion: The misperception or misinterpretation of real external
- visual or auditory - stimuli, attributing them to non-existent events & actions. Incorrect perception of a material
object. See: Hallucination.
Incoherence: Incomprehensible
speech, rife with severely loose associations, distorted grammar, tortured syntax & idiosyncratic definitions of
the words used by the patient ("private language").
A loosening of associations. A pattern of speech in which unrelated or loosely-related ideas are
expressed hurriedly & forcefully, using broken, ungrammatical, non-syntactical sentences, an idiosyncratic vocabulary
("private language"), topical shifts & inane juxtapositions ("word salad"). See: Loosening of Associations; Flight of Ideas; Tangentiality.
Insomnia: Sleep disorder or disturbance involving difficulties to either fall asleep ("initial insomnia") or to remain asleep ("middle
insomnia"). Waking up early & being unable to resume sleep is also a form of insomnia ("terminal insomnia").
Loosening of Associations: Thought & 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 &
his speech are incongruous & incoherent. A sign of schizophrenia & some psychotic states. See: Incoherence; Flight
of Ideas; Tangentiality.
Mood: Pervasive &
sustained feelings & emotions as subjectively described by the patient. The same phenomena observed by the clinician are called affect.
Mood can be either dysphoric (unpleasant) or euphoric (elevated, expansive, "good mood").
Dysphoric moods are characterized by a reduced sense of well-being, depleted energy & negative
self-regard or sense of self-worth. Euphoric moods typically involve an increased sense of well-being, ample energy &
a stable sense of self-worth & self-esteem. Also see: Affect.
Mood Congruence &
Incongruence: The contents of mood-congruent hallucinations & delusions are consistent
& compatible with the patient's mood. During the manic phase of the Bipolar Disorder, i.e., such hallucinations &
delusions involve grandiosity, omnipotence, personal identification with great personalities in history or with deities &
magical thinking.
In depression, mood-congruent hallucinations & delusions revolve around themes like the patient's self-misperceived faults,
shortcomings, failures, worthlessness, guilt - or the patient's impending doom, death & "well-deserved"
sadistic punishment.
The contents of mood-incongruent hallucinations & delusions
are inconsistent & incompatible with the patient's mood. Most persecutory delusions & delusions & ideas of reference,
as well as phenomena such as control "freakery" & Schneiderian First-rank Symptoms are mood-incongruent.
Mood incongruence is especially prevalent in schizophrenia, psychosis, mania & depression.
Mutism: Abstention from speech or refusal to speak. Common in
catatonia.
Negativism: In catatonia, complete opposition
& resistance to suggestion.
Neologism: In schizophrenia
& other psychotic disorders, the invention of new "words" which are meaningful to the patient but meaningless to everyone
else. To form the neologisms, the patient fuses together & combines syllables or other elements from existing words.
Obsession: Recurring & intrusive images, thoughts, ideas,
or wishes that dominate & exclude other cognitions. The patient often finds the contents of his obsessions unacceptable
or even repulsive & actively resists them, but to no avail. Common in schizophrenia & obsessive-compulsive disorder.
Panic Attack: A form of severe anxiety attack accompanied by a sense of losing control & of an impending
& 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 & difficulties breathing), hyperventilation, light-headedness
or dizziness, nausea & peripheral paresthesias (an abnormal sensation of burning, prickling,
tingling, or tickling).
In normal people it's a reaction to sustained & extreme stress. Common in many mental health
disorders.
Sudden, overpowering feelings of imminent threat & apprehension, bordering on fear & 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) & follow
exposure to "cues" (potentially or actually dangerous events or circumstances).
Most patients display a mixture of both types of attacks (they're 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.
Paranoia: Psychotic grandiose and persecutory delusions. Paranoids are characterized by a paranoid style:
they are rigid, sullen, suspicious, hypervigilant, hypersensitive, envious, guarded, resentful,
humorless, and litigious.
Paranoids often suffer from paranoid ideation - they believe (though
not firmly) that they are being stalked or followed, plotted against, or maliciously slandered. They constantly
gather information to prove their "case" that they are the objects of conspiracies against them. Paranoia is not the same
as Paranoid Schizophrenia, which is a subtype of schizophrenia.
Perseveration: Repeating the same gesture, behavior, concept, idea, phrase, or word in speech. Common in schizophrenia,
organic mental disorders, and psychotic disorders.
Phobia: Dread of a particular object or situation, acknowledged by the patient to be irrational
or excessive. Leads to all-pervasive avoidance behavior (attempts
to avoid the feared object or situation).
A persistent, unfounded, and irrational fear or dread of one or more classes of objects, activities,
situations, or locations (the phobic stimuli) and the resulting overwhelming
and compulsive desire to avoid them. See: Anxiety.
Posturing:
Assuming & remaining in abnormal and contorted bodily positions for prolonged
periods of time. Typical of catatonic states.
Poverty of Content (of Speech): Persistently vague, overly abstract or concrete,
repetitive, or stereotyped speech.
Poverty of Speech: Reactive,
non-spontaneous, extremely brief, intermittent, and halting speech. Such patients often remain silent for days on end unless
and until spoken to.
Pressure of Speech: 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.
Psychomotor
Agitation: Mounting internal tension associated with excessive, non-productive (not goal orientated) & repeated motor activity (hand
wringing, fidgeting & similar gestures). Hyperactivity & motor restlessness which co-occur with anxiety
& irritability.
Psychomotor Retardation: 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 & flat voice tone & constant feelings
of overwhelming fatigue.
Psychosis: Chaotic thinking
that's the result of a severely impaired reality test (the patient can't tell inner fantasy
from outside reality). Some psychotic states are short-lived & transient (micro-episodes).
These last from a few hours to a few days & are sometimes reactions to stress. Persistent psychoses are a fixture of the
patient's mental life & manifest for months or years.
Psychotics are fully aware
of events & people "out there". They can't, however separate data & 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 & representations.
Consequently, psychotics
have a distorted view of reality & aren't rational. No amount of objective evidence can cause them to doubt or reject
their hypotheses & convictions.
Full-fledged psychosis involves complex & ever more bizarre delusions & the unwillingness
to confront & consider contrary data & information (preoccupation with the subjective
rather than the objective). Thought becomes utterly disorganized & fantastic.
There's a thin line separating non-psychotic from psychotic perception & ideation. On this spectrum we also
find the schizotypal personality disorder.
Reality Sense: The
way one thinks about, perceives & feels reality.
Reality Testing: Comparing one's reality sense & one's hypotheses about the way things are & how things
operate to objective, external cues from the environment.
Schneiderian
First-rank Symptoms: A list of symptoms compiled by Kurt Schneider, a German
psychiatrist, in 1957 & indicative of the presence of schizophrenia. Includes:
Auditory
hallucinations: Hearing conversations between a few imaginary "interlocutors", or
one's thoughts spoken out loud, or a running background commentary on one's actions & thoughts.
Somatic hallucinations: Experiencing imagined sexual acts couple with delusions
attributed to forces, "energy", or hypnotic suggestion.
Thought withdrawal: The delusion that one's thoughts are taken over & controlled by others & then "drained"
from one's brain.
Thought insertion: The delusion
that thoughts are being implanted or inserted into one's mind involuntarily.
Thought broadcasting:
The delusion that everyone can read one's mind, as though one's thoughts were being
broadcast.
Delusional perception: Attaching unusual
meanings & significance to genuine perceptions, usually with some kind of (paranoid
or narcissistic) self-reference.
Delusion of control: The delusion that one's acts, thoughts, feelings, perceptions & impulses are directed or influenced by other people.
Stereotyping or
Stereotyped movement (or motion): Repetitive,
urgent, compulsive, purposeless & non-functional movements, such as head banging, waving, rocking, biting, or picking
at one's nose or skin. Common in catatonia, amphetamine poisoning & schizophrenia.
Stupor:
Restricted & constricted consciousness akin in some respects to coma. Activity,
both mental & physical, is limited. Some patients in stupor are unresponsive & seem to be unaware of the environment.
Others sit motionless & frozen but are clearly cognizant of their surroundings. Often the result of an organic impairment.
Common in catatonia, schizophrenia & extreme depressive states.
Tangentiality: Inability or unwillingness
to focus on an idea, issue, question, or theme of conversation. The patient "takes off on a tangent" and hops from one topic
to another in accordance with his own coherent inner agenda, frequently changing subjects & ignoring any attempts to restore
"discipline" to the communication.
Often co-occurs with speech derailment. As distinct from loosening of associations, tangential
thinking & speech are coherent & logical but they seek to evade the issue, problem, question, or theme raised by the
other interlocutor.
Thought Broadcasting, Though Insertion, Thought Withdrawal -
See: Schneiderian First-rank Symptoms
Thought Disorder:
A consistent disturbance that affects the process or content of thinking, the use of language & consequently, the ability to
communicate effectively. An all-pervasive failure to observe semantic, logical, or even syntactical rules & forms. A fundamental feature of schizophrenia.
Vegetative Signs: A set of signs in depression which includes:
- loss
of appetite
- sleep disorder
- loss
of sexual drive
- loss
of weight
- constipation
May also indicate an eating disorder.
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