Let’s forget about the ‘behavior’ part for a moment and just talk about what it means to be ‘abnormal’. In order to understand the concept of ‘abnormal’, you first need to understand what is meant by ‘normal’. The idea of ‘normal’ is statistical (mathematical) in nature, and refers to a way of making sense out of a group of things. In any group of things, you have some differences on important characteristics. For example, if you have a group of people, they vary on how much they weigh. If you wanted to have one number to describe the most common weight of your group members, you would want to find their average (or mean) weight. Knowing the average weight of the group members would help you to know who was very thin, who was very fat and who was in the middle in terms of weight. This is where the idea of normal comes in. Normal tends to mean Average. Those persons who were close to the average (middle) weight would be describable as being of ‘normal’ weight, while those very thin and very fat persons far from the average weight on either direction, would be considered to be of ‘abnormal’ (or far from average) weight. Take this concept of non-normality and apply it to how people behave instead of how much they weigh. Persons who act and behave in an average, common sort of way can be described as having normal behavior. Persons whose behavior is not typical or common can be described as displaying ‘abnormal behavior’. In the purest sense of the term, this is what abnormal behavior means. In actual practice, however, the term ‘abnormal behavior’ has become more or less synonymous with mental illness. (See also Psychopathology).
An automatic, unconscious reaction that a person has in response to a stimulus, which reminds the person of a situation they experienced before. This most commonly occurs when someone has been the victim of abuse. For example, lets say that a person who is physically abused as a child and is hit in the face feels fear, anger, shame, heart pounding, and physical shakes in response to being hit. As an adult, that person may experience the same feelings and reactions he/she had when being hit as a child if another persons hand simply comes too close to his/her face. Abreaction can also be used to describe the process a therapist uses to desensitize, or help the patient to stop having these automatic reactions unnecessarily. This process involves reproducing the unconscious feelings and reactions the client is having within the safety of the therapy session. The therapist then helps the client to replace the uncomfortable, distressing reaction he/she is having with a reaction that is appropriate and not uncomfortable.
At the simplest level, an addiction occurs when you cannot permanently stop yourself from doing something. The term addiction is generally applied to habits that are not necessary for life (e.g., eating and breathing are not addictions), and that are also unhealthy to engage in. Usually the things we become addicted to are either very exciting and stimulating, or act directly on the brain and body to produce a desirable alteration in how we think or feel. Common addictions are to cigarettes and other tobacco products, drugs (street/recreational drugs as well as ones prescribed by your doctor), alcohol, gambling, pornography and (some say) to the Internet itself. In many forms of addiction, it is common for the addicted person to experience Tolerance and Withdrawal. Tolerance occurs when it takes more and more of the stuff to get the same amount of pleasure. Withdrawal occurs when you experience painful (and sometimes dangerous!) symptoms (generally the opposite of how it feels to take the substance) when you go for any period without that substance. It is VERY VERY DANGEROUS to try to come off of alcohol (and some other drugs) cold turkey. If you are wanting to get sober, check yourself into a hospital that can help you come down safely.
Adjustment disorder occurs when a person experiences emotional and behavioral symptoms of depression and/or anxiety that is clearly in response to an identifiable stressor or stressors (changes in employment, marital status, deaths, divorce, etc.). The diagnosis of Adjustment Disorder is most appropriate when the patient is experiencing distress above the normal amount that might be expected in response to stressor(s) and/or when the stressor(s) cause school grades to drop or work performance to fall off. When the diagnosis is made, the clinician is encouraged to tag the diagnosis with a specifier that identifies the type of symptoms that are present (e.g., depression, anxiety, etc.).
As used in mental health, the term ‘Affect’ refers to the display of emotion, and more specifically, the display of facial signs of emotion. Affect thus describes what a person’s mood looks like. Affect is different than Mood – which is the term used to describe a person’s subjective report of how they feel. A person’s affect and mood are fairly independent of each other; they can be the same or different.
Literally, “fear of the marketplace”. Agoraphobia is an unwanted, often paralyzing fear of being in any public place in which people feel it will be difficult to escape from or receive the help they might need in case they have a panic attack. Persons with agoraphobia almost always have panic attacks that preceded and contributed to their agoraphobia. Once they have had intense anxiety feelings or a panic attack in a particular place they then associate that place with panic andanxiety which leads to avoidance. Over time they generalize more and more places with fear responses. In severe cases, persons with agoraphobia are unable/willing to leave their homes without the aid of a ‘safe’ person. The treatment of choice is exposure with response prevention; so they also need to learn relaxation techniques as well as cognitive techniques. Highly efficacious Cognitive Behavioral therapy for agoraphobia (based on the pioneering work of David Barlow, Ph.D.) is widely available these days within the Clinical Psychology community.
Akathesia translates to “inability to sit still”, or “restlessness”. One of several ‘drug-induced movement disorders’, Akathesia is a common side effect associated with the use of anti-psychotic medications (neuroleptics). It is characterized by excessive, usually stereotyped (repetitive) movements such as pacing, foot tapping and rocking the body back and forth. I’ve also heard Akathesia described as a ‘feeling that you are going to come out of your own skin” if you don’t move.
A psychological condition typified by the inability to feel pleasure from normally pleasurable experiences. A person stops receiving pleasure from activities that used to bring him/her pleasure in the past. This condition is often an integral feature of major depression.
A medicine that relieves anxiety. Common examples are Benzodaizapines (Valium, Xanax, Ativan, Klonopin), and Alcohol (which pushes more or less the same chemical buttons in the brain as the Benzodaizapines). While Benzodaizapines and Alcohol are all fairly addictive, there are several anxiolytic medicines that are less so.
According to the DSM-IV, Asperger’s Disorder is a type of pervasive developmental disorder similar to Autism that typically manifests in childhood. It is characterized by social impairments (which may include poor body language and eye contact skills, failure to develop peer relationships, lack of spontaneous sharing of experience, lack of reciprocity) and the presence of repetitive behavior and interest patterns. Asperger children typically become overly focused on their interests and may resist efforts to redirect their behavior. They also frequently show odd stereotyped hand or body movements. Unlike in autism, there are no significant delays in the development of language or cognitive abilities.
Assessment refers to the process of measurement. In mental health, assessment refers to the process of having your personality, intelligence or brain functioning tested. Common tests used these days are the Weschler Adult Intelligence Test (an IQ test), the Minnesota Multiphasic Personality Inventory (a personality test), the Millon Clinical Multiaxial Inventory (a personality test), and any of a variety of NeuroPsychological Tests that measure how well your brain is working after an accident or illness.
Assimilation refers to a process by which something becomes more and more similar to something else until it is absorbed by that something else and loses its independent identity. In psychology, the term Assimilation is used in two contexts. First, in the context of cultural assimilation, in which someone from a culture assimilates into another so that they can no longer be told apart from the new culture (In America, this process of cultural assimilation has been occurring for different immigrant groups for hundreds of years). Assimilation is also a process described by the famous Swiss psychologist-developmentalist Jean Piaget who described two cognitive processes (Assimilation and Accommodation) at work in the normal learning process of young human beings. According to Piaget, when a child becomes aware of something new that it has never seen before it has two choices for making sense out of that thing. It can interpret that thing in terms of what it already knows (Assimilation into the child’s existing knowledge base), or it can learn a new way, a new category, for making sense of that thing (Accommodation by the child’s mind of a new concept). Taken together, assimilation and accommodation make up adaptation, which refers to the child’s ability to adapt to his or her environment.
In the DSM-IV, a diagnosing clinician may specify that a person’s depression is “atypical” when that person’s mood lifts in response to positive events, and when that person also shows at least two of the following: weight gain or increased appetite, sleeping longer than normal, a heavy feeling in the body, or a history of sensitivity to social rejection. The same ‘atypical’ specifier can be applied to Bipolar depressions as well. In practice, the term is also sometimes used to indicate a subtype of depression that is characterized by agitated or angry mood instead of the more typical depressed one. See also Depression.
The following definition is from the Autism Society of America and can be found in this form as the definition link off of this page:
“AUTISM is a severely incapacitating lifelong developmental disability that typically appears during the first three years of life. It occurs in approximately fifteen out of every 10,000 births and is four times more common in boys than girls. It has been found throughout the world in families of all racial, ethnic and social backgrounds. No known factors in the psychological environment of a child have been shown to cause autism. The symptoms are caused by physical disorders of the brain. They include:
Disturbances in the rate of appearance of physical, social and language skills.
Abnormal responses to sensations. Any one or a combination of senses or responses are affected: sight, hearing, touch, pain, balance, smell, taste, and the way a child holds his body.
Speech and language are absent or delayed while specific thinking capabilities might be present.
Abnormal ways of relating to people, objects and events.
Autism occurs by itself or in association with other disorders which affect the function of the brain such as viral infections, metabolic disturbances, and epilepsy. It is important to distinguish autism from retardation or mental disorders since diagnostic confusion may result in referral to inappropriate and ineffective treatment techniques. The severe form of the syndrome may include extreme self-injurious, repetitive, highly unusual and aggressive behavior. Special educational programs using behavioral methods have proven to be the most helpful treatment.”
Broadly, the branch of Clinical Psychology that deals with the use of psychological interventions in the ‘physical health’ aspect of life. Also called Health Psychology. Applications are many – for example, Behavioral Medicine psychologists foster wellness in healthy persons (developing programs to help people stick with exercise, lose weight and stop smoking), augment and extend medical treatments (developing treatments for chronic physical pain, for instance), and to help the relationship between medical patients and physicians to work better (developing programs to help patients take their medicines on schedule).
See Behaviorism, also Cognitive Behavioral Therapy. Behavior therapy is a school or approach to psychotherapy originating in America and reflecting American pragmatic and functionalistic philosophy and objective/empirical bent. Simple BT analyzes problems of human functioning in mechanistic terms as inputs and outputs of a system – it is not important to know what is going on inside the system – only to know what goes into it and what comes out of it. BT uses learning theory to manipulate inputs to the ‘system’ so as to influence outputs to be a certain way. In English – a behavior therapist will analyze a person’s problematic behavior in terms of what reinforces or punishes that behavior. The behavioral therapist will then systematically alter the reinforcers or punishers to get the person to change their behaviors. Originally, Behavior therapy did not consider the role of the mind and thinking in how behavior changes. Over the years, however, BT has given way to Cognitive Behavior Therapy (a super-set of BT) that looks at both thinking (cognition) and behavior in the production of human problems.
Bipolar illness is a condition wherein a person swings between states of depression (low mood and energy) and mania (heightened, elevated, ecstatic mood and energy). Different types of Bipolar illness are distinguished based on how just how low or high people get. A person diagnosed with Bipolar I has a documented history of full-blown Clinical Depression that alternates with a full-blown Clinical Mania. In Bipolar II (a milder form of Bipolar), full-blown Depression alternates with a mild manic state known as a “hypomanic” state (more energy than normal, but less than in a true full-blown mania). The treatment of choice is a mood stabilizing medication such as Lithium, Depakote (Valproic Acid) or Tegretol, supplemented with psychotherapy to educate about the disorder, reinforce medication compliance and to develop coping skills. See the discussion of symptoms in the Bipolar Center.
If you bond something with glue, you get those things to stick together better. In the context of mental health, the same term means to get people to stick together better. Bonding refers to the process of how people form more emotionally intimate relationships with each other.
Borderline personality disorder is a disorder of relating to others and to self. Persons diagnosed with borderline personality disorder display “a pervasive pattern of instability of interpersonal relationships, self-image, and affects (feelings), and marked impulsiveness beginning by early adulthood and present in a variety of contexts…” (DSM-IV). Persons with BPD tend to have difficulty understanding themselves, other people, and the nature of the relationships they have with other people. They tend to see themselves as fairly worthless and empty inside, or to not really “know” who they are. They tend to use the defense mechanism known as splitting a lot, and to see others (and themselves) in a very black or white, good or bad sort of way. They are typically emotionally unstable (labile), and frequently will have outbursts of anger or depression, alternating rapidly with good feelings about themselves. As you might imagine, they have intensive relationships that do not tend to last very long. BPD persons are also very impulsive and frequently cannot or do not stop themselves from acting out in self-destructive ways (spending money they don’t have, abusing drugs and alcohol, binge eating, sexual promiscuity, etc.). They are also prone to feelings of suicidality. Some BPD persons (not all) engage in ‘cutting’ behaviors where they cut or burn their skin – not to kill themselves – but rather to self-punish or to have a sense of control over their internal chaos or to feel the sensation and know that they are indeed alive (and not just empty inside). There are treatments for BPD that are proven effective, not as a 100% cure, but in alleviating some of the suffering these people go through. The best studied form of psychotherapy, (Dialectical Behavior Therapy or DBT; Marsha Linehan, Ph.D) is known to be helpful, as are some psychiatric medications. See the Personality Disorders center for more information.
A boundary is division that separates things from one another. At one extreme, a boundary can be “impermeable” (e.g., a very solid thing like a wall that rigidly keeps all things of one type on one side of the division, and all things of the other type on the other side). On the other extreme, a boundary can also be “permeable” (e.g., insubstantial, allowing the different types of things that have been divided to intermingle freely). In-between these extremes you can find examples of boundaries that are semi-permeable; (e.g., that let some degree of intermingling occur while preventing other intermingling). In human relationships, the concept of boundaries is helpful to us in helping us to understand ourselves and our relationships with others. We have boundaries in our relationships with other persons. We let some people get close to us and know our vulnerabilities, while others we keep at a distance and don’t allow them near enough to hurt us. Sometimes our relationship boundaries get screwed up and we don’t set up proper sorts of boundaries. We might let someone who wants to hurt us in too close where they can hurt us, or we might keep someone who wants to love us at a too far distance to allow them to love us properly. Much psychotherapy is devoted to helping people to recognize the proper sorts of boundaries they need to put in place to have healthy relationships.
The Cerebral Cortex is the outer layer of the brain – the wrinkly stuff that looks like a walnut shell. The various lobes of the Cortex are responsible for doing different jobs that help a person to be conscious. For instance, the front part of the brain helps you with making judgments. The back part controls making sense out of what you see through your eyes. The Cortex is wrapped around other ‘inner’ parts of the brain that do other important jobs. Atrophy means that something is shrinking in size. Cerebral Atrophy means that the Cortex part of the brain is shrunken in size from what it should be. Less brain mass and volume means that you have less thinking power. Cerebral Atrophy occurs in a variety of illnesses and addictions.
Depression is not an on or off thing – but rather occurs across a spectrum. You can be a little depressed, fairly depressed, totally depressed, etc. Formal medical diagnosis, however, does not recognize spectrum disorders very well. Medical diagnosis was designed to accommodate more discrete phenomena such as viruses that are either present or not present. The term Clinical Depression thus is the somewhat arbitrary ‘line-in-the-sand’ that the medical establishment has drawn to distinguish mild (sub-clinical) depression (not in need of serious treatment) from more moderate to severe forms of depression (which are in need of treatment). Symptoms of depression usually consist of feelings of sadness, guilt, or unworthiness; crying spells; disturbance in appetite and weight changes; and disturbance in sleep. Excellent psychotherapeutic treatments are available including Cognitive behavioral therapies based on the pioneering work of Aaron Beck, MD, and Interpersonal Therapy for Depression based on the work of Myrna Weissman, Ph.D. Of course, I don’t need to mention that many anti-depressant medicines are available as well including Prozac, Paxil, Zoloft, and many others.
The branch of Psychology having to do with the applied use of psychological knowledge to improve human functioning. Clinical Psychology is itself sub-divided into different sub-fields including psychopathology (abnormal psychology and mental illness), health psychology (wellness and medical psychology), and neuropsychology (measurement of brain-behavior relationships) to name only the major ones.
The DSM-IV divides the personality disorder diagnoses into three groupings or clusters based on their having characteristics in common. Cluster A includes Paranoid, Schizoid, and Schizotypal personality disorders which are linked together based on their shared mild-psychosis symptom presentations. Cluster B includes Antisocial, Borderline, Histrionic, and Narcissistic personality disorders, grouped together based on their shared ‘dramatic and erratic’ characteristics. Cluster C includes Avoidant, Dependent, and Obsessive-Compulsive personality disorders, grouped together based on their shared anxious-avoidant qualities. Note that at this time (1994-2000) these clusterings are based on superficial symptom similarities only and not on any deep genetic or structural theoretical framework.
The generic acronym for Community Mental Health Centers around the USA. For many communities, these institutions form the backbone of publicly funded mental health services. Typically, they offer psychotherapy and psychiatry services on an outpatient basis. Some of them also have inpatient psychiatric hospitals and partial hospital programs (for intensive psych care that doesn’t require full hospitalization).
In healthcare the term “co-morbid’ refers to two or more things that are occurring at the same time. When a person has more than one disorder at a time, these disorders are referred to as being co-morbid.
The term “Co-Dependency is not officially recognized by the psychiatric or psychological establishment; there is no official DSM-IV definition and criteria list. Instead, Co-Dependency tends to be a loosely defined “condition” which has the following prominent symptoms: difficulty with open direct expression of feelings or discussion of interpersonal problems, and 2) willingness to enable others’ dysfunctional behavior (such as alcoholism, drug use or abuse (sexual, violent, emotional, incest, etc.)). Frequently the term is used to describe persons who are actively involved in a relationship with an alcoholic/drug user/abuser, and/or who had alcoholic/drug using/abusive parents or guardians while growing up. Having said this much, I will summarize by saying that Co-Dependency is the condition you have when you feel you have been taken advantage of by your partner (spouse, relationship partner), are beginning to recognize you have played some role in your own victimization, and are looking for a label to identify what is wrong with you.
CBT is a school of psychotherapy originating in the United States and is a direct extension and growth of the earlier Behavioral Therapy (BT) school of psychotherapy. CBT, like BT before it, is extensively informed by the behavioral emphasis on stimulus-response relationships and psychological learning theory. Where the psychodynamic forms of psychotherapy sought to understand the inner mental and emotional world of patients, the behavioral school of therapy sought rather to predict, regulate and control the patients’ problematic behavior. Although BT enjoyed many successes, it had become clear by the late 1970s that the exclusion of mental events from BT was a mistake – that mental events were in fact important. CBT thus developed as an extension of BT techniques to mental events such as thoughts and emotions. For example, a core CBT understanding of depressive emotions is that subliminal, often irrational thoughts precede and “cause” troubling feelings. To change the troubling feelings to more positive ones, it is necessary to help persons identify their thoughts, analyze them with respect to their rationality and challenge those that are ill-formed and exaggerated. The CBT therapist helps his or her patient by teaching the patient to view his or her thinking as a type of behavior that he or she can bring under conscious control with positive results.
Usually a generic term for someone who counsels – e.g., someone who provides advice and support to another person or persons. The word can be synonymous with “therapist”. It can also be short for Licensed Professional Counselor (LPC) which is a specific legal license (and a protected term) that a psychotherapist (usually at the MS/MA level of training) can get. Not all counselors are LPCs.
First read the definition of Transference and then come back here. The term “transference” always refers to the patient’s transfer of emotional energy from an older relationship to a newer one (such as a therapist). Counter-Transference occurs when a therapist transfers his or her emotional energy from an older relationship to a patient. For example, Classical Counter-Transference is occurring if a therapist cannot treat a molester because he or she was him or herself molested and cannot separate his or her anger at being victimized from the patient in front of him or her (who did not victimize the therapist). More commonly, the term counter-transference is used to describe situations where a therapist fails to keep appropriate emotional distance from the patient. So you might use the term counter transference to describe a therapist who feels hopeless and paralyzed when working with a depressed person, or a therapist who falls in love with a patient (or who seduces a patient). Counter-Transference in any form is undesirable in the therapeutic relationship as it does not help (and often hurts) the patient. Therapists have an ethical (and sometimes legal) responsibility to be aware of counter-transference issues and to see counsel or help if they become overwhelming.
A mild form of Bipolar Disorder, Cyclothymia is diagnosable when a person experiences alternating moods that swing on a regular (often monthly-quarterly basis) between mild mania (hypomania) and mild depression. For at least a two year period there must be no evidence that the mild hypomania ever turned into a true Mania, or that the mild depression turned into a true diagnosable Major Depression. The disorder must be present and documentable for at least two years before it can be formally diagnosed.
To ‘decompensate’ means (more or less) to fall apart mentally and emotionally. Decompensation occurs during the onset of a psychotic process. Other (non-psychotic) persons may decompensate when the stressors they are faced with are greater than their coping abilities can manage.
Defense mechanisms are proposed ways that people learn to cope with disturbing thoughts and emotions. Defense mechanisms are typically similar to coping mechanisms, but with a few distinctions. The term Defense mechanisms originated in the psychodynamic literature, while the term coping mechanisms originated in some other more empirical literature. Defense mechanisms are typically thought of as negative adaptations that are symptoms in themselves in need of help, while coping mechanisms are thought of as more evolved, positive adaptations to problems and stress. Examples of defense mechanisms defined in this glossary are Splitting and Projection.
A delusion is a persistent belief that something is true when there is no evidence suggesting that this is the case. The delusional person cannot be dissuaded from the delusional belief by force of logical argument. There are different types of delusions that tend to occur: Erotomanic (delusions that famous people love you), Grandiose (delusions that you are the Messiah, or deserve recognition and power just because of your inherent greatness), Jealous (delusion that your spouse is having an affair when he/she is not), Persecutory (paranoid delusion that people are after you to harm or harass you or someone you love), Somatic (delusion that you have some medical condition such as a tumor when you do not). As if there wasn’t enough variety in the above descriptions, people can also have mixed delusions (several different kinds at once). Delusions can be bizarre or non-bizarre. Non-bizarre delusions are plausible and consistent with what is possible within reality (even though these things are not actually happening). An example of a non-bizarre Persecutory delusion would be that the FBI was after you. A bizarre delusion is completely inconsistent with shared social reality and represents a psychotic state. An example of a bizarre Persecutory delusion is that alien beings were after you. Delusions can be present in Schizophrenia, or themselves (in non-bizarre form) as Delusional Disorder. They tend to be harder to treat than other symptoms associated with Schizophrenia (e.g., medicines don’t make them automatically go away, although they may lessen in intensity of conviction with treatment).
Depersonalization is a mild but often frightening form of dissociation. Persons who have depersonalized pretty much are still aware of what is going on around them, but feel that their identity has been messed up so that they don’t exactly recognize themselves, or feel alien to themselves.
Depression is a member of a family of mood regulation disorders. Clinicians differentiate among these disorders based on mood ‘episode’ type. There are three sorts of mood episodes; depressive, manic and mixed. During depressive episodes a person feels depressed, during manic episodes a person feels energized and over-happy, and during a mixed episode they just feel all messed up (depressed and energized at once). Most of the time, when someone talks about depression, they are referring to what is clinically termed unipolar depression, which is characterized by the presence of depressive episodes only. However, other forms of depression exist, such as bipolar depression (manic-depression) which is characterized by swings over time between depressive, and manic or mixed episodes. The clinical name for a significant unipolar depression is a Major Depressive Disorder. In a Major Depressive Disorder, a person experiences some of the following symptoms for more than two weeks: depressed mood, diminished pleasure in formerly pleasurable things, altered sleep and eating patterns (either more or less than normal), fatigue, agitation and irritability, difficulty concentrating and a sense of worthlessness. Suicidal ideation may be present. A small but significant minority of depressed persons do complete suicides so all suicidal statements should be taken seriously. Also, in very severe depressions, some persons experience delusions. People generally recover from depressive episodes over time, but become more vulnerable to experiencing depression again as a result of the experience. There are effective medicines and psychotherapies for depression. The best psychotherapies (cognitive behavioral therapy for depression) are as effective or more effective than medicines, and have the added benefit of helping persons learn how to resist future depressions. See theDepression Page for more information.
The DSM-IV (1994, APA) is the official manual listing psychiatric and psychological disorders. This document, published by the American Psychiatric Association, takes its coding scheme from the International Classification of Diseases (ICD; currently in its 9th edition I think) which is a diagnostic manual for all medical diseases, of which mental disorders are but a small part. It isn’t an official diagnosis if it isn’t in the DSM. Although many excellent and talented non-MD types (Ph.D.’s, etc.) contribute to the disorders categorized within it, the DSM is very much a document drenched in medical culture. Disorders within DSM are typically described in binary terms (you either have it or you don’t) and the mode of diagnosis is reminiscent of ordering at a Chinese Restaurant (“…I’ll take two from Column A and one from Column B, please.”). While this logical structure works rather well for most medical illnesses (like an infection), it is not nearly as suited to describing psychologically based illnesses (like some forms of depression that exist in states of continuum).
DBT is a form of Cognitive Behavioral psychotherapy developed by Psychologist Marsha Linehan, Ph.D. Linehan has made her career working with Borderline Personality Disordered patients. Such patients frequently alternate between very different mental/emotional states (e.g., anger vs. dependency). Linehan addressed these opposite presentations by using a dialectical approach wherein anger might be worked on for a while, followed by dependency issues, followed again by anger, etc. This approach better fits the particular alternating presentations of BPD patients than do some other approaches. DBT has been *very* well studied and is currently regarded as the premier form of psychotherapy for BPD and self-harming individuals. Also, DBT is now used for impulse control problems in general. Read more about DBT here.
Dissociation is probably best defined as a psychological process involving alterations of attention and memory so as to create alterations in identity or sense of self. These alterations in sense of self can range from a relatively mild and transient sense that the world or the self is ‘off’ or unreal (derealization and depersonalization), to more permanent states such as amnesia (loss of memory generally for past traumatic events), fugue states (wherein a person more or less forgets who they are, assumes a new identity and sets up residence in a new location), and to the most severe and problematic form known as Dissociative Identity Disorder (DID; formerly known as Multiple Personality Disorder) wherein identity is fragmented. The act of dissociation itself is probably most often triggered by trauma or other severe stress. In the case of DID, the triggering traumatic events are generally acknowledged to be severe childhood sexual and physical abuse. The exact nature of dissociation is not too well understood. Some researchers maintain that it is nothing more and nothing less than self-hypnosis. Others have different opinions.
Mental Disorders are diagnosed according to the DSM-IV or Diagnostic and Statistical Manual of Mental Disorders, currently in edition 4 published by the American Psychiatric Association (1994). A DSM-IV diagnosis has five parts. Each part is called an Axis. Each Axis gives information on a different sort of information. Axis I (1) provides information on clinical disorders such as depression, anxiety, schizophrenia, drug addiction, etc. Axis II (2) provides information on developmental disorders – ones that occurred in childhood and are still present (e.g., autism, or personality disorders). Axis III (3) provides information on a persons physical condition. Information on any significant medical disorders that could be contributing to the diagnosed individuals’ stress or symptoms is noted here. Axis IV (4) is a place to describe the individuals social and economic situation (e.g., their living and working situations, important relationships or the lack thereof, finances, etc.). Finally, Axis V (5) is a simple rating scale called the Global Assessment of Functioning. the GAF goes from 0 to 100 and provides a way to summarize in a single number just how messed up a person is by their diagnoses.
Term used to describe a condition where a single person has more than one Axis I major clinical psychological/psychiatric diagnosis. Often, this phrase is used to describe people who have a severe mental illness such as Major Depression, Bipolar Disorder, or Schizophrenia and also a co-existing substance abuse problem (alcohol dependence, cocaine dependence, opioid dependence, etc.)
There are several well defined schools of psychotherapy each with its own organizing philosophy, procedures, techniques and methods. Some therapists are theoretically ‘pure’ in that they do all of their clinical practice within the bounds of the teachings of one particular school of therapy. Other therapists (the majority of them it would seem) mix and match techniques, methods and assumptions drawn from these different ‘pure’ schools to create an eclectic way of doing therapy. Eclecticism can be a fine thing because different therapies do have strengths and weaknesses that proper ‘blending’ can even out (not unlike coffees and wines are blended together to get a consistently good product). However, eclecticism can also be a therapist’s excuse for not really understanding the philosophical rationales behind the different techniques that govern their use. Let the consumer of therapy beware!
Electro-Convulsive Therapy (ECT) is a psychiatric treatment for persons with very severe mental disorders that have proven unresponsive to other forms of treatment (typically multiple attempts to treat with medications of various types). ECT involves a Psychiatrist (a highly trained medical doctor specializing in the treatment of mental disorders) sending an electric current through the (sedated) patient’s brain under very controlled conditions. This doesn’t sound too good, I know, unless you consider that this treatment often has a remarkable therapeutic effect when no other known form of treatment can help. ECT patients often experience memory loss for the events that happened near in time to their treatments, but to my knowledge, patient’s ability to remember new information thereafter is not substantially affected. ECT is not used casually, but rather only when more conventional treatments have failed.
Eye Movement Desensitization and Reprocessing is a popular, but proprietary form of psychotherapy developed by Clinical Psychologist Francine Shapiro, Ph.D. Only clinicians who have completed Dr. Shapiro’s courses are able to legitimately offer this therapy. EMDR was originally intended for use with persons who have been traumatized (as in PTSD) but the therapy is claimed useful for a variety of other problems these days. While a fair bit of research supports the use of EMDR as a treatment for trauma patients, the jury is still out as to whether it offers a better ‘bang for the buck’ than other known psychotherapy modalities.
Gestalt Therapy technique for working with blocked emotions. The therapist puts an empty chair in front of a client (say – who has lost a parent and is angry at the dead parent but doesn’t know how to express this anger well). The therapist asks the client to imagine and speak in a heart-felt way to the dead parent ‘sitting’ in the chair. The act of doing this speaking often can release complex and powerful emotions that the client otherwise would not be able to get in touch with too easily. Don’t do this at home! This is a dangerous procedure that should not be attempted by untrained persons!
The term “Enmeshment” comes from the family systems theory tradition. Enmeshment refers to a condition where two or more people weave their lives and identities around one another so tightly that it is difficult for any one of them to function independently. The opposite extreme way of relating, Detachment, refers to a condition where the people are so independent in their functioning that it is difficult to figure out how they are related to one another. Healthy relationships are thought to be described by the space between enmeshment and detachment.
Euthymia is a fancy word that indicates a normal non-depressed, reasonably positive mood. It is distinguished from Euphoria (which refers to an extreme of happiness) and dysthymia (which refers to a depressed mood).
Existential Therapy refers to therapies that pay attention to themes most clearly delineated in existential philosophy: Death, The Meaning (of life), Freedom and Responsibility, Identity/Boundaries, etc. There is no precisely defined existential therapy. In one sense, all therapists, regardless of their orientations (behaviorist, psychodynamic) can be said to be practicing “existentially” if they pay attention to the themes in their work. More usually, however, existential therapists are also humanistically oriented and often person/client-centered. Read the great book by Irvin D. Yalom [“Existential Psychotherapy” 1990 Basic Books] for more info.
A term from psychological Learning Theory. Extinction refers to the process of losing a behavior (a behavior is something you do or think). When the behavior no longer occurs it is said to have been extinguished. Usually, behaviors become extinct when they are not reinforced for a while and thus don’t do anything for the behaving organism (person, animal, etc.)
Family Systems refers to a school of psychotherapy founded in the Cybernetic theories that became popular in the 1960s. Dr. Gregory Bateson was a key theorist and all around brilliant guy. Most therapies before Family Systems took as their object the individual patient (witness Dr. Freud and his single patient). Family systems theorists rejected this approach and focused instead on how an individual patient existed within the social group that they associated with – usually their family. The idea is that “no man is an island”, and that no individual’s problems can be made sense of without also looking at how these individual problems fit into the larger scheme of their family system (the complex arrangement of relationships among the members of the individual’s family group). In the family systems view – a child might express symptoms – not because he has a problem in a vacuum – but because his/her entire set of family relationships are messed up. The child becomes the “identified patient, expressing the problems for the parents who get to look problem-free. Rather than treating the child alone – the family systems way of thinking requires that the therapist treat the entire family including the parents of this child. Only by addressing the problems within the family system can the child stop expressing his/her individual problems.
Fear is the name given to the emotion you feel when you perceive yourself to be in acute danger. Fear is recognized as being one of the primary (most basic) human emotions. One of the main components of fear is arousal (increases in heart-beat, sweating, goose pimples, and a release of stored energy). The idea is that what we call fear is the body’s way of mobilizing itself for action to manage acute danger. Exactly how we manage the danger will vary with the circumstances and our own temperaments. Depending on the situation we may Fight (actively engage the danger with intent to reduce its dangerousness), Flee (retreat to reduce the dangerousness) or Freeze (become paralyzed and therefore less likely to provoke hostile action from others). To understand fear as a scientist sees it, it is necessary to compare it with anxiety. To a scientist, fear is the basic and immediate emotional response to a perceived danger and anxiety is understood to be a more cognitively (thinking-ly) mediated response to danger. There is more worry (a type of thinking) involved in anxiety and the danger is less immediate and acute.
Q: What is Fragile X? A: “Fragile X syndrome is a hereditary condition which can cause learning problems in both males and females. It is the most common cause of genetically-inherited mental impairment. The spectrum of intellectual involvement ranges from subtle learning disabilities and a normal IQ, to severe mental retardation and autism. In addition to mental impairment, Fragile X syndrome is characterized by a group of symptoms, which include physical and behavioral characteristics and speech and language delay. Fragile X syndrome can be passed on in a family by individuals with no sign of the condition. In some families it is a problem which has been occurring for decades, affecting numerous family members through the generations, while in others, it seems to have caused problems in only one person. Regardless, the genetic implications of this diagnosis are far reaching and can place a tremendous emotional burden on even distant relatives.”
In a nutshell, Fragile X Syndrome is an inherited form of genetic disorder that can cause learning problems and physical abnormalities in affected individuals. Severe cases can produce Mental Retardation outcomes.
There are two types of schools (at least) that produce Clinical Psychologists. The first (and older type) is the sort that is attached to a university department of psychology. Often this sort of school offers the Ph.D. degree to its graduates and expects its graduates to be scientific researchers as well as clinicians. Often these graduates are expected to look for academic and research jobs and to not go into practice as a clinician. The other type of school is known as a Free Standing school. Free Standing schools of professional psychology usually will offer the Psy.D. degree (although some offer Ph.D.s). They usually intend to produce clinicians and psychotherapists (and not researchers). They are not usually affiliated with a university. Free standing schools of psychology are often quite costly to attend (as opposed to the University affiliated schools that typically will subsidize student tuition’s with stipends and assistantships). Free standing schools often accept much larger classes (50 + is not uncommon) compared to the University affiliated schools which average a class size of 6-12 students per year. Also – it is often much easier to get into a free standing school than it is to get into a university affiliated one.
Generalized Anxiety Disorder (GAD) is a type of anxiety disorder characterized by excessive and difficult to control worry and anxiety, and some combination of at least three of the following: edgy feelings, easy fatigue, problems in concentrating, irritability, muscular tension and/or sleep disturbance. The worry is typically not confined to a single area, but rather roams across a large range of topics. There is no spike of panic in GAD, but rather only the constant hum of continual worry. Warning! Some medications used to treat this sort of worry are quite addictive. Ask for non-addictive medications! See the Anxiety Page for more details.
Gestalt Therapy refers to a specific school of psychotherapy founded by the brilliant but decidedly narcissistic Psychiatrist Fredrick Perls of South Africa (and later Big Sur, CA, USA), and most recently carried on by Irving and Miriam Polster in San Diego, CA, USA. Gestalt therapy is a sort of humanistic approach to psychotherapy. It was originally inspired by German Perceptual Psychologists from the 1940s who taught that human beings actively organize what they see – that they add things (organizing principles) to the world that aren’t present in the world itself. The ideas behind Gestalt Psychotherapy are complex and I can’t do them justice here. Basically – the approach proceeds from the idea that people are born to be spontaneous and whole in their beings but lose this awareness over time as they interact with others (and experience shame, guilt, etc.). The result of this loss of wholeness is a perception of the self as split (into mind and body, self and other, thinking and feeling, etc.). The Gestalt therapist works with his/her client to get back to a more holistic state of being. To do this the therapist frequently bypasses rational thinking processes and makes direct emotional appeals to the client who otherwise would be cut off from those emotions. One famous technique for doing this is called the “empty chair”. This is good stuff – but it has a decidedly humanistic flavor and most pure scientists can’t cope with it.
A learning theory term. Whenever a new stimulus is put in front of an animal (or human being – makes no difference), the animal’s natural tendency is to orient towards the stimulus. This is to say, a new thing to see, hear, etc. tends to capture attention. After a while, however, the animal gets used to this new thing in the environment and attention to the new thing tends to wane. This natural waning of attention to a stimulus is called habituation in the learning theory lingo.
Hallucinations occur when you sense things that are not actually occurring. Hallucinations may be auditory (hearing people speak when there is no one there speaking), visual (seeing things that aren’t there), olfactory (smelling scents that aren’t there), or even tactile (feeling things crawling on you that aren’t there). People having hallucinations may or may not be aware that they are hallucinating. From their internal perspective they may believe that the hallucinations are real! (are accurate reflections of actual voices, alien beings, dead people, smells, etc.). In Schizophrenia, it is common for patients to hear one or more voices, often providing a running commentary on what the patient is doing each moment. Often the voices are critical and hostile towards the patient. Hallucinations are usually a sign that there is something going wrong in the brain (either a significant mental illness is present such as schizophrenia, or there are drugs on board that are messing up brain chemistry – like LSD/acid). Hallucinations tend to respond fairly well to anti-psychotic medicines.
A term used to describe a personality style in which a person’s behavior or speech is overly dramatic. This term is also used in mental health to refer to Histrionic Personality Disorder. An individual with this personality disorder often needs to be the center of attention, and expresses emotion in a dramatized, theatrical way. People with Histrionic Personality Disorder may use their physical appearance or may dress rather provocatively in order to get attention from others. Also, those with Histrionic Personality Disorder often exaggerate the level of intimacy in their relationships and they tend to be easily influenced by others.
Ideas of Reference are a symptom of psychosis of the Paranoid Schizophrenic type. An Idea of Reference occurs when someone is watching TV or listening to the radio and they come to believe that there is a special message in the radio directed specifically at themselves (when there is no such message in existence). For example, the murderer Charles Manson was said to have believed that the Beatles (singing group from the 60s for you youngsters) song “Helter Skelter” contained a secrete message telling him (and only him) that he was to spearhead a revolt against society (Note that not all Ideas of Reference are so chilling). Ideas of Reference are challengeable; which is to say – if you call a person on their idea of reference and point out to them the lack of evidence for their belief they will be capable (by definition) of doubting that they were right. If the Idea of Reference becomes fixed and unchallenable, then it is called (by definition) a ‘Delusion of Reference”.
Sometimes victims of abuse grow up to be abusers. How can this be? It would seem that no one would be in a better position to know the horrors of being abused and to put a stop to it than the former abuse victim. And yet – it doesn’t always work that way. In order to understand this phenomena, it is helpful to have a theory for how people understand relationships in their minds. Each person has some ideas about who they are which collectively are called the self-concept. They also have ideas about who the other person is – called the other-concept. Now, when someone is a victim of violence from another person, their self-concept is likely to include the idea of being powerless, while their other-concept for the abuser is likely to include the idea of being powerful. Given the choice of feeling powerless or powerful, most persons will want to feel powerful. Because it is painful to feel powerless and to get beaten, some victims start to reject being a victim and to start to want to be powerful like the abuser. There are two ways that this identification with the powerful aggressor can play out. In the first scenario, the victim learns to see themselves as though through the eyes of the powerful aggressor – and come to believe that they are not just a random victim – but instead, a deserving victim. In effect, they forget how to see through their own eyes and identify with the aggressor’s view. In the second scenario, the victim goes looking for other persons to victimize. It is as if the victim needs to hurt someone else, to somehow make someone else the victim instead of themselves. By becoming an aggressor him or herself, the victim gets to feel more powerful and in control. So, in a tragic sort of way, a victim identifies with the aggressor so as to feel more powerful and in control, and in so doing, perpetuates aggression and victimization.
A term used to describe a person’s speech when it consistently lacks in detail and emphasizes emotions. For example, if you asked someone what they thought of something, and they said that the thing was “just wonderful, fabulous”. You then ask them to say what it was about that thing that was so wonderful and fabulous, and they reply, “I don’t know – it was just beautiful”. If they consistently speak this way, they are demonstrating an impressionistic speech style.
To meet the unique educational need of a student with a disability, such as mental retardation, an Individualized Educational Program is a plan developed by the students parents, students teachers, school administrator, and the student when appropriate. In order to ensure that children with disabilities and special needs receive a meaningful educational program, the Individuals with Disabilities Education Act (IDEA, 1997) was implemented stating that parents have the right to be an integral part in designing an educational plan for their child. The plan contains specific objectives and goals based upon the students current level of educational performance in a variety of areas. The plan details the services that are to be provided for a comprehensive educational program.
Intensive Outpatient Therapy (IOP) is a form of partial psychiatric hospitalization that is more intense than regular once-per-week outpatient therapy and less intense than 24/7 inpatient hospitalization. IOP patients come for therapy several days per week for several hours at a time. Often, IOP is done in groups as group therapy. IOP treatments are shorter in duration than full Partial Hospitalization Programs (PHPs).
The ‘Kindling Effect’ refers to how epileptic seizures are thought to occur. The idea of seizure kindling is that large scale seizures can be triggered by small but repeated stimulation events, just as a large scale fire can grow out of a small ignited pile of wood. Doesn’t have much on this topic, but this page offers a good introduction.
A neurological disorder that typically develops in the wake of severe and chronic alcohol abuse, Korsakoff’s Syndrome gradually (insidiously) erodes the patient’s ability to remember things (as well as creating brain damage and other cognitive/neurological damage). Korsakoff patients will frequently make up believable and detailed stories to fill in the gaps for things they can’t remember (a process called “fabrication”).
A type of counseling license that a therapist can apply for. Educational and experiential standards to achieve the LPC license are lower than the requirements for Psychologist or Psychiatrist licensure. While typically held by Masters level professionals, the LPC is sometimes held by doctoral level professionals as well who for whatever reason have not chosen to seek appropriate doctoral level licensure for their background.
Anyone can be a psychotherapist – but not all psychotherapists are created equal. Some professional groups have their practice of psychotherapy legally regulated by state and provincial boards to insure that all persons within that profession have met at least minimal certifications and training experiences. Examples of professions requiring a license in order to practice are Medicine, Clinical Psychology, Clinical Social Work, Nursing, and Licensed Professional Counselors (and others).
A recent trend in the professional psychotherapy literature is to produce therapy manuals, or step by step (session by session) guide books for conducting a particular type of therapy for a particular type of problem. A famous example is the “Mastery of Anxiety and Panic” manual for the treatment of, you guessed it, anxiety and panic conditions. In most cases the initial reason for the construction of the therapy manuals was to make it easier to conduct research on the efficacy and usefulness of a particular therapy approach. More recently, however, therapy manuals have been offered for sale to therapists through major psychology publishing houses.
Melancholia is an old word that describes a deep brooding form of depression. Think of melancholia as “Depression Classic” and you’ll get the idea. Melancholic forms of depression can be distinguished from anxious or angry “atypical” forms. In severe melancholic forms of depression, it is not uncommon for there to be psychotic features such as hallucinations and/or delusions.
MFCC is the designation given to persons with specialty training in Marriage and Family Counseling. This is a masters level training program and credential in counseling that specializes in the Family Systems approach to counseling (see above).
The term Mood Disorder refers to the family of depressive disorders, including Major Depression, Bipolar Affective Disorder (manic depression) and related diagnoses. Mood Disorders do not include Anxiety Disorders (which are listed separately in the DSM-IV)
Munchausen’s Syndrome is the popular name for what DSM-IV calls Factitious Disorder. Factitious Disorder is characterized by a person intentionally harming (e.g., poisoning, wounding, etc.) themselves, usually to gain the care of others by assuming the role of a sick person. In Factitious Disorder By Proxy, a person intentionally harms another person (often a minor child in his or her care), also presumably to gain access to the sick role and the attention that having someone be very sick brings. The recent movie, “The Sixth Sense” illustrated Factitious Disorder by Proxy in the character of a mother (dressed in red in the family scene towards the end of the movie) who poisoned her daughter repeatedly until she died.
According to the DSM-IV, the narcissistic personality exhibits, “…a pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements) is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions) requires excessive admiration has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends lacks empathy: is unwilling to recognize or identify with the feelings and needs of others is often envious of others or believes that others are envious of him or her shows arrogant, haughty behaviors or attitudes In short, Narcissists are typically controlling egomaniacs who do whatever they have to do in order to get other people to fawn over them and make them powerful. They are often drawn towards positions of power or fame and use power or fame to compel others to give them attention. Narcissists do not show normal regard for the rights of other human beings. Instead, they are highly interpersonally exploitive and will unscrupulously harm others who get in their way, often with out feeling much sense of guilt for their actions. Narcissists seem to have a very strong sense of self, but this is an illusion. Unlike normal people’s sense of self, Narcissists are typically very brittle and inflexible; they cannot stand criticism easily, even when it is constructive. The narcissists’ self-esteem is based almost entirely on external recognition of his or her accomplishments and the adulation of the ‘audience’ (those persons the narcissist has managed to control). Without the support of the audience, he or she frequently has a very tough time. For more information, check out Sam Vaknin’s Pathological Narcissism Pages.
The term Nervous Breakdown is not an official clinical diagnosis appearing in the official manuals, but rather a culturally defined disorder. Generally, it seems to refer to a condition of anxious or depressive collapse or overwhelm. Before the ‘breakdown’ occurs, the person is able to function (get up, go to work, have relationships with others, etc.) and afterwards they have difficulty functioning. Probably, what most people describe as a nervous breakdown best corresponds to some sort of depressive or anxious condition that may be in response to significant stressful life events.
The term Neuroleptic refers to a class of psychiatric medicines that are used to treat psychosis and a variety of other conditions. Classical members of this category include Thorazine and Haldol. Although it would be tempting to substitute the term “Anti-Psychotic” here, it should be noted that there are many instances where a psychiatrist will use medicines originally intended for the treatment of psychosis for the treatment of other mental disorders with good effect. So – it is no longer clear that Anti-Psychotic medicines are just for that purpose any more.
Neuropsychology is a joint field of clinical psychology and neuroscience. Neuropsychologists study the relationships between the brain and behavior. Many of them are experts in psychological testing, particularly in intellectual and cognitive tests of intelligence, memory and attention. Let’s say you are in a car accident and your head gets bounced about pretty badly. You go to the doctor and she orders an MRI image of your brain to see if anything is broken in there. The results come back negative – all seems to be well. Only problem with this is that you know that all is not well – you are having problems concentrating and you seem to be forgetting things more than before the accident. You see a Neuropsychologist who gives you a battery of tests that measure your memory, concentration, attention, etc. The Neuropsychologist is measuring what your brain can do (rather than what your brain looks like – which is what the MRI gives). The Neuropsychologist compares your test results against known norms for people who have healthy brains and determine that you are having a problem in certain areas. This is another way of saying that Neuropsychologists are experts at measuring functional relationships between brain and behavior.
Freud (and the Freudian school of psychotherapy) distinguished two levels of mental illness severity: less impaired (Neurosis) and more impaired (Psychosis). In Neurosis, a person has many internal psychological conflicts and shows mild to moderate impairments in their ability to “Love and Work” properly. Neurotics maintain contact with shared social reality, however. Psychosis was thought of as a state of severe psychological impairment where shared social reality was lost.
Neurotransmitters are the name given to a group of chemicals in people’s brain that are critical parts of how the brain works. You may know that the brain is the part of the body that controls the body. You may also know that the brain is made up of cells called neurons that function like wires in a telephone; messages get sent across the neurons sort of like messages get sent across the telephone wires. What you may not know is that in the brain, there may be several neurons between the beginning and the end of a message. The neurons don’t touch each other but still manage to talk to each other so that the message can go from one neuron to another and get the message across. Here is where neurotransmitter chemicals come in. At the end of one neuron and the beginning of another is a space called a synapse. When a message gets to the end of the first neuron, it triggers the release of neurotransmitter chemicals into the synapse. These little guys ferry across the synapse and touch the beginning part of the next neuron in the chain, triggering this next neuron to continue the message down its length (where the process repeats, etc.). Psychiatric drugs act on the brain at the level of the neurotransmitters. The presence of a given drug in the brain changes how many neurotransmitters are available to make the journey from one neuron to the next. By changing the levels of a drug in your brain, your doctor can make adjustments to how well different kinds of messages get transmitted through your brain – with the effect of changing how you feel and think. The art of medicating someone involves getting the levels of drug just right so that they balance the brain neurotransmitters out just so and help the person to think and feel more clearly. Examples of neurotransmitters are Serotonin, Dopamine, Adrenalin, Noradrenalin, and GABA.
Not Otherwise Specified. NOS is used as a broad based diagnostic category, for instance Depression NOS. The choice of the NOS diagnosis means that the diagnosing doctor is pretty sure that the patient’s problems fall into a particular family of disorders (e.g., depressive disorders, anxiety disorders, etc.) but that there is not enough information present at the time of diagnosis to better specify the type of disorder that is present.
Obsessive-Compulsive Disorder is a serious mental disorder characterized by the presence of obsessions and compulsions. Obsessions are repetitive, unwanted thoughts. People’s obsessive thoughts take many different forms but frequently center on themes about personal vulnerability and loss of control (whether or not they locked their door, turned off their stove, or were contaminated by germs). Often there is a sense of urgency and tension that rises until the person feels compelled to act on the obsessive thought. An action based on an obsessive thought is called a compulsion. Acting out a compulsion does not stop the obsession in most cases, except on a temporary basis. Compulsions often need to be acted on continually in a never-ending cycle. Compulsions range from mild checking behavior (to see if your door is locked, stove is off, etc.) to severe cases where the person is unable to function based on their compulsions having taken over their life. In moderately severe instances, for example, a person may be obsessed with the idea that he or she is contaminated with germs and act on compulsions to wash him or herself many times per day, often until the skin becomes raw and irritated. There are medical and psychological treatments for OCD. See the OCD page for more information on the disorder.
Panic attacks are features of some anxiety disorders. A panic attack typically seems to come on with no provocation, out of the “clear blue sky” as it were. A person experiencing a panic attack experiences multiple symptoms including but not limited to severe anxiety, sweating, heart palpitations, thoughts that you are having a heart attack, and shortness of breath. The panic comes on quickly and usually does not last for too long. Panic attacks are often associated with phobias (fear disorders) such as Agoraphobia wherein a person learns to fear being in ‘unsafe’ places (e.g., places they’ve experienced a panic attack in) and avoids entering into those places. There are really good treatments available for panic attack now, including Cognitive Behavioral treatments available from a Clinical Psychologist, and also some medications.
Paranoia is a disorder of understanding the nature of the social world. Paranoid persons see and act upon relationships and meanings that don’t exist. Most typically, the paranoid person comes to suspect or believe that others are out to harm or embarrass or discredit them. The paranoid person holds on to their suspicions despite the fact that there is no compelling evidence that their suspicions are founded. There are different types of paranoia that can occur. Paranoid Personality Disorder is a type of rigid personality stance that some persons develop. It manifests as a “pervasive distrust and suspiciousness of others such that their (the others) motives are interpreted as malevolent, beginning by early adulthood…” (DSM-IV). People with Paranoid PD fight back against perceive attacks that haven’t occurred, may suspect partners of infidelity that hasn’t occurred, bear grudges unrelentingly, and doubt the trustworthiness of their friends. A more serious form of paranoia occurs as a subtype of the disease known as Schizophrenia. Schizophrenia is a serious illness that compromises a person’s ability to perceive reality correctly, to communicate and to function in society. In the paranoid form of schizophrenia, the patient experiences hallucinations (auditory, visual, or even tactile and smell sensations of things that are not there) and/or delusions (fixed, often fantastic, sometimes grandiose beliefs that they are in danger, are king of the world, etc.) Delusions are fixed, and the patient is most often unwilling to abandon them even when it is pointed out that there is no evidence for these beliefs. As good examples of just how fantastic these sorts of paranoid delusions and hallucinations can be, I can report on working with a patient who “was in communication with an alien spaceship captain” as we were speaking, and also a patient who covered her floor with tinfoil squares “to keep the downstairs neighbor from firing her ray gun at me”. In any form, Paranoia is not pretty. See the personality disorders page and schizophrenia page for more information.
Partial Hospital Programs (PHPs) are very much like IOPs defined above, only they last longer (usually all day as opposed to IOPs that last for several hours). PHPs are rarer than IOPs because they cost more to run and Managed Care Organizations are hesitant to pay for them.
Passive aggressive behavior can occur when someone is angry at another person, but is restrained for some reason from openly expressing that anger. The restraint may come from some external agency (e.g., knowing that your boss will fire you if you express disagreement openly), or it may come from an internal belief that anger never should be expressed. The anger doesn’t go away, however, but rather leaks out to be expressed in a hidden way, via talking badly about that person behind their back, sabotaging of that person’s work, etc.
A Pastoral Counselor is basically a clergy person (priest, minister, reverend, rabbi, etc.) who counsels people. There are academic and theological programs for this, some of which terminate in the M.Div. degree, but not all Pastoral Counselors have been to these programs.
Most people have a fairly flexible personality that allows them to adapt to a variety of circumstances, people and events. Persons with Personality Disorders, however, lack this flexibility, and instead, get stuck in fairly rigid ways of relating. The rigid personality style of a personality disordered person is pervasive and chronic. It may affect how they think about themselves, others and events, how they experience emotion, how they function socially, and how well they can control their impulses. Due to their rigid, maladaptive personality styles, Personality Disordered persons typically have many problems with their work, social and intimate relationships. There are ten recognized personality disorders, typically arranged into three clusters. Cluster “A” includes Paranoid, Schizoid, and Schizotypal Personality Disorders, Cluster “B” includes Antisocial, Histrionic, Narcissistic and Borderline Personality disorders, and Cluster “C” includes Avoidant, Dependent and Obsessive-Compulsive Personality Disorders. It is possible for people to have traits or symptoms of more than one personality disorder at the same time, while not meeting criteria for any one of them. In this case of “mixed personality disorder” the diagnosis of Personality Disorder Not Otherwise Specified (NOS) is made, and the traits are listed out. For more extensive discussion, see our Personality Disorders Center.
Ph.D. stands for “Doctor of Philosophy”. This is a doctoral level degree generally requiring extended graduate level university training (4-6 years after completing regular college BA/BS programs). Clinical Psychologists will often have this degree, although the Ph.D. can be issued in many different fields and is not limited to psychology (e.g., a Ph.D. in Clinical Psychology, a Ph.D. in Education, a Ph.D. in (etc.)). When Clinical Psychologists have this degree it generally indicates that they have research training in addition to clinical training (this is not always the case however).
Symptoms of Psychosis and Schizophrenia are generally divided into two types: Positive and Negative. Positive symptoms describe excessive behavior (above and beyond normal behavior) such as hallucinations (hearing voices) and delusions (believing you are the Archangel Gabriel). Negative symptoms, on the other hand describe behaviors that are less than normal in terms of energy, physical movement, emotional state, etc. Catatonia (when a psychotic patient holds a rigid standing position for long periods of time), and flat affect (when a psychotic patient displays no emotion at all) are prime examples of negative symptoms.
PTSD is an anxiety disorder that occurs in the aftermath of a traumatic event. A traumatic event is usually (conservatively) defined as exposure to death or a near death event. Examples are combat, rape, motor vehicle accidents, etc. PTSD is diagnosed six months after the traumatic event (although an Acute Stress Disorder can occur prior to this six-month period). Basically, PTSD occurs when a person is unable to ‘digest’ the traumatic event. It is as though the trauma just sits inside the person, whose life becomes all about avoiding the trauma. There are three major types of PTSD symptoms. First, the traumatized person generally develops a heightened startle response and easy arousability and irritability even if they were a very mellow person before their exposure to the trauma. This change in mood and startle is relatively permanent and biological in nature – the traumatized person’s nervous system has been ‘reset’ by their exposure to the trauma. Second, they are vulnerable to having memories of the trauma come flooding back into their minds and hearts unbidden at any time. This usually is terribly frightening. Third, they will go to great lengths to avoid thinking about the trauma. These avoidance measures vary from not going near anything that reminds them of the trauma to full-on dissociation. PTSD responds fairly well to therapies (both medical and psychological). The best success rates come when the trauma is relatively recent and when the traumatized person did not dissociate during their exposure to the trauma. See the trauma links guide for more information.
The period of time before an outbreak of a serious condition during which subtle symptoms are present is known as the prodromal period. For example, a person who is about to become psychotic will typically have a prodromal period during which they may display some odd behaviors, but no obvious psychosis. The prodromal period gives way to a florid (“in full bloom” – not the technical term) period during which the full expression of the serious condition is manifest.
Projection is a type of defense mechanism (see also splitting which is also a defense mechanism). In projection, a person experiences an emotion or thought that they can’t deal with exactly for whatever reason. The unacceptable feeling or thought is experienced as though someone else had been thinking or feeling it. The classic example of projection is when a woman is angry at another person, but strongly believes that they are not the sort of person who experiences anger. Instead of owning it themselves, they think that the other person is angry with them! In this way they experience the unacceptable thought or feeling, but assign its source to someone else so that they don’t have to deal with the unacceptability of that thought or feeling directly. Here is another example. I’ve seen many studies now that show that highly homophobic persons are often very aroused by homoerotic stimulation (gay porn). Imagine a homophobic person who goes out and beats up a gay person “because he was looking at me funny”. This hypo pathetical homophobic person would be experiencing unacceptable homosexual arousal towards the gay man, but would project the source of that arousal onto the gay may himself (and not rightly own his own arousal).
Psy.D. stands for “Doctor of Psychology”. This is a doctoral level degree generally requiring extended graduate level university training (3-4 years after completing regular college BA/BS programs). Some Clinical Psychologists have this degree. Programs granting Psy.D. degrees are generally more Clinically focused (and less research focused) and have as their aim to produce clinicians and not academicians. The Psy.D. degree often does not require an “original research dissertation” as a precondition of graduation (but sometimes it does). Also – Psy.D. degrees are often granted from free standing schools of professional psychology (not university affiliated).
A Psychiatrist is a Medical Doctor or Physician who has completed medical school and also a multi-year residency in Psychiatry (treatment of mental illness), usually in a hospital setting and under supervision of senior Psychiatrists (known as Attendings). Psychiatrists are experts in the use of medications to treat mental disorders and also experts in the diagnosis and treatment of mental illnesses. Because they have medical training (stressing the role of biological dysfunction in illness) and not psychological training (stressing the role of behavioral and psychological dysfunction in illness) many of them tend to view mental problems as essentially biological dysfunctions that require chemical/medicine interventions. This is a way of saying that they don’t always recommend sound psychotherapy even when it would be indicated. While it is undoubtedly true that biology plays an enormous role in mental illness, it is not the case that biology is the only way (or always the best way) to treat these problems.
A Psychologist is an individual who has completed a doctoral level degree (about 5 years of graduate school resulting in the Ph.D, or Psy.D. degrees) in the science of Psychology – the study of how individuals behave, think, feel, know, etc. Psychology is a very diverse discipline; some psychologists are scientist-researchers, some are therapists, some become administrators, etc. Those that specialize in therapy are called Clinical Psychologists. As far as professional training goes, Psychologists are the most extensively trained therapists out there, and are also responsible for much of the innovation and research that is done to produce new forms of therapy. The term Psychologist is legally protected by state law – only persons who are licensed as psychologists can call themselves psychologists.
Psychopathology is a fancy word for the study of mental illness. The word can be broken down into ‘psycho’ which roughly means ‘having to do with the mind (and maybe spirit too)’, ‘patho’ which means ‘having to do with disease processes, and ‘logy’ which means ‘having to do with the study of something. Psychopathology, then, is the science that studies mental diseases.
Psychosis refers to a state of being completely out of touch with reality (as most other people agree upon it). Psychosis is generally a state (a temporary condition) rather than a trait (permanent condition). Persons prone to psychosis can go in and out of it. Many medications (called neuroleptics or anti-psychotics) are available to help psychotic persons regain their comprehension of reality. Psychosis is frequently associated with the family of disorders known as Schizophrenia. The stereotype is that a psychotic person will appear obviously crazy and out of touch with reality (and this is often the case). However, it is possible for people to be psychotic but to appear normal (enough) in their casual social contacts so that their condition goes untreated for years.
Punishment is a term from Psychological Learning Theory that has a precise meaning – it refers to something that causes a behavior to lessen in intensity. There is nothing that is intrinsically punishing. Rather – a thing is called punishing if when it is applied – it results in the reduction of behavior that you want to reduce. Let’s say that you have a child and the child sings all the time. You want to stop the child from doing this – but you want to do so in a humane manner. You decide that you will threaten the child with the withdrawal of his TV watching privilege if he continues to sing during meals. You make good on your threat – He sings and you tell him he can’t watch TV tonight. After a day or so you see that he has stopped singing at meals. Your removal of the TV privilege is acting as a Punisher. – Now – You continue this experiment for a few more days and you notice that your son has begun to sing all the time again despite the fact that he can’t watch TV anymore. Baffled, you follow him around some and learn that he is now on the internet during the time he used to watch TV. Your removal of the TV privilege has lost its punishing effect now that your son has discovered alternatives to TV. Hopefully this example makes the point clearer.
A method of therapy developed by the psychiatrist, William Glasser, MD in the 1960s. The main point of this therapeutic approach is that people can choose behaviors that will help them to better meet their needs in the future. Reality therapy focuses on the responsibility of the patient to develop their own effective strategies for handling lifes problems and to make better choices in their lives. The structure of this therapy includes creating an environment of trust and then utilizing specific techniques that help the patient gain awareness of their present behaviors and what they really want out of life. Dr. Glassers therapy is built upon what he calls Choice Theory. Choice theory basically states that our choices are made from internal factors or basic needs that we all possess and that the only behavior we can control is our own. The internal factors that drive a person to make his/her choices, according to Glasser, are Love/Belonging, Freedom, Fun, Power, and Survival.
Reward is a term from Psychological Learning Theory that has a precise meaning – it refers to something that causes a behavior to increase in intensity. There is nothing that is intrinsically rewarding. Rather – a thing is called rewarding if when it is applied – it results in the intensification of behavior (more of it!). See also Punishment (above)
The term scapegoating refers originally to a rather ancient sort of magical ritual, used extensively in religious practices, to clean a community of sin. In the scapegoating ritual, the sins of a community are magically transferred from the community members onto an animal (a goat or other animal suitable for sacrifice) and then the animal is destroyed or driven off away from the community. The community practicing scapegoating believed that, through the destruction or segregation of the sacrificial animal which ‘magically’ now carried all the sin for the community, that the community was cleansed in front of what ever form of deity might be judging them. To scapegoat a person, then, is to treat them as though they caused problems that they did not cause, and to treat them badly as a result of making this attribution. Some leaders and politicians use scapegoating as a means of rallying their constituencies together against a common enemy. See my May 2000 editorial on Scapegoating for an expanded perspective.
Schizoaffective Disorder is diagnosed when symptoms of schizophrenia (hallucinations, delusions, catatonia, disorganized speech, flattening of facial affect, etc.) co-occur (happen at the same time) with all necessary symptoms of a manic, depressive or mixed episode sufficient for the diagnosis of Bipolar or Major Depression. The diagnosis *is not* appropriate, however, until it can be documented that the psychotic symptoms (hallucinations, delusions) continue in the *absence* of mood symptoms for a period of at least two weeks. (This is important because mood disorders can produce psychotic symptoms all by themselves and if psychotic symptoms go away when the mood disorder does, then the diagnosis of mood disorder is probably a more accurate description of what is going on than Schizoaffective disorder would be) There are differences of opinion on the utility of diagnosing schizoaffective disorder: Some Drs. I’ve worked with will use this diagnosis, while others will insist upon separately diagnosing Schizophrenia and a separate mood disorder.
The field of Psychology is very diverse in nature and includes persons who are essentially scientists only and also people who are essentially psychotherapist-practitioners only. This diversity often creates tensions within the field; the scientists have tended to look down on the practitioners and the practitioners have tended to view the scientists as out-of-touch egghead geeks. Recognizing that practitioners were better therapists if they based their therapies on scientific research, and that scientists were more useful researchers if they focused their research on practical therapeutic problems – a group of psychologists met in Boulder Colorado several decades back and pondered the problem. Their solution was to promote a new model of training where student clinical psychologists were to be trained both as full scientists and as full practitioners. This is how much training of clinical psychologists proceeds today when it is done at university affiliated graduate programs in clinical psychology (Free-standing Professional Schools are often a different story). In theory this dual-track training works well. In practice there is too much to know and people tend to specialize – as scientists only or as practitioners only. Both groups are still suspicious of each other.
The self-concept is more or less the collection of ideas you have about who you are. Some writers talk about the self-concept as including only those ideas you could consciously have about yourself, while others include a variety of structural and/or unconscious sorts of ideas and processes. The precise definition then, is up to the author who is doing the writing.
A fairly loose term used to refer to any serious and persistent mental illness. Included normally would be Schizophrenia, Bipolar Affective Disorder, recurrent Major Depression, etc. To my knowledge there is no ‘set in stone’ listing of what illnesses fit in to this term.
The term ‘sociopath’ (and also the term ‘psychopath’) refers to people who are antisocial and who commits antisocial and/or criminal acts (con-artistry, serial killing, (lawyering – grin!) , etc.) without any corresponding sense of guilt. In this context, the term ‘anti-social’ refers to criminal or deviant actions that harm other people – it *does not* refer to people who are loners. Perhaps because they have little guilt to get in their way, they often develop extremely good social skills and are able to manipulate other people around them so as to get what they want from others. They may be perceived as charming, highly social and graceful (Don’t let this fool you – if some one is too good to be true – they probably are). The term sociopath is not a diagnostic term and doesn’t have a precise meaning. The nearest corresponding diagnosis would probably be that of Antisocial Personality Disorder.
People are complex creatures with good and bad characteristics. Our appreciation of this complexity is something that grows over time. When we are children, we are unable to grasp complexity and tend to see individuals as “all good” or “all bad”, all black or all white. As we grow, most of us learn to allow for “partially good persons” or “good persons with a few bad characteristics”; our representation of others gets increasingly complex and we learn to see people in shades of gray. For a variety of reasons, some persons do not successfully learn how to see others in these more complex ways, but rather remain viewing people in very black and white ways well into adulthood. The term splitting is often used to describe how such a black and white thinking adult will characterize others. For instance, a person who uses splitting as a defense mechanism may view one person as “all good” (perfect, wonderful, pure), and other people as “all bad” (foul, corrupt, hostile and evil). This separation of good from bad is thought to occur so as to allow the person who is doing the splitting to have a safe sense of there being good in the world at all – the good needs to be protected and cannot be allowed to be corrupted because the world is such a dangerous place. Because splitting produces unrealistic impressions of others, a splitters’ views of others’ goodness and badness are fairly unstable. Someone can be good on one day, but then the next day be very evil all because that person failed to please the splitter in some difficult to appreciate way. The splitting concept comes out of the psychodynamic literature. It is most associated with personality disordered persons, in particular persons diagnosed with borderline and narcissistic personality disorders.
Generally short for “Psychotherapist” – a person who professes to be able to help person who are suffering with problems amenable to psychological treatments. This is a generic term and does not imply any specific credentials or educational background.
Tolerance has two meanings. In addictions, tolerance is used to describe the phenomenon that occurs when someone starts needing more and more of a drug (such as alcohol or cocaine or heroin) in order to get the same high. In a different context, tolerance refers to how well a person can accept things that are different or stressful. Someone may be said to be highly tolerant if they don’t get stressed out when things are not going exactly the way they want.
Transference is a term derived from psychoanalytic psychology (via Freud). The term Transference refers to a type of “transfer” of emotions that frequently occurs in a psychotherapeutic relationship. The idea is this. People’s early relationships are characterized by particular emotions. For instance, you might feel fear more often than not in the presence of your father. Later in life, the emotions you learned in earlier relationships may color how you experience new relationships you form with new persons. For example, you come to fear your male psychotherapist (and many other adult male authority figures) because you’ve transferred your fear of your father onto him (and others). You may ask, “isn’t it possible that I just have a scary male psychotherapist, and that my fear of him is unrelated to my fear of my father?” Well, sure, that is possible. If that were the case, your fear of your psychotherapist would not be transference because the new fear you experience was not ‘transferred’ from any previous relationship. Most of the time, however, there is an exaggerated quality attached to transferred emotions. You may fear your psychotherapist in spite of the fact that he has not really done anything to merit this fear. Such exaggerated, prejudiced or unreasonable emotions are more probably examples of true transference. Psychodynamic psychotherapists love transference when it occurs because the occurrence of transference is an opportunity for the therapist to help the patient learn what is happening, and in so learning, to begin to resolve the original fear of the original person so that the fear no longer colors new relationships. “You zee, it iz not me zat you hate, but instead it iz your father!” “Thanks doc!, I’m cured!.” See also Counter-Transference.
These days, the word ‘Trauma’ has entered into general usage in the English language, and most anything that is uncomfortable can be described as a trauma. For clinical usage, however, the definition of a trauma is necessarily more circumscribed. A true Trauma occurs when a person is exposed to an event that threatens their physical or psychological safety. Exemplars of traumatic events include coming very close to death, watching (or participating in) the death of another, being raped or severely abused, surviving a serious car accident, etc. Some persons who have been traumatized are at increased risk of developing trauma related psychiatric/psychological disorders which include Posttraumatic Stress Disorder (PTSD), dissociative disorders (amnesia, psychogenic fugue (as experienced by the title character in the movie “Nurse Betty”) and possibly, (when the trauma occurs at a very young age), Dissociative Identity Disorder (the disorder formerly known as Multiple Personality Disorder). Not everyone who lives through a traumatic event develops a disorder, however.
Starting in the 1950s, physicians Meyer Friedman and Ray Rosenman began to wonder if there was a relationship between personality and vulnerability to heart disease. They published a series of papers suggesting that Type A personalities (their term for aggressive, hard-driving, controlling, competitive, goal-oriented personalities) were more prone to getting serious heart disease when compared with Type B personalities (their term for more relaxed, laid back, journey-oriented persons). Research since then has supported the proposed relationship with some modifications. Type A personalities show more physiological arousal and report fewer physical symptoms than Type Bs. Some research (the Western Collaborative Group Study, Rosenman and others, 1975) has supported the idea that Type A’s are two times more likely to have serious coronary heart disease than Type B’s. Most recently, researchers have suggested that the active ingredient in Type A that causes the trouble are the personality traits of chronic hostility, cynical anger and irritability.