GLOSSARY OF TERMS IN ENGLISH PSYCHIATRIC

A

Abreaction An emotional release or discharge after recalling a painful experience that has been repressed because it was not consciously tolerable. Often the release is surprising to the individual experiencing it because of it's intensity and the circumstances surrounding its onset. A therapeutic effect sometimes occurs through partial or repeated discharge of the painful affect.

Abstract attitude (categorical attitude) This is a type of thinking that includes voluntarily shifting one's mind set from a specific aspect of a situation to the general aspect; It involves keeping in mind different simultaneous aspects of a situation while grasping the essentials of the situation. It can involve breaking a situation down into its parts and isolating them voluntarily; planning ahead ideationally; and/or thinking or performing symbolically. A characteristic of many psychiatric disorders is the person's inability to assume the abstract attitude or to shift readily from the concrete to the abstract and back again as demanded by circumstances.

Abulia A lack of will or motivation which is often expressed as inability to make decisions or set goals. Often, the reduction in impulse to action and thought is coupled with an indifference or lack of concern about the consequences of action.

Acalculia The loss of a previously possessed ability to engage in arithmetic calculation.

Acculturation difficulty A problem stemming from an inability to appropriately adapt to a different culture or environment. The problem is not based on any coexisting mental disorder.

Acetylcholine A neurotransmitter in the brain, which helps to regulate memory, and in the peripheral nervous system, where it affects the actions of skeletal and smooth muscle.

Acting out This is the process of expressing unconscious emotional conflicts or feelings via actions rather than words. The person is not consciously aware of the meaning or etiology of such acts. Acting out may be harmful or, in controlled situations, therapeutic (e.g., children's play therapy).

Actualization The realization of one's full potential - intellectual, psychological, physical, etc.

Adiadochokinesia The inability to perform rapid alternating movements of one or more of the extremities. This task is sometimes requested by physicians of patients during physical examinations to determine if there exists neurological problems.

Adrenergic This refers to neuronal or neurologic activity caused by neurotransmitters such as epinephrine, norepinephrine, and dopamine.

Affect This word is used to described observable behavior that represents the expression of a subjectively experienced feeling state (emotion). Common examples of affect are sadness, fear, joy, and anger. The normal range of expressed affect varies considerably between different cultures and even within the same culture. Types of affect include: euthymic, irritable, constricted; blunted; flat; inappropriate, and labile.

Affective disorders Refers to disorders of mood. Examples would include Major Depressive Disorder, Dysthymia, Depressive Disorder, N.O.S., Adjustment Disorder with Depressed Mood, Bipolar Disorder...

Age-associated memory impairment (AAMI) The mild disturbance in memory function that occurs normally with aging; benign senescent forgetfulness. Such lapses in memory are lately humorously referred to as representing "a senior moment".

Agitation (psychomotor agitation) Excessive motor activity that accompanies and is associated with a feeling of inner tension. The activity is usually nonproductive and repetitious and consists of such behavior as pacing, fidgeting, wringing of the hands, pulling of clothes, and inability to sit still.

Agnosia Failure to recognize or identify objects despite intact sensory function; This may be seen in dementia of various types. An example would be the failure of someone to recognize a paper clip placed in their hand while keeping their eyes closed.

Agonist medication A chemical entity that is not naturally occuring within the body which acts upon a receptor and is capable of producing the maximal effect that can be produced by stimulating that receptor. A partial agonist is capable only of producing less than the maximal effect even when given in a concentration sufficient to bind with all available receptors.

Agonist/antagonist medication A chemical entity that is not naturally occuring within the body which acts on a family of receptors (such as mu, delta, and kappa opiate receptors) in such a fashion that it is an agonist or partial agonist on one type of receptor while at the same time it is also an antagonist on another different receptor.

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

Agraphia The loss of a pre-existing ability to express one's self through the act of writing.

Akathisia Complaints of restlessness accompanied by movements such as fidgeting of the legs, rocking from foot to foot, pacing, or inability to sit or stand. Symptoms can develop within a few weeks of starting or raising the dose of traditional neuroleptic medications or of reducing the dose of medication used to treat extrapyramidal symptoms. akathisia is a state of motor restlessness ranging from a feeling of inner disquiet to inability to sit still or lie quietly.

Akinesia A state of motor inhibition or reduced voluntary movement.

Akinetic mutism A state of apparent alertness with following eye movements but no speech or voluntary motor responses.

Alexia Loss of a previously intact ability to grasp the meaning of written or printed words and sentences.

Alexithymia A disturbance in affective and cognitive function that can be present in an assortment of diagnostic entities. Is common in psychosomatic disorders, addictive disorders, and posttraumatic stress disorder. The chief manifestations are difficulty in describing or recognizing one's own emotions, a limited fantasy life, and general constriction in affective life.

Algophobia Fear of pain.

Alienation The estrangement felt in a setting one views as foreign, unpredictable, or unacceptable. For example, in depersonalization phenomena, feelings of unreality or strangeness produce a sense of alienation from one's self or environment.

Alloplastic Referring to adaptation by means of altering the external environment. This can be contrasted to autoplastic, which refers to the alteration of one's own behavior and responses.

Alogia An impoverishment in thinking that is inferred from observing speech and language behavior. There may be brief and concrete replies to questions and restriction in the amount of spontaneous speech (poverty of speech). Sometimes the speech is adequate in amount but conveys little information because it is overconcrete, overabstract, repetitive, or stereotyped (poverty of content).

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

Amentia Subnormal development of the mind, with particular reference to intellectual capacities; a type of severe mental retardation.

Amimia A disorder of language characterized by an inability to make gestures or to understand the significance of gestures.

Amines Organic compounds containing the amino group. Amines such as epinephrine and norepinephrine are significant because they function as neurotransmitters.

Amnesia Loss of memory. Types of amnesia include: anterograde Loss of memory of events that occur after the onset of the etiological condition or agent. retrograde Loss of memory of events that occurred before the onset of the etiological condition or agent.

Amok A culture specific syndrome from Malay involving acute indiscriminate homicidal mania .

Amygdala This is a structure of the brain which is part of the basal ganglia located on the roof of the temporal horn of the lateral ventricle at the inferior end of the caudate nucleus. It is a structure in the forebrain that is an important component of the limbic system.

Amyloid Any one of various complex proteins that are deposited in tissues in different disease processes. These proteins have an affinity for Congo red dye. In neuropsychiatry, of particular interest are the beta-amyloid (A4) protein, which is the major component of the characteristic senile plaques of Alzheimer's disease, and the amyloid precursor protein (APP).

Anaclitic In psychoanalytic terminology, dependence of the infant on the mother or mother substitute for a sense of well-being. This is considered normal behavior in childhood, but pathologic in later years.

Anal stage The period of pregenital psychosexual development, usually from 1 to 3 years, in which the child has particular interest and concern with the process of defecation and the sensations connected with the anus. The pleasurable part of the experience is termed anal eroticism.

Anamnesis The developmental history of a patient and of his or her illness, especially recollections.

Anankastic personality Synonym for obsessive-compulsive personality.

Androgyny A combination of male and female characteristics in one person.

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

Anima In Jungian psychology, a person's inner being as opposed to the character or persona presented to the world. Further, the anima may be the more feminine "soul" or inner self of a man, and the animus the more masculine soul of a woman.

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

Anosognosia The apparent unawareness of or failure to recognize one's own functional defect (e.g., hemiplegia, hemianopsia). Aantagonist medication A chemical entity that is not naturally occuring within the body which occupies a receptor, produces no physiologic effects, and prevents endogenous and exogenous chemicals from producing an effect on that receptor.

Anxiety The apprehensive anticipation of future danger or misfortune accompanied by a feeling of dysphoria or somatic symptoms of tension. The focus of anticipated danger may be internal or external. Anxiety is often distinguished from fear in that fear is a more appropriate word to use when there exists threat or danger in the real world. Anxiety is reflective more of a threat that is not apparent or imminent in the real world, at least not to the experienced degree.

Apathy Lack of feeling, emotion, interest, or concern.

Aphasia An impairment in the understanding or transmission of ideas by language in any of its forms--reading, writing, or speaking--that is due to injury or disease of the brain centers involved in language.

Anomic or amnestic aphasia Loss of the ability to name objects.

Aphonia An inability to produce speech sounds that require the use of the larynx that is not due to a lesion in the central nervous system.

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

Apraxia Inability to carry out previously learned skilled motor activities despite intact comprehension and motor function; this may be seen in dementia.

Assimilation A Piagetian term describing a person's ability to comprehend and integrate new experiences.

Astereognosis Inability to recognize familiar objects by touch that cannot be explained by a defect of elementary tactile sensation.

Ataxia Partial or complete loss of coordination of voluntary muscular movement.

Attention The ability to focus in a sustained manner on a particular stimulus or activity. A disturbance in attention may be manifested by easy distractibility or difficulty in finishing tasks or in concentrating on work

Auditory hallucination A hallucination involving the perception of sound, most commonly of voices. Some clinicians and investigators would not include those experiences perceived as coming from inside the head and would instead limit the concept of true auditory hallucinations to those sounds whose source is perceived as being external.

Aura A premonitory, subjective brief sensation (e.g., a flash of light) that warns of an impending headache or convulsion. The nature of the sensation depends on the brain area in which the attack begins. Seen in migraine and epilepsy.

Autoeroticism Sensual self-gratification. Characteristic of, but not limited to, an early stage of emotional development. Includes satisfactions derived from genital play, masturbation, fantasy, and oral, anal, and visual sources.

Automatism Automatic and apparently undirected nonpurposeful behavior that is not consciously controlled. Seen in psychomotor epilepsy.

Autoplastic Referring to adaptation by changing the self.

Autotopagnosia Inability to localize and name the parts of one's own body. finger agnosia would be autotopagnosia restricted to the fingers.

Avolition An inability to initiate and persist in goal-directed activities. When severe enough to be considered pathological, avolition is pervasive and prevents the person from completing many different types of activities (e.g., work, intellectual pursuits, self-care).

B

Basal gangliaClusters of neurons located deep in the brain; they include the caudate nucleus and the putamen (corpus striatum), the globus pallidus, the subthalamic nucleus, and the substantia nigra. The basal ganglia appear to be involved in higher-order aspects of motor control, such as planning and execution of complex motor activity and the speed of movements. Lesions of the basal ganglia produce various types of involuntary movements such as athetosis, chorea, dystonia, and tremor. The basal ganglia are involved also in the pathophysiology of Parkinson's disease, Huntington's disease, and tardive dyskinesia. The internal capsule, containing all the fibers that ascend to or descend from the cortex, runs through the basal ganglia and separates them from the thalamus.

Bestiality Zoophilia; sexual relations between a human being and an animal. See also paraphilia.

Beta-blocker An agent that inhibits the action of beta-adrenergic receptors, which modulate cardiac functions, respiratory functions, and the dilation of blood vessels. Beta-blockers are of value in the treatment of hypertension, cardiac arrhythmias, and migraine. In psychiatry, they have been used in the treatment of aggression and violence, anxiety-related tremors and lithium-induced tremors, neuroleptic-induced akathisia, social phobias, panic states, and alcohol withdrawal.

Bizarre delusion A delusion that involves a phenomenon that the person's culture would regard as totally implausible.

Blind spot Visual scotoma, a circumscribed area of blindness or impaired vision in the visual field; by extension, an area of the personality of which the subject is unaware, typically because recognition of this area would cause painful emotions.

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

Blunted affect An affect type that represents significant reduction in the intensity of emotional expression

Body image One's sense of the self and one's body.

Bradykinesia Neurologic condition characterized by a generalized slowness of motor activity.

Broca's aphasia Loss of the ability to comprehend language coupled with production of inappropriate language.

Bruxism Grinding of the teeth, occurs unconsciously while awake or during stage 2 sleep. May be secondary to anxiety, tension, or dental problems.

C

Capgras' syndrome The delusion that others, or the self, have been replaced by imposters. It typically follows the development of negative feelings toward the other person that the subject cannot accept and attributes, instead, to the imposter. The syndrome has been reported in paranoid schizophrenia and, even more frequently, in organic brain disease.

Catalepsy Waxy flexibility--rigid maintenance of a body position over an extended period of time.

Cataplexy Episodes of sudden bilateral loss of muscle tone resulting in the individual collapsing, often in association with intense emotions such as laughter, anger, fear, or surprise.

Catatonic behavior Marked motor abnormalities including motoric immobility (i.e., catalepsy or stupor), certain types of excessive motor activity (apparently purposeless agitation not influenced by external stimuli), extreme negativism (apparent motiveless resistance to instructions or attempts to be moved) or mutism, posturing or stereotyped movements, and echolalia or echopraxia

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

Cathexis Attachment, conscious or unconscious, of emotional feeling and significance to an idea, an object, or, most commonly, a person.

Causalgia A sensation of intense pain of either organic or psychological origin.

Cerea flexibilitas The "waxy flexibility" often present in catatonic schizophrenia in which the patient's arm or leg remains in the position in which it is placed.

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

Clanging A type of thinking in which the sound of a word, rather than its meaning, gives the direction to subsequent associations.

Climacteric Menopausal period in women. Sometimes used to refer to the corresponding age period in men. Also called involutional period.

Cognitive Pertaining to thoughts or thinking. Cognitive disorders are disorders of thinking, for example, schizophrenia.

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

Compensation A defense mechanism, operating unconsciously, by which one attempts to make up for real or fancied deficiencies. Also a conscious process in which one strives to make up for real or imagined defects of physique, performance skills, or psychological attributes. The two types frequently merge. See also overcompensation.

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

Conative Pertains to one's basic strivings as expressed in behavior and actions

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

Condensation A psychological process, often present in dreams, in which two or more concepts are fused so that a single symbol represents the multiple components.

Confabulation Fabrication of stories in response to questions about situations or events that are not recalled.

Confrontation A communication that deliberately pressures or invites another to self-examine some aspect of behavior in which there is a discrepancy between self-reported and observed behavior.

Constricted affect Affect type that represents mild reduction in the range and intensity of emotional expression.

Constructional apraxia An acquired difficulty in drawing two-dimensional objects or forms, or in producing or copying three-dimensional arrangements of forms or shapes.

Contingency reinforcement In operant or instrumental conditioning, ensuring that desired behavior is followed by positive consequences and that undesired behavior is not rewarded.

Conversion A defense mechanism, operating unconsciously, by which intrapsychic conflicts that would otherwise give rise to anxiety are instead given symbolic external expression. The repressed ideas or impulses, and the psychological defenses against them, are converted into a variety of somatic symptoms. These may include such symptoms as paralysis, pain, or loss of sensory function.

Coping mechanisms Ways of adjusting to environmental stress without altering one's goals or purposes; includes both conscious and unconscious mechanisms.

Coprophagia Eating of filth or feces.

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

Countertransference The therapist's emotional reactions to the patient that are based on the therapist's unconscious needs and conflicts, as distinguished from his or her conscious responses to the patient's behavior. Countertransference may interfere with the therapist's ability to understand the patient and may adversely affect

the therapeutic technique. Currently, there is emphasis on the positive aspects of countertransference and its use as a guide to a more empathic understanding of the patient.

Cretinism A type of mental retardation and bodily malformation caused by severe, uncorrected thyroid deficiency in infancy and early childhood.

Cri du chat A type of mental retardation. The name is derived from a catlike cry emitted by children with this disorder, which is caused by partial deletion of chromosome 5.

Conversion symptom A loss of, or alteration in, voluntary motor or sensory functioning suggesting a neurological or general medical condition. Psychological factors are judged to be associated with the development of the symptom, and the symptom is not fully explained by a neurological or general medical condition or the direct effects of a substance. The symptom is not intentionally produced or feigned and is not culturally sanctioned.

Culture-specific syndromes Forms of disturbed behavior specific to certain cultural systems that do not conform to western nosologic entities. Some commonly cited syndromes are the following: amok; koro; latah; piblokto, and windigo.

D

Da Costa's syndrome Neurocirculatory asthenia; "soldier's heart"; a functional disorder of the circulatory system that is usually a part of an anxiety state or secondary to hyperventilation.

Decompensation The deterioration of existing defenses, leading to an exacerbation of pathological behavior.

Defense mechanism Automatic psychological process that protects the individual against anxiety and from awareness of internal or external stressors or dangers. Defense mechanisms mediate the individual's reaction to emotional conflicts and to external stressors. Some defense mechanisms (e.g., projection, splitting, and acting out) are almost invariably maladaptive. Others, such as suppression and denial, may be either maladaptive or adaptive, depending on their severity, their inflexibility, and the context in which they occur.

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

Delusion A false belief based on incorrect inference about external reality that is firmly sustained despite what almost everyone else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary. The belief is not one ordinarily accepted by other members of the person's culture or subculture (e.g., it is not an article of religious faith). When a false belief involves a value judgment, it is regarded as a delusion only when the judgment is so extreme as to defy credibility. Delusional conviction occurs on a continuum and can sometimes be inferred from an individual's behavior. It is often difficult to distinguish between a delusion and an overvalued idea (in which case the individual has an unreasonable belief or idea but does not hold it as firmly as is the case with a delusion). Delusions are subdivided according to their content. Some of the more common types are: bizarre; delusional jealousy; grandiose; delusion of reference; persecutory; somatic; thought broadcasting; thought insertion.

Delusional jealousy The delusion that one's sexual partner is unfaithful. erotomanic A delusion that another person, usually of higher status, is in love with the individual.

Delusion of reference A delusion whose theme is that events, objects, or other persons in one's immediate environment have a particular and unusual significance. These delusions are usually of a negative or pejorative nature, but also may be grandiose in content. This differs from an idea of reference, in which the false belief is not as firmly held nor as fully organized into a true belief.

Denial A defense mechanism where certain information is not accessed by the conscious mind. Denial is related to repression, a similar defense mechanism, but denial is more pronounced or intense. Denial involves some impairment of reality. Denial would be operating (as an example) if a cardiac patient who has been warned about the potential fatal outcome of engaging in heavy work, decides to start building a wall of heavy stones.

depersonalization An alteration in the perception or experience of the self so that one feels detached from, and as if one is an outside observer of, one's mental processes or body (e.g., feeling like one is in a dream).

derailment ("loosening of associations") A pattern of speech in which a person's ideas slip off one track onto another that is completely unrelated or only obliquely related. In moving from one sentence or clause to another, the person shifts the topic idiosyncratically from one frame of reference to another and things may be said in juxtaposition that lack a meaningful relationship. This disturbance occurs between clauses, in contrast to incoherence, in which the disturbance is within clauses. An occasional change of topic without warning or obvious connection does not constitute derailment.

Derealization An alteration in the perception or experience of the external world so that it seems strange or unreal (e.g., people may seem unfamiliar or mechanical).

Dereistic Mental activity that is not in accordance with reality, logic, or experience.

detachment A behavior pattern characterized by general aloofness in interpersonal contact; may include intellectualization, denial, and superficiality.

Diplopia Double vision due to paralysis of the ocular muscles; seen in inhalant intoxication and other conditions affecting the oculomotor nerve.

Disconnection syndrome Term coined by Norman Geschwind (1926¾1984) to describe the interruption of information transferred from one brain region to another.

Disinhibition Freedom to act according to one's inner drives or feelings, with less regard for restraints imposed by cultural norms or one's superego; removal of an inhibitory, constraining, or limiting influence, as in the escape from higher cortical control in neurologic injury, or in uncontrolled firing of impulses, as when a drug interferes with the usual limiting or inhibiting action of GABA within the central nervous system.

Disorientation Confusion about the time of day, date, or season (time), where one is (place), or who one is (person).

Dysphoric mood An unpleasant mood, such as sadness, anxiety, or irritability.

Displacement A defense mechanism, operating unconsciously, in which emotions, ideas, or wishes are transferred from their original object to a more acceptable substitute; often used to allay anxiety.

Dissociation A disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment. The disturbance may be sudden or gradual, transient or chronic.

Distractibility The inability to maintain attention, that is, the shifting from one area or topic to another with minimal provocation, or attention being drawn too frequently to unimportant or irrelevant external stimuli.

Double bind Interaction in which one person demands a response to a message containing mutually contradictory signals, while the other person is unable either to comment on the incongruity or to escape from the situation.

Drive Basic urge, instinct, motivation; a term used to avoid confusion with the more purely biological concept of instinct.

Dyad A two-person relationship, such as the therapeutic relationship between doctor and patient in individual psychotherapy.

Dysarthria Imperfect articulation of speech due to disturbances of muscular control or incoordination.

Dysgeusia Perversion of the sense of taste.

Dyskinesia Distortion of voluntary movements with involuntary muscular activity.

Dyslexia Inability or difficulty in reading, including word-blindness and a tendency to reverse letters and words in reading and writing.

Dyssomnia Primary disorders of sleep or wakefulness characterized by insomnia or hypersomnia as the major presenting symptom. Dyssomnias are disorders of the amount, quality, or timing of sleep.

Dystonia Disordered tonicity of muscles.

E

Echolalia The pathological, parrotlike, and apparently senseless repetition (echoing) of a word or phrase just spoken by another person. echolalia Parrot-like repetition of overheard words or fragments of speech.

Echopraxia Repetition by imitation of the movements of another. The action is not a willed or voluntary one and has a semiautomatic and uncontrollable quality.

Ego In psychoanalytic theory, one of the three major divisions in the model of the psychic apparatus, the others being the id and the superego. The ego represents the sum of certain mental mechanisms, such as perception and memory, and specific defense mechanisms. It serves to mediate between the demands of primitive instinctual drives (the id), of internalized parental and social prohibitions (the superego), and of reality. The compromises between these forces achieved by the ego tend to resolve intrapsychic conflict and serve an adaptive and executive function. Psychiatric usage of the term should not be confused with common usage, which connotes self-love or selfishness.

Ego ideal The part of the personality that comprises the aims and goals for the self; usually refers to the conscious or unconscious emulation of significant figures with whom one has identified. The ego ideal emphasizes what one should be or do in contrast to what one should not be or not do.

Ego-dystonic Referring to aspects of a person's behavior, thoughts, and attitudes that are viewed by the self as repugnant or inconsistent with the total personality.

Eidetic image Unusually vivid and apparently exact mental image; may be a memory, fantasy, or dream.

Elaboration An unconscious process consisting of expansion and embellishment of detail, especially with reference to a symbol or representation in a dream.

Elevated mood An exaggerated feeling of well-being, or euphoria or elation. A person with elevated mood may describe feeling "high," "ecstatic," "on top of the world," or "up in the clouds."

Engram A memory trace; a neurophysiological process that accounts for persistence of memory

Epigenesis Originally from the Greek "epi" (on, upon, on top of) and "genesis" (origin); the theory that the embryo is not preformed in the ovum or the sperm, but that it develops gradually by the successive formation of new parts. The concept has been extended to other areas of medicine, with different shades of meaning. Some of the other meanings are as follows: 1. Any change in an organism that is due to outside influences rather than to genetically determined ones. 2. The occurrence of secondary symptoms as a result of disease. 3. Developmental factors, and specifically the gene-environment interactions, that contribute to development. 4. The appearance of new functions that are not predictable on the basis of knowledge of the part-processes that have been combined. 5. The appearance of specific features at each stage of development, such as the different goals and risks that Erikson described for the eight stages of human life (trust vs. mistrust, autonomy vs. doubt, etc.). The life cycle theory adheres to the epigenetic principle in that each stage of development is characterized by crises or challenges that must be satisfactorily resolved if development is to proceed normally.

Ethnology A science that concerns itself with the division of human beings into races and their origin, distribution, relations, and characteristics.

Euthymic Mood in the "normal" range, which implies the absence of depressed or elevated mood.

Expansive mood Lack of restraint in expressing one's feelings, frequently with an overvaluation of one's significance or importance. irritable Easily annoyed and provoked to anger.

Extinction The weakening of a reinforced operant response as a result of ceasing reinforcement. See also operant conditioning. Also, the elimination of a conditioned response by repeated presentations of a conditioned stimulus without the unconditioned stimulus. See also respondent conditioning.

Extraversion A state in which attention and energies are largely directed outward from the self as opposed to inward toward the self, as in introversion.

F

Fantasy An imagined sequence of events or mental images (e.g., daydreams) that serves to express unconscious conflicts, to gratify unconscious wishes, or to prepare for anticipated future events.

Flashback A recurrence of a memory, feeling, or perceptual experience from the past.

Flat affect An affect type that indicates the absence of signs of affective expression.

Flight of ideas A nearly continuous flow of accelerated speech with abrupt changes from topic to topic that are usually based on understandable associations, distracting stimuli, or plays on words. When severe, speech may be disorganized and incoherent.

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

Folie à deux A shared psychotic disorder between 2 people, usually people who are mutually dependent upon each other.

formal thought disorder An inexact term referring to a disturbance in the form of thinking rather than to abnormality of content. See blocking; loosening of associations; poverty of speech.

Formication The tactile hallucination or illusion that insects are crawling on the body or under the skin.

Fragmentation Separation into different parts, or preventing their integration, or detaching one or more parts from the rest. A fear of fragmentation of the personality, also known as disintegration anxiety, is often observed in patients whenever they are exposed to repetitions of earlier experiences that interfered with development of the self. This fear may be expressed as feelings of falling apart, as a loss of identity, or as a fear of impending loss of one's vitality and of psychological depletion.

Free association In psychoanalytic therapy, spontaneous, uncensored verbalization by the patient of whatever comes to mind.

Frotteurism One of the paraphilias, consisting of recurrent, intense sexual urges involving touching and rubbing against a nonconsenting person; common sites in which such activities take place are crowded trains, buses, and elevators. Fondling the victim may be part of the condition and is called toucherism.

Fusion The union and integration of the instincts and drives so that they complement each other and help the organism to deal effectively with both internal needs and external demands.

G

Gegenhalten "Active" resistance to passive movement of the extremities that does not appear to be under voluntary control.

Globus hystericus The disturbing sensation of a lump in the throat.

Glossolalia Gibberish-like speech or "speaking in tongues."

Gender dysphoria A persistent aversion toward some or all of those physical characteristics or social roles that connote one's own biological sex.

Gender identity A person's inner conviction of being male or female.

Gender role Attitudes, patterns of behavior, and personality attributes defined by the culture in which the person lives as stereotypically "masculine" or "feminine" social roles.

Grandiosity An inflated appraisal of one's worth, power, knowledge, importance, or identity. When extreme, grandiosity may be of delusional proportions.

Grandiose delusion A delusion of inflated worth, power, knowledge, identity, or special relationship to a deity or famous person.

Gustatory hallucination A hallucination involving the perception of taste (usually unpleasant).

H

Hallucination A sensory perception that has the compelling sense of reality of a true perception but that occurs without external stimulation of the relevant sensory organ. Hallucinations should be distinguished from illusions, in which an actual external stimulus is misperceived or misinterpreted. The person may or may not have insight into the fact that he or she is having a hallucination. One person with auditory hallucinations may recognize that he or she is having a false sensory experience, whereas another may be convinced that the source of the sensory experience has an independent physical reality. The term hallucination is not ordinarily applied to the false perceptions that occur during dreaming, while falling asleep (hypnagogic), or when awakening (hypnopompic). Transient hallucinatory experiences may occur in people without a mental disorder.

Hedonism Pleasure-seeking behavior. Contrast with anhedonia.

5-HIAA (5-hydroxyindoleacetic acid) A major metabolite of serotonin, a biogenic amine found in the brain and other organs. Functional deficits of serotonin in the central nervous system have been implicated in certain types of major mood disorders, and particularly in suicide and impulsivity.

Hippocampus Olfactory brain; a sea-horse¾shaped structure located within the brain that is an important part of the limbic system. The hippocampus is involved in some aspects of memory, in the control of the autonomic functions, and in emotional expression.

Hyperacusis Inordinate sensitivity to sounds; it may be on an emotional or an organic basis.

Hypersomnia Excessive sleepiness, as evidenced by prolonged nocturnal sleep, difficulty maintaining an alert awake state during the day, or undesired daytime sleep episodes. ideas of reference The feeling that casual incidents and external events have a particular and unusual meaning that is specific to the person. This is to be distinguished from a delusion of reference, in which there is a belief that is held with delusional conviction

Hypnagogic Referring to the semiconscious state immediately preceding sleep; may include hallucinations that are of no pathological significance.

Hypnopompic Referring to the state immediately preceding awakening; may include hallucinations that are of no pathological significance.

I

Id In Freudian theory, the part of the personality that is the unconscious source of unstructured desires and drives. See also ego; superego.

Idealization A mental mechanism in which the person attributes exaggeratedly positive qualities to the self or others.

Ideas of reference Incorrect interpretations of casual incidents and external events as having direct reference to oneself. May reach sufficient intensity to constitute delusions.

Identification A defense mechanism, operating unconsciously, by which one patterns oneself after some other person. Identification plays a major role in the development of one's personality and specifically of the superego. To be differentiated from imitation or role modeling, which is a conscious process.

Idiot savant A person with gross mental retardation who nonetheless is capable of performing certain remarkable feats in sharply circumscribed intellectual areas, such as calendar calculation or puzzle solving.

Illusion A misperception or misinterpretation of a real external stimulus, such as hearing the rustling of leaves as the sound of voices. See also hallucination.

Imprinting A term in ethology referring to a process similar to rapid learning or behavioral patterning that occurs at critical points in very early stages of animal development. The extent to which imprinting occurs in human development has not been established.

Inappropriate affect An affect type that represents an unusual affective expression that does not match with the content of what is being said or thought.

Incoherence Speech or thinking that is essentially incomprehensible to others because words or phrases are joined together without a logical or meaningful connection. This disturbance occurs within clauses, in contrast to derailment, in which the disturbance is between clauses. This has sometimes been referred to as "word salad" to convey the degree of linguistic disorganization. Mildly ungrammatical constructions or idiomatic usages characteristic of particular regional or cultural backgrounds, lack of education, or low intelligence should not be considered incoherence. The term is generally not applied when there is evidence that the disturbance in speech is due to an aphasia.

Incorporation A primitive defense mechanism, operating unconsciously, in which the psychic representation of a person, or parts of the person, is figuratively ingested.

Individuation A process of differentiation, the end result of which is development of the individual personality that is separate and distinct from all others.

Indoleamine One of a group of biogenic amines (e.g., serotonin) that contains a five-membered, nitrogen-containing indole ring and an amine group within its chemical structure. inhibition Behavioral evidence of an unconscious defense against forbidden instinctual drives; may interfere with or restrict specific activities.

Insomnia A subjective complaint of difficulty falling or staying asleep or poor sleep quality. Types of insomnia include:

Initial insomnia Difficulty in falling asleep.

Instinct An inborn drive. The primary human instincts include self-preservation, sexuality, and according to some proponents the death instinct, of which aggression is one manifestation.

Integration The useful organization and incorporation of both new and old data, experience, and emotional capacities into the personality. Also refers to the organization and amalgamation of functions at various levels of psychosexual development.

Intellectualization A mental mechanism in which the person engages in excessive abstract thinking to avoid confrontation with conflicts or disturbing feelings.

Intersex condition A condition in which an individual shows intermingling, in various degrees, of the characteristics of each sex, including physical form, reproductive organs, and sexual behavior.

Introspection Self-observation; examination of one's feelings, often as a result of psychotherapy.

Introversion Preoccupation with oneself and accompanying reduction of interest in the outside world. Contrast to extraversion.

Isolation A defense mechanism operating unconsciously central to obsessive-compulsive phenomena in which the affect is detached from an idea and rendered unconscious, leaving the conscious idea colorless and emotionally neutral.

K

Klinefelter's syndrome Chromosomal defect in males in which there is an extra X chromosome; manifestations may include underdeveloped testes, physical feminization, sterility, and mental retardation.

Koro A culture specific syndrome of China involving fear of retraction of penis into abdomen with the belief that this will lead to death.

L

La belle indifférence Literally, "beautiful indifference." Seen in certain patients with conversion disorders who show an inappropriate lack of concern about their disabilities. labile Rapidly shifting (as applied to emotions); unstable.

Labile affect An affect type that indicates abnormal sudden rapid shifts in affect.

Latah A culture specific syndrome of Southeast Asia involving startle-induced disorganization, hypersuggestibility, automatic obedience, and echopraxia.

Latent content The hidden (i.e., unconscious) meaning of thoughts or actions, especially in dreams or fantasies. In dreams, it is expressed in distorted, disguised, condensed, and symbolic form.

Learned helplessness A condition in which a person attempts to establish and maintain contact with another by adopting a helpless, powerless stance.

Lethologica Temporary inability to remember a proper noun or name.

Libido The psychic drive or energy usually associated with the sexual instinct. (Sexual is used here in the broad sense to include pleasure and love-object seeking.)

Locus coeruleus A small area in the brain stem containing norepinephrine neurons that is considered to be a key brain center for anxiety and fear.

Long-term memory The final phase of memory in which information storage may last from hours to a lifetime.

Loosening of associations A disturbance of thinking shown by speech in which ideas shift from one subject to another that is unrelated or minimally related to the first. Statements that lack a meaningful relationship may be juxtaposed, or speech may shift suddenly from one frame of reference to another. The speaker gives no indication of being aware of the disconnectedness, contradictions, or illogicality of speech.

M

Macropsia The visual perception that objects are larger than they actually are.

Magical thinking A conviction that thinking equates with doing. Occurs in dreams in children, in primitive peoples, and in patients under a variety of conditions. Characterized by lack of realistic relationship between cause and effect.

Manifest content The remembered content of a dream or fantasy, as contrasted with latent content, which is concealed and distorted.

Masochism Pleasure derived from physical or psychological pain inflicted on oneself either by oneself or by others. It is called sexual masochism and classified as a paraphilia when it is consciously sought as a part of the sexual act or as a prerequisite to sexual gratification. It is the converse of sadism, although the two tend to coexist in the same person.

Memory consolidation The physical and psychological changes that take place as the brain organizes and restructures information that may become a permanent part of memory.

Mental retardation A major group of disorders of infancy, childhood, or adolescence characterized by intellectual functioning that is significantly below average (IQ of 70 or below), manifested before the age of 18 by impaired adaptive functioning (below expected performance for age in such areas as social or daily living skills, communication, and self-sufficiency). Different levels of severity are recognized: an IQ level of 50/55 to 70 is Mild; an IQ level of 35/40 to 50/55 is Moderate; an IQ level of 20/25 to 35/40 is Severe; an IQ level below 20/25 is Profound.

MHPG (3-methoxy-4-hydroxyphenylglycol) A major metabolite of brain norepinephrine excreted in urine.

Magical thinking The erroneous belief that one's thoughts, words, or actions will cause or prevent a specific outcome in some way that defies commonly understood laws of cause and effect. Magical thinking may be a part of normal child development.

Micropsia The visual perception that objects are smaller than they actually are.

Middle insomnia Awakening in the middle of the night followed by eventually falling back to sleep, but with difficulty.

Mirroring 1) The empathic responsiveness of the parent to the developing child's grandiose-exhibitionistic needs. Parental expressions of delight in the child's activities signal that the child's wishes and experiences are accepted as legitimate. This teaches the child which of his or her potential qualities are most highly esteemed and valued. Mirroring validates the child as to who he or she is and affirms his or her worth. The process transforms archaic aims to realizable aims, and it determines in part the content of the self-assessing, self-monitoring functions and their relationships to the rest of the personality. The content of the superego is the residue of the mirroring experience. 2) A technique in psychodrama in which another person in the group plays the role of the patient, who watches the enactment as if gazing into a mirror. The first person may exaggerate one or more aspects of the patient's behavior. Following the portrayal, the patient is usually encouraged to comment on what he or she has observed.

Mood A pervasive and sustained emotion that colors the perception of the world. Common examples of mood include depression, elation, anger, and anxiety. In contrast to affect, which refers to more fluctuating changes in emotional "weather," mood refers to a more pervasive and sustained emotional "climate." Types of mood include: dysphoric, elevated, euthymic, expansive, irritable.

Mood-congruent psychotic features Delusions or hallucinations whose content is entirely consistent with the typical themes of a depressed or manic mood. If the mood is depressed, the content of the delusions or hallucinations would involve themes of personal inadequacy, guilt, disease, death, nihilism, or deserved punishment. The content of the delusion may include themes of persecution if these are based on self-derogatory~ concepts such as deserved punishment. If the mood is manic, the content of the delusions or hallucinations would involve themes of inflated worth, power, knowledge, or identity, or a special relationship to a deity or a famous person. The content of the delusion may include themes of persecution if these are based on concepts such as inflated worth or deserved punishment.

Mood-incongruent psychotic features Delusions or hallucinations whose content is not consistent with the typical themes of a depressed or manic mood. In the case of depression, the delusions or hallucinations would not involve themes of personal inadequacy, guilt, disease, death, nihilism, or deserved punishment. In the case of mania, the delusions or hallucinations would not involve themes of inflated worth, power, knowledge, or identity, or a special relationship to a deity or a famous person. Examples of mood-incongruent psychotic features include persecutory delusions (without self-derogatory~ or grandiose content), thought insertion, thought broadcasting, and delusions of being controlled whose content has no apparent relationship to any of the themes listed above.

N

Negative symptoms Most commonly refers to a group of symptoms characteristic of schizophrenia that include loss of fluency and spontaneity of verbal expression, impaired ability to focus or sustain attention on a particular task, difficulty in initiating or following through on tasks, impaired ability to experience pleasure to form emotional attachment to others, and blunted affect.

Negativism Opposition or resistance, either covert or overt, to outside suggestions or advice. May be seen in schizophrenia.

Neologism In psychiatry, a new word or condensed combination of several words coined by a person to express a highly complex idea not readily understood by others; seen in schizophrenia and organic mental disorders.

Neurotic disorder A mental disorder in which the predominant disturbance is a distressing symptom or group of symptoms that one considers unacceptable and alien to one's personality. There is no marked loss of reality testing ; behavior does not actively violate gross social norms, although it may be quite disabling. The disturbance is relatively enduring or recurrent without treatment and is not limited to a mild transitory reaction to stress. There is no demonstrable organic etiology.

Nihilistic delusion The delusion of nonexistence of the self or part of the self, or of some object in external reality.

Nystagmus Involuntary rhythmic movements of the eyes that consist of small-amplitude~ rapid tremors in one direction and a larger, slower, recurrent sweep in the opposite direction. Nystagmus may be horizontal, vertical, or rotary.

Object relations The emotional bonds between one person and another, as contrasted with interest in and love for the self; usually described in terms of capacity for loving and reacting appropriately to others. Melanie Klein is generally credited with founding the British object-relations school.

Obsession Recurrent and persistent thought, impulse, or image experienced as intrusive and distressing. Recognized as being excessive and unreasonable even though it is the product of one's mind. This thought, impulse, or image cannot be expunged by logic or reasoning.

Oedipal stage Overlapping some with the phallic stage, this phase (ages 4 to 6) represents a time of inevitable conflict between the child and parents. The child must desexualize the relationship to both parents in order to retain affectionate kinship with both of them. The process is accomplished by the internalization of the images of both parents, thereby giving more definite shape to the child's personality. With this internalization largely completed, the regulation of self-esteem and moral behavior comes from within.

Oedipus complex Attachment of the child to the parent of the opposite sex, accompanied by envious and aggressive feelings toward the parent of the same sex. These feelings are largely repressed (i.e., made unconscious) because of the fear of displeasure or punishment by the parent of the same sex. In its original use, the term applied only to the boy or man.

Olfactory hallucination A hallucination involving the perception of odor, such as of burning rubber or decaying fish.

Ontogenetic Pertaining to the development of the individual.

Operant conditioning (instrumental conditioning) A process by which the results of the person's behavior determine whether the behavior is more or less likely to occur in the future.

Oral stage The earliest of the stages of infantile psychosexual development, lasting from birth to 12 months or longer. Usually subdivided into two stages: the oral erotic, relating to the pleasurable experience of sucking; and

the oral sadistic, associated with aggressive biting. Both oral eroticism and sadism continue into adult life in disguised and sublimated forms, such as the character traits of demandingness or pessimism. Oral conflict, as a general and pervasive influence, might underlie the psychological determinants of addictive disorders, depression, and some functional psychotic disorders.

Orientation Awareness of one's self in relation to time, place, and person.

Overcompensation A conscious or unconscious process in which a real or imagined physical or psychological deficit generates exaggerated correction. Concept introduced by Adler.

Overdetermination The concept of multiple unconscious causes of an emotional reaction or symptom.

Overvalued idea An unreasonable and sustained belief that is maintained with less than delusional intensity (i.e., the person is able to acknowledge the possibility that the belief may not be true). The belief is not one that is ordinarily accepted by other members of the person's culture or subculture

P

Panic attacks Discrete periods of sudden onset of intense apprehension, fearfulness, or terror, often associated with feelings of impending doom. During these attacks there are symptoms such as shortness of breath or smothering sensations; palpitations, pounding heart, or accelerated heart rate; chest pain or discomfort; choking; and fear of going crazy or losing control. Panic attacks may be unexpected (uncued), in which the onset of the attack is not associated with a situational trigger and instead occurs "out of the blue"; situationally bound, in which the panic attack almost invariably occurs immediately on exposure to, or in anticipation of, a situational trigger ("cue"); and situationally predisposed, in which the panic attack is more likely to occur on exposure to a situational trigger but is not invariably associated with it.

Paranoid ideation Ideation, of less than delusional proportions, involving suspiciousness or the belief that one is being harassed, persecuted, or unfairly treated.

Parasomnia Abnormal behavior or physiological events occurring during sleep or sleep-wake transitions.

Persecutory delusion A delusion in which the central theme is that one (or someone to whom one is close) is being attacked, harassed, cheated, persecuted, or conspired against.

Perseveration Tendency to emit the same verbal or motor response again and again to varied stimuli.

Personality Enduring patterns of perceiving, relating to, and thinking about the environment and oneself. Personality traits are prominent aspects of personality that are exhibited in a wide range of important social and personal contexts. Only when personality traits are inflexible and maladaptive and cause either significant functional impairment or subjective distress do they constitute a Personality Disorder.

Phallic stage The period, from about 21/2 to 6 years, during which sexual interest, curiosity, and pleasurable experience in boys center on the penis, and in girls, to a lesser extent, the clitoris.

Phobia A persistent, irrational fear of a specific object, activity, or situation (the phobic stimulus) that results in a compelling desire to avoid it. This often leads either to avoidance of the phobic stimulus or to enduring it with dread.

Piblokto A culture specific syndrome of Eskimos involving attacks of screaming, crying, and running naked through the snow

Preconscious Thoughts that are not in immediate awareness but that can be recalled by conscious effort.

Pregenital In psychoanalysis, refers to the period of early childhood before the genitals have begun to exert the predominant influence in the organization or patterning of sexual behavior. Oral and anal influences predominate during this period.

Pressured speech Speech that is increased in amount, accelerated, and difficult or impossible to interrupt. Usually it is also loud and emphatic. Frequently the person talks without any social stimulation and may continue to talk even though no one is listening.

Prevalence Frequency of a disorder, used particularly in epidemiology to denote the total number of cases existing within a unit of population at a given time or over a specified period.

Primary gain The relief from emotional conflict and the freedom from anxiety achieved by a defense mechanism. Contrast with secondary gain.

Primary process In psychoanalytic theory, the generally unorganized mental activity characteristic of the unconscious. This activity is marked by the free discharge of energy and excitation without regard to the demands of environment, reality, or logic.

Prodrome An early or premonitory sign or symptom of a disorder

Projection A defense mechanism, operating unconsciously, in which what is emotionally unacceptable in the self is unconsciously rejected and attributed (projected) to others.

Projective identification A term introduced by Melanie Klein to refer to the unconscious process of projection of one or more parts of the self or of the internal object into another person (such as the mother). What is projected may be an intolerable, painful, or dangerous part of the self or object (the bad object). It may also be a valued aspect of the self or object (the good object) that is projected into the other person for safekeeping. The other person is changed by the projection and is dealt with as though he or she is in fact characterized by the aspects of the self that have been projected.

Projective tests Psychological diagnostic tests in which the test material is unstructured so that any response will reflect a projection of some aspect of the subject's underlying personality and psychopathology

Prosopagnosia Inability to recognize familiar faces that is not explained by defective visual acuity or reduced consciousness or alertness.

Pseudocyesis Included in DSM-IV as one of the somatoform disorders. It is characterized by a false belief of being pregnant and by the occurrence of signs of being pregnant, such as abdominal enlargement, breast engorgement, and labor pains.

Pseudodementia A syndrome in which dementia is mimicked or caricatured by a functional psychiatric illness. Symptoms and response of mental status examination questions are similar to those found in verified cases of dementia. In pseudodementia, the chief diagnosis to be considered in the differential is depression in an older person vs. cognitive deterioration on the basis of organic brain disease.

Psychomotor agitation Excessive motor activity associated with a feeling of inner tension. When severe, agitation may involve shouting and loud complaining. The activity is usually nonproductive and repetitious, and consists of such behavior as pacing, wringing of hands, and inability to sit still.

Psychomotor retardation Visible generalized slowing of movements and speech.

Psychosexual development A series of stages from infancy to adulthood, relatively fixed in time, determined by the interaction between a person's biological drives and the environment. With resolution of this interaction, a balanced, reality-oriented development takes place; with disturbance, fixation and conflict ensue. This disturbance may remain latent or give rise to characterological or behavioral disorders.

Psychotic This term has historically received a number of different definitions, none of which has achieved universal acceptance. The narrowest definition of psychotic is restricted to delusions or prominent hallucinations, with the hallucinations occurring in the absence of insight into their pathological nature. A slightly less restrictive definition would also include prominent hallucinations that the individual realizes are hallucinatory experiences. Broader still is a definition that also includes other positive symptoms of Schizophrenia (i.e., disorganized speech, grossly disorganized or catatonic behavior). Unlike these definitions based on symptoms, the definition used in DSM-II and ICD-9 was probably far too inclusive and focused on the severity of functional impairment, so that a mental disorder was termed psychotic if it resulted in "impairment that grossly interferes with the capacity to meet ordinary demands of life." Finally, the term has been defined conceptually as a loss of ego boundaries or a gross impairment in reality testing. Based on their characteristic features, the different disorders in DSM-IV emphasize different aspects of the various definitions of psychotic.

Psychotropic medication Medication that affects thought processes or feeling states.

R

Rationalization A defense mechanism, operating unconsciously, in which an individual attempts to justify or make consciously tolerable by plausible means, feelings or behavior that otherwise would be intolerable. Not to be confused with conscious evasion or dissimulation. See also projection.

Reaction formation A defense mechanism, operating unconsciously, in which a person adopts affects, ideas, and behaviors that are the opposites of impulses harbored either consciously or unconsciously. For example, excessive moral zeal may be a reaction to strong but repressed asocial impulses.

Reality principle In psychoanalytic theory, the concept that the pleasure principle, which represents the claims of instinctual wishes, is normally modified by the demands and requirements of the external world. In fact, the reality principle may still work on behalf of the pleasure principle but reflects compromises and allows for the postponement of gratification to a more appropriate time. The reality principle usually becomes more prominent in the course of development but may be weak in certain psychiatric illnesses and undergo strengthening during treatment. reality testing The ability to evaluate the external world objectively and to differentiate adequately between it and the internal world. Falsification of reality, as with massive denial or projection, indicates a severe disturbance of ego functioning and/or of the perceptual and memory processes upon which it is partly based.

Reciprocal inhibition In behavior therapy, the hypothesis that if anxiety-provoking stimuli occur simultaneously with the inhibition of anxiety (e.g., relaxation), the bond between those stimuli and the anxiety will be weakened.

Regression Partial or symbolic return to earlier patterns of reacting or thinking. Manifested in a wide variety of circumstances such as normal sleep, play, physical illness, and in many mental disorders.

Reinforcement The strengthening of a response by reward or avoidance of punishment. This process is central in operant conditioning.

Repetition compulsion In psychoanalytic theory, the impulse to reenact earlier emotional experiences. Considered by Freud to be more fundamental than the pleasure principle. Defined by Jones in the following way: "The blind impulse to repeat earlier experiences and situations quite irrespective of any advantage that doing so might bring from a pleasure-pain point of view."

Repression A defense mechanism, operating unconsciously, that banishes unacceptable ideas, fantasies, affects, or impulses from consciousness or that keeps out of consciousness what has never been conscious. Although not subject to voluntary recall, the repressed material may emerge in disguised form. Often confused with the conscious mechanism of suppression. resistance One's conscious or unconscious psychological defense against bringing repressed (unconscious) thoughts into conscious awareness.

Respondent conditioning (classical conditioning, Pavlovian conditioning) Elicitation of a response by a stimulus that normally does not elicit that response. The response is one that is mediated primarily by the autonomic nervous system (such as salivation or a change in heart rate). A previously neutral stimulus is repeatedly presented just before an unconditioned stimulus that normally elicits that response. When the response subsequently occurs in the presence of the previously neutral stimulus, it is called a conditioned response, and the previously neutral stimulus, a conditioned stimulus.

Residual phase The phase of an illness that occurs after remission of the florid symptoms or the full syndrome.

S

Screen memory A consciously tolerable memory that serves as a cover for an associated memory that would be emotionally painful if recalled.

Secondary gain The external gain derived from any illness, such as personal attention and service, monetary gains, disability benefits, and release from unpleasant responsibilities. See also primary gain.

Secondary process In psychoanalytic theory, mental activity and thinking characteristic of the ego and influenced by the demands of the environment. Characterized by organization, systematization, intellectualization, and similar processes leading to logical thought and action in adult life. See also primary process; reality principle.

Sensory extinction Failure to report sensory stimuli from one region if another region is stimulated simultaneously, even though when the region in question is stimulated by itself, the stimulus is correctly reported.

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

Separation-individuation Psychological awareness of one's separateness, described by Margaret Mahler as a phase in the mother-child relationship that follows the symbiotic stage. In the separation-individuation stage, the child begins to perceive himself or herself as distinct from the mother and develops a sense of individual identity and an image of the self as object. Mahler described four subphases of the process: differentiation, practicing, rapprochement (i.e., active approach toward the mother, replacing the relative obliviousness to her that prevailed during the practicing period), and separation-individuation proper (i.e., awareness of discrete identity, separateness, and individuality).

Sex A person's biological status as male, female, or uncertain. Depending on the circumstances, this determination may be based on the appearance of the external genitalia or on karyotyping.

Sign An objective manifestation of a pathological condition. Signs are observed by the examiner rather than reported by the affected individual.

Shaping Reinforcement of responses in the patient's repertoire that increasingly approximate sought-after behavior.

Sick role An identity adopted by an individual as a "patient" that specifies a set of expected behaviors, usually dependent.

Signal anxiety An ego mechanism that results in activation of defensive operations to protect the ego from being overwhelmed by an excess of excitement. The anxiety reaction that was originally experienced in a traumatic situation is reproduced in an attenuated form, allowing defenses to be mobilized before the current threat does, in fact, become overwhelming.

Simultanagnosia Inability to comprehend more than one element of a visual scene at the same time or to integrate the parts into a whole

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

Social adaptation The ability to live and express oneself according to society's restrictions and cultural demands.

Somatic delusion A delusion whose main content pertains to the appearance or functioning of one's body.

somatic hallucination A hallucination involving the perception of a physical experience localized within the body (such as a feeling of electricity). A somatic hallucination is to be distinguished from physical sensations arising from an as-yet undiagnosed general medical condition, from hypochondriacal preoccupation with normal physical sensations, and from a tactile hallucination.

Spatial agnosia Inability to recognize spatial relations; disordered spatial orientation.

Splitting A mental mechanism in which the self or others are reviewed as all good or all bad, with failure to integrate the positive and negative qualities of self and others into cohesive images. Often the person alternately idealizes and devalues the same person.

Stereotyped movements Repetitive, seemingly driven, and nonfunctional motor behavior (e.g., hand shaking or waving, body rocking, head banging, mouthing of objects, self-biting, picking at skin or body orifices, hitting one's own body).

Stockholm syndrome A kidnapping or terrorist hostage identifies with and has sympathy for his or her captors on whom he or she is dependent for survival.

Stressor Any life event or life change that may be associated temporally (and perhaps causally) with the onset, occurrence, or exacerbation of a mental disorder.

Structural theory Freud's model of the mental apparatus composed of id, ego, and superego.

Stupor A state of unresponsiveness with immobility and mutism

Sublimation A defense mechanism, operating unconsciously, by which instinctual drives, consciously unacceptable, are diverted into personally and socially acceptable channels.

Substitution A defense mechanism, operating unconsciously, by which an unattainable or unacceptable goal, emotion, or object is replaced by one that is more attainable or acceptable.

Suggestibility Uncritical compliance or acceptance of an idea, belief, or attribute.

Suggestion The process of influencing a patient to accept an idea, belief, or attitude suggested by the therapist.

Superego In psychoanalytic theory, that part of the personality structure associated with ethics, standards, and self-criticism. It is formed by identification with important and esteemed persons in early life, particularly parents. The supposed or actual wishes of these significant persons are taken over as part of the child's own standards to help form the conscience.

Suppression The conscious effort to control and conceal unacceptable impulses, thoughts, feelings, or acts.

Symbiosis A mutually reinforcing relationship between two persons who are dependent on each other; a normal characteristic of the relationship between the mother and infant child. See separation-individuation

Symbolization A general mechanism in all human thinking by which some mental representation comes to stand for some other thing, class of things, or attribute of something. This mechanism underlies dream formation and some symptoms, such as conversion reactions, obsessions, and compulsions. The link between the latent meaning of the symptom and the symbol is usually

Symptom A subjective manifestation of a pathological condition. Symptoms are reported by the affected individual rather than observed by the examiner.

Syndrome A grouping of signs and symptoms, based on their frequent co-occurrence, that may suggest a common underlying pathogenesis, course, familial pattern, or treatment selection.

Synesthesia A condition in which a sensory experience associated with one modality occurs when another modality is stimulated, for example, a sound produces the sensation of a particular color.

Syntaxic mode The mode of perception that forms whole, logical, coherent pictures of reality that can be validated by others.

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

T

Tactile hallucination A hallucination involving the perception of being touched or of something being under one's skin. The most common tactile hallucinations are the sensation of electric shocks and formication (the sensation of something creeping or crawling on or under the skin).

Tangentiality Replying to a question in an oblique or irrelevant way. Compare with circumstantiality.

Temperament Constitutional predisposition to react in a particular way to stimuli.

Terminal insomnia Awakening before one's usual waking time and being unable to return to sleep.

Termination The act of ending or concluding. In psychotherapy, termination refers to the mutual agreement between patient and therapist to bring therapy to an end. The idea of termination often occurs to both, but usually

it is the therapist who introduces the subject into the session as a possibility to be considered. In psychoanalytic treatment, the patient's reactions are worked through to completion before the treatment ends. The early termination that is characteristic of focal psychotherapy and other forms of brief psychotherapy often requires more extensive work with the feelings of loss and separation.

Therapeutic community A term of British origin, now widely used, for a specially structured mental hospital milieu that encourages patients to function within the range of social norms.

Therapeutic window A well-defined range of blood levels associated with optimal clinical response to antidepressant drugs, such as nortriptyline. Levels above or below that range are associated with a poor response.

Thought broadcasting The delusion that one's thoughts are being broadcast out loud so that they can be perceived by others.

Thought insertion The delusion that certain of one's thoughts are not one's own, but rather are inserted into one's mind.

Tic An involuntary, sudden, rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalization.

Token economy A system involving the application of the principles and procedures of operant conditioning to the management of a social setting such as a ward, classroom, or halfway house. Tokens are given contingent on completion of specified activities and are exchangeable for goods or privileges desired by the patient.

Tolerance A characteristic of substance dependence that may be shown by the need for markedly increased amounts of the substance to achieve intoxication or the desired effect, by markedly diminished effect with continued use of the same amount of the substance, or by adequate functioning despite doses or blood levels of the substance that would be expected to produce significant impairment in a casual user.

Transference The unconscious assignment to others of feelings and attitudes that were originally associated with important figures (parents, siblings, etc.) in one's early life. The transference relationship follows the pattern of its prototype. The psychiatrist utilizes this phenomenon as a therapeutic tool to help the patient understand emotional problems and their origins. In the patient-physician relationship, the transference may be negative (hostile) or positive (affectionate). See also countertransference.

Transitional object An object, other than the mother, selected by an infant between 4 and 18 months of age for self-soothing and anxiety-reduction. Examples are a "security blanket" or a toy that helps the infant go to sleep. The transitional object provides an opportunity to master external objects and promotes the differentiation of self from outer world.

Transsexualism Severe gender dysphoria, coupled with a persistent desire for the physical characteristics and social roles that connote the opposite biological sex.

Transvestism Sexual pleasure derived from dressing or masquerading in the clothing of the opposite sex, with the strong wish to appear as a member of the opposite sex. The sexual origins of transvestism may be unconscious.

Trichotillomania The pulling out of one's own hair to the point that it is noticeable and causing significant distress or impairment.

U

Unconscious That part of the mind or mental functioning of which the content is only rarely subject to awareness. It is a repository for data that have never been conscious (primary repression) or that may have been conscious and are later repressed (secondary repression).

Undoing A mental mechanism consisting of behavior that symbolically atones for, makes amends for, or reverses previous thoughts, feelings, or actions.

Urophilia One of the paraphilias, characterized by marked distress over, or acting on, sexual urges that involve urine.

V

Verbigeration Stereotyped and seemingly meaningless repetition of words or sentences.

Visual hallucination A hallucination involving sight, which may consist of formed images, such as of people, or of unformed images, such as flashes of light. Visual hallucinations should be distinguished from illusions, which are misperceptions of real external stimuli.

voyeurism Peeping; one of the paraphilias, characterized by marked distress over, or acting on, urges to observe unsuspecting people, usually strangers, who are naked or in the process of disrobing, or who are engaging in sexual activity.

W

Wernicke's aphasia Loss of the ability to comprehend language coupled with production of inappropriate language.

Windigo A culture specific syndrome of Canadians involving delusions of being possessed by a cannibal-istic monster (windigo), attacks of agitated depression, oral sadistic fears and impulses.

Word salad A mixture of words and phrases that lack comprehensive meaning or logical coherence; commonly seen in schizophrenic states.

Z

Zeitgeist The general intellectual and cultural climate of taste characteristic of an era.

Zoophilia One of the paraphilias, characterized by marked distress over, or acting on, urges to indulge in sexual activity that involves animals.