DSM IV Appendix C

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.

Delusion of being controlled

A delusion in which feelings, impulses, thoughts, or actions are experienced as being under the control or some external force rather than being under one's own control.

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.

Grandiose Delusion

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

Erotomanic Delusion

A delusion that another person, usually of higher status, is in love with the individual.

Bizzare Delusion

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

Somatic Delusion

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

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.

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.

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. When a false belief involves a value judgement, it is regarded as a delusion only when the judgement 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.

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.

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 the physical sensations arising from an as-yet undiagnosed general medical condition, from hypochondriacal preoccupation with normal physical sensations, and from a tactile hallucination.

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).

Olfactory Hallucination

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

Auditory Hallucination

A hallucination involving the perception of sound, more 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, However, as used in DSM-IV no distinction is made as to whether the source of the voices is perceived as being inside or outside of the head.

Gustatory Hallucination

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

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.

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.

Affect

A pattern of observable behaviors that is the expression of a subjectively experienced feeling state (emotion). These are outward expressions of emotion (ex: that person has a sad affect). Disturbances in affect include: blunted, flat, inappropriate, labile, and restricted.

Gender Dysphoria

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

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.

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.

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 fluctuation changes in emotional "weather," mood refers to a more pervasive and sustained emotional "climate."

Flashback

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

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.

stupor

A state of unresponsiveness with immobility and mutism.

Insomnia

A subjective complaint of difficulty falling or staying asleep or poor sleep quality.

Derealization

An alteration in the perception or experience of the external world so that it seems strange or unreal (ex: people may seem unfamiliar or mechanical)

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 (ex; feeling like one is 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"

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.

Alogia

An impoverishment in thinking that is inferred from observing s of peech and language behavior. There may be brief and concrete replies to questions and restriction in the amount of spontaneous speech. Sometimes the speech is adequate in amount but conveys little information because it is over-concerete, overabstract, or stereotyped.

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 (ex: work, intellectual pursuits, self-care)

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.

Grandiosity

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

sign

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

Dysphoric Mood

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

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.

Agitation

Excessive motor activity associated with a feeling of inner tension. This activity is usually nonproductive and repetitious and consists of such behavior as pacing, fidgeting, wringing of hands, etc.

Hypersomnia

Excessive sleepiness, as evidenced by prolonged nocturnal sleep, difficulty maintaining an alert awake state during the day, or undesired daytime sleep episodes.

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.

Thought Broadcasting Delusion

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

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.

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.

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.

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 in coherence. The term is generally not applied when there is evidence that the disturbance in speech is due to an aphasia.

Anterograde Amnesia

Loss of memory of events that occur after the onset of the etiological condition or agent.

Retrograde Amnesia

Loss of memory of events that occurred before the onset of the etiological condition or agent.

Amnesia

Loss of memory. Types include: anterograde and retrograde.

Derailment

(or "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.

Agonist/Antagonist Medication

A chemical entity extrinsic to endogenously produced substances that acts on a family of receptors (mu, delta, and kappa opiate receptors) in such a fashion that it is an agonist or partial agonist on one type receptor and an antagonist on another.

Agonist Medication

A chemical entity extrinsic to endogenously produced substances that acts on a receptor and is capable of producing the maximal effect that can be produced in stimulating that receptor.

Antagonist Medication

A chemical entity extrinsic to endogenously produced substances that occupes a receptor, produces no physiologic effects, and prevents endogenous and exogenous chemicals from producing an effect on that receptor.

Illusion

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

Gender Identity

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

stressor, psychosocial

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

parasomnia

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

Labile Affect

Abnormal variability in affect with repeated, rapid, and abrupt shifts in affective expression.

Flat Affect

Absence or near absence of any signs of affective expression.

prodrome

An early or premonitory sign or symptom of a disorder.

Gender Role

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

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 (ex: 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.

Terminal Insomnia

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

Middle Insomnia

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

Inappropriate Affect

Discordance between affective expression and the content of speech or ideation.

Partial Agonist Medication

Capable only of producing less than the maximal effect even when given in a concentration sufficient to bind with all available receptors.

Disorientation

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

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.

Initial Insomnia

Difficulty in falling asleep

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.

Dystonia

Disordered tonicity of muscles.

Dyskinesia

Distortion of voluntary movements with involuntary muscular activity.

Irritable Mood

Easily annoyed and provoked to anger.

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.

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.

paranoid ideation

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

Dysarthria

Imperfect articulation of speech due to disturbances of muscular control.

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.

Expansive Mood

Lack of restraint in expressing one's feelings, frequently with an overvaluation of one's significance or importance.

Catatonic Behavior

Marked motor abnormalities including motoric immobility (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.

Restricted Affect

Mild reduction in the range and intensity of emotional expression.

Euthymic Mood

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

Dyssomnia

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

Hyperacusis

Painful sensitivity to sounds.

Ataxia

Partial or complete loss of coordination of voluntary muscular movement.

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.

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).

Blunted Affect

Significant reduction in the intensity of emotional expression.

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.

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.

Thought Insertion Delusion

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

Delusional Jealousy

The delusion that one's sexual partner is unfaithful.

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.

Echolalia

The pathological, parrotlike, and apparently senseless repetition (echoing) of a word or phrase just spoken by another person.

residual phase

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

Macropsia

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

Micropsia

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

psychomotor retardation

Visible generalized slowing of movements and speech.

Catalepsy

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