A Glossary of Psychiatric Terms

Like any field, psychiatry has its own collection of terminology. Some of it is self-explanatory, but some of it isn’t. I believe that knowing the jargon helps to narrow the power gap between health care providers and patients, so I put together this glossary of common psychiatric terms.

• Alexithymia: an inability to identify and describe one’s emotions; considered to be a personality trait
• Anhedonia: an inability to experience pleasure
• Anosognosia: lack of insight into one’s own illness and its effects (this isn’t disagreeing with one’s diagnosis, but rather a lack of self-awareness); anosognosia is often a symptom of illness
• Avolition: an inability to initiate and persist in goal-directed activities

• Confabulation: This is the unconscious filling in of memory gaps by imagined events that doesn’t involve intentional lying. It can be caused by traumatic brain injury.

• Depersonalization: a form of dissociation in which the self doesn’t feel real, which may include a feeling of looking at the self from a detached perspective
• Derealization: also a form of dissociation, this involves a sense that one’s surroundings aren’t fully real, and may feel like looking out at the world through a barrier

• Ego-dystonic: thoughts that are unwanted and inconsistent with what someone normally believes when they are well (the opposite of this is ego-syntonic); for example, OCD obsessions about being a risk to harm someone else would likely be ego-dystonic, while OCPD obsessiveness may be related to an ego-syntonic desire for perfection

Words to describe affect

The term affect refers to the facial expression of emotions.

• Euthymic: neutral, “normal”
• Expansive: unrestrained expression of feelings
• Incongruent: doesn’t match the reported mood, e.g. smiling while reporting feeling sad
• Labile: rapidly changing from one emotion to another, such as crying one minute and smiling brightly the next
• Restricted/blunted/flat: These all refer to decreased facial expressiveness. Restricted is the mildest term, and flat refers to almost no emotional expression.

Changes in movement

• Catatonia: markedly disrupted physical reactivity to the environment, including:
  • Stupor: lack of psychomotor activity, unreactive to the environment
  • Catalepsy: fixed, rigid posture held against gravity
  • Waxy flexibility: allows limbs to be moved into positions, and then holds them there
  • Mutism: lack of verbal responsiveness
  • Negativism: does not respond to instructions, and may actively oppose attempts to be moved
• Echopraxia: imitation of movements; can be part of catatonia
• Psychomotor agitation: unintentional, purposeless movement, such as hand wringing or pacing
• Psychomotor retardation: slowing of thoughts and movement that can be seen in major depressive episodes (I’ve made a Youtube video demonstrating this)

Disturbances in speech

• Alogia: lack of speech, implying impoverished thinking; can involve a decreased amount of speech production (may be referred to as poverty of speech) or a lack of content (may be referred to as poverty of thought)
• Dysprosody: abnormal rhythm of speech
• Echolalia: imitation of words/sounds
• Logorrhea (voluble speech): excessive amounts of speech; a similar colloquial term would be verbal diarrhea
• Pressured speech: speech that is very rapid and difficult to interrupt; a common symptom in mania

Suicidal ideation

Suicidal ideation (SI) refers to thoughts of suicide. It’s typically referred to as suicidal ideation (as in suicidal thinking) rather than suicidal ideations (as in suicidal thoughts).

• Active: thoughts of acting to take one’s life; may or may not have a specific plan, and the intent to act on those thoughts can be variable
• Passive: wishing to die, but not thinking about doing something to make that happen

Delusions

Delusions are fixed beliefs that can’t be budged with evidence to the contrary, that are not accounted for by culturally accepted beliefs and interfere with one’s ability to interact with reality. Simply believing something that isn’t true isn’t a delusion.

There’s more on this topic in the post Common Themes of Delusions in Psychosis.

Types of delusions

• Capgras: believing that people have been replaced by imposters

• Delusions of control: belief that one’s thoughts are controlled by outside forces
  • Thought broadcasting: believing that one’s thoughts can be heard by other people
  • Thought insertion/thought withdrawal: believing that thoughts are being put into or taken out of one’s head

• Erotomanic: believing that one is in a romantic relationship that doesn’t actually exist, often with a famous person

• Grandiose: an inflated self, abilities, and connections that reaches delusional proportions, such as the belief that one is a key advisor to a major political figure. It can be important to obtain collateral to verify whether certain beliefs are actually reality-based, but someone who is delusional about being an important public figure would typically speak differently about it than someone who actually is an important figure. Grandiosity can also be non-delusional, such as in narcissistic personality disorder.

• Ideas of reference: interpreting messages as being particularly directed at oneself, including things on billboards, tv, or radio; for example, something on a news broadcast might be perceived as containing a hidden message directed specifically at the individual.

• Paranoid/persecutory: This is probably what first comes to mind when many people think of delusions, and involves a belief that one will be harmed. These delusions may be further described as non-bizarre (within the realm of possibility, like being monitored by the government) or bizarre (aliens trying to enter their home via the cat door to steal their right foot). Paranoia can also occur in a non-delusional sense.

• Religious: religious delusions, such as believing that one is Jesus, that are a departure from an individual’s beliefs when non-psychotic, and are not in keeping with the accepted beliefs of their religious community; someone who is religious at baseline may become hyper-religious when unwell, which my involve delusional interpretations of elements of their religion

• Somatic: false beliefs about things that are happening in one’s body, ranging from something non-bizarre like cancer to something bizarre, like believing one’s stomach is filled with dancing turtles

Describing delusions

• Bizarre/non-bizarre: Bizarre delusions are very removed from the realm of possibility, such as aliens entering one’s home every night through the water pipes and removing one’s toes to implant them in one’s brain. Non-bizarre delusions are within the realm of possibilities, such as the government watching one’s every move, but the individual’s relationship with that belief is still delusional.

• Delusional proportions: this refers to experiences, such as guilt or obsessions, that may be or may have been experienced non-psychotically, but they have intensified enough that they have reached the strength of delusions

• Mood-congruent: people experiencing mood episodes may experience delusions that match their mood, such as delusions of guilt during a depressive episode or grandiose delusions during a manic episode

• Overvalued ideas: these are beliefs that someone is quite fixed on, but not to the extent that are delusional

Types of hallucinations

• Auditory (AH): hallucinations involving sound — may be voices or other sounds, familiar or unfamiliar voices, and single voices at a time or more than one voice conversing
• Gustatory: hallucinations involving taste
• Olfactory: hallucinations involving odours
• Tactile: hallucinations involving the sense of touch, such as bugs crawling on the skin
• Visual (VH): “seeing things”; these are less common than auditory hallucinations, and may be indicative of a physical (“organic”) problem within the brain

• Hypnogogic: these occur while during the transition from awake to sleep, and aren’t considered psychotic in nature
• Hypnopompic: these are similar to hypnogogic hallucinations, but happen while waking; again, these are considered normal rather than psychotic

• Command hallucinations: these are hallucinations that instruct people to perform certain acts, which may involve harming the self or others
• Responding to internal stimuli: This is sometimes used to describe someone who appears to be responding to hallucinations, such as if they appear to be listening to auditory hallucinations or talking back to them. They’re internal stimuli in the sense that they’re coming from within the mind rather than coming from the external environment via the senses. While many people talk to themselves, listening to someone who’s responding to internal stimuli sounds like you’re hearing only half of a conversation.

Thought form/thought process

• Circumstantiality: wandering away from the original idea, but eventually returning to it; like beating around the bush
• Clanging: grouping unrelated words based on sound (such as rhyming) in a non-meaningful way
• Concrete: This involves very literal interpretation of information, and can be tested by asking a patient to interpret proverbs, e.g. “it ain’t over til the fat lady sings” might be interpreted as an obese woman needing to sing O Sole Mio before something could be considered finished
• Loose associations: connecting ideas that seem to be totally unrelated
• Neologisms: making up new words; in a psychiatric context, this refers specifically to neologisms that arise due to thought disorder rather than intentional coining of new terms
• Overinclusive: including excessive, unnecessary amounts of detail, e.g. “I’m sorry I’m late. I left home on time, and I was driving here in my car—it’s a Toyota Corolla that’s a 2012, but I bought it in 2014, and it’s blue, but there are chips of paint missing where the passenger door has been dented; I really like that it has Bluetooth because it means I can listen to songs from my iPhone. I had my classic rock playlist on while I was coming here, because I like to sing along to ACDC. I parked my car on Laurel Avenue and then I was walking towards your office, but then I couldn’t cross Main St. because a fuel truck had overturned and was on fire, so that’s why I’m late.”
• Perseveration: repeatedly returning to the same topic, and may be veeeeeery difficult to redirect away from that topic
• Poverty of thought: an easy way to describe this might be that the lights are on but nobody’s home
• Tangentiality: going off on a tangent that may be only slightly related, and losing the original idea, never to return to it again; often seen in mania
• Word salad: words put together in a completely incoherent manner, e.g “The purple Christmas fish road living pie.” I’ve seen this term co-opted by the online narcissistic abuse community, but the meaning that’s been assigned to it in that context is not the same as the psychiatric meaning.

Passing judgment?

Some of these terms may sound rather judge-y, but they’re defined in such a way that they’re intended to be descriptors rather than value judgments. It’s also important to have standardized language in order to avoid confusion from people using different definitions or from vague language. Still, if a patient ends up reading their chart later on, drawing on their familiarity with colloquial usage of psychiatric jargon, it can be easy to infer judgments that aren’t actually present when the language is used in a purely psychiatric sense..

Have you ever had psychiatric jargon applied to you in some way that felt wrong or judgmental?

For a more extensive list of terms, the World Health Organization has a lexicon of psychiatric and mental health terms.