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.
- How We Talk About Mental Illness: Definitions vs. Connotations
- Psychosis, Psychopathy & Other Psych Terms
- The Mental Status Exam (MSE) in Psychiatry
Making Sense of Psychiatric Diagnosis aims to cut through the misunderstanding and stigma, drawing on the DSM-5 diagnostic criteria and guest narratives to present mental illness as it really is.
It’s available on Amazon and Google Play.
