When we think of mental health disorders, most of us are familiar with descriptions or diagnoses like anxiety, depression, and schizophrenia. But some of the terms used by professionals to describe mental health disorder symptoms are unfamiliar or a bit confusing. In this post, we will discuss some of the more commonly used, but least understood, terms your physician or professional may use. Having a better understanding of what these terms mean can be helpful for a veteran in preparation for a C&P exam, or in understanding benefits.
*Visit one of our most-read and useful blog posts, mental health rating myths part 1!
Commonly Used Terms Regarding Mental Disorders
Impaired Judgement
From 4.130 Schedule of ratings—mental disorders: “Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships.”
Impaired judgement is defined by the American Psychological Association (APA) as difficulty in forming evaluative opinions or reaching conclusions concerning available evidence, often about people and courses of action. Impaired judgment may lead to seemingly irrational actions and risk-taking behaviors. It has been thought of as both a diagnostic and a predictive criterion for delirium, dementia, and substance-related disorders, but its diagnosis and measurement are hindered by the lack of an agreed operational definition.
Impaired Abstract Thinking
From 4.130 Schedule of ratings—mental disorders: “Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships.”
Impaired abstract thinking is associated with less/reduced judgement, insight, creativity, reasoning, problem solving, mental flexibility, and foresight. Those struggling with impaired abstract thinking are often easily distracted and can be impulsive. Activities with more than one step, or goal-oriented activities can be very frustrating and difficult for them. Impaired abstract thinking is most common in those with traumatic brain injuries (TBI) or head injuries that result in the individual using the more primal parts of the brain, rather than the frontal lobe, which is responsible for reasoning and logical thinking.
Flattened Affect
From 4.130 Schedule of ratings—mental disorders: “Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships.”
Flat or flattened affect is a symptom that changes how an individual expresses emotions. Those with flattened affect struggle to speak with inflection, may talk in monotone, and avoid eye contact. They may also be less aware of things around them, or of other people’s feelings or expressions. This makes it very hard to connect and effectively communicate with others, as tone and facial expression are a huge part of positive and satisfactory communication. It is a symptom of other conditions, often associated with depression, brain injury, or schizophrenia.
Depressed Moods
From 4.130 Schedule of ratings—mental disorders: “Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events).”
Someone with a depressed mood may present with poor posture, feelings of low self-worth, little or no expression, lack of motivation or joy in things they used to love, withdrawal from activities, friends, family, increased or decreased appetite, insomnia or excessive sleep, and possibly suicidal thoughts.
Speech
A. Intermittently Illogical, Obscure or Irrelevant Speech
From 4.130 Schedule of ratings—mental disorders: “Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships.”
Simply put, illogical, obscure or irrelevant speech means that the speech doesn’t “fit” or make sense to the topic, conversation, or what’s going on. It is a nonsensical speech response.
B. Stereotyped Speech
From 4.130 Schedule of ratings—mental disorders: “Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships.”
Stereotyped speech is when the individual repeats themselves; they say the same thing over and over again.
Panic Attacks
From 4.130 Schedule of ratings—mental disorders: “Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships.”
Panic attacks are sudden and intense episodes of extreme fear/anxiety when no real danger is near or happening. They can be very frightening and often bring a slew of physical responses, such as: sense of impending doom/danger, fear of loss of control or death, rapid, pounding heart rate, sweating, trembling/shaking, shortness of breath, tightness in your throat, chills, hot flashes, nausea, abdominal cramping, chest pain, headache, dizziness, lightheadedness or faintness, numbness or tingling sensation, and feeling of unreality or detachment.
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