Coming to Terms With Symptoms

"Coming to Terms With Symptoms"

By Steven A. Weisblatt, M.D.

One of the ongoing challenges you and your clinician will face is making sure that you are speaking the same language. Specifically, is the doctor asking questions—and are you answering them—in a way that elicits clear information and allows accurate assessment of your current symptom picture?

Given the limited time available for you and your doctor to meet, it is critical that you know in advance what feelings to report and how to accurately describe them. In addition to reporting even mild or occasional symptoms, it is crucial that you understand the exact meaning of terms clinicians use to describe symptoms.

Accurate communication is, paradoxically, more critical the less ill a person is. Five to six times more people suffer from milder bipolar spectrum disorders than more severe forms of the disorder. These “soft bipolar” patients will not have classic and dramatic cycles of mood shift, but instead will likely have chronic, low-grade symptoms. While a more severely ill person may show symptoms to the clinician upon walking into the office, a more subtly ill patient will more likely require a very careful and accurate dialogue to establish an accurate diagnosis.

To further confuse matters, it is common for people to answer “no” when asked about having a symptom that occurs only intermittently. A similar negative response is often given when the person is able to “manage” the symptom.

As in cardiology, where you must inform the physician about any chest pain that occurred since the last visit—whether or not you were able to “manage” the pain by lying down, for example—it is critical in psychiatry to give a complete answer. This increases the likelihood that the clinician will pick up any subtle symptoms you have.

It is critical that you observe yourself well and accurately report your observations to your clinician. This will reduce the risk of under-communicating symptoms, lead to more accurate diagnoses and avoid less-than-optimal medication interventions that only make symptoms just “a bit better.” By being an educated consumer, you can actively promote getting treated to the point of full remission.

It may also be helpful to have an understanding of what a doctor means by the terms used to ask about different symptoms. For starters, here are definitions of two symptoms commonly reviewed during patient interviews.

Irritability:

This can best be thought of as an amplified form of irritation. Irritation, an absolutely normal human experience that occurs when something upsets you, would not be considered a symptom of anything. Irritability is when you feel easily upset or frustrated in different environments. In common use, a person with irritability can sometimes be described as angry, “bitchy” or moody—although some people with irritability simply withdraw. Another way of thinking about irritability is to understand that while the triggering event or stimulus would indeed be annoying to most people, the frustration, anger or annoyance you feel is increased, or “amplified”, out of proportion to the context.

That disproportionate reaction may or may not be visible to someone other than yourself. Some people, especially women, have been socialized to hide their irritability, so what they feel inside is not readily seen on the outside.

Also, in our society, calling someone “irritable” is considered a criticism. Perhaps that’s why many consumers and family members deny the presence of irritability when asked about the symptom—while readily admitting that the person with bipolar overreacts, has a low tolerance for frustration, is easily upset, has “anger problems” or that others “walk around them on eggshells.”

As well, because irritability only occurs in reaction to a stimulus (or stimuli), it is almost never present constantly and thus is often underreported.

Anxiety:

Purely defined, anxiety is a heightened state of fear or worry. Again, anxiety is an absolutely normal human experience. As a famous psychoanalyst wrote, a visit from the IRS brings out the hysteric in everybody.

Anxiety is only a symptom when it occurs out of context—that is, there is no real reason to be anxious—or the anxious feelings occur in a reasonable context but are increased out of proportion to the situation. Thus, the term “anxiety,” when used to describe a symptom, is best thought of as amplified anxiety.

Like irritability, amplified anxiety may not be obvious to others. Many consumers hide or don’t admit to having amplified anxiety, which complicates an accurate assessment of their response to treatment.




Steven A. Weisblatt, MD (www.drweisblatt.com) is a Former Assistant Professor of Psychiatry at State University of New York’s Downstate Medical Center in Brooklyn and has private practices in New York and Pennsylvania. He has spoken and consulted widely about accurate diagnoses and effective treatments.