Lost in translation: Be leery of lay language
Using examples and synonyms to clarify psychiatric terminology can help you gather a complete family history.
Patients may use diagnostic labels of psychiatric disorders when describing their mental distress to clinicians. Sometimes they use these words appropriately, but often they don’t understand the meaning of psychiatric terms they have read or heard (Table). For example, a study of U.S. newspapers found that 28% of articles incorrectly used “schizophrenic” to refer to a “split” or inconsistent personality.1
Terminology confusion could lead to 2 clinical problems:
- The patient may be confident in his or her self-diagnosis, which can strain the therapeutic relationship.
- The clinician may passively accept that the patient’s use of terms is accurate, resulting in a distorted diagnosis.
Psychiatric terms patients misuse to describe symptoms
Possible implied symptoms
‘ADHD’ or ‘ADD’
Poor concentration or forgetfulness, excessive energy or restlessness
Social withdrawal, unpleasant interpersonal relationships
Mood lability, unpredictability, anxiety attacks
Grief, remorse, loneliness, disappointment
Meticulousness, excessive worrying
Intense anxiety, even without physical symptoms
Worry, dread, pessimism
Emotional change following a significant, though not necessarily traumatic, event
Indecisive, ‘split personality’
ADHD: attention-deficit/hyperactivity disorder; OCD: obsessive-compulsive disorder; PTSD: posttraumatic stress disorder
Searching for meaning
When a patient uses a psychiatric term to describe symptoms, clarify what he or she means by asking; “Can you tell me more about your experience of (the term) without using that word to describe it?” Alternately, you could say, “Let’s not worry about applying a label right now, just describe what you are going through.”
Another approach is to offer phrases that are synonyms of the term’s standard use. For example, ask your patient, “By ‘schizophrenic’ do you mean ‘being in 2 minds’ or ‘having really unusual experiences?’” Using popular culture references also may be helpful. For example, “When I use the term ‘schizophrenia,’ I think of someone like Russell Crowe’s character in the movie A Beautiful Mind.” Similarly, for obsessive-compulsive disorder, reference Jack Nicholson’s character in As Good as it Gets.
Clarifying terminology also can help you gather a complete family history. A patient may say “Oh, that sounds like my mother” when you accurately describe a psychiatric symptom or disorder.
1. Duckworth K, Halpern JH, Schutt K, et al. Use of schizophrenia as a metaphor in U.S. newspapers. Psychiatr Serv 2003;54:1402-4.
Dr. Dunlop is assistant professor, department of psychiatry and behavioral sciences, Emory University, Atlanta, GA.