Is there a name or category this symptom falls under?
July 6, 2011 1:30 PM   Subscribe

I need help identifying a name or category for this troubling mental health symptom so that appropriate kinds of therapy may be sought.(Not me, thankfully.)

This person will start obsessing over a single thought, in the instances I know of its usually some perceived fault of a loved one, such as "they don't respect my opinion". This thought starts as almost nothing, but they can't shake it and begin to see examples of it everywhere. Its important to note, that they in what they call "the normal in there" know this thought is not true.

This thought takes up more and more of their brain space until it manifests itself in an outburst of very inappropriate/hurtful things directed at the object of this thought. This outbust is delivered with an almost flat affect, very detached. The supremely callous remarks will continue without recognition of any harm that is being caused for quite a while. This affect is out of character, this person is typically gentle, quiet, and humble.

This has happened with most of this persons family and confidants. After the outbursts, the person is honestly remorseful, to the point of being despondant.

Some things have worked to "break the spell" very occasionally once the outburst starts, Saying, "I love you, but I won't talk to you when you are like this works ok, one person flipped the fuck out, this was apparently scary enough to snap it. If the target is feeling like actually sitting through it, asking leading questions such as "what makes you think that? Do you believe that? How do you think that affects me?" seems to help work through it in his mind, but hell, who wants to sit there and do that?

Arguing or reasoning seems to exacerbate and prolong the state, as well as exposing the targeted party to more abuse. Being able to get out of the mental cycle that leads up to the outbust has proven thus far elusive.

So what is this? Its kind of like a fugue state, but not really. This person has mild physical tics and one doctor a long time ago thought he may have Tourettes, but its my understanding that the outbursts in Tourettes may be crass, they are often competely out of context. This is definitly contextual.
posted by stormygrey to Health & Fitness (14 answers total) 1 user marked this as a favorite
 
I have enough of a background in psych to have an idea of what this might be, but Internet Diagnosis is not what this person needs -- they need to talk to a doctor and ask for a referral to someone, perhaps with a general specialty, who can then refer to someone with a more specific specialty if relevant/necessary. Is there a reason that it is critical to start with a specific specialist rather than seeking the assistance of the sort of "base level" of medical professionals first?
posted by brainmouse at 1:36 PM on July 6, 2011


If you have an idea of what it may be, I'd really like to hear it. I promise real actual professionals will be involved in therapy.
posted by stormygrey at 1:52 PM on July 6, 2011 [1 favorite]


Are you looking for a term more specific than "obsessive thoughts"?
posted by Nomyte at 2:19 PM on July 6, 2011


Yes, Nomyte, the obsessive thoughts is a good start, but the weird, atypical, delivery of the outbust is something else entirely.

Others, please, telling me to see a professional isn't really answering the question. The person has seen therapists regularly, doctors here and there. I am looking to understand the origins and possible directions to persue, like cbt or whatever.. If there is anything worth trying to understand and learn abour, its ourselves and our minds.
posted by stormygrey at 2:52 PM on July 6, 2011


My psychiatrist calls this "rumination." (Yes, as in chewing one's cud.)
posted by Carol Anne at 3:17 PM on July 6, 2011


Sounds-- literally-- very much like the Tourette's to me.

One of my very favorite anecdotes from a Tourette's sufferer was told by a woman who was standing in line at a bank waiting for a teller behind a large black man, and found herself involuntarily muttering "purpleniggerpurpleniggerpurple..." unendingly in a low monotone.

After some time he turned around and said something like 'have you got a problem with black people, or do you just not like the color purple?'

If this behavior has developed suddenly, or sharply worsened, I think it's worth trying to figure out why.

It has been somewhat controversially claimed that a subpopulation of people with Tourette's have developed the disease after a childhood bout of strep, and that some of them have experienced exacerbations after strep throat later in life, but I think almost any insult to the brain can revive dormant Tourette's.
posted by jamjam at 3:23 PM on July 6, 2011 [1 favorite]


If your friends hasn't seen a competent psychiatrist, I think that would be useful. IME therapists aren't always able to diagnose the more unusual stuff a brain can do.
posted by tuesdayschild at 3:45 PM on July 6, 2011


Gaah! Friend, not friends.
posted by tuesdayschild at 3:46 PM on July 6, 2011


Obsessive thinking, which may be a component of obsessive-compulsive disorder. Therapist/doctor are the appropriate referral.
posted by theora55 at 3:48 PM on July 6, 2011


This could be various conditions dependent on many factors that aren't included in your description. The individual factors required can only be ascertained by a competent professional during a mental health evaluation or consultation.
posted by dchrssyr at 6:25 PM on July 6, 2011


The thoughts are obsessions and the verbal abuse is a compulsion. Rumination just refers to the thinking part, which would not hurt others. The compulsions are what are worrisome to other people.

I agree with those who say that more information is needed, and that should be obtained via psychiatric consultation. If the person doesn't want to see a psychiatrist, it wouldn't hurt to see a neurologist to rule out e.g. Tourette's.

From a psychological perspective, the person sounds very angry and he can express that only when he is "not himself," that is, when he is "compelled" to take those abusive actions (while the "observing ego" part of him watches in horror). It's a kind of dissociative process (hence the original poster's observation that these episodes seem sort of like a fugue state).

Essentially, then, if neurological conditions can be ruled out (and maybe they can and maybe they can't), we're left in the same state as usual in 21st-century psychotherapyland: you have a senient person who feels bad about stuff, and you have these "symptoms" that are expressing one thing or another, and then you get to choose either a treatment like psychoanalytic/psychodynamic psychotherapy where the process is looking at what has caused the symptoms (based on the person's history) and what is perpetuating them in the present, and, via the psychotherapeutic relationship, "working through" that stuff; or you get to focus on the external, behavioral symptoms and go to a behaviorist or cognitive-behaviorist and work on the behaviors, and if you do the latter you get to say that you're doing "science" and if you do the former you get to say that you're more sophisticated than the latter because you're looking at things in a deeper way that will actually change the individual's personality rather than extinguish symptoms (which may come back in another form).

Etc.

The point is: these symptoms are not so special that they're going to get some sort of special treatment from a special therapist who treats just this sort of thing. Rather, the psychiatrist is going to prescribe some pills to calm things down; the psychodynamic psychotherapist is going to try to get this person to talk a lot about his feelings and what they mean and where they came from; and the cognitive-behaviorist is going to focus on the behavior that the person wants to get rid of and find ways to modify it, regardless of where it came from (although the cog.-behaviorist will want to know things about what in the environment triggers and perpetuates the behavior) and will give HOMEWORK.

Personally, if I had this problem I would skip the psychiatrist because usually the pills that stop this sort of behavior also make you feel groggy, and I would skip the cognitive behaviorist because I hate HOMEWORK; so what's left is the psychodynamic therapist and facing one's anger.

On the other hand, it MIGHT be Tourette's.
posted by DMelanogaster at 6:48 PM on July 6, 2011 [5 favorites]


Wow, I know someone who does this exact thing. I thought it was just him being a jerk so it's weird to see your explanation. I guess I don't have any advice but just wanted to say that your person isn't the only one who does this.
posted by dawkins_7 at 7:33 PM on July 6, 2011


>This person will start obsessing over a single thought, in the instances I know of its usually some perceived fault of a loved one, such as "they don't respect my opinion". This thought starts as almost nothing, but they can't shake it and begin to see examples of it everywhere. Its important to note, that they in what they call "the normal in there" know this thought is not true.

This thought takes up more and more of their brain space until it manifests itself in an outburst of very inappropriate/hurtful things directed at the object of this thought.


You know, that sounds very familiar. You might check this thread about anxiety. Anxiety, as the thread suggests, can manifest in a ton of different ways. It doesn't feel like a shoe-in, but it might be a component to the overall problem.
posted by Ys at 9:19 PM on July 6, 2011


Ys: yes, and in fact obsessive-compulsive disorder is characterized as an anxiety disorder, because the obsessions and compulsions are thought to serve the purpose of decreasing of "binding" the person's anxiety (which, as with all symptoms, they do inadequately, and the anxiety and distress come leaking through anyway).
posted by DMelanogaster at 2:32 PM on July 7, 2011 [1 favorite]


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