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Differential Diagnosis in Psychiatry – Separating “Symptomatic” Processes from “Core” Processes

Posted on the 16 March 2018 by Calvinthedog

In an anxiety disorder, the main thing you see or the “meat” of the illness is the anxiety – I call it an “anxiety process.” In this sense, even some anxiety disorders that have gone psychotic, say Psychotic OCD or Body Dysmorphic Disorder, are still basically anxiety disorders at their core and not psychotic disorders.

The primary disturbance or process if you will is anxiety and the psychosis is just growing out of that process.

What we are doing here is looking for the core essence of the problem – the Gestalt if you will. We are ignoring symptomatic features on the outside and looking underneath them to see what the core or basic process is underneath.

In the same sense, mood disorders that have gone psychotic or even resemble schizophrenia are better seen as mood processes. In Bipolar Disorder, the primary disturbance is one of mood. The psychotic features, if any, are only present during the mood disturbance – the depression or mania. The psychotic features are flowing out of the mood issue and not the other way around as in the case of some schizophrenic persons who get depressed due to the depressing nature of their illness.

If you clear up the mood process and the psychosis is still there, it tends to go over to Schizoaffective Disorder. This is a controversial category, but it is valid. No one quite knows what it is, but I believe the best explanation is that this is simply Schizophrenia and a mood disorder – Major Depression or Bipolar Disorder – occurring in the same person. Persons with Schizoaffective Disorder tend to be heavily loaded genetically for both mood disorders and schizophrenia, whereas someone with a core mood disorder will tend to have mood disorders in their family history and someone with schizophrenia will tend to have relatives with schizophrenia.


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