What mental illnesses make eye contact difficult

Psychiatry, Psychosomatics & Psychotherapy

Schizophrenia is characterized by a very complex and diverse appearance. A distinction is made between the acute and the chronic phase of the disease. In acute schizophrenia, the focus is on phenomena that are not present in healthy people. Hearing voices and paranoia are, for example, part of these so-called positive symptoms. At this stage, patients refuse to be assigned any illness. During the chronic phase the restriction of certain psychological functions and emotionality predominates, which healthy people have to the fullest. These so-called negative or "minus" symptoms (i.e. something is missing) are characterized, among other things, by social withdrawal, decreasing (leisure) interests, impoverishment of speech, lack of feelings, drive disorders and neglect of the outside world.
The following symptoms of illness can occur as part of schizophrenia:

I disorder:

In the case of an ego disorder, the boundary between the environment and the "I" becomes blurred. Affected people experience themselves and their environment as unreal and strange. Own actions can no longer be experienced as a coherent unity of the person and the distinction between the own and the foreign is disturbed. Affected people believe, for example, that outsiders can read, influence or even "take away" their thoughts. Some patients report that they feel manipulated, remote-controlled or even hypnotized from the outside.

Disturbances of emotional impulses (disturbed affectivity):

The mood is often characterized by fluctuations, e.g. by the simultaneous or immediately alternating occurrence of extreme moods and feelings. In connection with acute episodes and delusional experiences, there is often a strong fear or depressed mood. With chronic illness there is often a "flattening of affect", i.e. the emotional state is indifferent, those affected feel empty inside. The facial expression is rigid, gestures and facial expressions impoverished, eye contact is avoided. The disturbed affectivity is also expressed in social withdrawal, the person affected appears less interested, joyless and is unable to feel closeness. Accompanying depressive episodes come to the fore relatively often. When the mood is high, folly, lack of distance and a ruthless disinhibition can prevail. In schizophrenic patients, the emotional expression and the current situation often do not match (e.g. being amused at terrible events). One speaks here of parathymia. On the behavioral level, i.e. facial expressions / gestures and mood do not match, this discrepancy is called paramimy.

Cognitive disorders

Cognitive impairments - in the areas of attention, concentration and memory - are a central component of the clinical picture of schizophrenia and often affect the majority of those affected in a severe and disabling manner.

Thinking and speech disorders

Thinking appears disheveled, incoherent and devoid of internal logic. As a result, the linguistic utterances are becoming increasingly bizarre, words are mixed up, the sentence structure is destroyed, new word formations (neologisms) are invented. The flow of thoughts and speech can be accelerated or slowed down. Sometimes the patients talk wrong, i.e. their statements do not match the topic or they suddenly “tear off” their thoughts, so that they “lose the thread” in the conversation.

Delusion:

In the case of delusion, the person concerned develops pathological misconceptions that deviate from reality. The delusions are so real for him that he sticks to them unwaveringly, does not check them against reality and cannot be corrected by others. Almost all circumstances can become delusional. The person concerned feels persecuted (paranoia) or in some other serious way impaired (e.g. intoxication mania), seriously ill (hypochondriac mania) or religiously or politically called for a major task (megalomania). Individual delusional ideas are not always easy to distinguish from reality. Delusional mood describes the mood in the run-up to a delusion, in which the patient has the certainty that something is happening that affects him directly. A false assignment of meanings to processes in the environment is referred to as delusional perception, whereby everyday processes are often experienced as signals or tests.

Hallucinations:

Hallucinations are disorders of perception in which the person concerned perceives things without actually being there. These disorders can involve all the senses - in schizophrenia there are mainly acoustic hallucinations, less frequent touch hallucinations and only rarely visual hallucinations. Acoustic hallucinations are mostly voices that are heard without anyone speaking. If the voices are experienced as the perception of one's own thinking, one speaks of the making of thoughts. There are also "dialogical voices", i.e. the person concerned thinks he is listening to conversations about himself. "Commentary voices" that can come from a part of the body, for example, describe all the patient's actions. "Imperative (requesting) voices" give the person concerned instructions for action.

Psychomotor abnormalities (catatonic symptoms):

There is a reduction in drive in terms of activity, spontaneity and initiative. The emotional responsiveness and the spontaneous affection and communication skills decrease. When fully conscious, the patient can be completely motionless and unresponsive (stupor). If, on the other hand, there is strong motor excitement, this can manifest itself from stereotypical movements to aimless aggressiveness. When dealing with schizophrenics, it can happen that everything is repeated or understood, the opposite or generally what is ordered is automatically carried out (stereotypes).

Depending on the prevalence of certain symptoms, a distinction can be made between subtypes that can merge into one another during the course of the disease. The subtypes (e.g. paranoid, hebephrenic or catatonic schizophrenia) do not form separate disease units, but merely describe the individual combination and severity of the symptoms.
Those affected often have other mental illnesses such as depression or addiction. A large number of young patients with schizophrenia consume cannabis (new scientific findings suggest that cannabis can trigger schizophrenia or accelerate the onset of the disease if there is a hereditary burden). Physical complaints such as constipation or diarrhea as well as palpitations and impaired mental performance can also be observed in some patients.