6.3: Mental Health Disorders

Mental illness or disorders are often categorized into Mood Disorders, Anxiety Disorders, Psychotic Disorders, and Eating Disorders.

Mood disorders, also called affective disorders, affect your emotional state focusing on how you feel from extreme sadness to extreme happiness. Anxiety disorders occur when a person responds to something with fear or dread and has a severe stress response that may include physical reactions such as rapid heart rate, overwhelming worry, muscle tension, trouble sleeping, nausea, and diarrhea. Psychotic Disorders, also called thought disorders, involve distorted awareness or thinking.

Mood Disorders include:

• Depression
• Bipolar disorders
• Seasonal affective disorder

Anxiety Disorders include:

• General anxiety
• Specific phobias and Agoraphobia
• Post-traumatic stress disorder
• Panic disorder
• Social anxiety disorder

Psychotic Disorders include:

• Schizophrenia

Eating Disorders include

• Anorexia Nervosa
• Bulimia Nervosa
• Binge Eating

Depression

Depression (major depressive disorder or clinical depression) is the most common mood disorder characterized by severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working. Depression is more than just feeling down or having a bad day. When a sad mood lasts for a long time and interferes with normal, everyday functioning, you may be clinically depressed.

It is estimated that about 1 out of every 6 adults will have depression at some time in their life. There are varying levels of depression and causes of depression. A person with persistent depressive disorder (also called dysthymia) means they have suffered from depressed mood that lasts for at least two years. A woman with perinatal depression has experienced full-blown major depression during pregnancy or after delivery (postpartum depression).

Symptoms of depression include:

• Feeling sad or anxious often or all the time
• Not wanting to do activities that used to be fun
• Feeling irritable‚ easily frustrated‚ or restless
• Having trouble falling asleep or staying asleep
• Waking up too early or sleeping too much
• Eating more or less than usual or having no appetite
• Experiencing aches, pains, headaches, or stomach problems that do not improve with treatment
• Having trouble concentrating, remembering details, or making decisions
• Feeling tired‚ even after sleeping well
• Feeling guilty, worthless, or helpless
• Thinking about suicide or hurting yourself

Not everyone who is depressed experiences every symptom. Some people experience only a few symptoms while others may experience many. Several persistent symptoms in addition to low mood are required for a diagnosis of major depression, but people with only a few – but distressing – symptoms may benefit from treatment of their “subsyndromal” depression. The severity and frequency of symptoms and how long they last will vary depending on the individual and his or her particular illness. Symptoms may also vary depending on the stage of the illness.

Bipolar Disorder

Bipolar disorder is a mood disorder characterized by intense mood swings. Sometimes you may feel extremely “up,” elated, irritable, or energized. This is called a manic episode. Other times you may feel “down,” sad, indifferent, or hopeless. This is called a depressive episode. You may have both manic and depressive symptoms together. This is called a mixed episode.

Symptoms of Bipolar include:

• The symptoms of a manic episode can include
  • Feeling very up, high, or elated
  • Feeling jumpy or wired, more active than usual
  • Having a very short temper or seeming extremely irritable
  • Having racing thoughts and talking very fast
  • Needing less sleep
  • Feeling like you are unusually important, talented, or powerful
  • Do risky things that show poor judgment, such as eating and drinking too much, spending or giving away a lot of money, or having reckless sex
• The symptoms of a depressive episode can include
  • Feeling very sad, hopeless, or worthless
  • Feeling lonely or isolating yourself from others
  • Talking very slowly, feeling like you have nothing to say, or forgetting a lot
  • Having little energySleeping too much
  • Eating too much or too little
  • Lack of interest in your usual activities and being unable to do even simple things
  • Thinking about death or suicide
• The symptoms of a mixed episode include both manic and depressive symptoms together. For example, you may feel very sad, empty, or hopeless, while at the same time feeling extremely energized.

Seasonal Affective Disorder (SAD)

SAD is a specific type of Depression (a mood disorder) that comes and goes with the seasons.

Seasonal affective disorder is characterized by the onset of depression during the winter months, when there is less natural sunlight. This depression generally lifts during spring and summer. Winter depression, typically accompanied by social withdrawal, increased sleep, and weight gain, predictably returns every year in seasonal affective disorder.

Symptoms of SAD include:

• Sadness
• Gloomy outlook
• Feeling hopeless, worthless, and irritable
• Loss of interest or pleasure in activities you used to enjoy
• Low energy
• Difficulty sleeping or oversleeping
• Carbohydrate cravings and weight gain
• Thoughts of death or suicide

General Anxiety

Generalized Anxiety Disorder is an anxiety disorder characterized by excessive worrying. People with GAD excessively worry about ordinary daily issues such as health, money, work, and family on most days for at least 6 months.

Symptoms of GAD include:

• Feeling restless, wound-up, or on-edge
• Being easily fatigued
• Having difficulty concentrating; mind going blank
• Being irritable
• Having muscle tension
• Difficulty controlling feelings of worry
• Having sleep problems, such as difficulty falling or staying asleep, restlessness, or unsatisfying sleep

Panic Disorder

Panic disorder is an anxiety disorder characterized by recurrent unexpected panic attacks, which are sudden periods of intense fear that may include palpitations, pounding heart, or accelerated heart rate; sweating; trembling or shaking; sensations of shortness of breath, smothering, or choking; and feeling of impending doom.

Symptoms of panic disorder include:

• Heart palpitations, a pounding heartbeat, or an accelerated heartrate
• Sweating
• Trembling or shaking
• Sensations of shortness of breath, smothering, or choking
• Feelings of impending doom
• Feelings of being out of control

People with panic disorder often worry about when the next attack will happen and actively try to prevent future attacks by avoiding places, situations, or behaviors they associate with panic attacks. Worry about panic attacks, and the effort spent trying to avoid attacks, cause significant problems in various areas of the person’s life, including the development of agoraphobia.

Specific Phobias and Agoraphobia

A phobia is an anxiety disorder characterized by a strong, irrational fear of something that poses little or no real danger. There are many specific phobias such as the fear of heights which is called Acrophobia, or the fear of spiders termed Arachnophobia. A person who has a fear of public spaces is termed Agoraphobia. If you become anxious and extremely self-conscious in everyday social situations, you could have a social phobia, also referred to as a social anxiety disorder.

Symptoms of specific phobias include:

• May have an irrational or excessive worry about encountering the feared object or situation
• Take active steps to avoid the feared object or situation
• Experience immediate intense anxiety upon encountering the feared object or situation
• Endure unavoidable objects and situations with intense anxiety

Agoraphobia: People with agoraphobia have an intense fear of two or more of the following situations:

• Using public transportation
• Being in open spaces
• Being in enclosed spaces
• Standing in line or being in a crowd
• Being outside of the home alone

People with agoraphobia often avoid these situations, in part, because they think being able to leave might be difficult or impossible in the event they have panic-like reactions or other embarrassing symptoms. In the most severe form of agoraphobia, an individual can become housebound.

Social Anxiety Disorder (social phobia)

Social anxiety disorder is an anxiety disorder characterized by a general intense fear of, or anxiety toward, social or performance situations. They worry that actions or behaviors associated with their anxiety will be negatively evaluated by others, leading them to feel embarrassed.

Symptoms of Social Anxiety Disorder include:

• Feeling highly anxious about being with other people and having a hard time talking to them
• Feeling very self-conscious in front of other people and worried about feeling humiliated, embarrassed, or rejected, or fearful of offending others
• Being very afraid that other people will judge them
• Worrying for days or weeks before an event where other people will be
• Staying away from places where there are other people
• Having a hard time making friends and keeping friends
• Blushing, sweating, or trembling around other people
• Feeling nauseous or sick to your stomach when other people are around

Post-traumatic stress disorder

PTSD is an anxiety disorder that develops in some people who have experienced a shocking, scary, or dangerous event. The “fight of flight” reaction is a natural process meant to keep a person from harm when in traumatic experiences, however for those with PTSD the reaction continues for a long period of time or they experience the reaction even when they are not in danger.

Symptoms include:

• To be diagnosed with PTSD, an adult must have all of the following for at least 1 month:
  • At least one re-experiencing symptom
  • At least one avoidance symptom
  • At least two arousal and reactivity symptoms
  • At least two cognition and mood symptoms
• Re-experiencing symptoms include:
  • Flashbacks—reliving the trauma over and over, including physical symptoms like a racing heart or sweating
  • Bad dreams
  • Frightening thoughts

Schizophrenia

Schizophrenia is a psychotic disorder that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality, which causes significant distress for the individual, their family members, and friends. Schizophrenia is typically diagnosed in the late teen years to the early thirties and tends to emerge earlier in males (late adolescence – early twenties) than females (early twenties – early thirties).

Symptoms of Schizophrenia include:

• Psychotic Symptoms
  • Hallucinations, such as hearing voices or seeing things that aren’t there
  • Delusions, which are firmly held beliefs not supported by objective facts (e.g., paranoia – irrational fears that others are “out to get you” or believing that the television, radio, or internet are broadcasting special messages that require some response)
• Negative Symptoms
  • Reduced motivation and difficulty planning, beginning, and sustaining activities
  • Diminished feelings of pleasure in everyday life
  • “Flat affect,” or reduced expression of emotions via facial expression or voice tone
  • Reduced speaking
• Cognitive Symptoms
  • Difficulty processing information to make decisions
  • Problems using information immediately after learning it
  • Trouble focusing or paying attention

Eating Disorders and Mental Health

Eating disorders are not a choice, rather they are serious and often fatal illnesses that are associated with severe disturbances in people’s eating behaviors and related thoughts and emotions. Researchers are finding that eating disorders are caused by a complex interaction of genetic, biological, behavioral, psychological, and social factors.

Review chapter 4 for more in-depth explanations of common eating disorders.

Suicide

Suicide is a major public health concern. In 2020, an estimated 12.2 million American adults seriously thought about suicide, 3.2 million planned a suicide attempt, 1.2 million attempted suicide, and 45,979 died by suicide. In 2020, suicide was among the top 9 leading causes of death for people ages 10-64 and the second leading cause of death for people ages 10-14 and 25-34. Depression, substance use disorders, and psychosis are the most relevant risk factors for suicide, with anxiety, personality, eating, and trauma-related disorders also contributing to risk of suicide. Most people, could be at least 90%, who have died by suicide have suffered from mental disorders^[7]. Suicide is complicated and tragic but it is often preventable. Knowing the warning signs for suicide and how to get help can help save lives.

Suicidal thoughts or actions are a sign of extreme distress and should not be ignored.

Warning signs that someone may be at immediate risk for attempting suicide include:

• Talking about wanting to die or wanting to kill themselves
• Talking about feeling empty or hopeless or having no reason to live
• Talking about feeling trapped or feeling that there are no solutions
• Feeling unbearable emotional or physical pain
• Talking about being a burden to others
• Withdrawing from family and friends
• Giving away important possessions
• Saying goodbye to friends and family
• Putting affairs in order, such as making a will
• Taking great risks that could lead to death, such as driving extremely fast
• Talking or thinking about death often

Other serious warning signs that someone may be at risk for attempting suicide include:

• Displaying extreme mood swings, suddenly changing from very sad to very calm or happy
• Making a plan or looking for ways to kill themselves, such as searching for lethal methods online, stockpiling pills, or buying a gun
• Talking about feeling great guilt or shame
• Using alcohol or drugs more often
• Acting anxious or agitated
• Changing eating or sleeping habits
• Showing rage or talking about seeking revenge

Risk Factors for suicide

• Depression, other mental disorders, or substance use disorder
• Chronic pain
• A history of suicide attempts
• Family history of a mental disorder or substance use
• Family history of suicide
• Exposure to family violence, including physical or sexual abuse
• Presence of guns or other firearms in the home
• Having recently been released from prison or jail
• Exposure, either directly or indirectly, to others’ suicidal behavior, such as that of family members, peers, or celebrities

How can you help? 5 Action Steps for Helping Someone in Emotional Pain

1. Ask: “Are you thinking about killing yourself?” It’s not an easy question but studies show that asking at-risk individuals if they are suicidal does not increase suicides or suicidal thoughts.
2. Keep them safe: Reducing a suicidal person’s access to highly lethal items or places is an important part of suicide prevention. While this is not always easy, asking if the at-risk person has a plan and removing or disabling the lethal means can make a difference.
3. Be there: Listen carefully and learn what the individual is thinking and feeling. Findings suggest acknowledging and talking about suicide may in fact reduce rather than increase suicidal thoughts.
4. Help them connect with help
   • Call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255), 24 hours a day, 7 days a week. The service is available to everyone.
   • You can also connect 24/7 to a crisis counselor by texting the Crisis Text Line.Text HOME to 741741.
   • The deaf and hard of hearing can contact the Lifeline via TTY at 1-800-799-4889.
   • You can also help make a connection with a trusted individual like a family member, friend, spiritual advisor, or mental health professional.
5. Stay Connected: Staying in touch after a crisis or after being discharged from care can make a difference. Studies have shown the number of suicide deaths goes down when someone follows up with the at-risk person.