Common mental health diagnoses
Psychology is the study of human behavior. With this in mind, all of us are amateur psychologists. We all study human behavior: our own, our family, our coworkers, and even the behaviors of that ‘interesting’ man over there talking to the lamppost.
I am going to talk generally about the common mental health problems many of us may have. But first a warning. Do not self diagnose. You don’t know what you don’t know. Please leave the diagnosing to professionals. They have taken a lot of time to study mental health issues, so let them feel important… let them do the diagnosing.
It is unfortunate that the clinical word depression is also the common word used for being sad or bummed out. Everyone feels depressed sometimes. It is a normal reaction to negative things in our lives. A child can feel depressed if she failed a math test. In fact, her depression can be quite dramatic with lots of tears, frustration, and withdrawing to her room. An adult can feel depressed if he loses his job and is worried about his finances. Being very sad is a normal reaction to bad and scary news.
In clinical depression, the feeling of sadness interferes with all aspects of one’s life. Sleep, work, family relationships all suffer. Eating habits can dramatically change. A deep feeling of hopelessness tends to take over the person at their core. This intense feeling can often be ‘felt’ by others who initially worry about the clinically depressed person, and then may pull away from them without even knowing that they are doing so.
In clinical depression, the symptoms go on and on. The person suffering from clinical depression feels pulled into a black hole of hopelessness and despair. They often see no hope in their future.
Some people will only have a single episode of clinical depression, while others may suffer many times over a lifetime. Some types of depression run in families.
Symptoms of depressive disorder are individualized and often in transition. The National Institute of Mental Health notes that people with depression generally have:
• Persistent sad, anxious, or ‘empty’ feelings
• Feelings of hopelessness or pessimism
• Feelings of guilt, worthlessness, or helplessness
• Irritability, restlessness
• Loss of interest in activities or hobbies once pleasurable, including sex
• Fatigue and decreased energy
• Difficulty concentrating, remembering details, and making decisions
• Insomnia, early-morning wakefulness, or excessive sleeping
• Overeating, or appetite loss
• Thoughts of suicide, suicide attempts
• Aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment.
The good news is that there is help for people suffering from depression. But, unfortunately, many people suffer silently for a long time because they do not know there is help available.
If you are showing symptoms of depression, get help. Tell your medical doctor, and/or get a referral to a psychotherapist. Untreated depression can be life threatening.
Many people with Depressive Disorder find themselves drawn to alcohol. Alcohol is a type of drug that is chemically classified as a depressant. Alcohol (and other drugs) can be very dangerous for a person suffering from depression.
If you suspect a friend or loved one is suffering from depression, get them to a mental health provider. When they feel better, they will thank you.
People suffering from Generalized Anxiety Disorder tend to report feeling 'all wound-up'.
“I was always worrying about something,” one patient told me. “At times I knew I had a great life, but I still worried. Were the kids OK? What if I forgot to call my mother on her birthday? Did I embarrass myself when I was talking to a friend last week? It was exhausting!”
Patients with Generalized Anxiety Disorder are unable to 'let go' of a concern and they tend to run from one worry to another, and then onto another. GAD often starts during the teen years. Over time the intensity of the anxiety goes up and down. Without help, GAD often gets worse.
Generalized Anxiety Disorder sufferers tend to have trouble sleeping and focusing throughout the day. During stressful times, GAD symptoms get much worse and can be extremely disruptive to the individual, their family, and in the workplace.
The National Institute of Mental Health notes that people with GAD:
Can’t seem to get rid of their concerns, even though they usually realize that their anxiety is more intense than the situation warrants. They can’t relax, startle easily, and have difficulty concentrating. Often they have trouble falling asleep or staying asleep. Physical symptoms that often accompany the anxiety include fatigue, headaches, muscle tension, muscle aches, difficulty swallowing, trembling, twitching, irritability, sweating, nausea, lightheadedness, having to go to the bathroom frequently, feeling out of breath, and hot flashes.
GAD develops slowly. It often starts during the teen years or young adulthood. Symptoms may get better or worse at different times, and often are worse during times of stress.
When their anxiety level is mild, people with GAD can function socially and hold down a job. Although they don’t avoid certain situations as a result of their disorder, people with GAD can have difficulty carrying out the simplest daily activities if their anxiety is severe.
Generalized Anxiety Disorder is commonly treated with psychotherapy, medication, or both in combination. A type of psychotherapy called cognitive behavioral therapy is especially useful for treating Generalized Anxiety Disorder.
Everyone finds themselves double checking their own thoughts or behaviors: Did I lock the door? Did I turn off the oven? In a complicated world this is normal behavior. There definitely is a lot for each of us to keep track of everyday and we don’t want to make mistakes.
People suffering from Obsessive-Compulsive Disorder find themselves checking, counting, or repeating an action or thought. They tend to know that checking, counting, or repeating an action or thought, is unnecessary, but they can’t stop themselves. They may have to wash their hair seven times every time they shower, even when it makes them late for work. They ‘have to’ flush the toilet eleven times before they feel comfortable enough to leave the bathroom. They may have ritualistic thoughts, such as having to recite a long poem to themselves, over and over whenever they eat.
These ritualistic thoughts and behaviors bring the person with OCD a feeling of brief comfort on one level and great distress on another. The completion of the OCD ritual helps the person feel safe, organized, or in control. While simultaneously the ritual is playing havoc on their daily schedule. Often friends, family, and coworkers initially laugh the idiosyncrasies off, in time, the person’s rituals become a time consuming distraction that can erode relationships.
It is common for OCD sufferers to have distressing thoughts that they try to control with ritualistic behaviors. For example, a teen may be concerned about doing well in school and develop the ritualistic behavior of copying her class notes four times. The ritual may make her feel safer, but keep her from reading the assigned chapter or getting to bed on time.
Common behaviors and symptoms of Obsessive-Compulsive Disorder:
The National Institute of Mental Health notes that people with OCD generally:
• Have repeated thoughts or images about many different things, such as fear of germs, dirt, or intruders; acts of violence; hurting loved ones; sexual acts; conflicts with religious beliefs; or being overly tidy
• Do the same rituals over and over such as washing hands, locking and unlocking doors, counting, keeping unneeded items, or repeating the same steps again and again
• Can't control the unwanted thoughts and behaviors
• Don't get pleasure when performing the behaviors or rituals, but get brief relief from the anxiety the thoughts cause
• Spend at least 1 hour a day on the thoughts and rituals, which cause distress and get in the way of daily life
Obsessive-Compulsive Disorder is commonly treated with psychotherapy, medication, or both in combination. A type of psychotherapy called cognitive behavioral therapy is especially useful for treating Obsessive-Compulsive Disorder.
Often OCD sufferers also exhibit other mental health concerns simultaneously, such as anxiety disorders or depressive disorders.
Attention Deficit Hyperactivity Disorder is a common and often misunderstood mental health disorder which usually starts in childhood, and can continue through the teen years, and into all stages of adulthood.
ADHD is often misunderstood because its symptoms often mimic childhood misbehavior or defiance. Often other childhood onset mental health disorders are confused with ADHD.
I hear it regularly, “My son’s teacher says that little Bobby has ADHD because he won’t listen to her.” Teachers, friends, or family members are not qualified to diagnose ADHD. Another thing I am often told, “My father says I’m too easy on the boy. If I took the belt to him he would listen.” In this situation, the grandfather is not qualified to diagnose if his grandson does not have ADHD.
It is important to get the correct diagnosis so that your child can get the help he or she may need.
There are three types of ADHD
1. Predominantly hyperactive-impulsive
In this form, your child exhibits multiple symptoms of hyperactivity with limited symptoms of inattentiveness.
2. Predominantly inattentive
In this form, your child exhibits multiple symptoms of inattentiveness with limited symptoms of impulsiveness
3. Combined hyperactive-impulsive and inattentive
This is the most common form of ADHD, with children exhibiting multiple symptoms of impulsiveness and inattentiveness.
The National Institute of Mental Health notes generally:
Inattention, hyperactivity, and impulsivity are the key behaviors of ADHD. It is normal for all children to be inattentive, hyperactive, or impulsive sometimes, but for children with ADHD, these behaviors are more severe and occur more often. To be diagnosed with the disorder, a child must have symptoms for 6 or more months and to a degree that is greater than other children of the same age.
Children who have symptoms of inattention may:
• Be easily distracted, miss details, forget things, and frequently switch from one activity to another
• Have difficulty focusing on one thing
• Become bored with a task after only a few minutes, unless they are doing something enjoyable
• Have difficulty focusing attention on organizing and completing a task or learning something new
• Have trouble completing or turning in homework assignments, often losing things (e.g., pencils, toys, assignments) needed to complete tasks or activities
• Not seem to listen when spoken to
• Daydream, become easily confused, and move slowly
• Have difficulty processing information as quickly and accurately as others
• Struggle to follow instructions
Children who have symptoms of hyperactivity may:
• Fidget and squirm in their seats
• Talk nonstop
• Dash around, touching or playing with anything and everything in sight
• Have trouble sitting still during dinner, school, and story time
• Be constantly in motion
• Have difficulty doing quiet tasks or activities.
Children who have symptoms of impulsivity may:
• Be very impatient
• Blurt out inappropriate comments, show their emotions without restraint, and act without regard for consequences
• Have difficulty waiting for things they want or waiting their turns in games
Often interrupt conversations or others' activities
Start with getting your child evaluated by a mental health professional with specific training in diagnosing and treating ADHD. Once the correct diagnosis is made, a path to treatment can begin.
I cannot overemphasize the importance of an evaluation. ADHD is a tricky diagnosis. There are many factors that can influence a child’s behaviors from: issues at home to problems at school; from learning disabilities to undiagnosed conduct disorders; or childhood onset depression. A comprehensive evaluation is important.
Treatments may include medication, psychotherapy, and family support services that are helpful in teaching the parents how to help their child deal with their behavioral disturbances and their personal disorganization.
Everyone, at some time, feels nervous in social situations. This is a normal part of growing up and being part of a community. Individuals suffering from Social Anxiety Disorder have strong to overwhelming fear of what others think of them. Often this fear can debilitate them to the point that it affects their home, school, or work life.
It is common for people with social phobia to fear events that may happen weeks or even months in the future. This fear is not based on evidence but on a nagging thought, 'it could happen.'
Social Phobia can also take the form of being fearful of doing common activities, such as eating in front of others or going through the checkout line at the supermarket. The person may have a 'secret fear’:
What if I choke on my food?
What if I say something stupid to the cashier?
What if I embarrass my children because of my clumsiness in the checkout line?
I call these thoughts 'secret' because the person is aware that their thoughts are not rational, but the fear is so real to them, they don’t tell anyone about these underlying thoughts; choosing to avoid situations rather than deal with them.
Social Anxiety Disorder can make a person’s contact with the world smaller and smaller over time, to the point that it becomes difficult for the person to leave their home. Sometimes their home can become fear provoking to the point that the person is limited to one room or just to their bed.
The National Institute of Mental Health notes that people with Social Anxiety Disorder tend to:
• Be very anxious about being with other people and have a hard time talking to them, even though they wish they could
• Be very self-conscious in front of other people and feel embarrassed
• Be very afraid that other people will judge them
• Worry for days or weeks before an event where other people will be
• Stay away from places where there are other people
• Have a hard time making friends and keeping friends
• Blush, sweat, or tremble around other people
Feel nauseous or sick to their stomach when with other people
Social Anxiety Disorder is commonly treated with psychotherapy, medication, or both in combination. A type of psychotherapy called cognitive behavioral therapy is especially useful for treating Social Anxiety Disorder.
A person with an eating disorder is liable to show a long term disturbance in their diet. They typically eat substantially too much or too little. Over time, a person with an eating disorder tends to have their food intake spiral out of control leading to secondary medical concerns. In severe cases, eating disorders can lead to medical emergencies and even death.
Common eating disorders are:
• anorexia nervosa: Irrational fear of gaining weight characterized by dramatic food restriction; Irrational fear of gaining weight even when deemed medically necessary; Irrational perception of one’s body or body weight leading to dangerously unhealthy weight loss.
• bulimia nervosa: Insatiable overeating; a feeling of an inability to stop eating. Following food consumption, behaviors to mitigate weight gain such as: vomiting, use of laxatives, or excessive exercising.
• binge-eating disorder: Insatiable overeating; a feeling of an inability to stop eating. The binge eating tends to happen at least once every 3 weeks. Episodes of binge eating are not usually followed by behaviors to mitigate weight gain. Following binge eating the person often feels angry with themselves, guilty, and/or depressed
The National Institute of Mental Health notes the following about Eating Disorders:
Anorexia nervosa displays the following symptoms:
• Extreme thinness (emaciation)
• A relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight
• Intense fear of gaining weight
• Distorted body image, a self-esteem that is heavily influenced by perceptions of body weight and shape, or a denial of the seriousness of low body weight
• Lack of menstruation among girls and women
• Extremely restricted eating
Other symptoms may develop over time, including:
• Thinning of the bones (osteopenia or osteoporosis)
• Brittle hair and nails
• Dry and yellowish skin
• Growth of fine hair all over the body (lanugo)
• Mild anemia and muscle wasting and weakness
• Severe constipation
• Low blood pressure, slowed breathing and pulse
• Damage to the structure and function of the heart
• Brain damage
• Multi-organ failure
• Drop in internal body temperature, causing a person to feel cold all the time
• Lethargy, sluggishness, or feeling tired all the time
People with bulimia nervosa usually maintain what is considered a healthy or normal weight, while some are slightly overweight. But like people with anorexia nervosa, they often fear gaining weight, want desperately to lose weight, and are intensely unhappy with their body size and shape. Usually, bulimic behavior is done secretly because it is often accompanied by feelings of disgust or shame. The binge-eating and purging cycle happens anywhere from several times a week to many times a day.
• Chronically inflamed and sore throat
• Swollen salivary glands in the neck and jaw area
• Worn tooth enamel, increasingly sensitive and decaying teeth as a result of exposure to stomach acid
• Acid reflux disorder and other gastrointestinal problems
• Intestinal distress and irritation from laxative abuse
• Severe dehydration from purging of fluids
• Electrolyte imbalance (too low or too high levels of sodium, calcium, potassium and other minerals) which can lead to heart attack.
With binge-eating disorder a person loses control over his or her eating. Unlike bulimia nervosa, periods of binge-eating are not followed by purging, excessive exercise, or fasting. As a result, people with binge-eating disorder often are over-weight or obese. People with binge-eating disorder who are obese are at higher risk for developing cardiovascular disease and high blood pressure. They also experience guilt, shame, and distress about their binge-eating, which can lead to more binge-eating.
Eating disorders are, or quickly can become, a medical and psychological emergency. It is best to start with a full medical evaluation. Often eating disorders are intertwined with other mental health disorders such as clinical depression, mood disorders, or anxiety disorders.
Eating disorder treatment tends to be complex, and often a team consisting of a medical doctor, a nutritionist, and a psychotherapist (individual and family) are needed. In some situations hospitalization may be needed due to malnutrition or suicidal behaviors.
When we are in real or perceived life threatening danger we naturally react with with a fight, flight or freeze response, commonly called the fight or flight response.
It is called a response because it is not under our control. In psychology, a response is outside of the person’s initial control, like flinching to an unexpected loud noise. The fight, flight or freeze response helped keep our ancestors alive when they were potential dinners for bigger, meaner, and intelligent predatory animals, giving a chance for us to be born, yeah!
Sometimes the fight, flight or freeze response has an unfortunate long term mental health consequence: Post-traumatic Stress Disorder (PTSD).
Following a terrifying experience when a person’s life is in danger; they see a loved one in severe danger; or they witness a horrifying event; the fight, flight or freeze response can be damaged.
A person suffering from PTSD can relive the horrors of the terrifying event long after they are safe.
The public has become aware of PTSD as the aftermath of war, but in addition to veterans, mental health professionals often diagnose PTSD in the victims of rape, domestic violence, workplace violence, natural disasters, physical and sexual child abuse, and tragic auto accidents.
Common behaviors and symptoms of Post-traumatic Stress Disorder:
The National Institute of Mental Health notes the following concerning post-traumatic stress disorder:
PTSD can cause many symptoms. These symptoms can be grouped into three categories:
1. Re-experiencing symptoms
• Flashbacks—reliving the trauma over and over, including physical symptoms like a racing heart or sweating
• Bad dreams
• Frightening thoughts
Re-experiencing symptoms may cause problems in a person’s everyday routine. They can start from the person’s own thoughts and feelings. Words, objects, or situations that are reminders of the event can also trigger re-experiencing.
2. Avoidance symptoms
• Staying away from places, events, or objects that are reminders of the experience
• Feeling emotionally numb
• Feeling strong guilt, depression, or worry
• Losing interest in activities that were enjoyable in the past
• Having trouble remembering the dangerous event.
Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine. For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car.
3. Hyperarousal symptoms
• Being easily startled
• Feeling tense or 'on edge'
• Having difficulty sleeping, and/or having angry outbursts.
Hyperarousal symptoms are usually constant, instead of being triggered by things that remind one of the traumatic event. They can make the person feel stressed and angry. These symptoms may make it hard to do daily tasks, such as sleeping, eating, or concentrating.
It’s natural to have some of these symptoms after a dangerous event. Sometimes people have very serious symptoms that go away after a few weeks. This is called Acute Stress Disorder, or ASD. When the symptoms last more than a few weeks and become an ongoing problem, they might be PTSD. Some people with PTSD don’t show any symptoms for weeks or months.
Children and teens can have extreme reactions to trauma, but their symptoms may not be the same as adults. In very young children, these symptoms can include:
• Bedwetting, when they’d learned how to use the toilet before
• Forgetting how or being unable to talk
• Acting out the scary event during playtime
• Being unusually clingy with a parent or other adult.
Older children and teens usually show symptoms more like those seen in adults. They may also develop disruptive, disrespectful, or destructive behaviors. Older children and teens may feel guilty for not preventing injury or deaths. They may also have thoughts of revenge.
PTSD is commonly treated with psychotherapy, medication, or both in combination. Often PTSD can affect the patient’s family and friends. Family and group psychotherapy, along with social work support, has been shown to be helpful.
For more information about The National Institute of Mental Health (NIMH)
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