Mental Illness Basics

Mental Illness Basics

Summary

Mental illness is a term used to describe significant disturbances in thought, mood or behavior that cause patients to have difficulty functioning psychologically. Patients may have difficulty interacting with others in social settings, performing efficiently on the job or at school, forging strong relationships or carrying out other aspects of day-to-day life.

There are many different formally recognized types of mental illness. Approximately 54 million people in the United States experience some form of mental illness annually, according to the National Mental Health Association.

Mental illnesses are classified according to the symptoms that a patient experiences, as well as the clinical features of the illness. Some of the major categories of mental illness include anxiety disorders, cognitive disorders, developmental disorders, dissociative disorders, mood disorders, personality disorders, schizophrenia and substance abuse disorders.

Although many mental illnesses are chronic, others are cyclical (e.g., seasonal affective disorder) or temporary (e.g., postpartum depression) in duration.

There are many different potential causes of mental illness. Some people are born with genetic factors or chemical imbalances that make them more likely than others to develop a particular mental condition. Risk factors other than biology, such as a traumatic event or environmental stress, can also trigger mental illness. In some cases, the cause of a particular mental illness is unknown. However, researchers are currently working to identify factors that contribute to these conditions.

The signs and symptoms of mental illness vary significantly in both nature and severity depending on the individual and the condition that is present. Some are obvious, whereas others are more subtle. In diagnosing a mental illness, a physician or a non-physician mental health professional will note these signs and symptoms, as well as any impairment in occupation or social functioning that is present.

Psychotherapy, medications or a combination of both are often used to treat symptoms associated with mental illness. Many mental illnesses cannot be prevented. However, some symptoms can be prevented or managed before they worsen by taking steps such as trying to remain positive about life circumstances, learning and using problem-solving skills that can help one cope with life’s challenges, and discussing concerns and difficulties with trusted family members and friends.

About mental illness

Mental illness is a term used to describe significant disturbances in thought, mood or behavior that cause patients to have trouble functioning in at least some aspects of day-to-day life. There are many formally recognized forms of mental illness. Approximately 54 million people in the United States experience some form of mental illness annually, according to the National Mental Health Association (NMHA).

Many mental illnesses are chronic. However, others are cyclical (e.g., seasonal affective disorder) or temporary (e.g., postpartum depression) in duration.

Many people have difficulties with depression, anxiety or other problems, but lack the persistent, severe symptoms that meet the diagnostic criteria for particular mental health disorders. People who have good mental health are in control of their thoughts, feelings and behaviors most of the time. They usually feel good about themselves and have strong relationships with family and friends. Such people have a strong foundation of mental health that allows them to keep problems in perspective when they occur.

In contrast, people with mental illnesses have disruptions in thoughts, feelings, moods and their ability to relate to others. They often have problems interacting with others in social settings or performing efficiently on the job or at school. Patients may find that mental illness inhibits their ability to forge strong relationships.

Today, society is more aware of the causes and costs of mental illness than ever before. As a result, people may be more willing to seek treatment for their illness. Nonetheless, many mentally ill people are unaware of their options or still feel stigmatized by their condition and are reluctant to take advantage of the help that is available to reduce their symptoms.

Types and differences of mental illnesses

Mental illnesses are classified according to the symptoms that a patient experiences, as well as the clinical features of the illness. All recognized mental illnesses have been assigned diagnostic criteria by the American Psychiatric Association (APA). Major categories of mental illness include:

  • Anxiety disorders. Conditions in which patients feel anxious or distressed for no logical reason. People with these disorders may experience chronic, intense and irrational anxiety on a regular or even daily basis. As a result, anxiety disorders can seriously diminish quality of life, hampering a person’s ability to work, travel and form and maintain interpersonal relationships. Examples include post-traumatic stress disorder(PTSD), panic disorder, obsessive-compulsive disorder(OCD), generalized anxiety disorder(GAD) and various specific phobias.

  • Cognitive disorders. Conditions marked by impaired awareness, perception, reasoning, memory and judgment. Patients with these disorders have difficulty with the basic processes of thinking. Examples include delirium, dementia and amnestic (amnesia) disorder.

  • Developmental disorders. Conditions that delay or impede a child’s physical or psychological development. They begin in childhood and involve a wide range of symptoms. Examples include  autism, attention-deficit hyperactivity disorder(ADHD) and learning disabilities.

  • Dissociative disorders. Conditions in which patients frequently escape reality by suppressing their memories or taking on other identities. This dissociation occurs when a group of normal mental processes becomes separated from other mental processes. Examples include dissociative amnesia, dissociative fugue, dissociative identity disorder([DID] formerly known as multiple personality disorder) and depersonalization disorder.

  • Eating disorders. Conditions that involve serious disturbances in eating behavior, including unhealthy reduction of food intake, severe overeating and/or dangerous methods to prevent weight gain, such as self-induced vomiting. Examples include anorexia nervosa, bulimia nervosa, binge eating disorder, rumination disorder and pica.

  • Mood disorders. Conditions with an abnormal mood as their primary feature. “Mood” refers to the sustained feelings and emotions through which a person interprets life. Most mood disorders are defined and diagnosed by the occurrence of one or more mood episodes, or periods of abnormal happiness or sadness. Examples include major depression, bipolar disorder, dysthymia and seasonal affective disorder.

  • Personality disorders. Conditions in which a person struggles to deal with other people and acts in a manner that is inflexible and not well-suited to coping with the demands and changes of life. Personality disorders begin by early adulthood, remain stable over time and create distress or impairment in a person’s life. Examples include borderline personality disorder(BPD), antisocial personality disorder and avoidant personality disorder(APD).

  • Schizophrenia. Chronic mental disorder that makes it difficult to distinguish between real and imagined experiences, think logically or have normal emotional responses to situations.

  • Sexual disorders. Conditions that prevent people from having rich and fulfilling sexual relationships. These disorders involve problems related to sexual functioning, desire or performance. Examples include sexual dysfunctions, paraphilias and gender identity disorders.

  • Sleep disorders. Conditions that involve include difficulty falling or staying asleep, falling asleep at inappropriate times, sleeping excessively or abnormal behaviors during sleep. Examples include dyssomnias (e.g., insomnia, narcolepsy), parasomnias (e.g., night terrors, sleepwalking), sleep disorders associated with medical or psychiatric conditions and proposed sleep disorders (sleep problems for which there is insufficient information to establish them as distinct disorders).

  • Somatoform disorders. Conditions in which individuals experience symptoms that cannot be attributed to a physical cause. Hypochondriasis is an example of a somatoform disorder.

  • Substance abuse disorders. Problems that are associated with the abuse of alcohol, nicotine, caffeine, nonprescription medications, prescription medications and illegal drugs.

Potential causes of mental illness

There are many different potential causes of mental illness. Some people are born with risk factors such as genetic predisposition or chemical imbalances that trigger their condition. For example, a person with a family history of depression may develop this disorder even if they have not experienced a distressing event.  

Mental functions are controlled and interpreted by the brain. For people with mental health disorders, the brain undergoes changes in structure and function which influence behavior.

Research has also shown that the incidence level of major mental illnesses such as schizophrenia and major depression is relatively consistent across diverse societies throughout the world. This lends additional support to the notion that the basis for these disorders is biological in part.

However, factors other than biology can also trigger mental illness, such as a stressful event or series of events. For example, some people with no history of or risk factors for mental illness may develop post-traumatic stress disorder (PTSD) following a tragic event, such as the death of a loved one, combat, rape or child abuse.

Scientists do not fully understand how most mental illnesses are triggered, and research continues in an attempt to further understand how these illnesses unfold.

Signs and symptoms of mental illness

The signs and symptoms of mental illness vary significantly in nature, duration and severity depending on both the individual and the condition that is present. In some cases, these signs and symptoms are indicators of an obvious problem. For example, patients who have schizophrenia may hear voices in their heads, a clear sign of a lack of mental well-being.

In other cases, symptoms may be more subtle. People who become sad over the unexpected death of a loved one experience normal emotion related to grief. However, sadness that continues for long periods – or that is debilitating – may indicate the mental disorder known as depression.

Symptoms associated with some forms of mental illness include:

  • Anxiety and fear
  • Changes in sleep patterns
  • Difficulty thinking or concentrating
  • Fatigue and loss of energy
  • Feelings of hopelessness, helplessness
  • Generalized pain
  • Restlessness and irritability
  • Significant change in appetite or weight
  • Delusions or hallucinations
  • Thoughts of suicide or self-destructive behavior

Diagnosis methods for mental illness

Diagnosis of a mental health condition is often made after a primary care physician consults with many other health professionals, including mental health professionals such as psychologists or psychiatrists.

Most types of mental illness cannot be identified through diagnostic procedures such as imaging tests, blood tests or urinalysis. Instead, mental health professionals use structured interviewing techniques  in which information gleaned from a patient’s signs (observations made objectively by the health professional) and symptoms (subjective feelings or emotions reported by the patient) lead to a likely diagnosis.

To approach the diagnosis of mental illnesses, mental health professionals rely on the criteria outlined in  the Diagnostic and Statistical Manual of Mental Disorders(DSM), which is published by American Psychiatric Association, or The International Classification of Disease (ICD), which is published by the World Health Organization. These guidelines provide standardized definitions and criteria which help the professionals categorize mental illnesses based on descriptions of symptoms and on the course of the illness.

The examiner will also pay close attention to any functional impairments the patient may have. A functional impairment is an inability to perform basic daily tasks. This can include anything from having difficulty dressing for work to fear of carrying out basic errands such as grocery shopping.

The professional may also ask a series of questions to gain additional insight into the patient’s condition. Such questions may include:

  • For how long has the patient been experiencing symptoms?
  • How severe are the patient’s symptoms?
  • Are the symptoms upsetting to the patient?
  • Are the symptoms disruptive to the patient’s life?

Psychological tests and scales are also commonly used for the measurement of cognition, abilities, attitudes, and personality traits.

Patients are sometimes reluctant to seek mental health care because of the stigma attached to mental illness. Nonetheless, mental health treatment is becoming more accepted by society and those who do seek care often find that good treatment solutions are available.

Treatment options for mental illness

Once a mental illness is diagnosed, it is usually treated with psychotherapy, medication to address the problems in brain chemistry or a combination of both. Just because two conditions share symptoms and clinical features does not necessarily mean that they should be treated in the same way. Instead, treatments should be selected based on the underlying biology that is causing the condition and the specific symptoms of the individual patient.

During psychotherapy, patients are encouraged to talk about their condition and any related issues with a mental health professional, such as a psychiatrist, psychologist or clinical social worker. Psychotherapy is based on the theory that patients can improve their emotional well-being and mental health by talking about their concerns or problems with a therapist.  The therapist can help them find better ways to cope, solve problems and set realistic goals for improvement. Treatment may take the form of individual therapy, group therapy or a combination of both. It can last anywhere from a few weeks to several years depending on the nature of a patient’s condition.

Common forms of psychotherapy used to treat emotional and mental health disorders include cognitive behavior therapy(CBT), psychodynamic psychotherapy and interpersonal therapy(IPT). Patients may also benefit from attending support groups where they discuss their feelings with others who share their mental illness.

In addition, many medications can help alleviate the symptoms of mental illness by restoring the brain’s chemistry to a more normal state. These include anti-anxiety drugs, antidepressants, antipsychotics, mood stabilizers and central nervous system (CNS) stimulants.

Patients should be aware that the U.S. Food and Drug Administration (FDA) has advised that antidepressants may increase the risk of suicidal thinking in some patients and all people being treated with them should be monitored closely for unusual changes in behavior.

Additionally, not all medications are suitable for all patients. For instance, women who are pregnant or breastfeeding may not be candidates for certain medications (e.g., selective serotonin reuptake inhibitors) because the drugs may adversely affect a developing fetus or nursing infant.

It is also advised that patients always consult their physician before beginning or discontinuing a medication.

Another option called electroconvulsive therapy (ECT, a series of electrical shocks are delivered to the brain to induce seizures) may be used to treat severe depression. Vagus nerve stimulation is a unique technique which recently became available specifically for treatment-resistant depression. Transcranial Magnetic Stimulation (TMS) is a non-invasive technique that appears promising as a treatment, particularly for major depression. However, TMS is still experimental and actual clinical use will require much more research.

Prevention of mental illness

Many mental illnesses cannot be prevented. For example, there is little that anyone can do to prevent the onset of cognitive disorders such as Alzheimer’s disease. However, the symptoms associated with many mental illnesses can be managed or reduced – if not eliminated – by taking certain steps.

Such steps include trying to remain positive about life circumstances, learning and using problem-solving skills that can help one cope with life’s challenges, taking all medications as prescribed by a physician and discussing concerns and difficulties with friends, family and mental health professionals. Eating right, exercising and getting proper amounts of rest may also help patients to feel more relaxed, which, in turn, may reduce symptoms.

In some cases, these steps can go beyond just reducing symptoms and can actually help prevent a mental illness from developing in the first place. For example, people who have depression after experiencing tragic events may be less likely to develop long-term symptoms if they can seek support from loved ones.

Questions for your doctor about mental illness

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions related to mental illness:

  1. What signs and symptoms do I display that might indicate mental illness?
  2. Which mental illness do you suspect I have?
  3. Why do you suspect that my feelings/thoughts/behaviors are not normal?
  4. How will you arrive at an official diagnosis of my condition?
  5. What is the likely cause of my mental illness?
  6. Is my mental illness chronic?
  7. What are my treatment options?
  8. What if I take a medication and it does not work for me?
  9. What is the long-term prognosis for my condition?
  10. Are there specific signs and symptoms that might indicate my condition is worsening or improving?
  11. Are there things I can do to reduce or prevent symptoms associated with my illness?
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