Glossary of Common Mental Health Conditions
There are several factors believed to contribute to ADHD:
- Genetics. ADHD often runs in families and some trends in specific brain areas that contribute to attention.
- Environmental factors. Studies show a link between cigarette smoking and alcohol use during pregnancy and children who have ADHD. Exposure to lead as a child has also been shown to increase the likelihood of ADHD in children.
ADHD occurs in both children and adults, but is most often diagnosed in childhood. The symptoms of ADHD are often typical behavior in most young children, so diagnosis can be challenging. Teachers are often the first to notice ADHD symptoms because they see children in a learning environment with peers every day. There is no one single test that can diagnose a child with ADHD, so meet with a doctor or mental health professional to gather all the necessary information to make a diagnosis. The goal is to rule out any outside causes for symptoms, such as environmental changes, difficulty in school and medical problems.
Someone with ADHD will have trouble controlling these behaviors and will show them much more frequently and for longer than 6 months.
Signs of inattention include:
- Becoming easily distracted, and jumping from activity to activity.
- Becoming bored with a task quickly.
- Difficulty focusing attention or completing a single task or activity.
- Trouble completing or turning in homework assignments.
- Losing things such as school supplies or toys.
- Not listening or paying attention when spoken to.
- Daydreaming or wandering with lack of motivation.
- Difficulty processing information quickly.
- Struggling to follow directions.
Signs of hyperactivity include:
- Fidgeting and squirming, having trouble sitting still.
- Non-stop talking.
- Touching or playing with everything.
- Difficulty doing quiet tasks or activities.
Signs of impulsivity include:
- Acting without regard for consequences, blurting things out.
- Difficulty taking turns, waiting or sharing.
- Interrupting others.
ADHD is managed and treated in several ways:
- Stimulants, nonstimulants and antidepressants
- Behavioral therapy
- Self-management, education programs and assistance through schools or work or alternative treatment approaches
- Genetics. Some families will have a higher than average numbers of members experiencing anxiety issues, and studies support the evidence that anxiety disorders run in families. This can be a factor in someone developing an anxiety disorder.
- Environmental. A stressful or traumatic event such as abuse, death of a loved one, violence or prolonged illness is often linked to the development of an anxiety disorder.
The physical symptoms of an anxiety disorder can be easily confused with other medical conditions, like heart disease or hyperthyroidism. Therefore, a doctor will likely perform an evaluation involving a physical examination, an interview and lab tests. After ruling out a medical illness, the doctor may recommend a visit with a mental health professional to make a diagnosis. Using the Diagnostic and Statistical Manual of Mental Disorders (DSM), a mental health professional is able to identify the specific type of anxiety disorder causing the symptoms as well as any other possible disorders.
No two people who have anxiety experience the same conditions. However, all anxiety disorders have one thing in common: persistent, excessive fear or worry in situations that are not threatening. People can experience one or more of the following symptoms
- Feelings of apprehension or dread
- Feeling tense and jumpy
- Restlessness or irritability
- Anticipating the worst and being watchful for signs of danger
- Pounding or racing heart and shortness of breath
- Sweating, tremors and twitches
- Headaches, fatigue and insomnia
- Upset stomach, frequent urination or diarrhea
Treatments vary on a case-by-case basis. Sometimes, individuals are prescribed multiple treatment options to combat their symptoms, and other times, one treatment suffices.
- Psychotherapy, including cognitive behavioral therapy
- Medications, including antianxiety medications and antidepressants
- Complementary health approaches, including stress and relaxation techniques
Scientists have not discovered a single cause of autism. They believe several factors may contribute to this developmental disorder:
Genetics. If one child in a family has autism, another sibling is more likely to develop it too. Likewise, identical twins are highly likely to both develop autism if it is present. Relatives of children with autism show minor signs of communication difficulties. Scans reveal that people on the autism spectrum have certain abnormalities of the brain’s structure and chemical function.
Environment. Scientists are currently researching many environmental factors that are thought to play a role in contributing to autism. Many prenatal factors may contribute to a child’s development, such as a mother’s health. Other postnatal factors may affect development as well. Despite many claims that have been highlighted by the media, strong evidence has been shown that vaccines do not cause autism.
Diagnosing autism is often a 2-stage process.
The first stage involves general developmental screening during well-child checkups with a pediatrician. Children who show some developmental problems are referred for more evaluation.
The second stage involves a thorough evaluation by a team of doctors and other health professionals with a wide range of specialties. At this stage, a child may be diagnosed as having autism or another developmental disorder. Typically, children with ASD can be reliably diagnosed by age 2, though some may not be diagnosed until they are older.
There is a wide range of symptoms that fall on the autism spectrum. Usually these symptoms start to reveal themselves within the first few years of a child’s life. These can include:
- Delay in language development, such as not responding to their own name or speaking only in single words, if at all.
- Repetitive and routine behaviors, such as walking in a specific pattern or insisting on eating the same meal every day.
- Difficulty making eye contact, such as focusing on a person’s mouth when that person is speaking instead of their eyes, as is usual in most young children.
- Sensory problems, such as experiencing pain from certain sounds, like a ringing telephone or not reacting to intense cold or pain, certain sights, sounds, smells, textures and tastes.
- Difficulty interpreting facial expressions, such as misreading or not noticing subtle facial cues, like a smile, wink or grimace, that could help understand the nuances of social communication.
- Problems with expressing emotions, such as facial expressions, movements, tone of voice and gestures that are often vague or do not match what is said or felt.
- Fixation on parts of objects, such as focusing on a rotating wheel instead of playing with peers.
- Absence of pretend play, such as taking a long time to line up toys in a certain way, rather than playing with them.
- Difficulty interacting with peers, because they have a difficult time understanding that others have different information, feelings and goals.
- Self-harm behavior, such as hitting his head against a wall as a way of expressing disapproval.
- Sleep problems, such as falling asleep or staying asleep.
Autism cannot be cured, but it can be treated and managed effectively in several ways:
- Education and development, including specialized classes and skills training, time with therapists and other specialists
- Behavioral treatments, such as applied behavior analysis (ABA)
- Medication for co-occurring symptoms, combined with therapy
- Complementary and alternative medicine (CAM), such as supplements and changes in diet
Scientists have not discovered a single cause of bipolar disorder. They believe several factors may contribute:
Genetics. The chances of developing bipolar disorder are increased if a child’s parents or siblings have the disorder. But the role of genetics is not absolute. A child from a family with a history of bipolar disorder may never develop the disorder. And studies of identical twins have found that even if one twin develops the disorder the other may not.
Stress. A stressful event such as a death in the family, an illness, a difficult relationship or financial problems can trigger the first bipolar episode. Thus, an individual’s style of handling stress may also play a role in the development of the illness. In some cases, drug abuse can trigger bipolar disorder.
Brain structure. Brain scans cannot diagnose bipolar disorder in an individual. Yet, researchers have identified subtle differences in the average size or activation of some brain structures in people with bipolar disorder. While brain structure alone may not cause it, there are some conditions in which damaged brain tissue can predispose a person. In some cases, concussions and traumatic head injuries can increase the risk of developing bipolar disorder.
A doctor may perform a physical examination, conduct an interview and order lab tests. While bipolar disorder cannot be identified through a blood test or body scan, these tests can help rule out other illnesses that can resemble the disorder, such as hyperthyroidism. If no other illnesses (or other medicines such as steroids) are causing the symptoms, the doctor may recommend the person see a psychiatrist. To be diagnosed with bipolar illness, a person has to have had at least one episode of mania or hypomania.
The Diagnostic and Statistical Manual (DSM) of mental disorders defines four types of bipolar illness:
Bipolar I Disorder is an illness in which people have experienced one or more episodes of mania. Most people diagnosed with bipolar I will have episodes of both mania and depression, though an episode of depression is not necessary for a diagnosis. To be diagnosed with bipolar I, a person’s manic or mixed episodes must last at least seven days or be so severe that he requires hospitalization.
Bipolar II Disorder is a subset of bipolar disorder in which people experience depressive episodes shifting back and forth with hypomanic episodes, but never a full manic episode.
Cyclothymic Disorder or Cyclothymia, is a chronically unstable mood state in which people experience hypomania and mild depression for at least two years. People with cyclothymia may have brief periods of normal mood, but these periods last less than eight weeks.
Bipolar Disorder “other specified” and “unspecified” is diagnosed when a person does not meet the criteria for bipolar I, II or cyclothymia but has had periods of clinically significant abnormal mood elevation. The symptoms may either not last long enough or not meet the full criteria for episodes required to diagnose bipolar I or II.
People can describe symptoms in a variety of ways. How a person describes symptoms often depends on the cultural lens she is looking through. So people who have been diagnosed with bipolar disorder should look for a health care professional who understands their background and shares their expectations for treatment.
Due to the variety of bipolar disorders and the varying experiences of each individual per their own cultural lens, symptoms differ widely. A person with bipolar disorder may have
- Distinct manic or depressed states: A person with mixed episodes experiences both extremes simultaneously or in rapid sequence. Severe bipolar episodes of mania or depression may also include psychotic symptoms such as hallucinations or delusions.
- Someone who is manic might believe he has special powers and may display risky behavior.
- Someone who is depressed might feel hopeless, helpless and be unable to perform normal tasks.
- People with bipolar disorder who have psychotic symptoms may be wrongly diagnosed as having schizophrenia.
- Mania: To be diagnosed with bipolar disorder, a person must have experienced mania or hypomania.
- Hypomania is a milder form of mania that doesn’t include psychotic episodes.
- People with hypomania can often function normally in social situations or at work.
- Some people with bipolar disorder will have episodes of mania or hypomania many times; others may experience them only rarely.
- Rapidly changing, unpredictable moods.
- During periods of mania, people frequently behave impulsively, make reckless decisions and take unusual risks.
- Most of the time, people in manic states are unaware of the negative consequences of their actions.
- Depression: Depression produces a combination of physical and emotional symptoms that inhibit a person’s ability to function nearly every day for a period of at least two weeks.
- The level of depression can range from severe to moderate to mild low mood, which is called dysthymia when it is chronic.
- The lows of bipolar depression are often so debilitating that people may be unable to get out of bed. Typically, depressed people have difficulty falling and staying asleep, but some sleep far more than usual.
- When people are depressed, even minor decisions such as what to have for dinner can be overwhelming.
- They may become obsessed with feelings of loss, personal failure, guilt or helplessness.
- This negative thinking can lead to thoughts of suicide. In bipolar disorder, suicide is an ever-present danger, as some people become suicidal in manic or mixed states.
Early warning signs of bipolar disorder in children and teens worth evaluating with a trained medical professional:
Children may experience severe temper tantrums when told “no.” Tantrums can last for hours while the child continues to become more violent. They may also show odd displays of happy or silly moods and behaviors.
Teenagers may experience a drop in grades, quit sports teams or other activities, be suspended from school or arrested for fighting or drug use, engage in risky sexual behavior or talk about death or even suicide.
Bipolar disorder is treated and managed in several ways:
- Medications, such as mood stabilizers, antipsychotic medications and antidepressants
- Psychotherapy, such as cognitive behavioral therapy and family-focused therapy
- Electroconvulsive therapy (ECT)
- Self-management strategies and education
- Complementary health approaches such as meditation, faith and prayer
The causes of borderline personality disorder are not fully understood, but scientists agree that it is the result of a combination of factors:
Genetics. While no specific gene has been shown to directly cause BPD, studies in twins suggest this illness has strong hereditary links. BPD is about five times more common among people who have a first-degree relative with the disorder.
Environmental factors. People who experience traumatic life events, such as physical or sexual abuse during childhood or neglect and separation from parents, are at increased risk of developing BPD.
Brain function. The way the brain works is often different in people with BPD, suggesting that there is a neurological basis for some of the symptoms. Specifically, the portions of the brain that control emotions and decision-making/judgment may not communicate well with one another.
There is no single medical test to diagnose BPD, and a diagnosis is not based on one sign or symptom. BPD is diagnosed by a mental health professional following a comprehensive psychiatric interview that may include talking with previous clinicians, medical evaluations and, when appropriate, interviews with friends and family. To be diagnosed with BPD, a person must have at least five of the nine BPD symptoms listed below.
People with BPD experience wide mood swings and can display a great sense of instability and insecurity. Signs and symptoms may include:
- Frantic efforts to avoid being abandoned by friends and family.
- Unstable personal relationships that alternate between idealization — “I’m so in love!” — and devaluation — “I hate her.” This is also sometimes known as “splitting.”
- Distorted and unstable self-image, which affects moods, values, opinions, goals and relationships.
- Impulsive behaviors that can have dangerous outcomes, such as excessive spending, unsafe sex, substance abuse or reckless driving.
- Suicidal and self-harming behavior.
- Periods of intense depressed mood, irritability or anxiety lasting a few hours to a few days.
- Chronic feelings of boredom or emptiness.
- Inappropriate, intense or uncontrollable anger often followed by shame and guilt.
- Dissociative feelings — disconnecting from your thoughts or sense of identity, or “out of body” type of feelings — and stress-related paranoid thoughts. Severe cases of stress can also lead to brief psychotic episodes.
Borderline personality disorder is ultimately characterized by the emotional turmoil it causes. People who have it feel emotions intensely and for long periods of time, and it is harder for them to return to a stable baseline after an emotionally intense event. Suicide threats and attempts are very common for people with BPD. Self-harming acts, such as cutting and burning, are also common.
A typical, well-rounded treatment plan includes psychotherapy, medications, and group, peer and family support. The overarching goal is for someone with BPD to increasingly self-direct his/her treatment plan as a person learns what works as well as what doesn’t.
Psychotherapy, such as dialectical behavioral therapy (DBT), cognitive behavioral therapy (CBT) and psychodynamic psychotherapy, is the first line of choice for BPD.
Medications are often instrumental to a treatment plan, but there is no one medication specifically made to treat the core symptoms of emptiness, abandonment and identity disturbance. Rather, several medications can be used off-label to treat the remaining symptoms. For example, mood stabilizers and antidepressants help with mood swings and dysphoria. Antipsychotic medication may help control symptoms of rage and disorganized thinking.
Short-term hospitalization may be necessary during times of extreme stress, and/or impulsive or suicidal behavior to ensure safety.
Depression does not have a single cause. It can be triggered, or it may occur spontaneously without being associated with a life crisis, physical illness or other risk. Scientists believe several factors contribute to cause depression:
- Trauma. When people experience trauma at an early age, it can cause long-term changes in how their brains respond to fear and stress. These brain changes may explain why people who have a history of childhood trauma are more likely to experience depression.
- Genetics. Mood disorders and risk of suicide tend to run in families, but genetic inheritance is only one factor. Identical twins share 100% of the same genes, but will both develop depression only about 30% of the time. People who have a genetic tendency to develop depression are more likely to show signs at a younger age. While a person may have a genetic tendency, life factors and events seem to influence whether he or she will ever actually experience an episode.
- Life circumstances. Marital status, financial standing and where a person lives have an effect on whether a person develops depression, but it can be a case of “the chicken or the egg.” For example, depression is more common in people who are homeless, but the depression itself may be the reason a person becomes homeless.
- Brain structure. Imaging studies have shown that the frontal lobe of the brain becomes less active when a person is depressed. Brain patterns during sleep change in a characteristic way. Depression is also associated with changes in how the pituitary gland and hypothalamus respond to hormone stimulation.
- Other medical conditions. People who have a history of sleep disturbances, medical illness, chronic pain, anxiety, and attention-deficit hyperactivity disorder (ADHD) are more likely to develop depression.
- Drug and alcohol abuse. Approximately 30% of people with substance abuse problems also have depression.
To be diagnosed with depression, a person must have experienced a major depressive episode that has lasted longer than two weeks. The symptoms of a major depressive episode include:
- Loss of interest or loss of pleasure in all activities
- Change in appetite or weight
- Sleep disturbances
- Feeling agitated or feeling slowed down
- Feelings of low self worth, guilt or shortcomings
- Difficulty concentrating or making decisions
- Suicidal thoughts or intentions
Diagnosing depression can be complicated because a depressive episode can be part of bipolar disorder or another mental illness. How a person describes symptoms often depends on the cultural lens she is looking through.
Just like with any mental health condition, people with depression or who are going through a depressive episode (also known as major or clinical depression) experience symptoms differently. But for most people, depression changes how they function day-to-day.
- Changes in sleep. Many people have trouble falling asleep, staying asleep or sleeping much longer than they used to. Waking up early in the morning is common for people with major depression.
- Changes in appetite. Depression can lead to serious weight loss or gain when a person stops eating or uses food as a coping mechanism.
- Lack of concentration. A person may be unable to focus during severe depression. Even reading the newspaper or following the plot of a TV show can be difficult. It becomes harder to make decisions, big or small.
- Loss of energy. People with depression may feel profound fatigue, think slowly or be unable to perform normal daily routines.
- Lack of interest. People may lose interest in their usual activities or lose the capacity to experience pleasure. A person may have no desire to eat or have sex.
- Low self esteem. During periods of depression, people dwell on losses or failures and feel excessive guilt and helplessness. Thoughts like “I am a loser” or “the world is a terrible place” or “I don’t want to be alive” can take over.
- Hopelessness. Depression can make a person feel that nothing good will ever happen. Suicidal thoughts often follow these kinds of negative thoughts—and need to be taken seriously.
- Changes in movement. People with depression may look physically depleted or they may be agitated. For example, a person may wake early in the morning and pace the floor for hours.
- Physical aches and pains. Instead of talking about their emotions or sadness, some people may complain about a headache or an upset stomach.
Although depression can be a devastating illness, it often responds to treatment. The key is to get a specific evaluation and a treatment plan. Today, there are a variety of treatment options available for people with depression:
- Medications including antidepressants, mood stabilizers and antipsychotic medications
- Psychotherapy including cognitive behavioral therapy, family-focused therapy and interpersonal therapy
- Brain stimulation therapies including electroconvulsive therapy (ECT) or repetitive transcranial magnetic stimulation (rTMS)
- Light therapy, which uses a light box to expose a person to full spectrum light and regulate the hormone melatonin
- Alternative therapies including acupuncture, meditation and nutrition
- Self-management strategies and education
- Mind/body/spirit approaches such as meditation, faith and prayer
Dissociative disorders usually develop as a way of dealing with trauma. Dissociative disorders most often form in children exposed to long-term physical, sexual or emotional abuse. Natural disasters and combat can also cause dissociative disorders.
Doctors diagnose dissociative disorders based on a review of symptoms and personal history. A doctor may perform tests to rule out physical conditions that can cause symptoms such as memory loss and a sense of unreality (for example, head injury, brain lesions or tumors, sleep deprivation or intoxication). If physical causes are ruled out, a mental health specialist is often consulted to make an evaluation.
Many features of dissociative disorders can be influenced by a person’s cultural background. In the case of dissociative identity disorder and dissociative amnesia, patients may present with unexplained, non-epileptic seizures, paralyses or sensory loss. In settings where possession is part of cultural beliefs, the fragmented identities of a person who has DID may take the form of spirits, deities, demons or animals. Intercultural contact may also influence the characteristics of other identities. For example, a person in India exposed to Western culture may present with an “alter” who only speaks English. In cultures with highly restrictive social conditions, amnesia is frequently triggered by severe psychological stress such as conflict caused by oppression. Finally, voluntarily induced states of depersonalization can be a part of meditative practices prevalent in many religions and cultures, and should not be diagnosed as a disorder.
Symptoms and signs of dissociative disorders include:
- Significant memory loss of specific times, people and events
- Out-of-body experiences, such as feeling as though you are watching a movie of yourself
- Mental health problems such as depression, anxiety and thoughts of suicide
- A sense of detachment from your emotions, or emotional numbness
- A lack of a sense of self-identity
The symptoms of dissociative disorders depend on the type of disorder that has been diagnosed. There are three types of dissociative disorders defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM):
- Dissociative Amnesia. The main symptom is difficulty remembering important information about one’s self. Dissociative amnesia may surround a particular event, such as combat or abuse, or more rarely, information about identity and life history. The onset for an amnesic episode is usually sudden, and an episode can last minutes, hours, days, or, rarely, months or years. There is no average for age onset or percentage, and a person may experience multiple episodes throughout her life.
- Depersonalization disorder. This disorder involves ongoing feelings of detachment from actions, feelings, thoughts and sensations as if they are watching a movie (depersonalization). Sometimes other people and things may feel like people and things in the world around them are unreal (derealization). A person may experience depersonalization, derealization or both. Symptoms can last just a matter of moments or return at times over the years. The average onset age is 16, although depersonalization episodes can start anywhere from early to mid childhood. Less than 20% of people with this disorder start experiencing episodes after the age of 20.
- Dissociative identity disorder. Formerly known as multiple personality disorder, this disorder is characterized by alternating between multiple identities. A person may feel like one or more voices are trying to take control in their head. Often these identities may have unique names, characteristics, mannerisms and voices. People with DID will experience gaps in memory of every day events, personal information and trauma. Onset for the full disorder at can happen at any age, but it is more likely to occur in people who have experienced severe, ongoing trauma before the age of 5. Women are more likely to be diagnosed, as they more frequently present with acute dissociative symptoms. Men are more likely to deny symptoms and trauma histories, and commonly exhibit more violent behavior, rather than amnesia or fugue states. This can lead to elevated false negative diagnosis.
Dissociative disorders are managed through various therapies including:
We are still learning about how and why psychosis develops, but several factors are likely involved. We do know that teenagers and young adults are at increased risk of experiencing an episode of psychosis because of hormonal changes in their brain during puberty.
Several factors that can contribute to psychosis:
- Genetics. Many genes can contribute to the development of psychosis, but just because a person has a gene doesn’t mean they will experience psychosis. Ongoing studies will help us better understand which genes play a role in psychosis.
- Trauma. A traumatic event such as a death, war or sexual assault can trigger a psychotic episode. The type of trauma—and a person’s age—affects whether a traumatic event will result in psychosis.
- Substance use. The use of marijuana, LSD, amphetamines and other substances can increase the risk of psychosis in people who are already vulnerable.
- Physical illness or injury. Traumatic brain injuries, brain tumors, strokes, HIV and some brain diseases such as Parkinson’s, Alzheimer’s and dementia can sometimes cause psychosis.
- Mental health conditions. Sometimes psychosis is a symptom of a condition like schizophrenia, schizoaffective disorder, bipolar disorder or depression.
A diagnosis identifies an illness; symptoms are components of an illness. Health care providers draw on information from medical and family history and a physical examination to diagnose someone. If causes such as a brain tumor, infection or epilepsy are ruled out, a mental illness might be the reason.
If the cause is related to a mental health condition, early diagnosis and treatment provide the best hope of recovery. Research shows that the earlier people experiencing psychosis receive treatment, the better their long-term quality of life.
Early psychosis or FEP rarely comes suddenly. Usually, a person has gradual, non-specific changes in thoughts and perceptions. Early warning signs can be difficult to distinguish from typical teen or young adult behavior. While such signs should not be cause for alarm, they may indicate the need to get an assessment from a doctor. Getting help early and beginning treatment provides the best hope of recovery by slowing, stopping and possibly reversing the effects of psychosis. Early warning signs include the following:
- A worrisome drop in grades or job performance
- Trouble thinking clearly or concentrating
- Suspiciousness or uneasiness with others
- A decline in self-care or personal hygiene
- Spending a lot more time alone than usual
- Strong, inappropriate emotions or having no feelings at all
Early or First-Episode Psychosis
Determining exactly when the first episode of psychosis begins can be hard, but these signs and symptoms strongly indicate an episode of psychosis:
- Hearing, seeing, tasting or believing things that others don’t
- Persistent, unusual thoughts or beliefs that can’t be set aside regardless of what others believe
- Strong and inappropriate emotions or no emotions at all
- Withdrawing from family or friends
- A sudden decline in self-care
- Trouble thinking clearly or concentrating
Such warning signs often point to a person’s deteriorating health, and a physical and neurological evaluation can help find the problem. A mental health professional performing a psychological evaluation can determine if a mental health condition is involved and discuss next steps. If the psychosis is a symptom of a mental health condition, early action helps to keep lives on track.
Psychosis includes a range of symptoms but typically involves one of these two major experiences:
- Hallucinations are seeing, hearing or feeling things that aren’t there, such as the following:
- Hearing voices (auditory hallucinations)
- Strange sensations or unexplainable feelings
- Seeing glimpses of objects or people that are not there or distortions
- Delusions are strong beliefs that are not consistent with the person’s culture, are unlikely to be true and may seem irrational to others, such as the following:
- Believing external forces are controlling thoughts, feelings and behaviors
- Believing that trivial remarks, events or objects have personal meaning or significance
- Thinking you have special powers, are on a special mission or even that you are God.
Early or First-Episode Psychosis
Early treatment of psychosis, especially during the first episode, leads to the best outcomes.
Research has shown significant success using a treatment approach called Coordinated Specialty Care (CSC). CSC uses a team of health professionals and specialists who work with a person to create a personal treatment plan based on life goals while involving family members as much as possible.
CSC has the following key components:
- Case management
- Family support and education
- Medication management
- Supported education and employment
- Peer support
Traditional treatment for psychosis involves psychotherapy and medication. Several types of therapy have successfully helped individuals learn to manage their condition. In addition, medication targets symptoms and helps reduce their impact.
Eating disorders are very complex conditions, and scientists are still learning about the causes. Although eating disorders all have food and weight issues in common, most experts now believe that eating disorders are caused by people attempting to cope with overwhelming feelings and painful emotions by controlling food. Unfortunately, this will eventually damage a person’s physical and emotional health, self-esteem and sense of control.
Factors that may be involved in developing an eating disorder include:
- Genetics. People with first degree relatives, siblings or parents, with an eating disorder appear to be more at risk of developing an eating disorder, too. This suggests a genetic link. Evidence that the brain chemical, serotonin, is involved also points a contributing genetic and biological factors.
- Environment. Cultural pressures that stress “thinness” as beautiful for women and muscular development and body size for men places undue pressure on people of achieve unrealistic standards. Popular culture and media images often tie being thin to popularity, success, beauty and happiness. This creates a strong desire to be very thin
- Peer Pressure. With young people, this can be a very powerful force. Pressure can appear in the form of teasing, bullying or ridicule because of size or weight. A history of physical or sexual abuse can also contribute to some people developing an eating disorder.
- Emotional Health. Perfectionism, impulsive behavior and difficult relationships can all contribute to lowering a person’s self-esteem and make them vulnerable to developing eating disorders.
Eating disorders affect all types of people. However, there are certain risk factors that put some people at greater risk for developing an eating disorder.
- Age. Eating disorders are much more common during teens and early 20s.
- Gender. Statistically, teenage girls and young women are more likely to have eating disorders, but they are more likely to be noticed/treated for one. Teenage boys and men are less likely seek help, but studies show that 1 out of 10 people diagnosed with eating disorders are male.
- Family history. Having a parent or sibling with an eating disorder increases the risk.
- Dieting. Dieting taken too far can become an eating disorder.
- Changes. Times of change like going to college, starting a new job, or getting divorced may be a stressor towards developing an eating disorder.
- Vocations and activities. Eating disorders are especially common among gymnasts, runners, wrestlers and dancers.
A person with an eating disorder will have the best recovery outcome if he or she receives an early diagnosis. If an eating disorder is believed to an issue, a doctor will usually perform a physical examination, conduct an interview and order lab tests. These will help form the diagnosis and check for related medical issues and complications.
In addition, a mental health professional will conduct a psychological evaluation. She may ask questions about eating habits, behaviors and beliefs. There may be questions about a patient’s history of dieting, exercise, bingeing and purging.
Symptoms must meet the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM) in order to warrant a diagnosis. Each eating disorder has its own diagnostic criteria that a mental health professional will use to determine which disorder is involved. It is not necessary to have all the criteria for a disorder to benefit from working with a mental health professional on food and eating issues.
Often a person with an eating disorder will have symptoms of another mental health condition that requires treatment. Whenever possible, it is best to identified and address all conditions at the same time. This gives a person comprehensive treatment support that helps insure a lasting recovery.
Eating disorders are a group of related conditions that cause serious emotional and physical problems. Each condition involves extreme food and weight issues; however, each has unique symptoms that separate it from the others.
- Anorexia Nervosa.A person with anorexia will deny themselves food to the point of self-starvation as she obsesses about weight loss. With anorexia, a person will deny hunger and refuse to eat, practice binge eating and purging behaviors or exercise to the point of exhaustion as she attempts to limit, eliminate or “burn” calories.
- The emotional symptoms of anorexia include irritability, social withdrawal, lack of mood or emotion, not able to understand the seriousness of the situation, fear of eating in public and obsessions with food and exercise. Often food rituals are developed or whole categories of food are eliminated from the person’s diet, out of fear of being “fat”.
- Anorexia can take a heavy physical toll. Very low food intake and inadequate nutrition causes a person to become very thin. The body is forced to slow down to conserve energy causing irregularities or loss of menstruation, constipation and abdominal pain, irregular heart rhythms, low blood pressure, dehydration and trouble sleeping. Some people with anorexia might also use binge eating and purge behaviors, while others only restrict eating.
- Bulimia Nervosa.Someone living with bulimia will feel out of control when binging on very large amounts of food during short periods of time, and then desperately try to rid himself of the extra calories using forced vomiting, abusing laxatives or excessive exercise. This becomes a repeating cycle that controls many aspects of the person’s life and has a very negative effect both emotionally and physically. People living with bulimia are usually normal weight or even a bit overweight.
- The emotional symptoms of bulimia include low self-esteem overly linked to body image, feelings of being out of control, feeling guilty or shameful about eating and withdrawal from friends and family.
- Like anorexia, bulimia will inflict physical damage. The binging and purging can severely harm the parts of the body involved in eating and digesting food, teeth are damaged by frequent vomiting, and acid reflux is common. Excessive purging can cause dehydration that effect the body’s electrolytes and leads to cardiac arrhythmias, heart failure and even death.
- Binge Eating Disorder (BED).A person with BED losses control over his eating and eats a very large amount of food in a short period of time. He may also eat large amounts of food even when he isn’t hungry or after he is uncomfortably full. This causes him to feel embarrassed, disgusted, depressed or guilty about his behavior. A person with BED, after an episode of binge eating, does not attempt to purge or exercise excessively like someone living with anorexia or bulimia would. A person with binge eating disorder may be normal weight, overweight or obese.
Eating disorders are managed using a variety of techniques. Treatments will vary depending on the type of disorder, but will generally include the following.
- Psychotherapy, such as talk therapy or behavioral therapy.
- Medicine, such as antidepressants and anti-anxiety drugs. Many people living with an eating disorder often have a co-occurring illness like depression or anxiety, and while there is no medication available to treat eating disorders themselves, many patients find that these medicines help with underlying issues.
- Nutritional counseling and weight restoration monitoring are also crucial. Family based treatment is especially important for families with children and adolescents because it enlists the families’ help to better insure healthy eating patterns, and increases awareness and support.
The exact cause of obsessive-compulsive disorders is unknown, but researchers believe that activity in several portions of the brain is responsible. More specifically, these areas of the brain may not respond normally to serotonin, a chemical that some nerve cells use to communicate with each other. Genetics are thought to be very important. If you, your parent or a sibling, have an obsessive-compulsive disorder, there’s close to a 25% chance that another immediate family member will have it.
A doctor or mental health care professional will make a diagnosis of OCD. A general physical with blood tests is recommended to make sure the symptoms are not caused by illegal drugs, medications, another mental illness, or by a general medical condition. The sudden appearance of symptoms in children or older people merits a thorough medical evaluation to ensure that another illness is not causing of these symptoms.
To be diagnosed with OCD, a person must have must have:
- Obsessions, compulsions or both
- Obsessions or compulsions that are upsetting and cause difficulty with work, relationships, other parts of life and typically last for at least an hour each day
Most people have occasional obsessive thoughts or compulsive behaviors. In an obsessive-compulsive disorder, however, these symptoms generally last more than an hour each day and interfere with daily life.
- Obsessions are intrusive, irrational thoughts or impulses that repeatedly occur. People with these disorders know these thoughts are irrational but are afraid that somehow they might be true. These thoughts and impulses are upsetting, and people may try to ignore or suppress them.
- Thoughts about harming or having harmed someone
- Doubts about having done something right, like turning off the stove or locking a door
- Unpleasant sexual images
- Fears of saying or shouting inappropriate things in public
- Compulsions are repetitive acts that temporarily relieve the stress brought on by an obsession. People with these disorders know that these rituals don’t make sense but feel they must perform them to relieve the anxiety and, in some cases, to prevent something bad from happening. Like obsessions, people may try not to perform compulsive acts but feel forced to do so to relieve anxiety.
- Hand washing due to a fear of germs
- Counting and recounting money because a person can’t be sure they added correctly
- Checking to see if a door is locked or the stove is off
- “Mental checking” that goes with intrusive thoughts is also a form of compulsion
A typical treatment plan will often include both psychotherapy and medications, and combined treatment is usually optimal.
- Medication, especially a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI), is helpful for many people to reduce the obsessions and compulsions.
- Psychotherapy is also helpful in relieving obsessions and compulsions. In particular, cognitive behavior therapy (CBT) and exposure and response therapy (ERT) are effective for many people. Exposure response prevention therapy helps a person tolerate the anxiety associated with obsessive thoughts while not acting out a compulsion to reduce that anxiety. Over time, this leads to less anxiety and more self-mastery.
Traumatic events, such as military combat, assault, an accident or a natural disaster, can have long-lasting negative effects. Sometimes our biological responses and instincts, which can be life-saving during a crisis, leave people with ongoing psychological symptoms because they are not integrated into consciousness.
Symptoms of PTSD usually begin within 3 months after a traumatic event, but occasionally emerge years afterward. Symptoms must last more than a month to be considered PTSD. PTSD is often accompanied by depression, substance abuse or another anxiety disorder.
People can describe symptoms in a variety of ways. How a person describes symptoms often depends on the cultural lens she is looking through. In Western cultures, people generally talk about their moods or feelings, whereas in many Eastern cultures, people more commonly refer to physical pain. African Americans and Latinos are more likely to be misdiagnosed, so they should look for a health care professional who understands their background and shares their expectations for treatment.
Because young children have emerging abstract cognitive and limited verbal expression, research indicates that diagnostic criteria needs to be more behaviorally anchored and developmentally sensitive to detect PTSD in preschool children. Read more on the preschool subtype at the National Center for PTSD.
The symptoms of PTSD fall into the following categories.
- Intrusive Memories, which can include flashbacks of reliving the moment of trauma, bad dreams and scary thoughts.
- Avoidance, which can include staying away from certain places or objects that are reminders of the traumatic event. A person may also feel numb, guilty, worried or depressed or having trouble remembering the traumatic event.
- Dissociation, which can include out-of-body experiences or feeling that the world is “not real” (derealization).
- Hypervigilance, which can include being startled very easily, feeling tense, trouble sleeping or outbursts of anger
Over the last 5 years, research on 1–6 year olds found that young children can develop PTSD, and the symptoms are quite different from those of adults. These findings also saw an increase in PTSD diagnoses in young children by more than 8 times when using the newer criteria. Symptoms in young children can include:
- Acting out scary events during playtime
- Forgetting how/being unable to talk
- Being excessively clingy with adults
- Extreme temper tantrums, as well as overly aggressive behavior
PTSD is treated and managed in several ways.
- Medications, including mood stabilizers, antipsychotic medications and antidepressants.
- Psychotherapy, such as cognitive behavioral therapy or group therapy.
- Self-management strategies, such as “self-soothing”. Many therapy techniques, including mindfulness, are helpful to ground a person and bring her back to reality after a dissociative episode or a flashback.
Service animals, especially dogs, can help soothe some of the symptoms of PTSD.
The exact cause of schizoaffective disorder is unknown. A combination of causes may contribute to the development of schizoaffective disorder.
- Genetics. Schizoaffective disorder tends to run in families. This does not mean that if a relative has an illness, you will absolutely get it. But it does mean that there is a greater chance of you developing the illness.
- Brain chemistry and structure. Brain function and structure may be different in ways that science is only beginning to understand. Brain scans are helping to advance research in this area.
- Stress. Stressful events such as a death in the family, end of a marriage or loss of a job can trigger symptoms or an onset of the illness.
- Drug use. Psychoactive drugs such as LSD have been linked to the development of schizoaffective disorder.
Schizoaffective disorder can be difficult to diagnose because it has symptoms of both schizophrenia and either depression or bipolar disorder. There are two major types of schizoaffective disorder: bipolar type and depressive type. To be diagnosed with schizoaffective disorder a person must have the following symptoms.
- A period during which there is a major mood disorder, either depression or mania, that occurs at the same time that symptoms of schizophrenia are present.
- Delusions or hallucinations for two or more weeks in the absence of a major mood episode.
- Symptoms that meet criteria for a major mood episode are present for the majority of the total duration of the illness.
- The abuse of drugs or a medication are not responsible for the symptoms.
The symptoms of schizoaffective disorder can be severe and need to be monitored closely. Depending on the type of mood disorder diagnosed, depression or bipolar disorder, people will experience different symptoms:
- Hallucinations, which are seeing or hearing things that aren’t there.
- Delusions, which are false, fixed beliefs that are held regardless of contradictory evidence.
- Disorganized thinking. A person may switch very quickly from one topic to another or provide answers that are completely unrelated.
- Depressed mood. If a person has been diagnosed with schizoaffective disorder depressive type they will experience feelings of sadness, emptiness, feelings of worthlessness or other symptoms of depression.
- Manic behavior. If a person has been diagnosed with schizoaffective disorder: bipolar type they will experience feelings of euphoria, racing thoughts, increased risky behavior and other symptoms of mania.
Schizoaffective disorder is treated and managed in several ways:
Research suggests that schizophrenia may have several possible causes:
- Genetics. Schizophrenia isn’t caused by just one genetic variation, but a complex interplay of genetics and environmental influences. While schizophrenia occurs in 1% of the general population, having a history of family psychosis greatly increases the risk. Schizophrenia occurs at roughly 10% of people who have a first-degree relative with the disorder, such as a parent or sibling. The highest risk occurs when an identical twin is diagnosed with schizophrenia. The unaffected twin has a roughly 50% chance of developing the disorder.
- Environment. Exposure to viruses or malnutrition before birth, particularly in the first and second trimesters has been shown to increase the risk of schizophrenia. Inflammation or autoimmune diseases can also lead to increased immune system
- Brain chemistry. Problems with certain brain chemicals, including neurotransmitters called dopamine and glutamate, may contribute to schizophrenia. Neurotransmitters allow brain cells to communicate with each other. Networks of neurons are likely involved as well.
- Substance use. Some studies have suggested that taking mind-altering drugs during teen years and young adulthood can increase the risk of schizophrenia. A growing body of evidence indicates that smoking marijuana increases the risk of psychotic incidents and the risk of ongoing psychotic experiences. The younger and more frequent the use, the greater the risk. Another study has found that smoking marijuana led to earlier onset of schizophrenia and often preceded the manifestation of the illness.
Diagnosing schizophrenia is not easy. Sometimes using drugs, such as methamphetamines or LSD, can cause a person to have schizophrenia-like symptoms. The difficulty of diagnosing this illness is compounded by the fact that many people who are diagnosed do not believe they have it. Lack of awareness is a common symptom of people diagnosed with schizophrenia and greatly complicates treatment.
While there is no single physical or lab test that can diagnosis schizophrenia, a health care provider who evaluates the symptoms and the course of a person’s illness over six months can help ensure a correct diagnosis. The health care provider must rule out other factors such as brain tumors, possible medical conditions and other psychiatric diagnoses, such as bipolar disorder.
To be diagnosed with schizophrenia, a person must have two or more of the following symptoms occurring persistently in the context of reduced functioning:
- Disorganized speech
- Disorganized or catatonic behavior
- Negative symptoms
Delusions or hallucinations alone can often be enough to lead to a diagnosis of schizophrenia. Identifying it as early as possible greatly improves a person’s chances of managing the illness, reducing psychotic episodes, and recovering. People who receive good care during their first psychotic episode are admitted to the hospital less often, and may require less time to control symptoms than those who don’t receive immediate help. The literature on the role of medicines early in treatment is evolving, but we do know that psychotherapy is essential.
People can describe symptoms in a variety of ways. How a person describes symptoms often depends on the cultural lens she is looking through. African Americans and Latinos are more likely to be misdiagnosed, probably due to differing cultural or religious beliefs or language barriers. Any person who has been diagnosed with schizophrenia should try to work with a health care professional that understands his or her cultural background and shares the same expectations for treatment.
It can be difficult to diagnose schizophrenia in teens. This is because the first signs can include a change of friends, a drop in grades, sleep problems, and irritability—common and nonspecific adolescent behavior. Other factors include isolating oneself and withdrawing from others, an increase in unusual thoughts and suspicions, and a family history of psychosis. In young people who develop schizophrenia, this stage of the disorder is called the “prodromal” period.
With any condition, it’s essential to get a comprehensive medical evaluation in order to obtain the best diagnosis. For a diagnosis of schizophrenia, some of the following symptoms are present in the context of reduced functioning for a least 6 months:
- These include a person hearing voices, seeing things, or smelling things others can’t perceive. The hallucination is very real to the person experiencing it, and it may be very confusing for a loved one to witness. The voices in the hallucination can be critical or threatening. Voices may involve people that are known or unknown to the person hearing them.
- These are false beliefs that don’t change even when the person who holds them is presented with new ideas or facts. People who have delusions often also have problems concentrating, confused thinking, or the sense that their thoughts are blocked.
- Negative symptoms are ones that diminish a person’s abilities. Negative symptoms often include being emotionally flat or speaking in a dull, disconnected way. People with the negative symptoms may be unable to start or follow through with activities, show little interest in life, or sustain relationships. Negative symptoms are sometimes confused with clinical depression.
- Cognitive issues/disorganized thinking. People with the cognitive symptoms of schizophrenia often struggle to remember things, organize their thoughts or complete tasks. Commonly, people with schizophrenia have anosognosia or “lack of insight.” This means the person is unaware that he has the illness, which can make treating or working with him much more challenging.
There is no cure for schizophrenia, but it can be treated and managed in several ways.