Your Go-To Guide to Mental Illness

 
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When people talk about taking care ourselves, many think about physical health as the end all and be all of health. However, mental and emotional health is just as equally important. Mental illness is an illness or injury affecting the one the most critical organs, the brain. Not to be confused with a brain injury where the brain shows physical signs of damage. It is important to note that many mental illnesses don’t have a cause. Sometimes it is hereditary, a result of too much or too little brain chemicals (dopamine or serotonin), or a result of trauma. Often the “cause” is not relevant, the fact remains that mental illness is a legitimate health concern and should be treated as such. 

Because there’s often no visual signs of mental illness, I will describe the categories of mental illness and highlight specific examples of mental illness within those categories. It is important to remember that everyone experiences mental illness differently. How I experience depression, for example, may be very different from how you experience depression. Secondly, stigma happens. And it sucks. If you do not experience stigma because of mental illness; that is amazing! But do not sit there and say mental illness stigma does not exist! Not cool, fam. Not okay. To quote Mean Girls: "you can’t sit with us…if you’re gonna be like that."

Now, there is a lot of information here. It’s okay to feel overwhelmed, hell, I’m overwhelmed writing this. I got the DSM-5, several textbooks and about four tabs open, so be assured you will get the most accurate information I can find. Now with that said, what I list as treatment options may work for some and not for others, but at least you will have a framework in mind when seeking treatment. However, I want to be very clear: doctors with psychiatric training, clinical psychologists, and social workers are the only people with the sufficient and rigorous training to diagnose anyone with a mental illness. 

Final reminder: if you were recently diagnosed with a mental illness, it is not the end of the world. Many go on to live fulfilling and healthy lives. 

We cool? Yes? Alright, let’s get started:

Anxiety Disorders

People with anxiety disorders respond to specific objects or situations with fear and dread, as well as with physical signs of anxiety or panic, such as a rapid heartbeat, sweating and in some cases, crying. In Canada, 3 million aged 18 and over reported they had an anxiety disorder. Anxiety disorders include Generalized Anxiety Disorder (GAD), panic disorder, social anxiety disorder (SAD), and specific phobias.

anxiety diagnosis:

The presence of excessive anxiety and worry about a variety of topics, events, or activities. Worry occurs more often than not for at least 6 months and is clearly excessive.

Treatment:

  1. Medication: many people use medication to help manage anxiety.
  2. Counseling is an option. And those who go through counseling often finding themselves being treated with Cognitive Behavior Therapy (CBT). A practice that helps people recognize and change their reactionary responses to situations or triggers.
  3. Many people also perform a lifestyle overhaul; better sleep hygiene, eating better, and exercise.

Mood Disorders

These disorders also called affective disorders, involve persistent feelings of sadness or periods of feeling overly happy, or fluctuations from extreme happiness to extreme sadness. The most common mood disorders are depression, bipolar disorder, and cyclothymic disorder. However, this can include disruptive mood disregulation disorder, persistent depressive disorder, and premenstrual dysphoric disorder.

mood disorder diagnosis:

I have to use an example as the new DSM-5 has divided the former diagnostic material for mood disorders. So, for instance; dysthymia (something I suffer from and a fancy title for persistent depressive disorder or mild chronic depression): depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least two years.

Treatment:

  1. Medication: anti depressants are usually prescribed.
  2. Counseling is also an option. CBT or talk therapy are usual frameworks therapists will use. 
  3. Many people also perform a lifestyle overhaul; better sleep hygiene, eating better, and exercise.

Psychotic Disorders

Psychotic disorders involve distorted awareness and thinking. Two of the most common symptoms of psychotic disorders are hallucinations and delusions. Schizophrenia is an example of a psychotic disorder.

Psychotic Disorder diagnosis:

Typical symptoms are hallucinations (the experience of images or sounds that are not real, such as hearing voices) and delusions (fixed false beliefs that the person accepts as true, despite evidence to the contrary). NOTE: no, fascists are not fascists because of a psychotic disorder. Fascists are just entitled, self-absorbed racists. Moving on…

Treatment:

  1. Medication is an option, although many whom I’ve spoken to say it’s not an option. A hard cocktail of anti psychotics that help manage the symptoms. 
  2. Counseling is an option. This will help the individual learn to decipher between the reality and the fantasy.
  3. Many people also perform a lifestyle overhaul; better sleep hygiene, eating better, and exercise.

Eating Disorders

Eating disorders involve extreme emotions, attitudes, and behaviors involving weight and food. Anorexia nervosa, bulimia nervosa, and binge eating disorders are the most common eating disorders. This also includes Pica, Rumination Disorder, avoidant/Restrictive food intake disorder (ARFID), Other specified feeding or eating disorder (OSFED) and unspecified feeding or eating disorder (UFED).

Eating disorder diagnosis:

I will include the DSM criteria for Anorexia, Bulimia and Binge Eating, because these are devastating disorders and unfortunately, have a high mortality rate. So learning the criteria also means recognizing the signs. 

1. Anorexia

Anorexia is defined by persistent restriction of energy intake leading to significantly low body weight (in context of what is minimally expected for age, sex, developmental trajectory, and physical health). There is also either an intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain (even though significantly low weight). And a disturbance in the way one's body weight or shape is experienced, undue influence of body shape and  weight on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

Subtypes: 

  • Restricting type
  • Binge-eating/purging type

2. Bulimia

Bulimia is defined by eating, in a discrete period of time (e.g. within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances. A sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating) is also present. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise are common symptoms. Also, the binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for three months and self-evaluation is unduly influenced by body shape and weight. The disturbance does not occur exclusively during episodes of Anorexia Nervosa.

3. Binge Eating Disorder

Binge eating is defined as a discrete period of time (e.g. within any 2-hour period) where an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances. The episode usually includes a sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating) and typically involves distress regarding binge eating. Binge eating occurs, on average, at least once a week for three months. Binge eating is not associated with the recurrent use of inappropriate compensatory behaviors as in Bulimia Nervosa and does not occur exclusively during the course of Bulimia Nervosa, or Anorexia Nervosa. Binge eating episodes are usually associated with three or more of the following:

  • eating much more rapidly than normal
  • eating until feeling uncomfortably full
  • eating large amounts of food when not feeling physically hungry
  • eating alone because of feeling embarrassed by how much one is eating
  • feeling disgusted with oneself, depressed or very guilty afterward

Note: Binge Eating Disorder is less common but much more severe than overeating. Binge Eating Disorder is associated with more subjective distress regarding the eating behavior, and commonly other co-occurring psychological problems.

Treatment:

  1. Inpatient treatment. Usually the last resort, but often the life saver. This may include tubing (a tube is inserted through the nose into the stomach for feeding), IVs, supervised eating, meetings with a registered dietician. This will be done in conjunction with counseling, either individual or group therapy. 
  2. Outpatient treatment. Also, effective as it does not isolate individuals from everything, but this an option for those who are not at, fortunately, death’s door. Through outpatient, individuals will benefit from counseling and regular meetings with a registered dietician. 
  3. Early intervention is key. Prevention is better. 

Impulse control & addiction disorders

People with impulse control disorders are unable to resist urges, or impulses, to perform act that could be harmful to themselves or others. Pyromania (starting fires), kleptomania (stealing), and compulsive gambling are examples of impulse control disorders. Substances, like alcohol or drugs, are common objects of addictions. Often, people with these disorders become so involved with the objects of their addiction that they begin to ignore responsibilities and relationships. 

Impulse control and addiction disorders diagnosis:

It is important to acknowledge that people who suffer from pyromania or kleptomania know what they are doing is wrong, but they cannot control it. Most have to act upon the impulse to make it go away, because nothing will make it go away. 

It is also important to acknowledge that those who drink alcohol or use substances are not all addicts. There is a spectrum of people who use substances ranging from beneficial to chronic use. I personally do not like the word “addiction,” I feel there is too much stigma attached to the word; however, individuals whose lives implode as a result of substance of use are often labelled as addicts. 

Treatment:

  • Impulse control
  1. Counseling will help learn healthy ways of coping with the impulses.
  • Addiction
  1. Either outpatient or inpatient treatment. I will always advocate for outpatient as substance users will learn to deal with triggers and situations that may encourage them to use substances. However, it is important to know that there are people who will not stop using substances. At that point, it becomes a question of how we can reduce the harm of using substances. This is known as strength-based harm reduction.
  2. Harm reduction may include regular access to new needles (formerly known as clean needles), reducing the amount of substances being used at once or during the day, budgeting for substance use and never going beyond that set amount.

Personality Disorders

People with personality disorders have extreme and inflexible personality traits that are distressing to the person and/or cause problems in work, school, or social relationships. In addition, the person’s patterns of thinking and behavior significantly differ from the expectation of society and are so rigid that they interfere with the person’s normal functioning. Examples include antisocial personality disorder, obsessive compulsive personality disorder and paranoid personality disorder. 

personality disorders diagnosis:

Individuals presenting with personality disorders will often have the following characteristics: Inappropriate extreme emotional responses. Like, having an rageful outburst over a small situation, for example. Extreme codependency, separation insecurity that cannot be explained, and the ability to express or perform empathy is compromised.

Treatment:

  1. Medication is an option.
  2. Counseling, specifically therapists who are trained in Dialectical Behavioral Therapy (DBT).

Dissociative Disorders

People with these disorders suffer severe disturbances or changes in memory, consciousness, identity and general awareness of themselves and their surroundings. These disorders usually are associated with overwhelming stress, which may be the result of traumatic events, accidents, or disasters that may be experienced or witnessed by the individual. Dissociative Identity Disorder (DID), formerly called “multiple personality disorder,” Depersonalization/Derealisation Disorder, and Dissociative Amnesia are the dissociative disorders. 

Dissociative Disorders diagnosis:

The DSM, states 4 criteria have to be met and fulfilled to have a diagnosis of DID. First, the presence of 2 or more identities or identity states must be present. Second, the alters (personalities) must take control of the body. Third, the inability to recall information. Finally, the dissociation is not caused by a side effect of a substance.

Treatment:

  1. Medication is an option. And we are talking about a cocktail of drugs that will suppress the dissociation and emergence of the identities/alters. 
  2. Counseling is an option.  Find a therapist that has experience with dissociative disorders, not dissociation brought on by depression or anxiety. That therapist will either be versed in Integration therapy or Conscious Therapy if looking for therapy for DID. These therapies not the same. In addition, to finding a therapist that is familiar with Dissociative Disorders they will be educated on Cognitive Behavior Therapy (CBT), Eye Movement Desensitization and Reprocessing (EMDR) and Exposure therapy. 

Post Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) is a condition that can develop following a traumatic and/or terrifying event, such as a sexual or physical assault, the unexpected death of a loved one, or a natural disaster. People with PTSD often have lasting and frightening thoughts and memories of an event and tend to be emotionally numb.

PTSD Diagnosis:

People presenting with PTSD often describe invasive and persistent flashbacks or memories of the trauma. Often these memories or flashbacks are triggered by something to remind them of the trauma. Physical reactions to reminders (triggers) of the trauma. Nightmares or night terrors are a common symptom. Also, incredible emotional distress with the unwanted memories and flashbacks. 

Treatment:

  1. Medication is an option. 
  2. Counseling is an option.  Studies have shown that Eye Movement Desensitization and Reprocessing (EMDR) is far more effective that Cognitive-Behavioral Therapy. 

 

IF YOU ARE EXPERIENCING THOUGHTS OF HURTING YOURSELF OR OTHERS, CALL 911 IMMEDIATELY OR GO TO YOUR NEAREST EMERGENCY ROOM OR PSYCHIATRIC HOSPITAL FOR A CRISIS EVALUATION.

 

BETHANY KILLEN - RESIDENT ADVICE COLUMNIST & SEX THERAPIST

Bethany Killen (she/her), whose time spent finding ways to navigate through her own personal struggles led her to pursue a career in social work.

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