Mental Health 101

How common are mental health issues?

Studies have shown that 1 in 4 individuals globally struggle with a mental health issue at any given time. If you expand that to the course of a lifetime, the number increases to 1 in 2. That means if it’s not you who is struggling, it’s someone you know or love.

Why is it important to talk about stigma?

When discussing mental health, two main types of stigma exist. One type is external stigma, which refers to the attitudes held by society that people with mental health issues are somehow lacking, incapable, incompetent, or not worthy of dignified and equitable treatment. The other type is internal stigma, which is the attitude held by the person with mental health challenges that they are unworthy, unlovable, and unvalued.

Stigma does a lot of harm to our society. For the people struggling with a mental health challenge, they often lack hope in recovery and don’t pursue treatment because they either don’t believe they can get better or fear discrimination from others. For those who don’t struggle but hold positions of power (such as law enforcement, educators, landlords, community leaders, etc.), stigma can lead to discrimination, which is the unfair treatment of those with mental health challenges.

Having honest conversations about stigma and sharing our personal stories of recovery are small steps we each can take to making our society more equitable and inclusive.

Is recovery actually possible?

Absolutely! One of the biggest misperceptions in society is that mental health issues are a life sentence.

Recovery means many things to many people and is personal in nature. For some, recovery is the complete absence of symptoms. For others, recovery means successfully managing symptoms as a normal part of life with no disruption to daily activities. Research has shown that even for those with the most serious mental illnesses, the right treatment can have someone living an independent, fulfilling, and successful life.

Does everyone with a mental health diagnosis need medication? What alternatives to medication exist?

It’s a common thought that the only cure to a mental health diagnosis is medication and if one stops taking his or her pills, it’s all downhill from there. While medication works for some people, it is hardly a cure-all. In fact, some medications can have side effects that are more harmful than the symptoms of the mental health challenge!

Deciding to try medication is a personal decision. The good news is that it is not the only option. Research has shown that other types of therapies can be extremely effective in maintaing a person’s level of wellness, including mindfulness, talk therapy, peer support, physical activity, and visual and performing arts, to name a few.

So, do I have to share my mental health issue with the world?

Not unless you want to! Some people are very open about their mental health issues because they value transparency and/or want to be an example of recovery. Others may not feel comfortable because they fear stigma, or simply don’t want the world knowing their personal business. Some may choose to tell family and close friends, but not coworkers or acquaintances. There is no right or wrong answer. You should do what makes you comfortable. If you want to start dialogue around mental health but aren’t quite sure if you’re ready to share your experiences, you can always frame the conversation around wellness, which applies to everyone, diagnosis or not.

What should I do if someone discloses their challenge to me?

Just listen. Providing a supportive ear is the best thing you can do for someone who chooses to open up. It’s not always easy to share something so personal with another human being, so taking a genuine interest and being free of judgment can go a long way and do a lot of good.

Feeling Anxious?

When most people think about anxiety, they picture the typical nervousness folks experience before taking a test at school, or perhaps speaking in public. Their pulse may quicken a bit, their face may feel a bit flushed, they may have “butterflies in their stomach,” but that is about it. It is a temporary feeling, and is generally considered to be a normal human reaction.

For some people though, anxiety rises to the point where a person’s ability to work or lead a normal life is impacted. According to the Centers for Disease Control and Prevention (CDC), in the U.S. the estimated lifetime prevalence of any anxiety disorder is over 15%, while the 12-month prevalence is more than 10%.

For example, if a child is so anxious about going to school that they regularly cannot get out the door on time, it may be time to see a mental health professional.  If a person avoids socializing with friends because the thought of being around people makes them feel lightheaded and nauseous, this may be cause for concern. Worse, if a person feels these sorts of symptoms WITHOUT a triggering event, then a conversation with a medical professional is may be warranted.

There are a number of anxiety disorders including:  generalized anxiety disorder, specific phobia, social anxiety disorder, separation anxiety disorder, agoraphobia, panic disorder, and selective mutism.

Panic Disorder

Let’s take a closer look at Panic Disorder. This disorder is known for the occurrence of “panic attacks” which is when the body’s “fight or flight” response kicks into overdrive, seemingly for no apparent reason. People who experience this describe feelings of imminent death, being unable to breathe properly, having sweaty palms and/or tingling hands or feet, of feeling pain in their chest and the belief that their racing heart will suddenly stop and they will die. In other words, an abject feeling of terror; again, coming on without warning after no apparent triggering event.

Treatment for Anxiety Disorders

There are common medical treatments for anxiety disorders. Medication, such as simple antidepressants like Lexapro or Prozac can be effective. Sometimes, anticonvulsant medicines (typically taken for epilepsy) and low-dose antipsychotic drugs can be utilized in conjunction with antidepressants. Other medications can include benzodiazepines (such as Klonopin, Xanax, Librium, Valium, etc.), or opioids (OxyContin, Vicodin, codeine, morphine, etc.). Care however must be taken, as these sorts of medications can become addictive.

Other, non-pharmacological interventions can be employed as well and include Dialectical Behavior Therapy (DBT), Cognitive Behavioral Therapy (CBT), meditation, mindfulness, breathing exercises, or even yoga. If the person has had a traumatic event in their past which acts as a trigger to their anxiety disorder, there are also therapies which can address and defuse trauma: EFT (Emotional Freedom Technique), EMDR (Eye Movement Desensitization and Reprocessing), art therapy, and even trauma informed yoga. Some folks have even had good results with therapy animals, such as dogs, cats, horses, or even guinea pigs or rabbits. Positive changes in diet and exercise have also proven to be beneficial.

Bottom Line

If you or a loved one is experiencing an anxiety disorder, treatment is readily available.

Personality disorders

The term “Personality Disorder” implies there is something not-quite-right about someone’s personality. However, the term “personality disorder” simply refers to a diagnostic category of psychiatric disorders characterized by a chronic, inflexible, and maladaptive pattern of relating to the world. There are many subset of personalities, all identifiable by their patterns. Personality disorders in particular are subsets that use maladaptive patterns of functioning, causing distress or problems integrating into society. This maladaptive pattern is evident in the way a person thinks, feels, and behaves. The most noticeable and significant feature of these disorders is their negative effect on interpersonal relationships. A person with an untreated personality disorder is rarely able to enjoy sustained, meaningful, and rewarding relationships with others, and any relationships they do form are often fraught with problems and difficulties.

 

To be diagnosed with a “personality disorder” does not mean that someone’s personality is fatally flawed. In fact, these disorders are not that uncommon and are deeply troubling and painful to those who are diagnosed. Studies on the prevalence of personality disorders performed in different countries and amongst different populations suggest that roughly 10% of adults can be diagnosed with a personality disorder (Torgersen, 2005).

 

Many types of disorders are evidenced by a complete and total deviation from normal and healthy functioning (e.g., epilepsy). However, personality disorders cannot be understood independently from healthy personalities.  Since everyone has a personality (but not everyone has epileptic seizures), personality disorders reflect a variant form of normal, healthy personality. Thus, a personality disorder exists as a special case of a normal, healthy personality in much the same way as a square is a special case of the more general construct of a rectangle. Therefore, it is useful for us to begin our discussion of personality disorders by first discussing the broader, more general construct of personality.

Resources:

http://www.mayoclinic.org/diseases-conditions/personality-disorders/home/ovc-20247654

https://medlineplus.gov/personalitydisorders.html

https://www.psychologytoday.com/basics/personality-disorders

https://www.psychiatry.org/patients-families/personality-disorders/what-are-personality-disorders

https://www.nami.org/Learn-More/Mental-Health-Conditions/Borderline-Personality-Disorder

Personality Disorders: Crash Course Psychology #34

https://www.mentalhealth.gov/what-to-look-for/personality-disorders/index.html

http://www.nhs.uk/conditions/personality-disorder/Pages/Definition.aspx

Social Anxiety disorder

Social anxiety, also known as social phobia, is a fear, anxiety and avoidance surrounding normal social situations. This is different from shyness, as there is an intense fear that cannot be controlled rather than discomfort. Symptoms of social anxiety include: anxiety or fear surrounding social interactions, being observed, and performing in front of others; fear that anxiety will be apparent to others; social situations almost always provoke fear or anxiety; situations are avoided or endured with intense anxiety; anxiety or fear is disproportionate to the actual threat posed by the situation. This must cause significant distress that lasts six months or longer without being attributable to any other substance or mental disorder. It is estimated that about 7% of Americans suffer from social anxiety at any one time. Treatment involves typically a combination of psychotherapy and medication. Psychotherapy can be in the form of cognitive-behavioral therapy or group therapy. Medications like anti-anxiety, antidepressants, and beta-blockers can be helpful in reducing symptoms. Beta-blockers, instead of targeting the brain, target the physical symptoms that appear while anxious. This may help sufferers with panicking about being anxious or panicking that others can see they are anxious.

 

Much of the college experience is about navigating differing social situations. Someone with social anxiety has almost an inability to do this. They have such intense fear and anxiety surrounding the situation that they cannot enjoy the interaction or take anything away from it. Going to class, speaking up in class, and doing presentations cause so much fear and anxiety that they are avoided, which can cause academic decline. Social situations like going out with friends or even meeting new people are difficult. College is all about thriving in these interactions and getting the most out of these experiences, and someone with social anxiety will try to avoid all of that even if it would be beneficial to them. Some people will attempt to use drugs or alcohol to cope with the anxiety, which can lead to a substance abuse problem and does not actually relieve the anxiety. The best thing for someone with social anxiety is to go to therapy and/or take medication. This will help them navigate social situations better and lead a more fulfilling life.

References:

http://www.mayoclinic.org/diseases-conditions/social-anxiety-disorder/basics/complications/con-20032524

https://www.nimh.nih.gov/health/publications/social-anxiety-disorder-more-than-just-shyness/index.shtml

https://socialanxietyinstitute.org/what-is-social-anxiety

Panic disorder

Panic disorder is characterized by recurrent panic attacks. These panic attacks cannot be explained by any other means (like PTSD, drugs, etc.) and are follow by a period of at least a month where the individual performs behaviors to prevent panic attacks or is generally intensely afraid of having another panic attack. Panic attacks consist of sudden feelings of fear or dread, an overactive fight or flight response when there is no reasonable risk. Panic attacks, along with the intense emotions, have many physical symptoms like shortness of breath, chest pain, shaking, feelings of numbness, or sensations of unreality. Because panic attacks do not typically have a specific cause, they can happen at any time. This simply perpetuates the fear around even having a panic attack or having someone see you have a panic attack. Intensity and frequency can vary by person. About 2-3% of the US population has panic disorder, and it is 2x more prevalent in women than men. Treatments include psychotherapy, like cognitive behavioral therapy, and medications, like antidepressants and beta-blockers.

 

As stated previously, panic attacks can happen at any time. This makes life very difficult for a college student with panic disorder. They live in constant fear of having another attack or having someone witness an attack. This avoidance gets in the way of what you’re really supposed to be doing: school. Many school environments cause lots of anxiety for any student, but a student with panic disorder is more likely to have a panic attack when already anxious or stressed. Avoiding that stress can simply look like avoiding school in general. Sometimes it can be so debilitating that sufferers prefer to stay locked inside rather than go out. Students miss out on college experiences. Those with panic disorder have a higher risk for drug or alcohol abuse. It’s hard to achieve when you are afraid of something you have no control over. But therapy and medications can help dramatically. Medications can lessen the load while going through therapy, or may be used long term. Therapy works by training your brain to react to stress in healthy ways, recognize panic attacks and stop them before they can fully develop, and be able to enter into situations where panic attacks have previously happened. It can become completely manageable with treatment.

Resources:

https://www.nimh.nih.gov/health/publications/panic-disorder-when-fear-overwhelms/index.shtml

http://www.apa.org/topics/anxiety/panic-disorder.aspx

http://www.mentalhealthamerica.net/conditions/panic-disorder

https://psychcentral.com/disorders/anxiety/panic-disorder-symptoms/

Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) consists of excessive worry around a variety of situations and functions. Most people are worried about something, but the worry of GAD is extreme and unwarranted by the specific situation. Normal worries may escalate to something beyond the individual’s control. These excessive worries must last most days for the 6 months and be around a variety of activities. There also has to be three or more physical symptoms, such as sleep disturbances, restlessness, and irritability, along with the anxiety. These symptoms cause significant distress and cannot be explained by any substance or other mental illness. GAD affects about 3.1% of Americans. Treatments for GAD involve medication and psychotherapy, usually in tandem. Medications can target the feelings of anxiety as well as the physical symptoms. Psychotherapy works on the behaviors and thinking surrounding the anxiety, developing new habits around the anxiety. This can help in coping with the anxiety and reduce its effect.

 

The nature of GAD is that worry is about anything and everything, and most likely the sufferer knows that it is. But they have no control over what they have anxiety around or how great it is. And sometimes this can prevent the individual from performing tasks, sleeping, and drain all energy. Part of college is to be efficient with time and energy, and anxiety makes it very hard to do that. The college environment in general is stressful, which exacerbates the problem. The majority of those with GAD have other mental illnesses as well, compounding the difficulty. They are more likely to have substance abuse problems. Someone with GAD in college can contact the disabilities office to set up accommodations that may aide in reducing anxiety and fostering success. This may include more time on exams, changes in housing, and more flexibility in course work. Medications and therapy are effective as well as likely essential. When untreated, GAD can lead to many other health problems, so it is important to address it. However, it is completely treatable and success in college is very possible.

Resources:

https://adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad

http://www.mayoclinic.org/diseases-conditions/generalized-anxiety-disorder/basics/complications/con-20024562

https://www.psychologytoday.com/conditions/generalized-anxiety-disorder

https://www.nimh.nih.gov/health/publications/generalized-anxiety-disorder-gad/index.shtml

Obsessive Compulsive Disorder

Obsessive compulsive disorder, or OCD, is characterized by disruptive obsession and compulsions. Obsessions are recurrent and persistent thoughts that are both unwanted and cause distress. The individual attempts to neutralize them by performing an action. Compulsions are repetitive behaviors or mental acts that the individual feels compelled to complete. These acts aim to reduce anxiety and distress, even though they may only be loosely related to the cause of distress or are excessive. The individual may even be aware that the thoughts and actions used to reduce them are unreasonable and unlikely, but they have no power over them. Obsessions and compulsions usually occur together, though only one may be present in some individuals. These obsessions are time consuming or cause significant distress and impairment in several areas of functioning. Obsessions can take up anywhere between 1-3 hours per day in more mild cases, and in more severe  cases consuming most of the day. Symptoms cannot be associated with substance use, medications, or be better explained by another mental illness. About 1.2% of Americans have OCD. Treatment consists of typically a combination of medication and psychotherapy, though medication will not work for all cases. Medications for OCD are most commonly antidepressants in high doses. Psychotherapy focuses on reducing anxiety surrounding obsessions and reducing compulsive behaviors. Eventually, after managing the anxiety, the individual will feel less and less anxiety around the obsessions.

 

Depending on the obsessions and compulsions, OCD can be very disruptive in a lot of different areas. But specific functioning differs between sufferers. Some have problems with relationships because they obsess over losing or hurting loved ones. Some have rituals that make completing school-related tasks difficult or time consuming, such as needing to read each page a certain number of times or anxiety surrounding a task becoming so overwhelming that the task is avoided altogether. Those without OCD have a hard time understanding that these are not made up, that someone with OCD cannot control what they obsess over or what compulsions are needed to reduce anxiety. And because these thoughts can pop up at any time, it is difficult to predict what the student will need to succeed. Many of the more common accommodations are of no use to a student with OCD. Students are encouraged to seek help in managing their symptoms, as this will aide them in the long run for reducing stress. While in college, it may be helpful to contact the disabilities office and set up specific accommodations for what the individual needs to function in college while being treated. Not all accommodations will look the same from one OCD student to the next. This illness is completely manageable, and success in a college environment is very possible.

Resources:

https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml

https://iocdf.org/about-ocd/

http://www.mayoclinic.org/diseases-conditions/obsessive-compulsive-disorder/symptoms-causes/dxc-20245951

https://www.collegemagazine.com/feel-crazy-living-ocd/

https://www.hercampus.com/school/chapel-hill/her-story-coping-ocd-college

https://psychcentral.com/lib/ocd-and-college-accommodations/

http://beyondocd.org/information-for-college-students/disability-accommodations

Anorexia [nervosa]

Anorexia nervosa, or simply anorexia, is an eating disorder characterized by an individual restricting their diet because of an intense fear of gaining weight. This fear of gaining weight is usually founded in personal insecurities, and not necessarily a vain attempt to be thin. Anorexic individuals restrict their energy intake, relative to their individual requirements, which leads to significantly low body weight. They will continue to take weight loss measures, such as excessive exercise or laxative use, even though they are at a significantly low weight already. Anorexia also involves a skewed vision of the individual’s body, undue influence of body weight or shape on self-evaluation, or a consistent lack of recognition of seriousness of current low body weight. About 0.3-0.4% of women and 0.1% of men in America have anorexia. Treatment consists primarily of psychotherapy, though medications can be used to treat underlying conditions such as depression. If not treated, anorexia can lead to anemia, heart problems, bone loss, gastrointestinal problems, kidney problems, death, and other issues.

 

Anorexia tends to take over the individual’s life. And stressful life events can trigger disordered eating, so college is no exception. College is used as an excuse. “I didn’t have time to eat.” “I could only grab something small on the go.” Drowning in responsibilities can be an excellent reason not to eat properly or at all. But it can also lead to avoiding going out with friends, especially when social interactions in college frequently surround a meal. If the individual ends up participating in meals with friends, they spend their time counting calories, hiding food, and worrying about weight gain rather than enjoying the experience. Functioning is possible, as this does not directly interfere with the ability to finish assignments, study, or get to class. However, anorexia is not sustainable considering other health problems that develop and thought patterns that are self-destructive. Other mental illnesses may occur along with anorexia, and those also need to be treated in tandem. Psychiatric services and counseling support may be helpful throughout this process. In some cases, taking a semester off to visit a treatment facility can do more for the individual than traditional counseling. It is possible to reach remission and return to normal college life.

Resources:

https://www.nationaleatingdisorders.org/anorexia-nervosa

http://www.mayoclinic.org/diseases-conditions/anorexia/symptoms-causes/dxc-20179513

https://www.psychologytoday.com/conditions/anorexia-nervosa

http://proud2bme.org/content/recovering-eating-disorder-college-survival-guide

http://www.seventeen.com/life/real-girl-stories/a29763/my-struggle-with-an-eating-disorder-forced-me-to-take-a-semester-off-of-college/

https://www.hercampus.com/health/food/her-story-i-recovered-anorexia

Bulimia [nervosa]

Bulimia nervosa, or simply bulimia, is an eating disorder characterized by purging following a binge eating episode. During binge eating, the individual eats more than what an average person would eat in the same amount of time under the same circumstances. They feel a lack of control over eating, often unable to stop once started and may enter into a trance while eating. After eating, they use inappropriate behaviors to compensate for overeating. This may include vomiting, laxative use, diuretic use, excessive exercising, or other ways of purging. Binging and purging cycles happen at least once a week for three months or more. Self-evaluation is unduly influenced by body weight and shape. None of these symptoms occur during periods of anorexia nervosa. About 1.1%-4.6% of females and 0.1%-0.5% of males will have bulimia. Treatment consists primarily of psychotherapy and medications to treat underlying conditions. Psychotherapy aims to interrupt the binge/purge cycle, address negative thought about self and body image, and resolve emotional issues related to the disorder. Bulimia frequently occurs with other mental illnesses, such as depression and alcohol abuse.

 

Bulimia, like anorexia, takes over the individual’s life. Life becomes about staying thin, taking steps to lose weight, and trying to hid how much food you consume. Some people will spend upwards of three hours a day exercising. Health problems related to the eating disorder can get in the way of school work. But generally bulimia doesn’t interfere with the individuals ability to complete school work, study, get to class, or keep appointments. Bulimia is not, however, a sustainable habit. Severe health complications arise, other mental illnesses can develop, and even death can occur. Specifically, bulimia can cause dehydration, kidney failure, heart problems, severe tooth decay and gum disease, digestive problems, alcohol or drug use, and possibly suicide. Balanced living is a large part of the college life, and bulimia disrupts that. Treatment is the best option for restoring balance and recovering. Sometimes campus psychiatry and support services can be enough. Sometimes taking a semester off and going to a recovery facility may be more effective. It depends on the individual, but recovery is always possible.

Resource:

https://www.nationaleatingdisorders.org/bulimia-nervosa

https://www.eatingdisorderhope.com/information/bulimia

http://www.mayoclinic.org/diseases-conditions/bulimia/diagnosis-treatment/treatment/txc-20179842

http://www.mamashealth.com/eat/bulstory.asp

http://www.teenvogue.com/story/eating-disorder-recovery-bulimia

Binge Eating Disorder

Binge eating disorder, or BED, is an eating disorder characterized by binge eating episodes that result in feelings of shame, guilt, or depression. Eating more than someone else in similar circumstances during a specified period of time, as well as feeling a lack of control over food consumption during that time, is considered binge eating. Three or more physical symptoms are also present during this time, such as eating more rapidly than normal or eating when not feeling hungry. The individual has marked distress from their binge eating. Binge eating occurs at least once per week for three months and does not occur during anorexia nervosa or bulimia nervosa. There is also no inappropriate use of compensatory actions for the amount eaten, such as laxative use or inducing vomiting. Prevalence in the United States is about 1.6% of females and 0.8% of males. About 0.2%-3.5% of all females and 0.9%-2.0% of all males will develop BED. Treatment consists of mostly psychotherapy and nutrition counseling. Medications can help to treat underlying conditions that frequently come along with BED. The goal of therapy is to work though issues that lead to eating disorder and develop a better relationship with food consumption.

 

BED, like other eating disorders, affects mostly the social side of college life. Eating in and of itself does not affect academic performance, unless it takes up more than its allotted time per day. However, much of college life revolves around eating. Social outings typically revolve around a shared meal. But someone with BED has severe shame around these situations, and will often avoid them. Or they will binge eat and have guilt around people seeing them that way. College also comes with complete control over what, when, and how much you eat. Late night studying is often fueled by food. Students don’t have time to make food and dining options typically aren’t healthy. Anxiety and stress over school and other obligations can be hard to handle, for anyone. But for those who already have an eating disorder or are already predisposed to it, the stress can fuel the disease. The best course of action is treatment. Throughout treatment, the individual learns to handle food and themselves better, which will help in getting through social situations involving food. Without treatment, BED can lead to many health issues related to obesity. Enjoying college while maintaining academic status is the goal, and is completely possible with an eating disorder.

Resources:

https://www.nationaleatingdisorders.org/binge-eating-disorder

http://www.mayoclinic.org/diseases-conditions/binge-eating-disorder/symptoms-causes/dxc-20182932

http://www.mayoclinic.org/diseases-conditions/binge-eating-disorder/diagnosis-treatment/treatment/txc-20182948

https://www.hercampus.com/health/mental-health/binge-eating-invisible-eating-disorder