Understanding Mental Health
What Is a Mental Disorder?
There is no sharp line between "normal" and "disordered." Mental health exists on a continuum.
A condition is typically considered a disorder when it:
- Causes significant distress or impairment
- Is not a normal response to circumstances
- Involves dysfunction in psychological processes
The DSM (Diagnostic and Statistical Manual) is the primary classification system in the US; the ICD is used internationally[1].
The Problem of Labeling
Cultural context mattersⓘ-behaviors considered abnormal in one culture may be normal in another.
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Common Mental Health Conditions
Anxiety Disorders
Characterized by: Excessive fear, worry, and avoidance that interfere with daily life.
### Generalized Anxiety Disorder (GAD)
- Persistent, excessive worry about many things
- Difficulty controlling worry
- Physical symptoms: muscle tension, fatigue, sleep problems
- Affects about 2.7% of U.S. adults annually[3]
### Panic Disorder
- Recurrent unexpected panic attacks
- Fear of future attacks
- Panic attacks are intense but not dangerousⓘ-they peak within 10 minutes
### Social Anxiety Disorder
- Fear of social situations where one might be judged
- More than shyness-causes significant impairment
- One of the most common anxiety disorders[5]
### Specific Phobias
- Intense fear of specific objects or situations
- Fear is disproportionate to actual danger
- Common phobias: heights, animals, blood/injury, flying
Mood Disorders
### Major Depressive Disorder (MDD)
Core symptoms:
- Depressed mood most of the day
- Loss of interest or pleasure (anhedonia)
Additional symptoms may include:
- Sleep changes (too much or too little)
- Appetite/weight changes
- Fatigue
- Feelings of worthlessness or guilt
- Difficulty concentrating
- Thoughts of death or suicide
To meet criteria, symptoms must persist for at least 2 weeks and cause significant impairment[6].
Depression is highly treatable[7]-most people improve with therapy, medication, or both.
### Bipolar Disorder
Characterized by: Episodes of mania (or hypomania) and depression.
Mania:
- Elevated or irritable mood
- Decreased need for sleep
- Racing thoughts
- Increased activity and risk-taking
- Distinct from simply "feeling good"ⓘ-causes impairment or hospitalization
Bipolar I: Full manic episodes
Bipolar II: Hypomanic episodes (less severe) + major depression
### Persistent Depressive Disorder (Dysthymia)
- Chronic low mood lasting 2+ years
- Less severe but longer-lasting than MDD
- Can include episodes of major depression ("double depression")
Trauma-Related Disorders
### Post-Traumatic Stress Disorder (PTSD)
Develops after: Exposure to actual or threatened death, serious injury, or sexual violence.
Symptom clusters:
1. Re-experiencing: Flashbacks, nightmares, intrusive memories
2. Avoidance: Avoiding reminders of the trauma
3. Negative cognitions: Guilt, shame, negative beliefs about self/world
4. Hyperarousal: Startle response, sleep problems, irritability
Most people who experience trauma do NOT develop PTSD[9]-resilience is the norm.
PTSD is highly treatable with evidence-based therapies[10].
Obsessive-Compulsive and Related Disorders
### OCD
Obsessions: Intrusive, unwanted thoughts that cause anxiety.
Compulsions: Repetitive behaviors or mental acts to reduce anxiety.
Common themes: contamination, harm, symmetry, forbidden thoughtsⓘ.
### Body Dysmorphic Disorder
- Preoccupation with perceived flaws in appearance
- Flaws are not observable or appear slight to others
- Repetitive behaviors (mirror checking, reassurance seeking)
Eating Disorders
### Anorexia Nervosa
- Restriction of food intake leading to low body weight
- Intense fear of gaining weight
- Disturbed body image
- Has the highest mortality rate of any mental disorder[12]
### Bulimia Nervosa
- Episodes of binge eating
- Compensatory behaviors (purging, fasting, excessive exercise)
- Self-evaluation unduly influenced by body shape/weight
### Binge Eating Disorder
- Recurrent binge eating episodes
- Eating rapidly, eating when not hungry, eating until uncomfortably full
- Marked distress
- No compensatory behaviors (distinguishes from bulimia)
Psychotic Disorders
### Schizophrenia
Positive symptoms (added to normal experience):
- Hallucinations (usually auditory)
- Delusions (false beliefs)
- Disorganized speech and behavior
Negative symptoms (subtracted from normal functioning):
- Flat affect
- Lack of motivation
- Social withdrawal
Cognitive symptoms:
- Working memory problems
- Attention difficulties
Schizophrenia is a brain disorder with genetic and environmental components[13].
With treatment, many people with schizophrenia lead fulfilling lives[14].
Personality Disorders
Characterized by: Enduring patterns of inner experience and behavior that deviate from cultural expectations, are pervasive and inflexible, and cause distress or impairment.
Cluster A (odd/eccentric): Paranoid, Schizoid, Schizotypal
Cluster B (dramatic/emotional): Antisocial, Borderline, Histrionic, Narcissistic
Cluster C (anxious/fearful): Avoidant, Dependent, Obsessive-Compulsive
### Borderline Personality Disorder (BPD)
- Unstable relationships, self-image, and emotions
- Fear of abandonment
- Impulsivity
- Highly treatable with DBT and other therapies[15]
Neurodevelopmental Disorders
### ADHD
Characterized by: Persistent patterns of inattention and/or hyperactivity-impulsivity.
ADHD is a real neurobiological condition[16]-brain imaging shows differences in structure and function.
ADHD persists into adulthood for most people[17]-it does not disappear at 18.
### Autism Spectrum Disorder
Characterized by:
- Differences in social communication
- Restricted interests and repetitive behaviors
- Sensory sensitivities
Autism is a spectrumⓘ-there is huge variation in how it presents.
Many autistic people prefer identity-first language ("autistic person")[19]-but preferences vary.
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Treatment Approaches
Psychotherapy
### Cognitive-Behavioral Therapy (CBT)
- Focuses on changing unhelpful thoughts and behaviors
- Structured, time-limited (typically 12-20 sessions)
- Strong evidence for depression, anxiety, OCD, and many other conditions[20]
Core idea: Thoughts, feelings, and behaviors are interconnected. Changing one affects the others.
### Exposure Therapy
- Gradually confronting feared situations or objects
- Core treatment for anxiety disorders and PTSD
- Very effective when done properly[21]-works better than avoidance
### Dialectical Behavior Therapy (DBT)
- Developed for borderline personality disorder
- Combines CBT with mindfulness and acceptance
- Teaches skills in four areas: mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness
### Psychodynamic Therapy
- Focuses on unconscious processes and past relationships
- Less structured than CBT
- Evidence for depression and some personality disorders[22]
### Interpersonal Therapy (IPT)
- Focuses on relationships and life transitions
- Time-limited (typically 12-16 sessions)
- Strong evidence for depression[23]
### EMDR
- Eye Movement Desensitization and Reprocessing
- Used primarily for PTSD
- Evidence comparable to trauma-focused CBT[24]
Medication
### Antidepressants
SSRIs (e.g., fluoxetine, sertraline):
- First-line treatment for depression and anxiety
- Take 4-6 weeks to reach full effect
- Do not cause dependence but should be tapered when stopping[25]
SNRIs (e.g., venlafaxine, duloxetine):
- Similar to SSRIs, also affect norepinephrine
Other classes: TCAs, MAOIs, atypicals (bupropion, mirtazapine)
### Anti-anxiety Medications
Benzodiazepines (e.g., alprazolam, lorazepam):
- Fast-acting
- Risk of dependence with long-term use[26]
- Best used short-term
Buspirone:
- Slower acting but no dependence risk
### Mood Stabilizers
- Lithium: gold standard for bipolar disorder
- Anticonvulsants: valproate, lamotrigine
### Antipsychotics
- First-generation (typical): older, more movement side effects
- Second-generation (atypical): newer, different side effect profile
- Used for schizophrenia, bipolar, and augmentation in depression
### Stimulants
- First-line treatment for ADHD
- Safe and effective when used as prescribed[27]
Combining Treatments
For many conditions, combined therapy and medication works better than either alone[28].
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See also: [Mental Health](/mentalhealth) for everyday coping strategies, [Psychology](/psychology) for cognitive biases, [Stress](/stress) for stress management
References
- American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). American Psychiatric Association Publishing. [DOI]
- National Institute of Mental Health (2017). National Comorbidity Survey Replication (NCS-R) - Generalized Anxiety Disorder. NIMH Statistics.
- National Institute of Mental Health (2017). National Comorbidity Survey Replication (NCS-R) - Social Anxiety Disorder. NIMH Statistics.
- American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). American Psychiatric Association Publishing. [DOI]
- Cuijpers P et al. (2019). The effects of psychotherapies for depression on response, remission, reliable change, and deterioration. World Psychiatry. [DOI]
- National Institute of Mental Health (2023). Post-Traumatic Stress Disorder Statistics. NIMH Statistics.
- VA/DoD (2023). VA/DoD Clinical Practice Guideline for the Management of Posttraumatic Stress Disorder and Acute Stress Disorder. VA/DoD Clinical Practice Guidelines.
- Arcelus J et al. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders. Archives of General Psychiatry. [DOI]
- Sullivan PF et al. (2012). Schizophrenia as a complex trait: evidence from a meta-analysis of twin studies. Nature Reviews Genetics. [DOI]
- Jääskeläinen E et al. (2013). A systematic review and meta-analysis of recovery in schizophrenia. Schizophrenia Bulletin. [DOI]
- Storebø OJ et al. (2020). Psychological therapies for people with borderline personality disorder. Cochrane Database of Systematic Reviews. [DOI]
- Hoogman M et al. (2017). Subcortical brain volume differences in participants with attention deficit hyperactivity disorder in children and adults. Lancet Psychiatry. [DOI]
- Barbaresi WJ et al. (2013). Mortality, ADHD, and Psychosocial Adversity in Adults With Childhood ADHD. Pediatrics. [DOI]
- Kenny L et al. (2016). Which terms should be used to describe autism? Perspectives from the UK autism community. Autism. [DOI]
- Hofmann SG et al. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research. [DOI]
- Wolitzky-Taylor KB et al. (2008). The efficacy of exposure-based treatment in anxiety disorders. Clinical Psychology Review. [DOI]
- Driessen E et al. (2015). The Efficacy of Short-Term Psychodynamic Psychotherapy for Depression. JAMA Psychiatry. [DOI]
- Cuijpers P et al. (2011). Interpersonal psychotherapy for depression: A meta-analysis. American Journal of Psychiatry. [DOI]
- Chen YR et al. (2014). Comparative effectiveness of EMDR and cognitive-behavioral therapy. PLOS Medicine. [DOI]
- U.S. Food and Drug Administration (2024). FDA SSRI Prescribing Information. FDA Drug Labels.
- Lader M (2011). Benzodiazepines revisited—will we ever learn?. CNS Drugs. [DOI]
- National Institute of Mental Health (2023). Attention-Deficit/Hyperactivity Disorder (ADHD) Statistics. NIMH Statistics.
- Cuijpers P et al. (2014). Combining pharmacotherapy and psychotherapy for depression: A meta-analysis. World Psychiatry. [DOI]