A mental disorder or mental illness is a psychological or behavioral pattern associated with distress or disability and which is not considered a part of the standard development of an individual. Such disorders are associated with a combination of affective, behavioral, cognitive or perceptual components of a brain or nervous system, often in a social context. The recognition and understanding of mental health conditions have changed over time and there are still variations in definition, assessment and classification of disorder. Over a third of people, in the U.S. report problems, which meets the criteria for diagnosis of various types of mental disorder.
Mental illness falls along a continuum of severity. Even though mental illness is widespread within the population, the main burden of illness is concentrated in a much smaller proportion ? about six percent, or one in seventeen Americans ? all of whom live with a serious mental disorder. The National Institute of Mental Health reports that one in four adults ? approximately 57.7 million Americans ? experience a mental health disorder in a given year.
Types of Mental Disorder
There are different categories of mental disorder, along with different facets of human behavior and personality, which can be associated with various forms of mental health disorder.
Anxiety, or fear that interferes with normal functioning, may be classified as an anxiety disorder. Commonly recognized categories include specific phobias, generalized anxiety disorder, social anxiety disorder, panic disorder, agoraphobia, obsessive-compulsive disorder and post-traumatic stress disorder.
Other affective (emotion/mood) processes can also transform into disorders. Mood disorder, involving intense and sustained sadness, melancholia or despair, is known as major depression or clinical depression (milder but still prolonged depression can be diagnosed as dysthymia). Bipolar disorder (also known as manic depression) involves abnormally ‘high’ or pressured mood states, known as mania or hypomania, alternating with normal or depressed mood. Whether unipolar and bipolar mood phenomena represent distinct categories of disorder, or whether they merge together along a dimension or spectrum of mood, is under debate in the scientific world.
Patterns of belief, language use or perception can be classified into mental disorders (e.g. delusions, thought disorders or hallucinations). Psychotic disorders in this domain include schizophrenia, and delusional disorder. Schizoaffective disorder is used to describe individuals showing aspects of schizophrenia and affective disorders. Schizotype is a term used to describe individuals showing some of the characteristics associated with schizophrenia, but without meeting cut-off criteria.
Eating disorders involve disproportionate concerns in matters of food and weight. Categories of disorder in this area include anorexia nervosa, bulimia nervosa, exercise bulimia or binge eating disorder.
Sleep disorders such as insomnia involve disruption to normal sleep patterns, or a feeling of tiredness despite sleep appearing normal.
People who are abnormally unable to resist certain urges or impulses that could be harmful to themselves or others, may be classed as having an impulse control disorder, including various kinds of tic disorders such as Tourette’s syndrome and disorders such as kleptomania (stealing) or pyromania (fire-setting). Various behavioral addictions, such as gambling addiction, may be classed as a disorder. Obsessive-compulsive disorder can sometimes involve an inability to resist certain acts but is classed separately as being primarily an anxiety disorder.
People who suffer severe disturbances of their self-identity, memory and general awareness of themselves and their surroundings may be classed as having a dissociative identity disorder, such as depersonalization disorder or Dissociative Identity Disorder itself (which has also been called multiple personality disorder, or ‘split personality’). Other memory or cognitive disorders include amnesia or various kinds of age related dementia.
A range of developmental disorders that initially occur in childhood may be diagnosed, for example autism spectrum disorders, oppositional defiant disorder, conduct disorder and attention deficit hyperactivity disorder (ADHD), which may continue in adulthood.
Factitious disorders, such as Munchausen syndrome, are diagnosed where symptoms are thought to be experienced (deliberately produced) and/or reported (feigned) for personal gain.
There are attempts to introduce a category of relational disorder, where the diagnosis is of a relationship rather than on any one individual in that relationship. The relationship may be between children and their parents, between couples or others. There already exists, under the category of psychosis, a diagnosis of shared psychotic disorder where two or more individuals share a particular delusion because of their close relationship with each other.
Treatment and Management:
A mental illness, like many chronic illnesses, requires ongoing mental health treatment. Fortunately, much progress has been made in the last two decades in treating mental illnesses. As a result, many mental conditions can be effectively treated with one or a combination of the following therapies:
• Group therapy
• Day treatment or partial hospital treatment
• Specific therapies, such as cognitive-behavior therapy and behavior modification
Other treatments available include:
• Alternative therapies, such as water therapy, massage and biofeedback
• Creative therapies, such as art therapy, music therapy or play therapy
• Electroconvulsive therapy (ECT)
• Vagal nerve stimulation (VNS)
Diet and Mental Health
Scientists, psychiatrists, and other health care professionals accept the fact that food affects how people feel, think and behave. Most experts accept that dietary interventions could have an impact on a number of the mental health challenges which society faces today.
The evidence that diet can play a significant role in the care and treatment of people with mental health problems is becoming more compelling. Disorders including depression, ADHD (attention deficit hyperactivity disorder), to name but a few, have been proven to respond to changes in diet. If experts are talking about an integrated approach, which recognizes the interplay of biological, psychological, social and environmental factors – with diet in the middle of it as being key – and challenges the growing burden of mental health problems in developed nations, surely individuals can speed things up and do something about their diet themselves in order to improve their mental health.
Exercise and Mental Health
An interesting animal study found that both physical and mental exercises help to improve schizophrenia symptoms. A Harvard University study found that exercise may help people with depression by enhancing body image, providing social support from exercise groups, a distraction for every day worries, heightened self-confidence from meeting a goal and altered circulation of the neurotransmitters serotonin, norepinephrine, and the endorphins.
Even a very small amount of additional exercise has been seen to have an important impact on mental health. A Scottish study involving 20,000 people found that performing as little as twenty minutes of any physical activity, including housework, per week is enough to boost mental health.
A major option for mental disorders is psychotherapy. Cognitive behavioral therapy (CBT) is widely used and is based on modifying the patterns of thought and behavior associated with a particular disorder. Psychoanalysis, addressing underlying psychic conflicts and defenses, has been a dominant school of psychotherapy and is still in use. Systemic therapy or family therapy is also used, addressing a network of significant others as well as an individual.
Some psychotherapies are based on a humanistic approach. There are a number of specific therapies used for particular disorders, which may be offshoots or hybrids of the above types. Mental health professionals often employ an eclectic or integrative approach. Much may depend on the therapeutic relationship and there may be problems with trust, confidentiality and engagement.
A major option for many mental disorders is psychiatric medication and there are several main groups. Antidepressants are used for the treatment of clinical depression, as well as often for anxiety and a range of other disorders. Anxiolytics (including sedatives are used for anxiety disorders and related problems such as insomnia. Mood stabilizers are used primarily in bipolar disorder. Antipsychotics are used for psychotic disorders, notably for positive symptoms in schizophrenia and also, increasingly, for a range of other disorders. Stimulants are commonly used, notably for ADHD.
Despite the different conventional names of the drug groups, there may be considerable overlap in the disorders for which they are actually indicated. There may also be off-label use of medications. There can be problems with adverse effects of medication and adherence to them and there is also criticism of pharmaceutical marketing and professional conflicts of interest.
Counseling (professional) and co-counseling (between peers) may be used for mental health treatment. Psychoeducation programs may provide people with the information to understand and manage their problems. Creative therapies are sometimes used, including music therapy, art therapy or drama therapy. Lifestyle adjustments and supportive measures are often used, including peer support, self-help groups for mental health and supported housing or supported employment (including social firms). Some advocate dietary supplements.
Reasonable accommodations (adjustments and supports) might be put in place to help an individual cope and succeed in environments, despite potential disability related to mental health problems.
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