Everyone feels worried or anxious or down from time to time. But relatively few people develop a mental illness. What's the difference? A mental illness is a mental health condition that gets in the way of thinking, relating to others, and day-to-day function.
Dozens of mental illnesses have been identified and defined. They include depression, generalized anxiety disorder, bipolar disorder, obsessive-compulsive disorder, post-traumatic stress disorder, schizophrenia, and many more.
Mental illness is an equal opportunity issue. It affects young and old, male and female, and individuals of every race, ethnic background, education level, and income level. The good news is that it can often be treated.
Signs and symptoms of mental illness depend in part on the illness. Common symptoms include
- feeling down for a while
- extreme swings in mood
- withdrawing from family, friends, or activities
- low energy or problems sleeping
- often feeling angry, hostile, or violent
- feeling paranoid, hearing voices, or having hallucinations
- often thinking about death or suicide.
In some people, symptoms of a mental illness first appear as physical problems such as stomach aches, back pain, or insomnia.
Individuals with a mental illness can often ease their symptoms and feel better by talking with a therapist and following a treatment plan that may or may not include medication.
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In generalized anxiety disorder, a person has frequent or nearly constant, nagging feelings of worry or anxiety. These feelings are either unusually intense or out of proportion to the real troubles and dangers of the person's everyday life.
The disorder is defined as persistent worry for more days than not, for at least several months. In some cases, a person with generalized anxiety disorder feels he or she has always been a worrier, even since childhood or adolescence. In other cases, the anxiety may be triggered by a crisis or a period of stress, such as a job loss, a family illness or the death of a relative. The crisis or stress may have ended, but an unexplained feeling of anxiety may last months or years.
In addition to suffering from constant (or non-stop) worries and anxieties, people with generalized anxiety disorder may have low self-esteem or feel insecure because they see people's intentions or events in negative terms, or they experience them as intimidating or critical. Physical symptoms may lead them to seek treatment from a primary care doctor, cardiologist, pulmonary specialist or gastroenterologist. Stress can intensify the anxiety.
Experts believe that some people with this disorder have a genetic (inherited) tendency to develop it. The disorder probably stems from how a variety of brain structures communicate with each other as they manage the fear response. Chemical messengers, gamma aminobutyric acid (GABA) and serotonin, transmit signals along the circuits connecting brain regions. The medications used to treat anxiety affect these circuits.
About 3% to 8% of people in the United States have generalized anxiety disorder. Women have the problem twice as often as men. The average adult patient first seeks professional help between the ages of 20 and 30. However, the illness can occur at any age. Generalized anxiety disorder also has been diagnosed in young children, teenagers and elderly people. The illness is the most common anxiety disorder affecting people age 65 and older.
Of all psychiatric illnesses, generalized anxiety disorder is the least likely to occur alone. Between 50% and 90% of people with the disorder also have at least one other problem, usually panic disorder, a phobia, depression, dysthymia (a less severe form of depression), alcoholism or some other form of substance abuse.
A phobia is a persistent, excessive, unrealistic fear of an object, person, animal, activity or situation. It is a type of anxiety disorder. A person with a phobia either tries to avoid the thing that triggers the fear, or endures it with great anxiety and distress.
There are three major types of phobia:
Specific phobia (simple phobia). With this most common form of phobia, people may fear specific animals (such as dogs, cats, spiders, snakes), people (such as clowns, dentists, doctors), environments (such as dark places, thunderstorms, high places) or situations (such as flying in a plane, riding on a train, being in a confined space). These conditions are at least partly genetic (inherited) and seem to run in families.
Social phobia (social anxiety disorder). People with social phobia fear social situations where they may be humiliated, embarrassed or judged by others. They become particularly anxious when unfamiliar people are involved.
Agoraphobia. Agoraphobia is a fear of being in public places where it would be difficult or embarrassing to make a sudden exit.
Childhood phobias occur most commonly between the ages of 5 and 9, and tend to last a short while. Most longer-lasting phobias begin later in life, especially in people in their 20s. Adult phobias tend to last for many years, and they are less likely to go away on their own. Without proper treatment, phobia can increase an adult's risk of other types of psychiatric illness, especially other anxiety disorders, depression and substance abuse.
Schizophrenia is a chronic (long-lasting) brain disorder that is easily misunderstood. Although symptoms may vary widely, people with schizophrenia frequently have a hard time recognizing reality, thinking logically and behaving naturally in social situations. Schizophrenia is surprisingly common, affecting 1 in every 100 people worldwide.
Experts believe schizophrenia results from a combination of genetic and environmental causes. The chance of having schizophrenia is 10% if an immediate family member (a parent or sibling) has the illness. The risk is as high as 65% for those who have an identical twin with schizophrenia.
Scientists have identified several genes that increase the risk of getting this illness. In fact, so many problem genes have been investigated that schizophrenia can be seen as several illnesses rather than one. These genes probably affect the way the brain develops and how nerve cells communicate with one another. In a vulnerable person, a stress (such as a toxin, an infection or a nutritional deficiency) may trigger the illness during critical periods of brain development.
Schizophrenia may start as early as childhood and last throughout life. People with this illness periodically have difficulty with their thoughts and their perceptions. They may withdraw from social contacts. Without treatment, symptoms get worse.
Schizophrenia is one of several "psychotic" disorders. Psychosis can be defined as the inability to recognize reality. It may include such symptoms as delusions (false beliefs), hallucinations (false perceptions), and disorganized speech or behavior. Psychosis is a symptom of many mental disorders. In other words, having a psychotic symptom does not necessarily mean a person has schizophrenia.
Symptoms in schizophrenia are described as either "positive" or "negative." Positive symptoms are psychotic symptoms such as delusions, hallucinations and disorganized behavior. Negative symptoms are the tendency toward restricted emotions, flat affect (diminished emotional expressiveness), and the inability to start or continue productive activity.
In addition to positive and negative symptoms, many people with schizophrenia also have cognitive symptoms (problems with their intellectual functioning). They may have trouble with "working memory." That is, they have trouble keeping information in mind in order to use it, for example, remembering a phone number that they have just heard. These problems can be very subtle, but in many cases may account for why a person with schizophrenia has such a hard time managing day-to-day life.
Schizophrenia can be marked by a steady deterioration of logical thinking, social skills and behavior. These problems can interfere with personal relationships or functioning at work. Self-care can also suffer.
As people with schizophrenia realize what it means to have the disease, they may become depressed. People with schizophrenia are therefore at greater than average risk of committing suicide. Family members and health care professionals need to stay alert to this possibility.
People with schizophrenia are also at more risk for developing substance abuse problems. People who drink and use substances have a harder time adhering to treatment. People with schizophrenia smoke more than people in the general population. The smoking leads to more health problems.
Anyone with serious and chronic mental illness is at greater risk for developing metabolic syndrome. Metabolic syndrome is a group of risk factors that increase risk for cardiovascular disease and diabetes. The risk factors include obesity, high blood pressure and abnormal lipid levels in the bloodstream.
Schizophrenia has historically been divided into several subtypes, but researchers in the last several years have determined that these divisions are probably not clinically useful.
Dysthymia, also called dysthymic disorder, is a form of depression. It is less severe than major depression, but usually lasts longer. Many people with this type of depression describe having been depressed as long as they can remember, or they feel they are going in and out of depression all the time.
The symptoms of dysthymia are similar to those of major depression, though they tend to be less intense. In both conditions, a person can have a low or irritable mood, a decrease in pleasure, and a loss of energy. They feel relatively unmotivated and disengaged from the world. Appetite and weight can increase or decrease. The person may sleep too much or have trouble sleeping. He or she may have difficulty concentrating. The person may be indecisive and pessimistic and have a poor self-image.
Symptoms can grow into a full-blown episode of major depression. This situation is sometimes called "double depression" because the second problem (major depressive episode) is superimposed on the usual feelings of low mood. People with dysthymia have a greater-than-average chance of developing major depression.