BPD	Borderline personality disorder
GI	Gastro-intestinal
NIAAA	National Institute on Alcohol Abuse and Alcoholism
NIMH	National Institute of Mental Health
OCD	Obsessive-compulsive disorder
PTSD	Post-traumatic stress disorder

The whole person has physical, social, psychological, and spiritual parts. Each part affects the other.

• A physical problem has social, mental, and spiritual effects.

• A mental health problem can affect the person physically, socially, and spiritually.

• A social problem can have physical, mental health, and spiritual effects.

Basic concepts

Mental relates to the mind. It is something that exists in the mind or is done by the mind. Therefore mental health involves the mind. Mental health and mental disorders involve stress:

• Stress—is the response or change in the body caused by any emotional, physical, social, or economic factor.

• Mental health—means that the person copes with and adjusts to everyday stresses in ways accepted by society.

• Mental disorder—is a disturbance in the ability to cope with or adjust to stress. Behavior and function are impaired. Mental illness, emotional illness, and psychiatric disorder are other names.

Causes of mental health disorders include:

• Not being able to cope or adjust to stress

• Chemical imbalances

• Genetics

• Physical or biologic factors

• Psychological factors

• Drug or substance abuse

• Social and cultural factors

Anxiety disorders

Anxiety is a vague, uneasy feeling in response to stress. The person may not know why or the cause. Danger or harm—real or imagined—is sensed. The person acts to relieve the unpleasant feeling. Often anxiety occurs when needs are not met.

Some anxiety is normal. Persons with mental health problems have higher levels of anxiety. Signs and symptoms depend on the degree of anxiety (Box 43-1).

Box 43-1

Signs and Symptoms of Anxiety

• A “lump” in the throat

• “Butterflies” in the stomach

• Pulse: rapid

• Respirations: rapid

• Blood pressure: increased

• Speech: rapid, voice changes

• Urinary frequency and urgency

• Attention span: poor

• Directions: difficulty following

• Sleep: difficulty

• Appetite: loss of

Anxiety level depends on the stressor. A stressor is the event or factor that causes stress. It can be physical, emotional, social, or economic. Past experiences affect how a person reacts. So does the number of stressors. A stressor may produce mild anxiety. The same stressor can cause higher anxiety at another time.

Coping and defense mechanisms are used to relieve anxiety. Some are healthy. Others are not—eating, drinking, smoking, fighting are examples. Healthy ways to cope include discussing the problem, exercising, playing music, taking a hot bath, wanting to be alone.

Defense mechanisms are unconscious reactions that block unpleasant or threatening feelings (Box 43-2). Some use of defense mechanisms is normal. In mental disorders, they are used poorly.

Box 43-2

Defense Mechanisms

Compensation. Compensate means to make up for, replace, or substitute. The person makes up for or substitutes a strength for a weakness.

EXAMPLE: Not good in sports, a child develops another talent.

Conversion. Convert means to change. An emotion is shown as a physical symptom or changed into a physical symptom.

EXAMPLE: Not wanting to read out loud in school, a child complains of a headache.

Denial. Deny means refusing to accept or believe something that is true. The person refuses to face or accept unpleasant or threatening things.

EXAMPLE: After a heart attack, a person continues to smoke.

Displacement. Displace means to move or take the place of. An individual moves behaviors or emotions from one person, place, or thing to a safe person, place, or thing.

EXAMPLE: Angry at your boss, you yell at a friend.

Identification. Identify means to relate or recognize. A person assumes the ideas, behaviors, and traits of another person.

EXAMPLE: A neighbor is a high school cheerleader. A little girl practices cheerleading in her backyard.

Projection. Project means to blame another. An individual blames another person or object for unacceptable behaviors, emotions, ideas, or wishes.

EXAMPLE: Sleeping too long, a worker blames the traffic when late for work.

Rationalization. Rational means sensible, reasonable, or logical. An acceptable reason or excuse is given for behaviors or actions. The real reason is not given.

EXAMPLE: Often late for work, an employee does not get a raise. The employee thinks “My boss doesn’t like me.”

Reaction formation. A person acts in a way opposite to what he or she truly feels.

EXAMPLE: A worker does not like his boss. He buys the boss an expensive gift.

Regression. Regress means to move back or to retreat. The person retreats or moves back to an earlier time or condition.

EXAMPLE: A 3-year-old wants a baby bottle when a new baby comes into the family.

Repression. Repress means to hold down or keep back. The person keeps unpleasant or painful thoughts or experiences from the conscious mind. They cannot be recalled or remembered.

EXAMPLE: A child was sexually abused. Now 33 years old, there is no memory of the event.

Panic disorder

Panic is the highest level of anxiety. Panic is an intense and sudden feeling of fear, anxiety, terror, or dread. Onset is sudden with no obvious reason. The person cannot function. Signs and symptoms of anxiety are severe (see Box 43-1). The person may also have:

• Chest pain

• Shortness of breath

• Rapid heart rate (“heart pounding”)

• Numbness and tingling in the hands

• Dizziness

• A smothering sensation

• Feeling of impending doom or loss of control

The person may feel that he or she is having a heart attack, losing his or her mind, or on the verge of death. Attacks can occur at any time, even during sleep.

Panic attacks can last for 10 minutes or longer. They can occur often. Panic disorder can last for a few months or for many years.

Many people avoid places where panic attacks occurred. For example, a person had a panic attack in a shopping mall. Malls are avoided.

Phobias

Phobia means an intense fear. The person has an intense fear of an object, situation, or activity that has little or no actual danger. Common phobias are fear of:

• Being in an open, crowded, or public place (agoraphobia—agora means marketplace)

• Being in pain or seeing others in pain (algophobia—algo means pain)

• Water (aquaphobia—aqua means water)

• Being in or being trapped in an enclosed or narrow space (claustrophobia—claustro means closing)

• The slightest uncleanliness (mysophobia—myso means anything that is disgusting)

• Night or darkness (nyctophobia—nycto means night or darkness)

• Fire (pyrophobia—pyro means fire)

• Strangers (xenophobia—xeno means strange)

The person avoids what is feared. When faced with the fear, the person has high anxiety and cannot function.

Obsessive-compulsive disorder

The person with obsessive-compulsive disorder (OCD) has obsessions and compulsions. An obsession is a recurrent, unwanted thought, idea, or image. Some people are obsessed with microbes, dirt, violent thoughts, or things forbidden by religious beliefs. Compulsion is repeating an act over and over again (a ritual). The act may not make sense. However, the person has much anxiety if the act is not done.

Common rituals are hand washing, constant checking to make sure the stove is off, cleaning, counting things to a certain number, or touching things in a certain order. Such rituals can take over an hour every day. They are very distressing and affect daily life. Some persons with OCD also have depression, eating disorders, substance abuse, and other anxiety disorders.

Post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) occurs after a terrifying ordeal. The ordeal involved physical harm or the threat of physical harm. Signs and symptoms of PTSD are listed in Box 43-3. PTSD can develop:

• After being harmed

• After a loved one was harmed

• After seeing a harmful event happen to loved ones or strangers

Box 43-3

Signs and Symptoms of Post-Traumatic Stress Disorder

• Startles easily

• Emotionally numb—especially to those with whom the person used to be close

• Difficulty trusting people

• Difficulty feeling close to people

• Loss of interest in things he or she used to enjoy

• Problems being affectionate

• Feelings of intense guilt

• Irritability

• Avoiding situations that remind of the harmful event

• Difficulty around the anniversary of the harmful event

• Gets mad easily

• Outbursts of anger

• Problems sleeping

• Increasingly aggressive

• Becoming more violent

• Physical symptoms:

• Headache

• Gastro-intestinal (GI) distress

• Immune system problems

• Dizziness

• Chest pain

• Discomfort in other body parts

PTSD can result from many traumatic events. They include:

• A crash—vehicle, train, plane

• Bombing

• A natural disaster—flood, tornado, hurricane

Most people with PTSD have flashbacks. A flashback is reliving the trauma in thoughts during the day and in nightmares during sleep. Flashbacks may involve images, sounds, smells, or feelings. Everyday things can trigger them. A door slamming is an example. During a flashback, the person may lose touch with reality. He or she may believe that the trauma is happening all over again.

Signs and symptoms usually develop about 3 months after the harmful event. However, they may not emerge until years later. Some people recover within 6 months. PTSD lasts longer in other people. The condition may become chronic.

PTSD can develop at any age including during childhood. The person may also suffer from depression, substance abuse, and other anxiety disorders.

Schizophrenia

Schizophrenia means split (schizo) mind (phrenia). It is a severe, chronic, disabling brain disorder. It involves:

• Psychosis—a state of severe mental impairment. The person does not view the real or unreal correctly.

• Delusion—a false belief. For example, the person believes that a radio station is broadcasting the person’s thoughts.

• Hallucination—seeing, hearing, smelling, or feeling something that is not real. A person may see animals, insects, or people that are not real. “Voices” are the most common type of hallucination in schizophrenia. “Voices” may comment on behavior, order the person to do things, warn of danger, or talk to other voices.

• Paranoia—a disorder (para) of the mind (noia). The person has false beliefs (delusions). He or she is suspicious about a person or situation. For example, a person may believe that others are cheating, harassing, poisoning, spying upon, or plotting against him or her.

• Delusion of grandeur—an exaggerated belief about one’s importance, wealth, power, or talents. For example, a man believes he is Superman. Or a woman believes she is the Queen of England.

• Delusion of persecution—the false belief that one is being mistreated, abused, or harassed. For example, a person believes that someone is “out to get” him or her.

The person with schizophrenia has severe mental impairment (psychosis). Thinking and behavior are disturbed. The person has false beliefs (delusions). He or she also has hallucinations. That is, the person sees, hears, smells, or feels things that are not real. The person has problems relating to others. He or she may be paranoid. That is, the person is suspicious about a person or situation. The person may have difficulty organizing thoughts. Responses are not appropriate. Communication is disturbed. The person may ramble or repeat what another says. Sometimes speech cannot be understood. He or she may make up words. The person may withdraw. That is, the person lacks interest in others. He or she is not involved with people or society.

Disorders of movement occur. These include: