AUD	Alcohol use disorder
BPD	Borderline personality disorder
CDC	Centers for Disease Control and Prevention
GAD	Generalized anxiety disorder
OCD	Obsessive-compulsive disorder
OTC	Over-the-counter
PTSD	Post-traumatic stress disorder

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

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

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

• A social problem can have physical, mental, 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 health disorders involve stress.

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

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

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

Causes of mental health disorders include:

• Not being able to cope with or adjust to stress.

• Chemical imbalances.

• Genetics. Many mental health disorders tend to run in families. Generalized anxiety disorder, schizophrenia, bipolar disorder, and depression are examples.

• Physical, biological, or psychological factors.

• Drug or substance abuse.

• Social and cultural factors.

• Abuse.

Personality

Personality is the set of attitudes, values, behaviors, and traits of a person. Personality development starts at birth. Influencing factors include genes, culture, environment, parenting, and social experiences.

Maslow’s theory of basic needs (Chapter 9) affects personality development. Physical needs are met before safety and security, love and belonging, self-esteem, and self-actualization needs. Children who grow up hungry, neglected, cold, or abused will not feel safe and secure. Higher-level needs cannot be met. Unmet needs at any age affect personality development.

Growth and development also affect personality development (Chapter 11). They occur in a sequence, order, and pattern. Certain tasks must be achieved at each stage. Each stage is the basis for the next stage.

Anxiety Disorders

Anxiety is a vague, uneasy feeling in response to stress. The person senses danger or harm—real or imagined. The person acts to relieve the unpleasant feeling. Often anxiety occurs when needs are not met.

Some anxiety is normal. Persons with mental health disorders have higher levels of anxiety. Signs and symptoms depend on the degree of anxiety (Box 48-1).

Box 48-1

Anxiety—

Signs and Symptoms

• Appetite: loss of

• Apprehension

• Attention span: poor

• Blood pressure: increased

• “Butterflies” in the stomach

• Diarrhea

• Directions: difficulty following

• “Lump” in the throat

• Mouth: dry

• Nausea

• Pulse: rapid

• Respirations: rapid

• Sleep: difficulty

• Speech: rapid, voice changes

• Sweating

• Tiredness

• Trembling

• Urinary frequency and urgency

• Weakness

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 and the number of stressors affect how a person reacts. A stressor may cause mild anxiety. Or it can cause higher anxiety at another time.

Coping and defense mechanisms may help relieve anxiety. Unhealthy coping includes over-eating, drinking, smoking, and fighting. Healthy coping includes discussing the problem, exercising, playing music, taking a hot bath, and wanting to be alone.

Defense mechanisms are unconscious reactions that block unpleasant or threatening feelings (Box 48-2). (Unconscious reactions are experiences and feelings that cannot be recalled.) Some use of defense mechanisms is normal. In mental health disorders, they are used poorly.

Box 48-2

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 1 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 a 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.

Anxiety disorders last at least 6 months. They often occur with other physical illnesses or mental health disorders. Depression, eating disorders, and substance abuse are examples. Persons 18 years of age and older are at risk. However, anxiety disorders can develop in childhood.

Generalized Anxiety Disorder

Some worry and anxiety are normal. However, the person with generalized anxiety disorder (GAD) has extreme worry for little or no reason. The person has extreme anxiety. He or she worries about health, money, or family problems. Getting through the day can be difficult. Worry can prevent the person from normal function.

Panic Disorder

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 48-1). The person may also have:

• Chest pain

• Shortness of breath

• Numbness and tingling in the hands

• Dizziness

• A smothering feeling

• 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 during sleep.

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:

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, sexual acts, or things forbidden by religion. Compulsion is repeating an act over and over again (a ritual). The act may not make sense. Anxiety is great if the act is not done.

Common rituals are hand-washing, cleaning, counting things to a certain number, or touching things in a certain order. Such rituals can take over an hour every day. Hoarding is another OCD behavior. OCD behaviors are very distressing and affect daily life.

Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) occurs after a terrifying event. There was physical harm or the threat of physical harm. PTSD can develop at any age. See Box 48-3 for signs and symptoms. PTSD can develop:

• After being harmed or after a loved one was harmed

• After seeing a harmful event happen to a loved one or stranger

Box 48-3

Post-Traumatic Stress Disorder—

Signs and Symptoms

• Affection: problems with

• Aggressive and violent behaviors

• Anger: gets mad easily; outbursts

• Avoidance of situations that remind of the harmful event

• Closeness: problems with

• Difficulty around the anniversary of the harmful event

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

• Flashbacks

• Guilt: intense

• Irritability

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

• Physical symptoms:

• Headache

• Gastro-intestinal (GI) distress

• Immune system problems

• Dizziness

• Chest pain

• Discomfort in other body parts

• Sleeping: problems with

• Startles easily

• Trusting people: problems with

PTSD can result from many traumatic events. They include:

• War, terrorist attack, bombing

• Abuse, mugging, rape, torture

• Kidnapping, being held captive

• Crashes—vehicle, train, plane

• Natural disasters—flood, tornado, hurricane, earthquake

Flashbacks are common. 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 believe that the trauma is happening all over again.

Signs and symptoms usually develop about 3 months after the event. Some people recover within 6 months. PTSD lasts longer in other people. The condition may become chronic.

Schizophrenia

Schizophrenia means split (schizo) mind (phrenia). The person’s thinking and emotions are not in balance. A severe, chronic, disabling brain disorder, schizophrenia involves:

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

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

• Delusions—false beliefs. For example, the person believes that a radio station is airing the person’s thoughts or that he or she is being harmed. The person may have:

• Delusions of grandeur—exaggerated beliefs 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.

• Delusions of persecution—false beliefs that one is being mistreated, abused, or harassed. For example, a person believes that someone is “out to get” him or her. Or a person thinks others are cheating, harassing, poisoning, spying on, or plotting against him or her.

• Thought disorders. The person has trouble organizing thoughts or connecting thoughts logically. Speech may be garbled and hard to understand. The person may suddenly stop speaking in the middle of a thought. Some persons make up words that have no meaning.

• Movement disorders. These include:

• Agitated body movements

• Repeating motions over and over

• Sitting for hours without moving, speaking, or responding

• Emotional and behavioral problems. Normal functions are impaired or absent. The person may:

• Lose motivation or interest in daily activities.

• Be unable to plan or do activities.

• Seem to lack emotions.

• Neglect personal hygiene.

• Withdraw socially.

• Cognitive problems. Cognitive relates to understanding, remembering, and reasoning. The person may have trouble paying attention or understanding or remembering information. Symptoms make it hard for the person to perform daily tasks.