Although substantial progress has been made in reducing the stigma of mental illness, many people continue to consider mental illness a relatively rare affliction. In fact, in the United States, about one of every four American adults suffer from a mental disorder for any given year (NIMH Fact Sheet). Thus, mental illness is quite common.
In addition, mental illness is costly. The NIMH states “The burden of mental illness on health and productivity in the United States and throughout the world has long been underestimated.”
Consider these facts:
● Mental illness, including suicide, accounts for over 15.5 % of the burden of disease in established market economies, such as the U.S. This is more than the disease burden caused by all cancers.
● Major depression is the second highest contributor to disease burden, resulting in this mental illness being the leading cause of disability worldwide.
● Although some mental illness resolves without treatment (e.g., adjustment reactions with depressive or anxious features), the majority of illnesses do not go away on their own.
● Effective treatments are available for most mental illness (c.f., American Psychiatric Association; American Psychological Association) and even serious mental illness that is considered chronic can be effectively managed so that quality of life is improved.
If you, or someone you care about, suffers from mental illness, you are not alone. Below we define the most common mental illnesses, describe the symptoms of these illnesses, as well as the available treatments, and list some links to additional sources of information and help.
Disorders with Onset Common in Adulthood
Mood Disorders
● In any given year, about 9.5% of the population has a mood disorder or depressive illness.
● Most people with a mood disorder do not seek treatment (NIMH Fact sheet).
● There are three primary types of mood disorders: Major Depression, Dysthymia and Bipolar Disorder.
Major Depression is characterized by five or more of the following symptoms, for at least two weeks duration which must impair functioning and performance:
Depressed mood most of the day
Reduced interest and pleasure un all or almost all, activities
Significant weight change without a desire to change weight
Sleeping too much or too little nearly every day
Visible agitation or severe slowing nearly every day
Fatigue or loss of energy nearly every day
Feelings of intense worthlessness
Diminished ability to think or to concentrate
Recurrent thoughts of death, recurrent suicidal thoughts without a plan, or a suicide attempt or a suicide plan
Dysthymia is characterized by a persistent sad or depressed mood, of more than two years duration, as well as the presence of 2 or more of the following:
Poor appetite or overeating
Excessive sleeping or Insomnia
Low energy or fatigue
Low self-esteem
Poor concentration or decision making ability
Feelings of Hopelessness
Bipolar Disorder, formerly referred to as manic-depression, is characterized by periods of a depression as well as at least one manic or hypomanic period. Mania is defined as a period of no less than a week of abnormally elevated mood with three or more of the following symptoms:
Inflated self-esteem or grandiosity
Decreased need for sleep
Pressure to talk or speaking more than usual, and at a rapid pace
Flight of ideas or the sense that thoughts are racing
Marked increase in activities or agitation
Excessive involvement in pleasurable activities that have a high potential for negative consequences (e.g., buying sprees, sexual binges, poor judgements in business)
Treatment begins with consulting your doctor to rule out other illnesses that can create depressive symptoms. When assessment is complete, a course of medication and psychotherapy is usually the most effective treatment. The interested reader is referred to the following web links for more information on Mood Disorders and their treatments.
Anxiety Disorders affect about 40 million American adults age 18 years and older (about 18%). These troubling but treatable problems must last at least 6 months to meet the definaition of anxiety disorder. Anxiety disorders get worse if they are not treated.
According to the National Institute of Mental Health, there are five major types of anxiety disorders, and the links below will lead you to NIMH fact sheets. These disorders are:
Generalized Anxiety Disorder, GAD, is an anxiety disorder characterized by chronic anxiety, exaggerated worry and tension, even when there is little or nothing to provoke it
Obsessive-Compulsive Disorder (OCD) OCD, is an anxiety disorder and is characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). Repetitive behaviors such as handwashing, counting, checking, or cleaning are often performed with the hope of preventing obsessive thoughts or making them go away. Performing these so-called "rituals," however, provides only temporary relief, and not performing them markedly increases anxiety.
Panic Disorder Panic disorder is an anxiety disorder and is characterized by unexpected and repeated episodes of intense fear accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of breath, dizziness, or abdominal distress.
Post-Traumatic Stress Disorder (PTSD) is described thoroughly in the website on the link “Responses to Traumatic Stressors”
Social Phobia (or Social Anxiety Disorder) Social Phobia, or Social Anxiety Disorder, is an anxiety disorder characterized by overwhelming anxiety and excessive self-consciousness in everyday social situations. Social phobia can be limited to only one type of situation — such as a fear of speaking in formal or informal situations, or eating or drinking in front of others — or, in its most severe form, may be so broad that a person experiences symptoms almost anytime they are around other people.
In general, anxiety disorders are treated with medication, specific types of psychotherapy, or both. Treatment choices depend on the problem and the person's preference. Before treatment begins, a doctor must conduct a careful diagnostic evaluation to determine whether a person's symptoms are caused by an anxiety disorder or a physical problem. If an anxiety disorder is diagnosed, the type of disorder or the combination of disorders that are present must be identified, as well as any coexisting conditions, such as depression or substance abuse. Sometimes alcoholism, depression, or other coexisting conditions have such a strong effect on the individual that treating the anxiety disorder must wait until the coexisting conditions are brought under control.
Substance Use Disorder is only briefly mentioned here, because substance use disorder is carefully addressed in the Health Risk Behavior portion of the website. Alcohol and drug abuse are not problems that are confined to the user; in fact, the people most effected by alcohol and drug problems may be those close to, or dependent on, the user (e.g., family, friends and coworkers). Thus, people who have crossed over into health risk from their alcohol and or drug misuse should know that lots of help is available, and the variety of effective help is increasing every year.
Firefighters who want to learn more about the types of help available can find excellent web resources at the National Institute of Health (www.nih.gov; www.nida.nih.gov; www.niaaa.nih.gov)
Schizophrenia and other Psychotic Disorders are characterized by the presence of psychotic features including seeing or hearing things that are not there (hallucinations), disorganized speech, disorganized behavior, and sometimes, catatonia. People with psychotic spectrum disorders are usually profoundly effected by these symptoms, although the course of the illness can be as little as one month (brief psychotic disorder) and as much as a lifetime (typical of schizophrenia).
Schizophrenia is a severe form of mental illness affecting about 7 per thousand of the adult population, mostly in the age group 15-35 years.
• Schizophrenia is a treatable disorder, treatment being more effective in its initial stages.
• More than 50% of persons with schizophrenia are not receiving appropriate care.
• Care of persons with schizophrenia can be provided at community level, with active family and community involvement.
The essential features of schizophrenia, the most common psychotic disorder, are:
Two or more of the following:
Delusions
Hallucinations
Disorganized Speech
Grossly Disorganized or catatonic behavior
Flattened Affect, Alogia (nonsense speech)
Social and Occupational Dysfunction
Symptoms occurring for at least six months
No mood disorder evident
No Substance abuse that would account for the psychotic thought processes
No history of autism or pervasive developmental disorder
In addition, schizophrenia has different subtypes including paranoid type, disorganized type, catatonic type, and undifferentiated type.
Other Psychotic Disorders include Schizophreniform Disorder, Schizoaffective Disorder, and Delusional Disorder.
Treatments are effective, and these treatments are a combination of pharmacological and psychosocial interventions. The earlier treatment is initiated, the better the outcome. Unfortunately, the majority of the persons with chronic schizophrenia do not receive treatment, which contributes to the chronicity. If you, or someone you care about, seems to be suffering from a psychotic disorder, seek attention early from doctors, community mental health systems and local mental illness advocacy organizations. Each state has a Department of Mental Health that can provide lists of treatment options in your vicinity.
Disorders with Onset in Childhood or Adolescence
Disorders which typically first appear and are diagnosed in childhood or adolescence include the learning disabilities including retardation, learning disorders, motor skills disorders, communication disorders, and developmental disorders. Also occurring during childhood are attention deficit disorder, and disruptive behavior disorders. Some types of anxiety disorders occur in childhood, and eating disorders usually begin in adolescence.
The signs and symptoms of these disorders are beyond the scope of this website, but the interested firefighter is referred to the National Institute of Mental Health for excellent free resources on all of the disorders of childhood. This site also contains valuable referral resources. Check it out at www.nimh.nih.gov.