Order in Mental Disorders: Please Understand the Differences
You've heard it and maybe you've said it: "He's being schizo," or "She's bipolar today," or even, "They're just plain crazy."
You don't really mean those things, do you? When you casually toss out labels about mental illnesses that affect millions of people, it can be a way of responding to a situation in the moment. It also contributes to stigma — that "thing" that happens and disgraces or discredits a person who has a mental disorder, according to the National Alliance on Mental Illness (NAMI).
The current Diagnostic and Statistical Manual (DSM-5), the psychiatrist's "Bible," lists several hundred disorders — one in five American adults has at least one. Mental health advocates encourage us to understand basic differences between disorders so we don’t misidentify them, since "one size does not fit all."
Know your disorders
Let's start with the basics. Here's a handy list that explains common mental disorders, courtesy of the American Psychiatric Association. These typically rank as the "top four:"
- Anxiety (six types) (42 million people): These involve — you guessed it — anxiety that is anticipation of a future concern, or excessive fear. Fear is an emotional response to an immediate threat. For a diagnosis, the fear or anxiety must be out of proportion to the situation, be "age inappropriate," or hinder your ability to function normally.
Major depression or depressive disorder (16 million people): It's characterized by feeling sad or having a depressed mood, loss of interest or pleasure in activities, appetite change, sleeping too much or too little, feeling worthless or guilty, difficulty concentrating, or thoughts of death or suicide.
Bipolar disorder (three types) (6.1 million people): A person exhibits extreme and intense emotional states that occur at distinct times, called mood episodes. These mood episodes are categorized as manic, hypomanic, or depressive.
Schizophrenia (2.4 million people): When active, symptoms can include delusions, hallucinations, trouble with thinking and concentration, and lack of motivation. It is not split personality or multiple-personality disorder.
That mind-body connection
Most people really don't grasp the nuances, says Tina Collins, 52, of Baltimore, who is diagnosed with schizoaffective disorder. She's learned to be patient when people don't understand her disorder. NAMI says it's characterized primarily by symptoms of schizophrenia, such as hallucinations or delusions, as well as symptoms of a mood disorder, such as mania and depression.
Collins, a proactive mental health advocate, blogger and TEDx Talk speaker, reminds us that people can have disorders in the spectrum, a wide range or "a mass of symptoms," she said in a telephone interview with HealthCentral.
"They can affect people uniquely enough to make diagnosis difficult. Many people can exist on the spectrum, with symptoms that aren't completely unrelated, but shift back and forth,"
Collins, who hasn't been shy about chronicling her journey of recovery, also hopes more people will realize a mental disorder can have a lot in common with a physical ailment and that "the body functions as a whole organism. If you're anxious, you might get an upset stomach. The brain and body really are connected."
It's what they have
The latest DSM "did not significantly increase the number of disorders from the previous version," said psychologist Gary Gintner, Ph.D., associate professor at Louisiana State University's school of education in a telephone interview with HealthCentral.
"It did change the titles of a number of disorders so as not to dissuade people from seeking treatment," Dr. Gintner says.
For example, he says, what used to be called alcohol dependence is now called alcohol use disorder: mild, moderate, or severe.
He hopes none of us will define a person by their disorder.
"A mental disorder is not what a person is, but it's something a person has," he says.
Also, be cognizant that yes, this could happen to you or someone you know — and it probably will. Consider that NAMI says nearly one in 25 (10 million) American adults lives with a serious mental illness.
"There's a 50 percent chance a person will have a mental disorder at some point in their lifetime that's codable (meaning the diagnosis receives a numeric code from the provider)," he says. "Yes, people may have a reaction to a life stressor, but when it goes beyond the normal reaction of grief or bereavement — having a number of symptoms for a longer, designated period of time — that is different."
Mental is medical and social
Mental health conditions are both medical and social justice issues, said Katrina Gay in a telephone interview with HealthCentral. As NAMI's National Director of Strategic Partnerships, Gay says: "Social justice does not necessarily exist with other kinds of health conditions. It's more complex, since we see mental conditions through a social lens and not just through a medical lens as we do cancer or diabetes, for example. Take OCD (obsessive-compulsive disorder), a condition people often make fun of and trivialize — it can be challenging and often debilitating."
Humans often need to simplify complicated things in order to relate to others, to generalize complex topics such as mental illness. Pop culture references can also influence us, Gay says.
"Sometimes we use humor so we can begin to talk about them — many times we don't mean to be offensive. We really do the best we can to make sense of those things that don't make sense."
Now Collins remains open and comfortable talking about her disorder: "Some people listen, sometimes they don't. When I hear people say something wrong, I resist the urge to lecture, for I don't want to make anyone feel uncomfortable and ashamed. I find a sense of humor also saves people when they want to understand why a person is doing something. It's good sometimes to find the absurdity – but to do it kindly."
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