By Susan Davis Gryder 2014-02-27 19:08:59
Mental illness takes many forms and affects millions of Americans of all ages. Even though we rarely talk about mental health and illness, the odds are such that you or someone close to you has grappled with some kind of mental or mood disorder in recent months. According to the National Institute of Mental Health, roughly 26% of Americans ages 18 or older struggle with a diagnosable mental disorder in a given year. That’s one in four adults, or more than 57 million people. It’s no wonder that mental disorders are the leading cause of disability in the United States. Those already are impressive statistics. Now, consider the fact that experts believe there is a high percentage of unreported mental illness in this country—and also recognize that the diagnosis of mental illness typically is less than straightforward. After all, you can’t do an x-ray or a blood test to arrive at a definitive diagnosis of a particular mental illness. Instead, health care providers must rely on accepted lists of symptoms and behaviors (see the box on page 34 ) to determine if a person is suffering from a mental or mood disorder. In addition, mental illness has a high rate of comorbidity, a term to describe two disorders or illnesses that are found together. For example, anxiety often pairs with another mental disorder, like depression or ADHD. Nearly half of all people with a mental illness actually meet the criteria for two or more disorders. School Nutrition offers an overview of one of the most common types of mood disorders in “Depression: More Than Just a Bad Day,” on page 20. Following is a look at some of the other major mental illnesses that affect millions. Remember, this information is intended to raise your overall awareness of various conditions and not to be used as a substitute for professional medical opinions and advice. ANXIETY DISORDERS We all experience anxiety. In fact, the anxiety integral to our natural fight-or-flight response is evolutionarily advantageous; it helped our ancestors avoid real dangers, and it can help us do the same today. Periodic anxiety itself isn’t a disorder, but it can become one when it’s chronic and interferes with daily life. The next time you feel anxious, imagine what it would be like to have that feeling with much greater frequency and an intensity that makes it overwhelming, difficult to control and even disabling. More than just shyness, social anxiety disorder can be debilitating, affecting a person’s ability to make friends, enter into romantic relationships and succeed in a career. It’s likely that some of you don’t have to use your imaginations. Anxiety disorders are extremely common, said to affect 40 million American adults in a given year. They frequently appear with other illnesses like depression or substance abuse. There are different types of anxiety disorders, and they often occur together—most anxiety disorder sufferers struggle with at least two. The most common is generalized anxiety disorder, which is estimated to affect almost 7 million American adults. Someone with this condition experiences frequent, exaggerated worry or anxiety for at least six months; worries can be related to large or small issues and often seem to “float” from one concern directly to another. The individual also can feel an overall sense of dread and have difficulty relaxing. Panic disorder, another common form of anxiety disorder, produces symptoms that are acute and downright frightening. A panic attack includes rapid heartbeat, shortness of breath, dizziness, uncomfortable chest sensations and an overwhelming sense of anxiety. These attacks can occur in childhood, adolescence or adulthood and often lead to anticipatory anxiety: Once you’ve had one attack, you fear having another. As a consequence, the anxiety over the possibility of a repeat attack can prompt isolation and avoidance of situations that might give rise to the next one. Each year, some 2.2 million Americans suffer one or more panic attacks. Those with recurring or unexpected attacks may be diagnosed with panic disorder. Some wind up turning to various substances as a way to self-medicate, and this leads to other problems: Experts estimate that 30% of people with panic disorder abuse alcohol and 17% abuse drugs. Social anxiety disorder has been described as an extreme fear of being scrutinized and judged by others, according to the Anxiety and Depression Association of America. This disorder typically begins to appear around age 13. More than just shyness, social anxiety disorder can be debilitating, affecting a person’s ability to make friends, enter into romantic relationships and succeed in a career. In addition to these more general anxiety conditions, individuals also may suffer from specific phobias: strong and irrational fear reactions to certain situations, objects or experiences. Just as anxiety itself isn’t abnormal, phobias can involve things that many people might view with some trepidation (like spiders, snakes, heights or closed spaces) but not outright panic. Other phobias involve objects or activities that a person without this unusual condition wouldn’t think twice about, such as elevators or even being in public (agoraphobia). In a current bestseller, author Scott Stossel shares his debilitating phobia of cheese. No matter the subject of the phobia, a person’s reaction to it can be overwhelming and far out of proportion. Like panic disorder, phobias can lead people to avoid everyday activities and become isolated. Sometimes, anxieties manifest themselves in obsessive-compulsive disorder (OCD) . Those with this condition become completely preoccupied by unwanted or intrusive thoughts, which then cause anxiety. OCD sufferers subsequently feel compelled to carry out ritualistic routines to try to eliminate anxiety. Examples of compulsive behavior include obsessive handwashing, obsessive checking (to ensure that a stove is off, for example) or ritualistic movements or behaviors like counting or arranging items. Hoarding is a special type of obsessive-compulsive disorder. PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) are associated with the sudden onset in children of obsessivecompulsive symptoms, vocal and motor tics and other behavioral changes. A rare autoimmune response to the strep virus, PANDAS was first described by researchers at the National Institutes of Health in the 1990s, and it is only now being more widely understood and recognized by pediatricians. Post-Traumatic Stress Disorder (PTSD) is an anxiety disorder that arises from an individual’s traumatic experience(s). It’s most well-known in regard to military service members who’ve served during wartime, but it can occur after any violent personal incident, such as an accident, rape or domestic violence, or among those who’ve survived natural or man-made disasters or terrorist attacks. PTSD occurs more frequently than most people think, affecting 7.7 million Americans ages 18 or older. The spectrum of anxiety disorders is wide, and there are a number of ways that patients receive relief from symptoms. Medication is a common component of treatment and includes antidepressants, anti-anxiety drugs and beta blockers, which can keep the specific physical symptoms of anxiety in check. Patients also can benefit from psychotherapy and/or cognitive behavior therapy—which addresses both the thinking patterns behind the anxiety and the reactions to situations that create anxiety. ADDICTIVE DISORDERS The Substance Abuse and Mental Health Services Administration estimates that 25 million Americans over the age of 12 suffer from a problem with substance abuse, primarily involving alcohol and/or drugs. That said, addictive behavior doesn’t begin and end with a physical dependence on such substances. It also can center around compulsive shopping, gambling, work, overeating, smoking, exercise, Internet use and sexual activity. A person might be struggling with addiction if she or he displays an aggressively chronic compulsion to act on a behavior or use a particular substance. In addition to the specific compulsion, the individual may spend excessively, neglect daily responsibilities and have trouble maintaining healthy relationships and performing appropriately and effectively at work. Ceasing the behavior isn’t easy or painless; the addicted person may experience such withdrawal symptoms as sweating, shaking or other physical symptoms, even if the addiction is not a physical dependency. Physical dependence on alcohol, cigarettes and drugs can have serious long-term health effects, including organ damage, cancer and neurological damage. Strictly speaking, a substance dependency is a neurological issue. The addictive substance changes the structure of the brain and the way it processes pleasurable responses. Over time, the use of the substance doesn’t provide the same pleasure, and the addicted person requires more and more of the substance. Eventually, the substance may not provide any pleasure at all, but the person must continue taking it to avoid withdrawal symptoms. It’s unknown what causes addiction. Genetic factors can substantially increase one’s risk, but no specific “addiction gene” has been identified. Scientists have theorized that some people have deficiencies in the part of their brains that provides rewards, leading them to become addicted to substances like opiates that increase pleasure sensations. Others may use drugs or alcohol to selfmedicate to cope with the symptoms of another mental illness or neurological issue, such as depression or ADHD. And some psychiatrists assert that people who don’t learn to adequately self-regulate themselves when they are toddlers may be more prone to addictive behavior; in fact, this may be one cause of eating disorders (look for more information on those in this month’s Bonus Web Content). Addiction is treated in a number of ways, depending on the behavior or substance that the person has become dependent upon. The most well-known is group therapy, which includes 12-step programs like Alcoholics Anonymous and Gamblers Anonymous. Some people benefit from one-on-one behavioral modification and psychotherapy. Certain prescription drugs are effective in helping an individual overcome addiction, and, in many cases, patients benefit from in-patient or out-patient hospital programs. Those who love and care for an individual caught up in the throes of addiction suffer, as well. Stress and anxiety are common, and these are exacerbated by the chaotic consequences that can result from a loved one’s addiction, such as the loss of a job or emotional and physical abuse. Group therapy programs (such as Al-Anon), as well as family therapy with an individual counselor, can help family members cope and learn how to detach from enabling behaviors. Treatment facilities also often have programs for the families of patients. (For more information about dealing with a loved one who has an addiction or another type of mental illness, see “Love and ‘Madness,’” on page 36. ) Those who love and care for an individual caught up in the throes of addiction suffer, as well. Stress and anxiety are common. ATTENTION DISORDERS Attention Deficit Hyperactivity Disorder (ADHD) is the same condition as Attention Deficit Disorder (ADD); experts have just updated the name. It is a neuropsychological disorder that can result in difficulty paying attention, hyperactivity and impulsive behavior. It is six times more common in boys than in girls, according to the National Institutes of Health. And while it’s often thought of as a disorder primarily of childhood, it’s estimated that roughly half of all cases continue into adolescence and also into adulthood. Individuals with ADHD can have difficulty staying focused on various activities—but they also might “hyperfocus” on activities of intense interest. Other common symptoms include difficulty in controlling behavior and curbing impulses. ADHD can affect a student’s academic success (or an adult’s effectiveness at work), but that’s not all. It also can impede social interaction, resulting in low self-esteem and difficulties in establishing or maintaining relationships. Adolescents or adults with ADHD are at some risk for self-medicating their symptoms with alcohol or drugs. Children with ADHD are often portrayed in the media as hyperactive and out of control, but ADHD actually has three distinct subtypes: predominately hyperactive-impulsive, predominately inattentive and combined. The names are good descriptors. Kids with inattentive-type ADHD, for example, are not hyperactive and don’t act out, but they do have trouble paying attention and can “space out” during class. (And their symptoms often are overlooked, which means their needs are more rarely addressed.) ADHD is frequently comorbid with related issues. These include learning disabilities, executive functioning difficulties, conduct disorders, anxiety, depression and bipolar disorder. There is no single test for diagnosing ADHD. Practitioners use a variety of techniques, such as observation, neuropsychological tests and surveys of parents and teachers. The average age of diagnosis is 7. Today, an estimated 9% of American children have received an ADHD diagnosis. As noted earlier, roughly half of these cases will continue to experience the symptoms of ADHD into adulthood. Scientists aren’t sure what causes ADHD, but evidence tends to support a genetic component. Environmental factors such as a mother’s smoking or alcohol use during pregnancy or exposure to certain pesticides and food additives also have been the subject of research, but there’s simply no smoking gun. And despite popular opinion, a number of recent studies have demonstrated that consumption of sugar is not a factor in ADHD. ADHD can be treated by medication, specifically with a class of drugs known as stimulants (of which Ritalin® is probably best known). Despite the name, stimulants actually produce the opposite effect in people with ADHD, improving their ability to remain calm and focused. Non-stimulant medications like Strattera® provide relief for some individuals with ADHD. In addition to medication, successful treatment for ADHD often involves psychotherapy, including both talk therapy and cognitive behavioral therapy, as well as tutoring and practical support. Many people with ADHD, both children and adults, benefit from learning strategies specifically developed to help them process information and stay organized in their personal and professional lives. THE WAY FORWARD Mental illness often is viewed with fear or misunderstanding. And that’s not surprising, given the years of stereotyped portrayals of mental illness in movies and television, as well as the media’s coverage of recent violent events involving people with mental illness. In fact, people with all types of mental illness are much more likely to be victims of violence than they are to commit it. In addition, individuals with serious mental illnesses and substance dependency are more likely to be poor or homeless. Plus, they often experience discrimination in the workplace and social isolation at home. The new Affordable Care Act has greatly expanded insurance coverage for mental health problems and substance abuse, including no-cost coverage for screening and assessments. And as of this year, insurance companies can’t deny coverage or charge more due to a pre-existing mental health condition. This is terrific news for people with mental health issues and their families. Have you personally been affected by mental illness? Whether you suffer from a particular mental or mood disorder or a loved one does, it’s likely you haven’t shared this information beyond a very tight circle of family members and associates. Let this article be a first step in broaching the topic with others. You can ask a friend or coworker to read it first, and then follow up with a conversation about what you’ve been dealing with. Such conversations can help to reduce any feelings of shame or stigma for you and be a valuable learning experience that eliminates fear and misunderstanding by others. The Diagnosis Dilemma Mental illness or neurological disorder? Both laypeople and health professionals often use these terms interchangeably, but there are certain differences. Some experts describe neurological disorders as “hardware” issues, while considering mental illness as a “software” issue. There are also neuropsychiatric disorders, in which a set of psychiatric outcomes are associated with some kind of known problem with the nervous system. ADHD, depression, addiction disorders and even certain types of anxiety and obsessive-compulsive disorder are considered by some experts to be neuropsychiatric disorders. Sometimes, neurological problems like brain tumors can lead people to exhibit symptoms associated with mental illness. This can make diagnosis more difficult, as doctors may try to treat the mental health issue without addressing the underlying neurological component. Other times, it’s an issue with the way the brain processes certain chemicals. The Diagnosis Dilemma There’s no blood test or radiology scan that allows doctors to make a definitive diagnosis of mental illness. In general, mental health practitioners identify your condition and establish your treatment by a particular number called a DSM code. DSM stands for the Diagnostic and Statistical Manual—the standard reference that mental health practitioners, clinicians and researchers use to classify and communicate about mental disorders. The DSM was recently reissued in its fifth edition. Each disorder included in the DSM has a set of diagnostic criteria, associated with a specific code, which is used to identify and define it. The DSM also provides codes identifying the length of time for a particular type of treatment. For example, there are different codes for 30-, 45- and 60-minute psychotherapy sessions. The DSM code also is used by insurance companies and government agencies to process health care claims. Susan Davis Gryder is a freelance writer in Silver Spring, Md. Photography by ktsimage, Steve Deber, Ben Goode/istockphoto.com and maurusone/jiunlimited. SNAPSHOT • Mental disorders are the leading cause of disability in the United States. • Physical dependence on substances and addictive behaviors around certain activities are classified as mental illnesses. • ADHD is commonly associated with children, but roughly half of all cases continue into adolescence and adulthood. BONUS WEB CONTENT Two other classes of mental illness, personality and psychotic disorders, affect a smaller number of people, and are even more misunderstood than relatively common conditions like depression and anxiety. School Nutrition provides a brief overview of these illnesses online at www.schoolnutrition.org/snmagazinebonuscontent. In addition, we offer a look at another class of mental impairment: eating disorders.
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