So now you know the difference between mental health and mental illness, how do you know when it’s a question of a (prolonged) period of poor mental health or if it’s a mental illness?
First of all, it’s a disease, and as with all diseases, you should have a medical or mental health professional diagnose you. Mental illness is a health condition involving changes in your mental health, e.g. changes in thinking, emotion or behavior. It’s usually associated with not being able to function anymore at work, socially or with your family. It’s often paired with distress or self-harm.
Mental illness, mental health conditions, mental disorders, whatever you wish to call a clinically significant change in behavior, mood or thinking, is actually quite common. According to the World Health Organization, 1 in 8 people world-wide suffer from mental health conditions.
How is a mental illness diagnosed?
A doctor, like your physician, may be able to diagnose “simple” or “common” disorders such as depression or generalized anxiety. I put “simple” and “common” in quotes, because even though most people know or have heard of these conditions, or maybe even have experienced them themselves, they are anything but simple to those suffering from such disorders. Your doctor may prescribe medication, changes in life-style or therapy in order to deal with these conditions. But your doctor may also send you to a specialist for further diagnosis.
Psychological Assessment
In the United States, and quite a few other countries, doctors and mental health professionals use the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) to determine if you have a mental health condition, and if so, what this condition may be.
A proper psychological assessment will include things such as standardized tests (lots of questionnaires), a personal history, observations by mental health professionals, and perhaps even input from your friends and family.
Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR)
A lot of mental health professionals use the DSM 5, as the basis for diagnosing mental health disorders. It’s “the standard classification of mental disorders used by mental health professionals in the United States”. And most of the rest of the world.
Here’s the problem: standardized testing in and of itself has issues. And as part of the diagnosis is observation and perhaps input from the environment, diagnosis is still very much open to interpretation by people. People who may be prone to projecting their own emotions and experiences without really listening to the patient or loved one. They may not be allowing for differences in culture, social norms, social-economic standing or level of education.
The other issue is that the DSM 5 is used by insurance companies to determine what will and will not be covered medically when it comes to treatment of mental illness.
That means that if you don’t fit neatly into a category you may either be misdiagnosed, ineligible for treatment that might be beneficial to you or not receive coverage by your insurance company.
So until there’s a test that conclusively diagnoses mental illness, through a brain scan or some other form of testing, there is definitely room for error. Especially if you’re not a standard person to begin with.
Note: in Aruba the DSM-4 is still used widely. This means that cultural norms, norms when it comes to ethnicity and language norms, are not considered at all. That means if you’re diagnosed here on Aruba, despite being ethnically diverse, speaking another language and having very different cultural norms, you will be diagnosed as if you were an American or European person.
How many mental illnesses are there?
Currently the DSM 5 lists about 300 mental illnesses. The first edition listed a little over 100. How many are there really? I have no idea. But cPTSD, for example, is not in the DSM-5, despite being identified more than 30 years ago. Various organizations, such as the World Health Organization and the British National Health Services, have acknowledged cPTSD as a mental disorder. The American Psychiatric Association has not.
Can you have multiple Mental Illnesses at once?
Yes you can. This is called comorbidity.
Can a mental illness be cured?
According to today’s standards, no, it cannot be cured. But either medication or treatment my lessen the symptoms to the extent that one can function as a member of society.
There are also people who are high-functioning despite their mental illness. They may not even be diagnosed, as the standards for testing their ability to “function” don’t mesh with the clinical definition of mental illness.
Why are mental illnesses sometimes misdiagnosed?
We are all individuals. Both patients, medical professionals and mental health care professionals. So are the people around us. Some things are very much defined by cultural standards, or perhaps even gender-specific standards, let alone things such as ethnicity, social-economic standing or level of education.
Plus, throughout the years our knowledge has increased in certain areas, but perhaps our empathy or social responsibilities have decreased. Studies conducted in the 1980’s might have indicated that 5% of test subjects would be considered mentally ill, while with today’s standards, that group would be closer to 30%.
Some disorders also overlap, or mimic each-other. Complex Post Traumatic Stress Disorder is often misdiagnosed as Borderline personality disorders, for example.
What should I do if I think I’ve been misdiagnosed?
Talk to your doctors and mental-health professionals. There may be new evidence or studies done to support your case. And if you can, read up on things yourself. There might be new information your mental health care professionals or doctors do not have yet.
Also realize that your mental health or illness may have changed, or that perhaps there is a case of comorbidity. And at the end of the day you deserve fitting treatment. That will be difficult to get if you’re being treated for the wrong disease.
What types of mental illnesses are there?
There are about 20 types of mental illnesses. Here’s a general overview of a few of them:
Anxiety Disorders
Feeling anxious or worried is normal. When it does not go away, or becomes worse over time, and the symptoms affect daily functioning, it may be a disorder. Panic disorder, obsessive-compulsive disorder (OCD) and phobias are all examples of anxiety disorders.
Behavioral Disorders
Everyone can behave oddly at times. If it persists for 6 months or longer, it may be a disorder instead. Examples are: attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD) and conduct disorder (CD).
Developmental disorders
Developmental disorders are psychiatric conditions that developed in childhood, that impair the functioning of an individual. Think of things such as learning disorders, autism spectrum disorders and motor disorders.
Dissociative Disorders
Disassociation means disengaging or separating from something. In psychology and psychiatry this usually involves problems with things such as memory, identity, emotion or perception. Think of things like feeling outside your own body, or perhaps not being able to remember things correctly. Dissociative identity disorder, dissociative amnesia and depersonalization- or derealization disorders are examples of dissociative disorders.
Eating Disorders
Our eating habits can be linked to how we feel. We lose our appetite if we’re grieving, stressed or upset. Maybe we comfort ourselves with a big tub of ice-cream, or binge on a bag of nachos to comfort ourselves. In eating disorders this relationship between emotion and food is extreme, and behavior and attitude when it comes to food and weight may be paramount. Anorexia-nervosa, binge eating and bulimia are examples of eating disorders.
Mood disorders
Sometimes we’re sad, sometimes we’re happy. With mood disorders, those feelings can be disproportional and last long, or fluctuate rapidly. Depression, seasonal affect disorder, bipolar disorder are examples of mood disorders.
Neuro-psychological disorders
A constant and severe need to do something. Addiction is an example.
Personality Disorders
Personality is what makes us us. There are tons of theories about personality and what the different types are. In the case of personality disorders it’s a question of a deviation from the norms over an extended period of time, that is also all-encompassing. Of course, what the norms are is highly dependent on numerous factors. What in one person’s eyes is “stubborn and domineering” is considered “assertive and standing up for oneself” according to others, or perhaps even in a different situation. What one considers all-encompassing in a negative way, others see as drive or passion.
There are a lot of different personality disorders, but some commonly known ones are narcissistic personality disorder, avoidant personality disorder and paranoid personality disorder. Symptoms of personality disorders may include things like pathological lying, disregard for other’s feelings, being consistently irresponsible and lack of remorse for behavior.
Psychotic Disorders
A psychosis is a break from reality. Think of hallucinations (seeing or hearing things that aren’t there) or delusions (believing things that aren’t true). Not everyone who experiences a psychosis necessarily has a psychotic disorder. It could be caused by other conditions such as a brain tumor, dementia, or substance abuse. A psychotic disorder means that someone loses touch with reality with extreme symptoms such as hallucinations or delusions. Schizophrenia is an example of such a disorder.
Trauma disorders
Most of us have experienced or witnessed something traumatic, or will do so in the future.
There are 3 types of trauma:
Acute trauma – this usually results from a single incident, such as physical assault, an accident, medical emergency, moving or rape.
Chronic trauma – is repeated and prolonged trauma such as domestic violence, homelessness, or chronic illness.
Complex trauma – is exposure to varied and multiple traumatic events, often of an invasive, interpersonal nature. Think of childhood abuse or profound neglect. Being forced into prostitution, being tortured or caught in war.
Traumatic events, especially if left untreated, may lead to a variety of mental health conditions. In cases where it occurs in (early) childhood, it may even lead to issues in development.
Traumatic disorders include Post-Traumatic Stress Disorder, complex PTSD and acute stress disorder.
