Mind your mental health

We all feel down or panicky at times. But when does it translate to a mental illness requiring treatment? Kasmiah Mustapha look at seven recognised mental disorders and their symptoms

THERE are different types of mental illnesses and it is important to recognise the symptoms and to seek the right medical treatment. Here are some of them:

The most common of mental illnesses, anxiety disorder is the umbrella that groups together panic disorder, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), social phobia (or social anxiety disorder), specific phobias and generalised anxiety disorder (GAD).

According to the US National Institute of Mental Health (NIMH), anxiety disorders last at least six months — unlike the relatively mild, brief anxiety caused by an event such as speaking in public or a first date — and can get worse if not treated.

Panic disorder is characterised by sudden attacks of terror, usually accompanied by a pounding heart, sweating and feeling weak, faint or dizzy. Those with OCD will have persistent, upsetting thoughts (obsessions) and use rituals (compulsions) to control the anxiety these thoughts produce. Most of the time, the rituals end up controlling them.

A person who faces traumatic events can suffer from PTSD. They will lose interest in daily things, become irritable, aggressive or even turn violent.

Social phobia, also called social anxiety disorder, is when people become overwhelmingly anxious and excessively self-conscious in everyday social situations. They have an intense, persistent and chronic fear of being watched and judged by others and of doing things that may embarrass them.

They can worry for days or weeks before a dreaded situation. The fear may become so severe that it interferes with work, school and other ordinary activities, making it hard to make and keep friends.

NIMH states that most people who have one anxiety disorder may also have at least one more. Nearly 75 per cent of those with an anxiety disorder will experience their first episode by the age of 2.
•     Women are 60 per cent more likely than men to have an anxiety disorder at some point in their lives.
•  Famous people who suffer from anxiety disorders include Eric Clapton, Sheryl Crow, Johnny Depp, Anthony Hopkins, Nicole Kidman and Oprah Winfrey.

This commonly diagnosed mental disorder in children is more common in boys than in girls. It is usually discovered in the early years. The American Academy of Pediatrics expanded the age range of diagnostic guidelines to include children as young as 4 and up to age 18.

There are three subtypes: Predominately hyperactive-impulsive, predominately inattentive, and combined hyperactive-impulsive and inattentive.

A child may have all the symptoms in one category, or several from each. These include not paying attention to details, making careless mistakes, trouble focusing on tasks, not listening when spoken to directly, not following instructions, failing to finish work or chores (because of failure to understand, not defiance), having trouble organising activities and being easily distracted and forgetful in daily activities.

According to the Malaysian Psychiatric Association (MPA), a child may show inattention, distractibility, impulsivity, or hyperactivity at times but the one with ADHD shows these symptoms and behaviours more frequently and severely than his peers.

Children with ADHD would display these behaviours so frequently and severely that they interfere with normal activities, leaving them confused, frustrated or angry.

According to MPA, ADHD occurs in three to five per cent of school-going children. It usually begin before the age of 7 and  can continue into adulthood.
•     It runs in families, with about 25 per cent of biological parents having a similar condition.
•     People diagnosed with ADHD include  Britney Spears, Liv Tyler, Michael Phelps, Salma Hayek, Zooey Deschanel, Robin Williams, Justin Timberlake, Jamie Oliver, Will Smith and Jim Carrey.

This serious mental illness, previously known as manic depression, is characterised by extreme changes in mood. Someone with bipolar disorder experiences alternating “highs” (what clinicians call mania) and “lows” (also known as depression).

Both manic and depressive periods can be brief, from just a few hours to a few days or longer and can last up to several weeks or even months.

Patients experience unusually intense emotional states in distinct periods called “mood episodes”. An overly joyful or overexcited state is called a manic episode and an extremely sad or hopeless state is called a depressive episode.

But because the pattern of highs and lows varies in individuals, bipolar disorder is a complex disease to diagnose.

When a sufferer is in a mania mood, he or she will be very happy or outgoing, behaves impulsively and takes part in high-risk behaviours. When experiencing depression, he or she will be restless, has trouble sleeping and eating, thinks of death or suicide and even attempt suicide.

Bipolar disorder is recurrent, meaning that more than 90 per cent of those who have had a single episode will go on to experience more.
•     Roughly 70 per cent  of manic episodes in bipolar disorder occur immediately before or after a depressive episode.
•     People who suffer from bipolar disorder include Carrie Fisher, Linda Hamilton, Sinead O’Connor, Vincent van Gogh, Catherine Zeta-Jones, Kurt Cobain and F. Scott Fitzgerald

The sufferers have brief psychotic episodes and experts originally thought of this illness as atypical or borderline versions of other mental disorders. According to NIMH, borderline personality disorder sufferers will show extreme reactions — including panic, depression, rage, or frantic actions — to abandonment, whether real or perceived.

They will have a pattern of intense and stormy relationships with family, friends, and loved ones, often veering from extreme closeness and love to extreme dislike or anger, distorted and unstable self-image or sense of self, which can result in sudden changes in feelings, opinions, values, or plans and goals for the future.

They will engage in impulsive and often dangerous behaviours, such as spending sprees, unsafe sex, substance abuse and binge eating as well as have recurring suicidal behaviours or threats or self-harming behaviour, such as cutting themselves.

The US National Education Alliance Borderline Personality Disorder (NEABPD) states that the illness rarely stands alone. People with borderline personality disorder often have other diagnosis. This is called co-morbidity or having co-occurring disorders. Common co-occurring disorders include substance abuse, eating disorders, anxiety disorders, bipolar disorder as well as other personality disorders. Over half of those with borderline personality disorder population suffers from major depressive disorder.

NEABPD states that the illness is more common than schizophrenia or bipolar disorder.
•     An estimated 11 per cent of outpatients, 20 per cent of psychiatric inpatients and six per cent of primary care visits meet the criteria for the disorder.
•     Obtaining an accurate diagnosis can be difficult.

We all feel depressed at one time or another. Some of us will be able to overcome the feeling but some may need to seek treatment as it can interfere with daily life and their ability to to function normally.

There are different types of depression —  major depressive disorder or major depression, dysthymic disorder or dysthymia, psychotic depression and postpartum depression.

Depression is characterised by a number of common symptoms, including a persistent sad, anxious, or “empty” mood and feelings of hopelessness or pessimism. A person who is depressed often feels guilty, worthless and helpless.

They also lose interest in activities or hobbies that they once found pleasurable. They experience fatigue and decreased energy, have difficulty concentrating and remembering details, insomnia (or they sleep excessively), overeat (or have no appetite), think of or attempt suicide and suffer aches and pain such as headaches, cramps, or digestive problems that do not ease with treatment.

The condition often goes undetected as we tend to dismiss the signs. Depression doesn’t need to strike all at once. It can be a gradual and nearly unnoticeable change from your normal life.

The World Health Organisation (WHO) has called for an end to the stigmatisation of depression and other mental disorders and for better access to treatment for all people who need it.

WHO states that globally, more than 350 million people suffer from depression but because of the stigma still attached to it, many fail to acknowledge that they are ill and do not seek treatment.
• People who have had to deal with depression include Ashley Judd, Billy Joel, Brooke Shields, Emma Thompson, Harrison Ford, Heath Ledger, J.K. Rowling, Olivia Newton-John, Owen Wilson and Rosie O’Donnell.

Eating disorders are real and treatable. They frequently coexist with other illnesses such as depression, substance abuse or anxiety disorders.

A person with an eating disorder may start by eating smaller or larger amounts of food but, at some point, the urge to eat less or more spirals out of control. Severe distress or concern about body weight or shape may also characterise an eating disorder.

Common eating disorders are anorexia nervosa, bulimia nervosa and binge-eating. Anorexia nervosa is characterised by a relentless pursuit of thinness and the unwillingness to maintain a normal or healthy weight, an intense fear of gaining weight, a distorted image of one’s body, a self-esteem that is heavily influenced by perceptions of body weight and shape, or a denial of the seriousness of low body weight.

Those who suffer from bulimia nervosa seem to lack control over recurrent and frequent episodes of overeating. This is followed by forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise or a combination of these behaviours.

Some patients maintain what is considered a healthy or normal weight, while some are slightly overweight. But they also have the fear of gaining weight, want desperately to lose weight and are intensely unhappy with their body size and shape. Usually, bulimic behaviour is done in secret because it is often accompanied by feelings of disgust or shame.

The binge eating and purging cycle can happen several times a week to many times a day. With binge-eating disorder, a person loses control over his or her eating pattern but, unlike bulimia nervosa, this is not followed with purging, excessive exercise or fasting. As a result, sufferers are often overweight or obese. They experience guilt, shame and distress about their binge-eating, which can lead to more binge-eating.

People with anorexia nervosa are 18 times more likely to die early compared with people of similar age.
•     Singer Karen Carpenter died of complications from anorexia nervosa.
•     Others who have struggled with eating disorders include Paula Abdul, Lily Allen,  Victoria Beckham, Kate Beckinsale,  Kelly Clarkson, Katie Couric, Sally Field, Calista Flockhart, Lady Gaga, Demi Lovato, Mary-Kate Olsen and Oprah Winfrey.

According to Mayo Clinic, schizophrenia is a group of severe brain disorders in which people interpret reality abnormally. Schizophrenia may result in a combination of hallucination, delusion and disordered thinking and behaviour. It is not split personality or multiple personality.

Symptoms fall into three categories — positive, negative and cognitive. Positive symptoms reflect an excess or distortion of normal functions and include delusion, hallucination, thought disorder and  disorganised behaviour.

The negative symptoms refer to a diminishment or absence of characteristics of normal function. These include loss of interest in everyday activities, appearing to lack emotion, reduced ability to plan or carry out activities, social withdrawal and loss of motivation.

Cognitive symptoms involve problems with thought processes. These may be the most disabling in schizophrenia because they interfere with the ability to perform routine daily tasks. A person with schizophrenia may be born with these symptoms which include having a problem making sense of information, difficulty paying attention and memory problems.

Sufferers often aren’t aware that they require medical attention, so it is important for family members and friends to get them help.

Schizophrenia typically begins in early adulthood between the ages of 15 and 25. The average age of onset is 18 in men and 25 in women.
•     Schizophrenia onset is quite rare for people under 10 years of age, or over 40 years of age.
•     People with schizophrenia are not usually violent. In fact, few violent crimes are committed by people with schizophrenia who instead, are more inclined to  attempt suicide. About 10 per cent (especially young adult males) die by suicide.


Having frequent full-blown and long-lasting panic attacks mean treatment is required.

A child with ADHD often has trouble paying attention in class.

Catherine Zeta-Jones was diagnosed with bipolar disorder.

Depression is common yet many do not seek treatment even when the symptoms last a long time.

Karen Carpenter died of complications from anorexia nervosa.