Mental illness

Mental illness refers to a wide range of mental health conditions — disorders that affect your mood, thinking and behavior. Examples of mental illness include depression, anxiety disorders, schizophrenia, eating disorders and addictive behaviors.

Many people have mental health concerns from time to time. But a mental health concern becomes a mental illness when ongoing signs and symptoms cause frequent stress and affect your ability to function.

A mental illness can make you miserable and can cause problems in your daily life, such as at work or in relationships. In most cases, symptoms can be managed with a combination of medications and counseling (psychotherapy).

SYMPTOMS
Signs and symptoms of mental illness can vary, depending on the particular disorder, circumstances and other factors. Mental illness symptoms can affect emotions, thoughts and behaviors.

Examples of signs and symptoms include:

Feeling sad or downConfused thinking or reduced ability to concentrateExcessive fears or worries, or extreme feelings of guiltExtreme mood changes of highs and lowsWithdrawal from friends and activitiesSignificant tiredness, low energy or problems sleepingDetachment from reality (delusions), paranoia or hallucinationsInability to cope with daily problems or stress Trouble understanding and relating to situations and to people Alcohol or drug abuseMajor changes in eating habits Sex drive changesExcessive anger, hostility or violenceSuicidal thinking

Sometimes symptoms of a mental health disorder appear as physical problems, such as stomach pain, back pain, headache, or other unexplained aches and pains.

If you have any signs or symptoms of a mental illness, see your primary care provider or mental health specialist. Most mental illnesses don't improve on their own, and if untreated, a mental illness may get worse over time and cause serious problems.

If you have suicidal thoughts

Suicidal thoughts and behavior are common with some mental illnesses. If you think you may hurt yourself or attempt suicide, get help right away:

Call your local emergency number immediately.Reach out to a close friend or loved one.Contact a minister, spiritual leader or someone in your faith community.Contact your doctor, other health care provider or mental health specialist.

Suicidal thinking doesn't get better on its own — so get help.

Helping a loved one

If your loved one shows signs of mental illness, have an open and honest discussion with him or her about your concerns. You may not be able to force someone to get professional care, but you can offer encouragement and support. You can also help your loved one find a qualified mental health provider and make an appointment. You may even be able to go along to the appointment.

If your loved one has done self-harm or is seriously considering doing so, take the person to the hospital or call for emergency help.

CAUSES
Mental illnesses, in general, are thought to be caused by a variety of genetic and environmental factors:

Inherited traits. Mental illness is more common in people whose biological (blood) relatives also have a mental illness. Certain genes may increase your risk of developing a mental illness, and your life situation may trigger it.Environmental exposures before birth. Exposure to viruses, toxins, alcohol or drugs while in the womb can sometimes be linked to mental illness. Brain chemistry. Biochemical changes in the brain are thought to affect mood and other aspects of mental health. Naturally occurring brain chemicals called neurotransmitters play a role in some mental illnesses. In some cases, hormonal imbalances affect mental health.

COMPLICATIONS
Mental illness is a leading cause of disability. Untreated mental illness can cause severe emotional, behavioral and physical health problems. Mental illness can also cause legal and financial problems. Complications sometimes linked to mental illness include:

Unhappiness and decreased enjoyment of lifeWeakened immune system, so your body has a hard time resisting infectionsFamily conflictsRelationship difficultiesSocial isolationProblems with tobacco, alcohol and other drugs Missed work or school, or other problems related to work or school Poverty and homelessnessSelf-harm and harm to others, including suicide or homicideIncreased risk of motor vehicle accidentsHeart disease and other medical conditions

DIAGNOSIS
To determine a diagnosis and check for any related complications, you may have:

A physical exam. Your doctor will try to rule out physical problems that could cause your symptoms.Lab tests. These may include a check of your thyroid function or a screening for alcohol and drugs, for example.A psychological evaluation. A doctor or mental health provider talks to you about your symptoms, thoughts, feelings and behavior patterns. You may be asked to fill out a questionnaire to help answer these questions.

Determining which mental illness you have

Sometimes it's difficult to find out which mental illness may be causing your symptoms. But taking the time and effort to get an accurate diagnosis will help determine the appropriate treatment.

The defining symptoms for each mental illness are detailed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. This manual is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

Classes of mental illness

The main classes of mental illness are:

Neurodevelopmental disorders. This class covers a wide range of problems that usually begin in infancy, childhood or the teenage years. Examples include autism spectrum disorder, attention-deficit/hyperactivity disorder (ADHD) and learning disorders.Schizophrenia spectrum and other psychotic disorders. Psychotic disorders cause detachment from reality (delusions, paranoia and hallucinations). The most notable example is schizophrenia, although other classes of disorders can be associated with detachment from reality at times.Bipolar and related disorders. This class includes disorders with alternating episodes of mania — periods of excessive activity, energy and excitement — and depression. Depressive disorders. These include disorders that affect how you feel emotionally, such as the level of sadness and happiness. Examples include major depressive disorder and premenstrual dysphoric disorder.Anxiety disorders. Anxiety is an emotion characterized by the anticipation of future danger or misfortune, accompanied by feeling ill at ease. This class includes generalized anxiety disorder, panic disorder and phobias.Obsessive-compulsive and related disorders. These disorders involve preoccupations or obsessions and repetitive thoughts and actions. Examples include obsessive-compulsive disorder, hoarding and hair-pulling disorder (trichotillomania).Trauma- and stressor-related disorders. These are adjustment disorders in which a person has trouble coping during or after a stressful life event. Examples include post-traumatic stress disorder (PTSD) and acute stress disorder.Dissociative disorders. These are disorders in which your sense of self is disrupted, such as with dissociative identity disorder and dissociative amnesia.Somatic symptom and related disorders. A person with one of these disorders may have physical symptoms with no clear medical cause, but the disorders are associated with significant distress and impairment. The disorders include somatic symptom disorder (previously known as hypochondriasis) and factitious disorder.Feeding and eating disorders. These disorders include disturbances related to eating, such as anorexia nervosa and binge-eating disorder.Elimination disorders. These disorders relate to the inappropriate elimination of urine or stool by accident or on purpose. Bedwetting (enuresis) is an example.Sleep-wake disorders. These are disorders of sleep severe enough to require clinical attention, such as insomnia, sleep apnea and restless legs syndrome.Sexual dysfunctions. These include disorders of sexual response, such as premature ejaculation and female orgasmic disorder.Gender dysphoria. This refers to the distress that accompanies a person's stated desire to be another gender. Disruptive, impulse-control and conduct disorders. These disorders include problems with emotional and behavioral self-control, such as kleptomania or intermittent explosive disorder.Substance-related and addictive disorders. These include problems associated with the use of alcohol, caffeine, tobacco and drugs. This class also includes gambling disorder.Neurocognitive disorders. Neurocognitive disorders affect your ability to think and reason. This class includes delirium, as well as neurocognitive disorders due to conditions or diseases such as traumatic brain injury or Alzheimer's disease.Personality disorders. A personality disorder involves a lasting pattern of emotional instability and unhealthy behavior that causes problems in your life and relationships. Examples include borderline personality disorder and antisocial personality disorder.Paraphilic disorders. These disorders include sexual interest that causes personal distress or impairment or causes potential or actual harm to another person. Examples are sexual sadism, voyeuristic disorder and pedophilic disorder.Other mental disorders. This class includes mental disorders that are due to other medical conditions or that don't meet the full criteria for one of the above disorders.

TREATMENT
Your treatment depends on the type of mental illness you have, its severity and what works best for you. In many cases, a combination of treatments works best.

If you have a mild mental illness with well-controlled symptoms, treatment from one health care provider may be sufficient. However, often a team approach is appropriate to make sure all your psychiatric, medical and social needs are met. This is especially important for severe mental illnesses, such as schizophrenia.

Your treatment team

Your treatment team may include your:

Family or primary care doctorNurse practitionerPhysician assistantPsychiatrist, a medical doctor who diagnoses and treats mental illnessesPsychotherapist, such as a psychologist or a licensed counselorPharmacistSocial workerFamily members

Medications

Although psychiatric medications don't cure mental illness, they can often significantly improve symptoms. Psychiatric medications can also help make other treatments, such as psychotherapy, more effective. The best medications for you will depend on your particular situation and how your body responds to the medication.

Some of the most commonly used classes of prescription psychiatric medications include:

Antidepressants. Antidepressants are used to treat depression, anxiety and sometimes other conditions. They can help improve symptoms such as sadness, anxiety, hopelessness, lack of energy, difficulty concentrating and lack of interest in activities. Antidepressants are not addictive and do not cause dependency. Anti-anxiety medications. Anti-anxiety medications are used to treat anxiety disorders, such as generalized anxiety disorder and panic disorder. They may also help reduce agitation and insomnia. Long-term anxiety medications consist mostly of antidepressants that also work for anxiety. There also are fast-acting anti-anxiety medications, which help with short-term relief —but they have the potential to cause dependency and ideally would be used short term. Mood-stabilizing medications. Mood stabilizers are most commonly used to treat bipolar disorder, which involves alternating episodes of mania and depression. Sometimes mood stabilizers are used with antidepressants to treat depression.Antipsychotic medications. Antipsychotic medications, also called neuroleptics, are typically used to treat psychotic disorders such as schizophrenia. Antipsychotic medications may also be used to treat bipolar disorders or used with antidepressants to treat depression.

Psychotherapy

Psychotherapy, also called talk therapy, involves talking about your condition and related issues with a mental health provider. During psychotherapy, you learn about your condition and your moods, feelings, thoughts and behavior. With the insights and knowledge you gain, you can learn coping and stress management skills.

There are many types of psychotherapy, each with its own approach to improving your mental well-being. Psychotherapy often can be successfully completed in a few months, but in some cases, long-term treatment may be needed. It can take place one-on-one, in a group or with family members.

Brain-stimulation treatments

Brain-stimulation treatments are sometimes used for depression and other mental health disorders. They're generally reserved for situations in which medications and psychotherapy haven't worked. They include electroconvulsive therapy, transcranial magnetic stimulation, vagus nerve stimulation and an experimental treatment called deep brain stimulation.

Make sure you understand all the risks and benefits of any recommended treatment.

Hospital and residential treatment programs

Sometimes mental illness becomes so severe that you need care in a psychiatric hospital. This is generally recommended when you can't care for yourself properly or when you're in immediate danger of harming yourself or someone else.

Options include 24-hour inpatient care, partial or day hospitalization, or residential treatment, which offers a temporary supportive place to live. Another option may be intensive outpatient treatment.

Substance abuse treatment

Substance abuse commonly occurs along with mental illness. Often it interferes with treatment and worsens mental illness. If you can't stop using drugs or alcohol on your own, you need treatment. Substance abuse treatments include:

Psychotherapy, to learn more about your condition and gain insightMedications, which may help ease withdrawal symptoms or reduce cravingsInpatient treatment, such as withdrawal (detox) treatmentOutpatient treatment programs, which require regular attendance for a set period of timeSupport groups or 12-step programs, such as Alcoholics Anonymous (A.A.)

Participating in your own care

Working together, you and your health care provider can decide which treatment may be best, depending on your symptoms and their severity, personal preferences, medication side effects, and other factors. In some cases, a mental illness may be so severe that a doctor or loved one may need to guide your care until you're well enough to participate in decision-making.