Chapter 43
Mental Health Problems
LEARNING OUTCOMES:
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Define the key terms and key abbreviations listed in this chapter
Explain the difference between mental health and mental illness
List the causes of mental illness
Explain how personality develops
Describe four anxiety disorders
Explain the defense mechanisms used to relieve anxiety
Describe common phobias
Explain schizophrenia
Describe bipolar disorder and depression
Describe personality disorders
Describe substance abuse
Describe eating disorders
Describe suicide and the persons at risk
Describe the care required by persons with mental health disorders
BASIC
CONCEPTS
Mental relates to the mind.
•Mental health involves the mind.
•Mental health and mental illness involve stress.
Stress is the response or change in the body caused by any emotional, physical, social,
or economic factor.
•Mental health means that the person copes with and adjusts to everyday stresses in ways
accepted by society.
•Mental illness is a disturbance in the ability to cope with or adjust to stress.
Mental disorder, emotional illness, and psychiatric disorder also mean mental illness.
Causes
of mental health disorders include:
•Not being able to cope or adjust to stress
•Chemical imbalances
•Genetics
•Drug or substance abuse
•Social and cultural factors
Personality is
the set of attitudes, values, behaviors, and traits of a person.
•Maslow’s theory of basic needs affects personality development.
Lower-level needs must be met before higher-level needs.
Physical needs are met before safety and security, love and belonging, self-esteem, and
self-actualization needs.
Unmet needs at any age affect personality development.
•Growth and development also affect personality development.
They occur in a sequence, order, and pattern.
Certain tasks must be accomplished at each stage.
Each stage lays the foundation for the next stage.

Freud’s
theory of personality development
•Freud’s theory involves three levels of awareness:
Conscious (awareness of the environment and experiences)
Subconscious (memory, past experiences, and thoughts of which the person is not
aware)
Unconscious (experiences and feelings that cannot be recalled)
•Freud’s theory also involves the id, ego, and superego.
The id is concerned with pleasure.
The ego deals with reality.
The superego is concerned with right and wrong.
ANXIETY
DISORDERS
Anxiety is a vague, uneasy feeling in response
Often anxiety occurs when needs are not met.
Some anxiety is normal.
to stress.
•Persons with mental health problems have higher levels of anxiety.
Signs and symptoms depend on the degree of anxiety.
Anxiety level
depends on the stressor.
•A stressor is the event or factor that causes stress.
Coping and defense mechanisms are used to relieve anxiety.
•Some are healthy; others are not.
•Defense mechanisms are unconscious reactions that block unpleasant or threatening
feelings.
Some use of defense mechanisms is normal.
With mental health problems, defense mechanisms are used poorly.
Panic
disorder
•Panic is the highest level of anxiety.
•Panic is an intense and sudden feeling of fear, anxiety, terror, or dread.
Onset is sudden with no obvious reason.
Signs and symptoms of anxiety are severe.
• A panic attack can last for 10 minutes or longer.
Attacks can occur often.
•Panic disorder can last for a few months or for many years.
Phobia
means an intense fear.
•The person has an intense fear of an object, situation, or activity that has little or no
actual danger.
•When faced with the fear, the person has high anxiety and cannot function.
Obsessive-compulsive disorder (OCD)
•An obsession is a recurrent, unwanted thought, idea, or image.
•Compulsion is repeating an act over and over again (a ritual).
The act may not make sense.
The person has much anxiety if the act is not done.

Post-traumatic
stress disorder (PTSD) occurs after a terrifying ordeal.
•The ordeal involved physical harm or the threat of physical harm.
•PTSD can develop:
After being harmed
After a loved one was harmed
After seeing a harmful event happen to loved ones or strangers
•Most people with PTSD have flashbacks.
A flashback is reliving the trauma in thoughts during the day and in nightmares during
sleep.
•PTSD can develop at any age.
SCHIZOPHRENIA
MEANS SPLIT MIND.
is a severe, chronic, disabling brain disorder.
involves:
•Psychosis (a state of severe mental impairment)
•Delusion (a false belief)
•Hallucination (seeing, hearing, smelling, or feeling something that is not real)
•Paranoia (a disorder of the mind)
•Delusion of grandeur (an exaggerated belief of one’s importance, wealth, power, or
talents)
•Delusion of persecution (the false belief that one is being mistreated, abused, or
harassed)
It
It
The
person with schizophrenia has severe mental impairment (psychosis).
•The person has problems relating to others.
•The person may have difficulty organizing thoughts.
•Responses are inappropriate.
•Communication is disturbed.
•The person may withdraw.
•Disorders of movement occur.
•Some persons regress.
People with schizophrenia do not tend to be violent.
MOOD
DISORDERS
Mood or affect relates to feelings and emotions.
Mood (or affective) disorders involve feelings, emotions, and moods.
The
person with bipolar disorder (manic-depressive illness) has severe extremes in
mood, energy, and ability to function.
•The person may:
Be more depressed than manic
Be more manic than depressed
Alternate between depression and mania
•The disorder:
Tends to run in families
Usually develops in the late teens or in early adulthood
Requires life-long management
Major
depression
•Depression involves the body, mood, and thoughts.
•Symptoms affect work, study, sleep, eating, and other activities.
•The person is very sad.
•The person loses interest in daily activities.
•Depression may occur because of a stressful event.
•Some physical disorders can cause depression.
•Hormonal factors may cause depression in women.
PERSONALITY
DISORDERS
involve rigid and maladaptive behaviors.
•Maladaptive means to change or adjust in the wrong way.
•Those with personality disorders cannot function well in society.
Personality disorders
Antisocial
personality disorder
•The person is at least 18 years old and has poor judgment.
•The person lacks responsibility and is hostile.
•Morals and ethics are lacking.
•The rights of others do not matter.
Borderline personality disorder (BPD)
•The person has problems with moods, interpersonal relationships, self-image, and
behavior.
•Aggression, self-injury, and drug or alcohol abuse may occur.
•The person may have other mental health disorders.
SUBSTANCE
ABUSE AND ADDICTION
Substance abuse or addiction occurs when a person overuses or depends on alcohol or
drugs.
•The person’s physical and mental health are affected.
•The welfare of others is affected.
Substances involved in abuse and addiction affect the nervous system.
•They affect the mind and thinking.
According
to the National Institute on Alcohol Abuse and Alcoholism (NIAAA),
alcoholism (alcohol dependence) includes these symptoms:
•Craving
The person has a strong need or urge to drink.
•Loss of control
The person cannot stop drinking once drinking has begun.
•Physical dependence
The person has withdrawal symptoms when he or she stops drinking.
•Tolerance
The person needs to drink greater amounts of alcohol to get “high.”

•Alcoholism is a chronic disease.
•Life-style and genetics are risk factors.
•Some people turn to alcohol for relief from life stresses.
•The craving for alcohol can be as strong as the need for food or water.
•There is no cure.
•Alcoholism can be treated.
Counseling and drugs are used to help the person stop drinking.
The person must avoid all alcohol to avoid a relapse.
•Alcohol abuse is just as harmful as alcoholism.
A person who abuses alcohol drinks too much but is not dependent on alcohol.
•According to the NIAAA, a person needs help if he or she:
Drinks to calm nerves, forget worries, or reduce depression
Has lost interest in food
Gulps drinks down fast
Lies or tries to hide drinking habits
Drinks alone more often
Has hurt oneself or someone else while drinking
Was drunk more than 3 or 4 times in one year
Needs more alcohol to get “high”
Feels irritable, resentful, or unreasonable when not drinking
Has medical, social, or money problems caused by drinking
Drug
abuse and addiction
•Drug abuse is the overuse of a drug for non-medical or non-therapy effects.
•Drug addition is a chronic, relapsing brain disease.
The person has an overwhelming desire to take a drug.
The person repeatedly takes the drug because of its effect.
Often higher doses are needed.
The person cannot stop taking the drug without treatment.
•Drug abuse and addiction:
Affect social and mental function
Are linked to crimes, violence, and motor vehicle crashes
Have physical affects
•Legal and illegal drugs are abused.
Legal drugs are approved for use in the United States.
Illegal drugs are not approved for use. They are obtained through illegal means.
Often legal drugs also are obtained through illegal means.
•Treatment depends on the drug and the person.
A drug treatment program combines various therapies and services to meet the person’s
needs.
EATING
DISORDERS
nervosa occurs when a person has an intense fear of weight gain or obesity.
•It occurs mainly in teenage girls and young women.
•The person believes she is fat despite being dangerously thin.
•Poor eating habits include:
Avoiding food and meals
Choosing a few foods and eating them in small amounts
Weighing and measuring food
•Intense exercise and vomiting are common.
•Some people abuse laxatives and enemas.
•Diuretic abuse may occur.
•Death is a risk from cardiac arrest or suicide.
Anorexia
Bulimia
nervosa
•Bulimia occurs mainly in teenage girls and young women.
•Binge eating occurs.
The person eats large amounts of food.
Then the body is purged (rid) of the food eaten to prevent weight gain.
Vomiting, laxatives, enemas, diuretics, fasting, and intense exercise are some methods
used to purge the body of food.
SUICIDE
Suicide
means to kill oneself.
According
to a 2004 National Institute of Mental Health (NIMH) report:
•Suicide was the 11th leading cause of death in the United States.
•There were more suicides than homicides.
•There were more deaths due to suicide than from HIV and AIDS.
•Suicide by firearms was the most common method for men and women.
•More men than women die by suicide.
•The highest rate of suicide was among white men aged 85 years and older.
•Suicide was the third leading cause of death among persons aged 15 to 20.
•There are about 8 to 25 attempted suicides for each suicide death.
•Women attempt suicide more often than men do.
More men die from suicide.
•Some disorders that run in families increase the risk of suicide behaviors.
Bipolar disorder
Major depression
Schizophrenia
Alcoholism
Substance abuse
Certain personality disorders
•Over half the people who commit suicide have a mood disorder.
•Younger persons who commit suicide often have both a substance abuse disorder and
depression.
•Among Native Americans and Alaskan natives, depression and alcohol use and abuse
are the most common risk factors for completed suicide.
•Alcohol and substance abuse problems contribute to suicidal behavior.
People
think about suicide when they are feeling hopeless or when they cannot see
solutions to their problems.
If a person mentions or talks about suicide:
•Take the person seriously.
•Call for the nurse at once.
•Do not leave the person alone.
Agencies that treat persons with mental health problems must identify persons at risk
for suicide.
Suicide
contagion
•The NIMH defines suicide contagion as exposure to suicide or suicidal behaviors within
the family, peer group, or media reports of suicide.
The exposure has led to an increase in suicide and suicidal behaviors in persons at risk
for suicide.
•Adolescents and young adults are at risk for suicide contagion.
•Following suicide exposure, those close to the victim should be evaluated by a mental
health professional.
Persons at risk for suicide need mental health services.
CARE
AND TREATMENT
Treatment of mental health problems involves having the person explore his or her
thoughts and feelings.
Often drugs are ordered.
The care plan reflects the person’s needs.
Communication is important.