We live in a time of more significant mental health awareness than ever before. Our social media feeds are brimming with hashtags like #itsokaytotalk and #mentalhealthmatters, which are excellent. Truly, they are. Awareness is the first step to action, and more people feel comfortable talking about how they’re feeling now than at any other point in modern history.
However, there’s still a significant disconnect between general awareness and specific understanding of certain mental illnesses. Indeed, with many, there’s actually a lot of misinformation out there that harms rather than helps matters. With that in mind, we’ve curated a list of five of the most misunderstood mental illnesses. First, though, we need to understand why this education matters.
If the symptoms we’ll list strike a chord with you as you read this, then contact your medical professional to discuss things further. They’ll be able to hear your concerns in a safe, non-judgmental space and hopefully offer you the support you need moving forward!
Why Discussing these Mental Illnesses Matters
Language matters, and education matters, especially regarding our mental health. How often have you heard someone described as being “just a little bit OCD” simply because they’re tidy? Or being called “bipolar” just because they happen to have had a sudden mood swing?
These generalisations aren’t just inaccurate; they’re damaging and hurtful to those suffering from these mental illnesses. The mental illnesses we’ll be listing here can be incredibly debilitating. They can leave people bedridden, unable to leave the house, or living in a constant state of either fear or apathy.
It takes immense courage and strength to live with a mental illness, and so to hear the terms banded about in a light-hearted, throwaway fashion can invalidate a person’s suffering. That’s why education matters so much, and we can all do our bit to be a little more informed every day.
1. Depression
This might seem an odd one to include in the list because most people will think they’ve got a reasonably good understanding of what depression is. However, there’s a world of difference between having periods of low, depressed mood and having clinically diagnosable depression.
We’re all prone to feeling blue occasionally; being human is hard, after all. That’s just the way it is – we’re faced with challenges every single day, both personal and professional, and sometimes it just gets to you. Finding yourself going through the odd rough patch doesn’t automatically mean you have diagnosable depression, though.
Clinical Depression
The NHS characterises clinical depression as:
“A low mood that can last a long time or keep returning, affecting your everyday life.”
To be diagnosed with depression, you need to be suffering from symptoms (which we’ll come onto) most of the day, every day, for over two weeks. You’ll be assessed by a medical professional – your GP or a psychiatrist – using a mixture of questions and assessments/questionnaires. They will then be able to determine whether you have depression and, if so, how severe it is.
The most typical symptoms of depression include (but aren’t limited to):
- Low mood (persistent) or feelings of emptiness/apathy
- Irritability or outbursts of anger or frustration
- Crying spells for no apparent reason
- Anhedonia – an inability to feel pleasure
- Feeling exhausted all the time
- Weight loss/gain
- Gastrointestinal problems
- Changes to libido
Depression – A Vicious Cycle
People with depression often report they find it difficult to get out of bed or do other daily activities like showering or brushing their teeth. The feelings of hopelessness which can go with depression often fuel a vicious cycle. As sufferers lose motivation, they’re less likely to engage in their daily routine, which in turn can lead to an even more significant loss of motivation, and so on.
The inertia of depression can be one of the most challenging aspects to tackle. Think of a vast boulder made of stone. Getting it moving can be incredibly difficult, but once it starts rolling, it becomes easier to keep moving.
The same can be said of depression; getting back to doing those activities that were once enjoyable is, initially, incredibly difficult and probably won’t be pleasant. Little by little, however, as the sufferer continues to engage in value-driven activities, the hope is that they start to derive just a little bit more joy each time.
How is Depression Treated?
Depression is similar to several other mental illnesses in that it’s most commonly treated using a form of therapy called Cognitive Behavioural Therapy, or CBT. CBT works by examining our thought patterns and restructuring the way we think about things.
It can also be treated with a type of medication known as a Selective Serotonin Reuptake Inhibitor (SSRI), which is more often called an antidepressant. The most frequently used SSRIs include fluoxetine, sertraline, citalopram and escitalopram.
2. Obsessive-Compulsive Disorder (OCD)
Arguably, the most misunderstood mental illness out there is obsessive-compulsive disorder or OCD. And if it doesn’t take the number one spot, it’s certainly up there vying for the title. Many people use OCD as an adjective, describing their need to be neat, tidy or orderly as so OCD. That’s not OCD.
Even for those people who do have a basic understanding of OCD, it tends to be limited. People think of checking whether the door is locked or repeatedly washing their hands. Now, these are typical examples of compulsions (or rituals) in OCD, but they’re far from the only ones. We’re getting ahead of ourselves, though. What is OCD?
What is OCD?
OCD consists of two main elements: obsessions and compulsions (the O and the C of OCD). Obsessions relate to unwanted thoughts, images, feelings or sensations that cause the sufferer great distress. An example of an intrusive thought might be, having left the house and set off in your car, “What if I didn’t lock the front door and I got burgled?”
Compulsions are the activities the sufferer engages with, either physical or mental, to relieve the distress caused by the obsession. So, to continue our example from above, the person with OCD might drive back home to double-check that they’d locked the door.
Everybody gets intrusive thoughts, but the difference between people with and without OCD is that the latter can brush their intrusive thoughts aside and not pay them too much attention. For those with OCD, by contrast, the thoughts are much stickier.
There’s a sense of urgency and a need for certainty. One of the critical aspects of OCD is being uncomfortable with sitting in the grey of uncertainty. Engaging in the compulsions is an attempt to gain that certainty.
You Can’t Always See Compulsions
One of the biggest misunderstandings around OCD is that the compulsions have to be physical (like hand-washing or checking). But compulsions can be mental, too, and a person with OCD might suffer without anyone knowing what they’re going through.
A person with primarily mental compulsions might excessively ruminate on (or think about) what their thoughts (or obsessions) mean about them; they might try to stop their thoughts in their head or replace them with “good” ones.
OCD typically attacks a person’s values. Therefore, if someone is deeply religious, then their OCD might target that aspect of their life, bringing up inappropriate thoughts of the deity they worship, for instance. Or, if family is the most essential part of somebody’s life, they may get unwanted harmful thoughts towards family members.
As you might’ve imagined, this can be incredibly distressing. Like depression, OCD is primarily tackled using a combination of both therapy and medications. The primary therapy used is Exposure and Response Prevention (ERP) therapy.
ERP involves exposing yourself to the feared outcome and, importantly, not engaging in the compulsions the sufferer would generally undertake. The idea is that, over time, the sufferer learns that they can withstand the distress and uncertainty when, before, they didn’t believe that was the case.
An Example of ERP
Let’s say somebody has a subset of OCD known as harm OCD, in which their main concern is that they’ll cause harm (either physical or emotional) to a loved one in some way. An intrusive thought relating to this might be, “What if I pick up this knife and slash at my family member?”
Understandably, this is a terrifying thought to have! The sufferer might then attach meaning to the thought, thinking, “Well, why did I have that thought? Does that mean something about me? I must be a danger to my loved one!”
As a response to this distress, the person might continually analyse their thoughts, and they might even lock away their knives to “keep others safe” even though they’re not actually a danger to anybody. It’s precisely because the thought is so against the person’s values and abhorrent to them that the obsession causes such distress.
As part of an ERP “exposure”, the sufferer might be deliberately required to pick up a knife and then refrain from engaging in their usual compulsions. Doing this over and over, the sufferer learns that the feared outcome (that the person would hurt their family member) didn’t come true.
Symptoms of OCD include:
- Unwanted intrusive thoughts relating to harm, contamination, religion, etc.
- Checking
- Counting
- Reassurance-seeking
- Cleaning
- Thought suppression and neutralisation
- Avoidance
- Rumination
So, do you have OCD? Quite possibly, but it’s not simply because you like your house to be neat and tidy. In fact, many people with OCD can actually be quite messy!
3. Bipolar Disorder
Per the NHS’ definition, bipolar disorder is “a mental health condition that affects your moods, which can swing from one extreme to another.” It’s another one of those conditions that’s often talked about flippantly when, in fact, it can be incredibly challenging to live with.
It’s characterised by two leading mood states: mania and depression. The periods of depression are like major or persistent depressive disorder (the types of depression we were talking about earlier). However, mania refers to a significantly elevated mood and intensity of feelings.
The frequency of these cycles can vary, usually from monthly to annually, and there may be periods in between the mania and depression where things feel more stable. In other words, they don’t necessarily jump automatically from one episode to another. The episodes themselves also often differ in length. Symptoms of mania include:
- Feelings of extreme happiness and joy
- Coming up with lots of new, innovative ideas
- Rapid speech
- Racing thoughts
- Engaging in higher-risk behaviours, like gambling or substance abuse
- Making big decisions without giving them proper thought
- Higher self-esteem than normal
Bipolar disorder isn’t as rare as people think, and there are over one million people in the UK living with the illness, with one in fifty people suffering. It’s more than just mood swings, and it’s treated using medications like lithium and talking therapies like CBT.
4. Borderline Personality Disorder (BPD)
Borderline Personality Disorder is, to put it mildly, severely misunderstood. Even today, when there’s a lot more awareness around mental illnesses, BPD (along with our final illness on the list) is still heavily stigmatised.
BPD is a personality disorder which affects how the sufferer interacts with other people. People with BPD can struggle to regulate their emotions, have disturbed patterns of thinking, typically have intense relationships with others, and display impulsive behaviours.
For a person to qualify for a BPD diagnosis, they need to meet at least five of the following nine criteria, as outlined by borderlinepersonality.org:
- Fear of abandonment
- Unstable relationships
- Unstable self-image
- Impulsive or self-damaging behaviours
- Suicidal behaviour or self-injury
- Varied or random mood swings
- Constant feelings of worthlessness or sadness
- Problems with anger
- Stress-related paranoia or loss of contact with reality
Remember, a person only needs to consistently display five of these criteria for a possible BPD diagnosis.
Why is BPD So Misunderstood?
Borderline Personality Disorder is, even mathematically speaking, a complex mental illness; diagnostically, there are over 200 different combinations of criteria that can lead to a BPD diagnosis (using the presenting traits above), so there are many ways in which a sufferer can have this personality disorder.
There has even been a stigma towards BPD within the medical profession itself. Some professionals have even outright refused to treat patients with the disorder. As you can imagine, this has hardly helped progress the fight against BPD’s negative image… Combine that with misinformation online and in popular culture, and you have a potent melting pot of shame and stigma.
Fortunately, that’s beginning to change, but there’s still a long way to go.
How is BPD Treated?
One of the primary therapies used to treat BPD, alongside CBT, is called Dialectical Behavioural Therapy (DBT). DBT helps sufferers better deal with complex and challenging emotions and often involves more group work than CBT.
According to mental health charity Mind, DBT helps you: “Understand and accept your difficult feelings, learn skills to manage them, [and] become able to make positive changes in your life”. DBT is particularly helpful in tackling self-harm, depression and suicide attempts.
5. Schizophrenia
If you tell someone you have anxiety, you’ll get a supportive smile. If you tell someone you’re struggling with depression – even though we’ve talked about how it’s misunderstood – people will still know what you’re talking about and likely know what a suitable response will be for the situation.
If you tell someone you have schizophrenia, however, sadly, there’s still a good chance you’ll be misunderstood and met with at least some judgment. There’s lots of negative language surrounding the illness, like “crazy”, for instance, which helps nobody – least of all the person suffering.
Schizophrenia is a mental illness in which the sufferer experiences things that aren’t real, be that visual or auditory hallucinations or delusions, and in which they can feel as though they’ve lost touch with reality.
Symptoms of schizophrenia include:
- Hallucinations
- Delusions
- Avoiding social interaction
- Having low energy
- Having trouble focusing or paying attention
- Having little/no motivation
- Poor personal hygiene/grooming
- Flat affect/expression
Schizophrenia can be incredibly scary to live with; imagine living with regular voices and hallucinations and trying to go about your daily life. Well, that’s what sufferers with schizophrenia have to do and it takes an inordinate amount of strength and courage.
How is Schizophrenia Treated?
Schizophrenia is most often treated with a combination of CBT and antipsychotic medications. The most common antipsychotics for schizophrenia include olanzapine, risperidone and aripiprazole.
Final Thoughts
Hopefully, having read this, you have more of an understanding of these five mental illnesses. We don’t judge somebody for having a physical illness like cancer, so we shouldn’t judge people for developing equally uncontrollable mental illnesses like those listed above. The more we learn and the more we talk openly about these conditions, the better.
