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What is mental illness?

Recall from the previous lesson that the
American Psychiatric Association Parekh, R. (2018, August). What Is Mental Illness?. American Psychiatric Association.
defines mental illnesses (also referred to as mental disorders) as “health conditions involving changes in emotion, thinking or behaviour (or a combination of these), [and suggests that] mental illnesses are associated with distress and/or problems functioning in social, work or family activities”. There are many different types of mental illness, with different presentations. However, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is used by clinicians to classify disorders, includes
over 295 different diagnoses. Ghaemi, N. (2013, July 18). Requiem for DSM. Psychiatric Times.
For more information about different mental illnesses, review the brief descriptions below.

What is anxiety? Is anxiety bad?

Anxiety is a natural response to uncertainty, perceived danger, or important events. In fact, the Yerkes-Dodson law suggests that a certain degree of arousal is necessary for optimal performance. Increased arousal improves your performance, but only to a certain point. After that point, the degree of arousal, or anxiety, becomes debilitating and diminishes performance. For example, if you weren’t nervous for an important presentation, then you might not invest enough time practicing and preparing beforehand. But, if you’re too nervous, then you won’t be able to carry out the presentation. Arousal, or anxiety, is natural and not inherently bad. Instead, it’s an excess of anxiety that causes concern.

Anxiety Disorders

Anxiety disorders involve experiencing a disproportionate amount or intensity of anxiety relative to your context, and it can create significant disruptions in your life. Anxiety Canada recognizes that although anxiety protects you from danger, it becomes a problem when it:

  • Goes off when there is no real or immediate danger
  • Happens a lot
  • Feels pretty intense
  • Is upsetting and causes you distress
  • Stops you from doing fun and important things (ex. school, work, social life, setting goals)

There are eleven different types of anxiety disorders:

Each disorder is associated with a list of commonly experienced physical, cognitive, emotional, and behavioural symptoms. Briefly, these disorders include:

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Agoraphobia

People with agoraphobia avoid situations or places where they think they will not be able to escape or find help because they fear having a panic attack or other anxiety-related symptoms.

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Body-Focused Repetitive Behaviours (BFRBs)

A cluster of habitual behaviours that include hair pulling, skin picking, nail-biting, and lip or cheek biting. These behaviours are related to obsessive-compulsive symptoms and result in physical damage.

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Generalized Anxiety Disorder (GAD)

People with GAD worry excessively and uncontrollably about daily life events and activities. Their anxiety is not related to a specific thing or situation but is diffused – a general feeling of dread and worry.

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Health Anxiety

A class of anxiety disorders that defines several disorders characterized by excessive anxiety and misinterpretation of normal bodily sensations or the outcome of a common illness or condition. People with health anxiety experience excessive worry about having a serious medical condition.

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Hoarding Disorder

People with hoarding disorder have significant difficulty getting rid of possessions (regardless of their value), and strong urges to acquire new, non-essential items that lead to distress if the urges are not acted on. Their living space will often become compromised with extreme clutter and their function in social, occupational, or health-related areas of life becomes impaired.

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Obsessive-Compulsive Disorder (OCD)

People with OCD may experience obsessions (unwanted and disturbing thoughts, images or impulses that suddenly pop into their mind and cause a great deal of anxiety or distress), or compulsions (deliberate behaviours or mental acts that are carried out to reduce the anxiety caused by the obsessions), or both.

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Panic Disorder

People with panic disorder experience recurrent, unexpected panic attacks, as well as an intense fear that something bad will happen because of the panic attack (ex. dying).

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Post-Traumatic Stress Disorder (PTSD)

People develop PTSD after experiencing, witnessing, or being repeatedly exposed to major trauma. PTSD is characterized by intrusive symptoms (ex. upsetting, recurring, and unwanted memories about the event; nightmares about the trauma; reliving the trauma, etc.), attempts to avoid thoughts, feelings or memories related to the trauma, negative changes in thinking or mood, as well as changes in arousal (ex. heightened startle response, difficulty sleeping, etc.)

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Separation Anxiety

People with separation anxiety experience excessive fear or anxiety with regards to being apart from those to whom they are attached, which typically involves a close blood relative or intimate partner.

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Social Anxiety Disorder

People with social anxiety disorder feel incredibly uncomfortable or nervous in social situations, which include performance situations (ex. public speaking, meetings, public washrooms, eating in public, etc.), as well as interpersonal situations (ex. meeting new people, going to social events, talking on the phone, etc.). People with Social Anxiety Disorder are very self-conscious and generally fear that they will do something humiliating or embarrassing, or that others will think badly of them.

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Specific Phobia

Phobias are an extreme or irrational fear about specific places, situations, or things that can make it hard for you to participate fully in everyday life. People with phobias do whatever they can to avoid the terrifying feelings associated with facing their fears. In general, there are five different categories of phobias: animals (ex. spiders, snakes), natural environment (ex. heights, water), blood-injection injury (ex. medical procedures), situational (ex. confined spaces, dark), and “other”.

For more information about any of these disorders, visit the Anxiety Canada website.

What are Mood Disorders?

Mood describes a temporary state of mind and feeling. It’s common to experience fluctuations in mood (i.e. mood swings) and many people describe their day-to-day life as a “roller coaster” of emotions. These fluctuations may be the result of internal changes (ex. thoughts, worries, physical symptoms) or external changes (ex. work, school, relationships). In general, Mood Disorders describe a class of mental disorders that involve emotional disturbances consisting of prolonged periods of excessive sadness, excessive joyousness, or both. If you have a mood disorder, you might feel “stuck” in a low mood, “stuck” in a high mood, or unnaturally cycle between the two extremes. The emotional state or mood of a person with a Mood Disorder is generally inconsistent with their circumstances and interferes with their ability to think, feel, or function in everyday life.

There are two major classes of mood disorders:

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Major Depressive Disorder (i.e. Clinical Depression)

The most prominent symptom of Major Depressive Disorder is a persistent low mood or sense of despair. People with Major Depressive Disorder also often experience a loss of interest or pleasure in activities they previously enjoyed. Extreme self-criticism and feelings of hopelessness often lead to self-destructive behaviour as well as thoughts of death or suicide.

  • Persistent Depressive Disorder (i.e. Dysthymia)
    Dysthymia can be described as chronic, mild depression. The sadness, despair or gloomy mood experienced with Dysthymia is not as extreme as that which is associated with Major Depressive Disorder, but it can persist for years, making it challenging to engage in everyday life (ex. relationships, school, work, daily activities).
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Bipolar (I and II) Disorder

People with Bipolar Disorder experience extreme and fluctuating changes in mood, energy, activity, and concentration and focus. Bipolar Disorder was previously called Manic-depressive Disorder or Manic Depression, because of the tendency to swing between manic and depressive episodes. The symptoms of a depressive episode are similar to those in Major Depressive Disorder and include feeling very down or sad, empty, hopeless or worthless, and unmotivated. Manic episodes involve feeling elated and wired, racing thoughts and fast talking, decreased need for sleep, and an unnatural sense of being able to accomplish anything. Bipolar Disorder can be classified as Bipolar I or Bipolar II based on how intense the manic episodes are. Bipolar I Disorder involves manic episodes that last at least seven days, or which are so intense they require hospitalization, whereas Bipolar II Disorder is defined by hypomanic episodes that are shorter and/or less intense. Both Bipolar I and Bipolar II involve depressive episodes.

  • Cyclothymic Disorder (i.e. Cyclothymia)
    People with Cyclothymia experience mood swings between short periods of mild depression and hypomania (elevated mood). Similar to how Dysthymia is a “milder” form of Major Depressive Disorder, people with Cyclothymia experience milder mood swings than people with Bipolar disorder. Cyclothymia is sometimes classified as a type of bipolar disorder.

Mood Cycles Graph


What are Eating Disorders?

Eating disorders are complex disorders characterized by severe disturbances in eating behaviours as well as thoughts and emotions related to eating. People with eating disorders are typically preoccupied with food and body weight or shape, have low self-esteem, distorted body image, and tend to be perfectionistic. Without proper treatment of the psychological and physical symptoms of eating disorders, these disorders can result in malnutrition, heart problems, and other fatal physical conditions.

There are three major types of eating disorders:

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Anorexia nervosa
People with anorexia nervosa typically have an intense fear of being “fat”, and struggle to maintain a normal weight because of restricting food intake, excessive exercise, purging, or laxative use.
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Bulimia nervosa
People with bulimia nervosa struggle with episodes of binge eating during which they typically feel out of control and eat an astounding amount of food in a short period. These binges are followed by purging behaviours (ex. throwing up or laxative use) because of a fear of weight gain or physical sensations like stomach pains. This cycle of binging and purging may occur several times a week or even several times a day.
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Binge eating disorder
People with binge eating disorder have episodes of binge eating (similar to bulimia nervosa) where they consume large quantities of food in a brief period and feel out of control. However, unlike Bulimia nervosa, people with Binge eating disorder do not engage in purging behaviours after the episodes of binge eating.

What are other mental disorders?

The brief descriptions provided in this section merely scratch the surface of the
295 different diagnoses Ghaemi, N. (2013, July 18). Requiem for DSM. Psychiatric Times.
listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Other common mental disorders include:

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Substance-Use Disorders
More commonly referred to as addictions, substance use disorders involve misusing and/or abusing drugs including alcohol, marijuana, hallucinogens (ex. LSD, PCP), stimulants (ex. cocaine, methamphetamine), opioids (ex. heroin, fentanyl), tobacco, and more. People with addictions may become psychologically and physiologically dependent on the substance, and experience intense withdrawal when they cannot access or use the drug. This intense focus or dependence on a certain substance(s) takes over their life and many people feel compelled to use the drug despite being aware of the consequences.
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Psychotic Disorders
Severe mental disorders characterized by psychosis or psychotic episodes that involve abnormal thinking and perceptions, or an impaired relationship with reality. The two most “iconic” symptoms of psychotic disorders are hallucinations (hearing, seeing, tasting, smelling, or feeling something that is not there) and delusions (false beliefs or impressions that are firmly held despite contradicting what is generally accepted as reality, or rational). The most common psychotic disorder is schizophrenia.
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Personality Disorders

Characterized by rigid and unhealthy patterns of thinking, functioning, and behaving. There are ten different personality disorders, grouped into three clusters according to shared characteristics:

  • Cluster A
    Characterized by feeling paranoid, distrustful, and suspicious. Includes Paranoid, Schizoid, and Schizotypal personality disorders
  • Cluster B
    Characterized by impulsivity and difficulty controlling emotions, fears, desires, and anger. Includes Borderline, Narcissistic, Histrionic, and Antisocial personality disorders.
  • Cluster C
    Characterized by anxiety and compulsions. Includes Obsessive-compulsive, Dependent, and Avoidant personality disorders.

Why is it important to talk about mental illness?

A commonly voiced fear of parents, guardians, and educators, is that they don’t want to talk about mental illness or specific behaviours like suicide because they don’t want to “plant a seed”. In reality,
researchers and doctors Fuller, K. (2018, September 6). 5 Common Myths About Suicide Debunked. National Alliance on Mental Illness.
encourage healthy, age-appropriate conversations about mental illness and suicide, because talking about mental health and suicide “not only reduces the stigma, but also allows individuals to seek help, rethink their opinions, and share their story with others”.

Failing to talk about mental illness, normalize the conversation, and familiarize children with various psychological and physical symptoms, essentially sets our children up for failure. Sure, it would be nice to believe that mental health problems are only experienced by adults but, the reality is that
70% of mental health problems Government of Canada. (2006). The human face of mental health and mental illness in Canada. Minister of Public Works and Government Services Canada.
have their onset during childhood and adolescence and
17% of children Clinton, J., Kays-Burden, A., Carter, C., Bhasin, K., Cairney, J., Carrey, N., Janus, M., Kulkarni, C., & Williams, R. (2014). Supporting Ontario’s Youngest Minds: Investing in the Mental Health of Children Under 6. Ontario Centre of Excellence for Child and Youth Mental Health.
as young as 2-5 years of age meet diagnostic criteria for mental health problems.
Research indicates Ratnayake, P., & Hyde, C. (2019). Mental Health Literacy, Help-Seeking Behaviour and Wellbeing in Young People: Implications for Practice. The Educational and Developmental Psychologist, 36(1), 16–21.
that mental health literacy is required for people to identify symptoms of psychological distress and to be capable (and willing) to seek out the appropriate support services. After reviewing twenty-two published studies of perceived barriers to help-seeking behaviour in adolescents and young adults,
researchers concluded Griffiths K. M., Gulliver, A., & Christensen, H. (2010). Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC Psychiatry, 10(1), 113.
that the biggest barriers to help-seeking were the perceived stigma and difficulties recognizing symptoms, both of which can be minimized by talking about mental health and illness.

As an option, watch Wendy Smith’s TEDx Talk, “Mental health literacy can be taught in grade school”, to get a deeper understanding of why it’s important to talk about mental health and mental illness from a young age.  



Where can I learn more?

Canadian Mental Health Association (CMHA)

The Mental Health Commission of Canada (MHCC)

The Centre for Addiction and Mental Health (CAMH)

Anxiety Canada – Online resources and information about Anxiety Disorders

National Institute of Mental Health – Bipolar Disorder

National Eating Disorder Information Centre

Classroom Mental Health – How to Talk to a Student

What will students learn?

By the end of this lesson, students will be able to…

  • Recognize that mental illness is no different than physical illness with regards to the presence of symptoms, as well as the availability of professional support, treatment, and recovery
  • Identify and describe common mental illnesses, their symptoms, and treatment options
  • Respect and understand the challenges associated with experiencing mental illness
References
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Clinton, J., Kays-Burden, A., Carter, C., Bhasin, K., Cairney, J., Carrey, N., Janus, M., Kulkarni, C., & Williams, R. (2014). Supporting Ontario’s Youngest Minds: Investing in the Mental Health of Children Under 6. Ontario Centre of Excellence for Child and Youth Mental Health.

Fuller, K. (2018, September 6). 5 Common Myths About Suicide Debunked. National Alliance on Mental Illness.

Ghaemi, N. (2013, July 18). Requiem for DSM. Psychiatric Times.

Government of Canada. (2006). The human face of mental health and mental illness in Canada. Minister of Public Works and Government Services Canada.

Griffiths K. M., Gulliver, A., & Christensen, H. (2010). Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC Psychiatry, 10(1), 113.

Parekh, R. (2018, August). What Is Mental Illness?. American Psychiatric Association.

Phillips, M., & Kupfer, D. (2013). Bipolar disorder diagnosis: challenges and future directions. The Lancet, 381(9878), 1663–1671.

Ratnayake, P., & Hyde, C. (2019). Mental Health Literacy, Help-Seeking Behaviour and Wellbeing in Young People: Implications for Practice. The Educational and Developmental Psychologist, 36(1), 16–21.

Smith, W. (2017, May 3). Mental health literacy can be taught in grade school [Video]. TEDxLincolnSquare.

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