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Mental Disorders samhsa.gov http://www.samhsa.gov/disorders/mental Mental Disorders The following are descriptions of the most common categories of mental illness in the United States. Anxiety Disorders Anxiety disorders are characterized by excessive fear or anxiety that is difficult to control and negatively and substantially impacts daily functioning. Fear refers to the emotional response to a real or perceived threat while anxiety is the anticipation of a future threat. These disorders can range from specific fears (called phobias), such as the fear of flying or public speaking, to more generalized feelings of worry and tension. Anxiety disorders typically develop in childhood and persist to adulthood. Specific anxiety disorders include generalized anxiety disorder (GAD), panic disorder, separation anxiety disorder, and social anxiety disorder (social phobia). National prevalence data indicate that nearly 40 million people in the United States (18%) experience an anxiety disorder in any given year. According to SAMHSA’s report, Behavioral Health, United States – 2012, lifetime phobias and generalized anxiety disorders are the most prevalent among adolescents between the ages of 13 and 18 and have the earliest median age of first onset, around age 6. Phobias and generalized anxiety usually first appear around age 11, and they are the most prevalent anxiety disorders in adults. Evidence suggests that many anxiety disorders may be caused by a combination of genetics, biology, and environmental factors. Adverse childhood experiences may also contribute to risk for developing anxiety disorders. For information about the treatment of anxiety disorders, visit SAMHSA’s Treatments for Mental Disorders page. Find more information about anxiety disorders on the National Institute of Mental Health (NIMH) website. Attention Deficit Hyperactivity Disorder Attention deficit hyperactivity disorder (ADHD) is defined by a persistent pattern of inattention (for example, difficulty keeping focus) and/or hyperactivity-impulsivity (for example, difficulty controlling behavior, excessive and inappropriate motor activity). Children with ADHD have difficulty performing well in school, interacting with other children, and following through on tasks. Adults with ADHD are often extremely distractible and have significant difficulties with organization. There are three sub-types of the disorder: Predominantly hyperactive/impulsive Predominantly inattentive Combined hyperactive/inattentive ADHD is one of the more common mental disorders diagnosed among children. Data from the 2011 National Health Interview Survey (NHIS) indicate that parents of 8.4% of children aged 3 to 17 years had been informed that their child had ADHD. For youth ages 13 to 18, the prevalence rate is 9%. The disorder occurs four times as often among boys than girls. It is estimated that the prevalence of ADHD among adults is 2.5%. Current research suggests that ADHD has a high degree of heritability, however, the exact gene or constellation of genes that give rise to the disorder are not known. Environmental risk factors may include low birth weight, smoking and alcohol use during pregnancy, exposure to lead, and history of child maltreatment. The three overarching features of ADHD include inattention, hyperactivity, and impulsivity. Inattentive children may have trouble paying close attention to details, make careless mistakes in schoolwork, are easily distracted, have difficulty following through on tasks, such as homework assignments, or quickly become bored with a task. Hyperactivity may be defined by fidgeting or squirming, excessive talking, running about, or difficulty sitting still. Finally, impulsive children may be impatient, may blurt out answers to questions prematurely, have trouble waiting their turn, may frequently interrupt conversations, or intrude on others’ activities. For information about the treatment of ADHD, visit SAMHSA’s Treatments for Mental Disorders page. Find more information about ADHD on the NIMH website. Bipolar and Related Disorders People with bipolar and related disorders experience atypical, dramatic swings in mood, and activity levels that go from periods of feeling intensely happy, irritable, and impulsive to periods of intense sadness and feelings of hopelessness. Individuals with this disorder experience discrete mood episodes, characterized as either a: Manic episode—abnormally elevated, expansive, or irritable mood accompanied by increased energy or activity that substantially impairs functioning Hypomanic episode—similar to a manic episode, however not severe enough to cause serious social or occupational problems Major depressive episode—persistent depressed mood or loss of interest or pleasure Mixed state—includes symptoms of both a manic episode and a major depressive episode People exhibiting these symptoms are most frequently identified as having one of two types of bipolar disorders: bipolar I disorder or bipolar II disorder. The bipolar I diagnosis is used when there has been at least one manic episode in a person’s life. The bipolar II diagnosis is used when there has been a more regular occurrence of depressive episodes along with a hypomanic episode, but not a full-blown manic episode. Cyclothymic disorder, or cyclothymia, is a diagnosis used for a mild form of bipolar disorder. The combined prevalence of bipolar I disorder, bipolar II disorder and cyclothymia is estimated at 2.6% of the U.S. adult population and 11.2% for 13 to 18 year olds. A family history of bipolar disorder is the strongest risk factor for the condition, and the level of risk increases with the degree of kinship. As mentioned previously, bipolar disorders are characterized by manic and depressive episodes. In children, manic episodes may present as an excessively silly or joyful mood that is unusual for the child or an uncharacteristically irritable temperament and are accompanied by unusual behavioral changes, such as decreased need for sleep, risk- seeking behavior, and distractibility. Depressive episodes may present as a persistent, sad mood, feelings of worthlessness or guilt, and loss of interest in previously enjoyable activities. Behavioral changes associated with depressive episodes may include fatigue or loss of energy, gaining or losing a significant amount of weight, complaining about pain, or suicidal thoughts or plans. For information about the treatment of bipolar disorder, visit SAMHSA’s Treatments for Mental Disorders page. Find more information about bipolar disorder on the NIMH website. Depressive Disorders (Including Major Depressive Disorder) Depressive disorders are among the most common mental health disorders in the United States. They are characterized by a sad, hopeless, empty, or irritable mood, and somatic and cognitive changes that significantly interfere with daily life. Major depressive disorder (MDD) is defined as having a depressed mood for most of the day and a marked loss of interest or pleasure, among other symptoms present nearly every day for at least a two-week period. In children and adolescents, MDD may manifest as an irritable rather than a sad disposition. Suicidal thoughts or plans can occur during an episode of major depression, which can require immediate attention (to be connected to a skilled, trained counselor at a local crisis center, people can call 1-800-272-TALK (8255) anytime 24/7). Based on the 2014 NSDUH data, 6.6% of adults aged 18 or older had a major depressive episode (MDE) in 2014, which was defined by the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The NSDUH data also show that the prevalence of MDE among adolescents aged 12 to 17 was 11.4% in 2014, while female youths were about three times as likely as male youths to experience a MDE. MDD is thought to have many possible causes, including genetic, biological, and environmental factors. Adverse childhood experiences and stressful life experiences are known to contribute to risk for MDD. In addition, those with closely related family members (for example, parents or siblings) who are diagnosed with the disorder are at increased risk. A diagnosis for MDD at a minimum requires that symptoms of depressed mood (for example, feelings of sadness, emptiness, hopelessness) and loss of interest or pleasure in activities are present. Additional symptoms may include significant weight loss or gain, insomnia or hypersomnia, feelings of restlessness, lethargy, feelings of worthlessness or excessive guilt, distractibility, and recurrent thoughts of death, including suicidal ideation. Symptoms must be present for at least two-weeks and cause significant impairment or dysfunction in daily life. For information about the treatment of depressive disorder, visit SAMHSA’s Treatments for Mental Disorders page. Find more information about depressive disorder on the NIMH website. Disruptive, Impulse Control, and Conduct Disorders This class of disorders is characterized by problems with self-control of emotions or behaviors that violate the rights of others and/or bring a person into conflict with societal norms or authority figures. Oppositional defiant disorder and conduct disorder are the most prominent of this class of disorders in children. Oppositional Defiant Disorder Children with oppositional defiant disorder (ODD) display a frequent and persistent pattern of angry or irritable mood, argumentative/defiant behavior, or vindictiveness. Symptoms are typically first seen in the preschool years, and often precede the development of conduct
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