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More than 44 million Americans experience a mental illness every year. According to a NAMI report, roughly one in five adults in the United States experiences a psychological disorder which significantly hinders their day to day activities. During ages thirteen to eighteen years old, one in five teens experience a serious mental illness. The DSM-V is the handbook used by healthcare professionals in the United States, and acts as the official guide for the diagnosis of mental disorders.
In the DSM-V, there are approximately 157 disorders, ranging from anxiety to psychotic disorders (American Psychiatric Association, 2013). This paper will focus on only three disorders: Attention Deficit Hyperactivity Disorder (ADHD), Bipolar Disorder, and Borderline Personality Disorder. The biological, psychological, and environmental factors (including social and cultural factors) may influence some of these disorders. Although most people only notice the negative effects of these disorders -with the yin comes the yang- in some cases, there may be some positive aspects that go along with them.
Attention Deficit Hyperactivity Disorder
ADHD is a neurodevelopmental disorder that affects how one thinks, learns and acts (Thapar, Cooper, Eyre, & Langley, 2013). According to a parent report in 2016, 9.4% (6.1 million) of American children ages ranging 2 to 17 have been diagnosed with ADHD (“Attention-Deficit,” 2018). Diagnosing ADHD is measured by the shown symptoms according to the Diagnostic and Statistical Manual of Mental Disorders or more commonly known as the DSM-V. Hyperactivity, fidgeting, excessive talking, and forgetfulness along with a few other measurable symptoms are all common in those with ADHD.
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All of the applicable symptoms are added together and if any of these symptoms are felt or performed in more than 2 different settings with more than a 6-month duration, the patient may be diagnosed with ADHD (Wilens & Spencer, 2010). Studies done in multiple countries suggest that there is a heritability rate for ADHD of about 71-90% (Thapar et al., 2013). ADHD is rooted in the prefrontal cortex and is caused by differing levels in DA (dopamine).
DA is the influencer to “cognitive control” behavior and conducts working memory (memory that consists of things people need to know currently, helping with focus) which aids with the performing actions. It controls the ability to overcome distractions and the control of attention. This cognitive control is alter with the presence of ADHD due to the lack of DA. That’s where the role of stimulants come into play as they are able to block DAT and increase dopamine levels, allowing attention levels to increase and ability to overcome distractions easier (Nestler, Hymen, & Malenka, 2009). One of the biggest issues those with ADHD face are issues regarding organization, time management, and planning, or OTMP.
ADHD makes it difficult to focus due to the lack of dopaminergic activity (Abikoff et al., 2013). About one-half of children show signs and symptoms of ADHD into adulthood, whereas the other half tend to grow and stray away from their symptoms (Wilens & Spencer, 2010). This means that OTMP is something that both adults and children are affected by. Misplacement and forgetfulness are commonplace when organization is impaired through ADHD. These aspects can be hurtful in school performance as well as impacting family life at home.
Working memory and issues with arousal affect the daily life of someone with ADHD, making them significantly more disorganized than the average person. ADHD affects overall performance, but with proper treatment, one can overcome these issues and lead a healthy, functional life (Abikoff et al., 2013). ADHD can be best managed using a mixture of psychosocial treatment and pharmacotherapy. Children diagnosed with ADHD are encouraged to seek educational plans with consistency and structure to help them succeed in school.
With the help of parents and school psychologists, children with ADHD are able to find ways to feel more focused and comfortable in a school environment. Medication is a major aspect in treatment for ADHD because it helps the brain to allow a child or adult to focus. Methylphenidate-based and amphetamine-based medications are the most common forms of stimulants used in treating ADHD. Stimulants increase the production of catecholamines and prevent the reuptake of catecholamines which allows neurotransmitters like dopamine and norepinephrine to stay in the body longer.
Because the catecholamines are allowed to stay in the synaptic gap longer, the dopamine can function similarly to someone without ADHD. Stimulants are proven to work in all age groups of those diagnosed with ADHD although, it is shown that in preschoolers it works more efficiently and with fewer side effects. Stimulants are not for everyone though, as up to one-third of children report their tics worsening with the exposure of stimulants (Wilens & Spencer, 2010).
Bipolar Disorder
Classic bipolar disorder is called cyclothymia: the chronic fluctuating mood disorder that includes periods of hypomania and depression (Monsun B.L et. 2004). Diagnosing bipolar disorder requires knowing the specific details differentiating Bipolar I and bipolar II disorder. After patient experiencing one or more manic episodes or at least one mixed episode, the patient would be diagnosed with bipolar I disorder. If a patient has suffered symptoms from experiencing a major depressive episode one or more times along with one or more hypermaniac episodes then they would be diagnosed with bipolar II as long as there have been no signs of a mixed mania episode (Chung H & Culpepper L et. 2007).
In most patients with the disorder, the initial presence of depression is the first sign of their bipolar symptoms. Depressive episodes caused by bipolar disorder, usually happen more frequently then most and last longer than hypomanic or manic episodes. As many as 4% of American adults suffer from bipolar I disorder and bipolar II disorder. 19.8% of individuals with positive screens for bipolar I and II disorders reported that they had previously received a diagnosis of bipolar disorder from a physician, whereas 31.2% reported receiving a diagnosis of unipolar depression.
The remaining 50% reported not receiving either diagnosis (study by Hirschfield and colleagues). Manic episodes are an elevated and abnormal amount of energy that result in irritability and heightened goal-directed activities and commonly last a week long at a minimum. These s states of mania are constant and occur throughout the day and everyday. Pure mania or hypomania, presents itself as part of a mixed mood state in which depression is accompanied by peevish and restless driven energy.
The DSM-V describes hypomanic episodes as an elevated and abnormal amount of energy that conclude in irritability, and heightened goal-directed activities, lasting the duration of 4 continuous days (DSM5). Before prescribing an antidepressant, a professional will look for signs that the patient may have bipolar disorder rather than a unipolar depression by monitoring their episodes for signs of mania. For patients with mixed episodes, treatment with selective serotonin reuptake inhibitor (SSRI) antidepressants alone can be particularly risky, amplifying both the mania and the depression.
Hypomanic episodes are an elevated and abnormal amount of energy that conclude in irritability, and heightened goal-directed activities, lasting the duration of 4 continuous days (American Psychiatric Association, 2013). Treating bipolar I and II disorder is only necessary during acute, severe episodes of mania or depression, and is only treated with daily maintenance medication because if not, it can cause recurrent mood cycles in the patient (Mansun B.L et. 2004). The main goals in treating bipolar disorder is to stabilize the symptoms and prevent relapse to gain total function.
Bipolar disorder has chronic symptoms, for example those with the disorder usually face problems like sleep difficulties, cognitive dysfunction, a high mood reactivity, along with psychiatric and medical comorbidity (McIntyre, R. S. et. (2015). Lithium was the first medication used to treat patients with bipolar disorder and lithium has proven to be highly effective in preventing suicide. Antidepressants are also prescribed for those with bipolar disorder but they should be prescribed with caution as antidepressants can cause either a manic episode or rapid cycling between depression and mania (Treatment of mood disorders, 2010).
Borderline Personality Disorder
Borderline personality disorder, or BPD, is a category B personality disorders. It is often confused with bipolar disorder because both conditions have marked mood swing, but the difference is between the two are actually in the mood swings. Bipolar mood swings shift over a period of several days or weeks and borderline personality disorder mood swings shift over a period of hours. Individuals with BPD have an inability to regulate emotion.
The DSM-5 outlines 9 criteria for BPD, five of which must be present for the diagnosis to be made. The following is a description of the 9 criteria. Real or imagined fear of abandonment. Extreme reactions and measures to stimuli the individual perceives as abandonment to avoid real or imagined separation or rejection. Pattern of unstable and intense interpersonal relationships. These relationships can be with partners, family, friends, and coworkers.
Individual will idealize someone one moment and then suddenly believe the person doesn’t care enough or is cruel. Identity Disturbance. Rapid changes in self-identity and self-image that may include chronic changing of appearance or even name, sudden changes in opinions, sexual identity, types of friends, career, goals, and values. Impulsivity that is potentially self-damaging. This may include gambling, reckless driving, unsafe sex, spending sprees, drug abuse, binge eating or sabotaging success by suddenly quitting a job or ending a relationship. Recurrent suicidal behavior. This is often reflective in suicidal threats or attempts and often in response to fear of separation or rejection or in response to inner pain.
Affective instability due to a marked reactivity of mood. Moods are not inhibited and can be all over the place in a very short period of time. Individual may overreact to everything in their environment. Chronic feelings of emptiness. Individual doesn’t feel whole and tries to fill the emptiness by looking to the rest of the world. Inappropriate and intense anger. Individuals have really thin skin and over feel everything. After displays of temper, constant anger, and recurrent physical fights regret sets in and they become terrified of abandonment.
This anger is internalized and possibly sets them up for self-harm. Transient, stress-related paranoid ideation. Under stress, a person may experience paranoid symptoms and feel everyone is out to get them (American Psychiatric Association, 2013). Causes of borderline personality disorder aren’t fully understood. Developmental environmental factors are thought to contribute to BPD. A chronic invalidating family environment and physical or sexual abuse may lead to stress levels that impact brain development. Biological factors indicated by some studies of twins and families suggest that personality disorders may be inherited or strongly associated with other mental health disorders among family members. (Bornovalova, Huibregtse, Hicks, Keyes, McGue, & Iacono, 2013).
Causes leading to BPD are still inconclusive because biological factors that could potentially influence the contraction of BPD may affect the person or may not and those facing negative environmental factors affiliated with BPD also might not experience the symptoms associated with BPD. More women are diagnosed with BPD than men. This may not be statistically valid because men aren’t always correctly diagnosed because of societal emotional standards and biases making it less likely for men to be accurately diagnosed or be diagnosed at all. Men can mistakenly get diagnosed with anger management or narcissism instead.
As a result of this flaw in diagnosis, men get treatment later than women (Jackson & Westbrook, 2009). Parts of BPD like anxiety and depression may be treated with medication, but currently there are no specific medications only for this condition. It is most effectively treated using intensive therapy by train the patients to learn new behavioral skills. Dialectical Behavior Therapy, also known as DBT, is a standard type of cognitive behavioral therapy used to treat BPD. (National Institute of Mental Health, 2011).
There are three important therapeutic settings required in DBT. Initially, intensive training regarding behavioral skills for in or outpatient is completed, followed by individual and group therapy on a weekly basis. Finally, phone checks with an approved therapist are performed on a daily basis. Usually, DBT therapy is done by a team of clinicians because of how draining taking care of BPT patients can be on staff. People undergoing DBT are taught how to effectively change their behavior using four main strategies: mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation.
The effects of BPD ease with age as the individual learns skills and coping mechanisms for dealing with their emotional regulation (Pederson & Pederson, 2017). The more people study human behaviors and their connections to physiological, environmental, or social factors, the better the knowledge they will have of how and why some people have to learn to live with mental disorders. Like many other medical specialties, the study of psychology is an ever-growing field, with technological advancements, increasing social awareness, and a vast population of new psychologists with new theories and perspectives.
Looking back on the advancements in psychology, from even a few decades ago, it is clear today’s universal understanding indicates one thing – society will continue to innovate and devote more time to all fields of medicine for many years to come. The study of psychology will absolutely change and improve in a matter of days, months, and years, which will only bring society closer to better treatments and understandings of mental illnesses and abnormal behaviors. As of now, there may be treatments for some mental disorders, and for others some coping mechanisms or therapies that may or may not help.
While most may only see the negative effects of mental disorders like attention-deficit hyperactivity disorder, bipolar disorder, and borderline personality disorder, there are some silver linings or positive effects on those who have certain mental disorders. For example, some people may have a better focus on certain tasks, an amazing sense of creativity, or reputation for being genuine and likable. Accepting that mental illnesses is what makes people who they are and raising awareness for those who fight harder than others are just two simple things that anyone can do, but they can make all the difference in the world for even one person.
