Each person you serve is unique. Understanding their diagnosis is helpful, but only goes so far in determining how best to support them. By understanding general characteristics of mental health diagnoses and their common symptoms, you can gain insight on how best to support them.
But the single most important factor in your effectiveness as a mental health practitioner is your relationship with each person you serve. Compassion, empathy, listening skills, and unconditional positive regard are the skills that will help you develop that relationship. You will establish trust, develop a partnership in which you both gain further insight into how each unique person you serve experiences the symptoms of his or her own diagnosis uniquely, and how he or she can develop coping skills to manage these symptoms.
This section of the guide is under construction. Please check back often for updates and additional information.
Identify disorders and symptoms in order to best understand and serve individual clients.
There is no medical test or precise tool for diagnosing mental health disorders. Rather, mental health clinicians observe behavior, discuss emotions and thoughts; examine history of stressful or traumatic experiences and childhood development problems, identify other disorders, such as substance abuse and addictions, and learn about any other medical issues or illnesses.
In establishing a diagnosis, then, in mental health examine current symptoms, and in the context of these and a person's history, align these symptoms, history, and patterns of behavior to characteristics that have been scrupulously and scientifically studied and cataloged in the Diagnostic and Statistical Manual of Mental Disorders, fifth addition (DSM-5), to make a diagnosis.
Causes of mental health disorders are not well understood. Some diagnoses (or symptoms) may have a biological or genetic origin. Others are a product of environment and life events.
What is most important to understand is that each person, regardless of diagnosis, is a unique individual with a unique history, for whom the factors contributing to current symptoms and behavior are unique, and who experience and respond to symptoms uniquely.
A diagnosis is necessary for establishing medical necessity for mental health services. It can also be helpful to understand the characteristics of different mental health diagnoses as a way of gaining insight into a person's current symptoms and behavior, and some best practices for helping them learn, gain insight, develop coping skills and pursue a recovery vision.
According to SAMHSA (the Substance Abuse and Mental Health Services Administration):
"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."
SAMHSA defines Major depressive disorder (MDD) 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."
According to statistics by the National Survey on Drug Use and Health, 7.1% of adults experienced an episode of MDD in 2017.
MDD occurs more frequently in women (8.7%) than in men (5.3%), and more frequently in young adults aged 18-25 (13.1%) than in adults over 25 (11.2%).
The survey also found that 13.3% of adolescents (age 12-17) experienced an episode of MDD in 2017.
Symptoms of MDD (described in more detail on the SAMHSA site) include 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.
Persons experiencing a severe episode of major depressive disorder may experience psychosis. They may also resist or decline mental health services. Suicidal thoughts or plans can occur during an episode of major depression, which can require immediate intervention. This is when your relationship with them, as a trusted mental health provider will be essential to helping them stay safe, or recognize what is happening, and get back on course for recovery.
The National Institute of Mental Health (NIMH) defines Persistent depressive disorder (also called dysthymia) as "a depressed mood that lasts for at least two years." The symptoms of persistent depressive disorder include episodes of major depression with periods of less severe symptoms.
SAMHSA defines bipolar disorder as "a mental disorder that involves unusual shifts in mood, energy, activity levels, and the way a person thinks. These shifts include periods when the person feels manic (extremely “up,” energized, irritable) and periods when the person feels depressed (“down,” hopeless, irritable, sad, and apathetic)." In order to be diagnosed with bipolar disorder, National Alliance on Mental Illness (NAMI) identifies that a person must have experienced at least one episode of mania or hypomania. Mania includes extreme low and high moods. Hypomania is experiencing mania for a short period of time and the symptoms do not cause distress and disruption.
Symptoms of bipolar disorder include intense emotions, changes in sleep patterns and activity levels, and unusual behaviors. Symptoms can lead to harmful and dangerous actions, keep people from participating in everyday life, and suicidal thoughts.
Bipolar I disorder requires a person to have had at least one manic episode, and usually, but not necessary for diagnosis, depression. NAMI states that the manic episode must have lasted for at least 7 days, or have been severe enough to require hospitalization in order to be diagnosed with bipolar I disorder.
SAMHSA defines bipolar II disorder as "at least one each of a hypomanic and a depressive episode; depressive episodes occur more often than hypomanic episodes; the person has no manic episodes."
A person diagnosed with cyclothyma has depressive and hypomanic symptoms for at least two years for adults, or one year for youth.
According to NIMH, people who are diagnosed with anxiety disorders experience fear and anxiety that persists and worsens over time. The symptoms interfere with the person's day to day life.
Social anxiety disorder is sometimes referred to as social phobia. People with social anxiety disorder fear social or performance situations. They often worry that others will judge their actions or behaviors associated with their anxiety. They often avoid social situations.
NIMH lists the symptoms of social anxiety as "being afraid or worrying about social situations, feeling self-conscious in front of others, avoiding social situations that cause fear or anxiety, feeling dread or doom prior to a feared situation, being uncomfortable if able to stay in a social situation, experiencing problems at work, school, or in a relationship due to symptoms, changing daily routine as a response to symptoms for more than six months."
People with generalized anxiety disorder experience excessive anxiety most days for at least 6 months. They feel anxious or worry about personal health, work, social interactions, and everyday routine life circumstances.
NIMH indicates that symptoms of generalized anxiety disorder include "feeling restless, wound-up, or on edge, being easily fatigued, having difficulty concentrating; mind going blank, being irritable, having muscle tension, difficulty controlling feelings of worry, having sleep problems, such as difficulty falling or staying asleep, restlessness, or unsatisfying sleep."
People with panic disorder have repeated sudden panic attacks. Panic attacks are unexpected periods of extreme fear that happen suddenly. A trigger can provoke attacks. People with panic disorder try to limit future attacks by avoiding places, situations, and behaviors they associate with panic attacks. Avoiding attacks cause problems in various aspects of the person's life.
During a panic attack, people may experience heart palpations, pounding heartbeats, or an accelerated heart rate, sweating, trembling or shaking, sensations of impending doom, feelings of being out of control.
According to NIMH, people with agoraphobia have an extreme fear of at least two or more of the following situations:
They often avoid these situations partially because they fear that they think it may be hard to leave if they have panic-like symptoms.
People with separation anxiety disorder fear being parted from someone they are close to. They may fear that an outward circumstance will harm the person they are attached to when they are separated, and do not want to leave that person. They may have nightmares about being separated from the person they are attached to.
NIMH defines post-traumatic stress disorder (PTSD) as "a disorder that develops in some people who have experienced a shocking, scary, or dangerous event." A person's natural response to trauma is flight or fight. When a person experiences trauma, their body defends itself from harm by causing split-second changes in the body to help defend against danger (fight) or avoid danger (flight). Some people may not be able to do anything (freeze) when experiencing trauma.
All of the following criteria, as stated by The U.S. Department of Veterans Affairs, are required to diagnose a person with PTSD:
| Criteria | Criteria Description | Diagnostic Criteria |
| Criteria A (one diagnostic criteria required) | The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s): | |
| Criteria B (one diagnostic criteria required) | The traumatic event is persistently re-experienced, in the following way(s): | |
| Criteria C (one diagnostic criteria required) | The traumatic event is persistently re-experienced, in the following way(s): | |
| Criteria D (two diagnostic criteria required) | Negative thoughts or feelings that began or worsened after the trauma, in the following way(s): | |
| Criteria E (two diagnostic criteria required) | Trauma-related arousal and reactivity that began or worsened after the trauma, in the following way(s): | |
| Criteria F (required) | ||
| Criteria G (required) | ||
| Criteria H (required) |
Schizophrenia and other psychotic disorders include symptoms such as delusions, hallucinations, disorganized thinking and speech, extremely disorganized motor behavior, and negative symptoms. Negative symptoms are associated with disruptions to normal emotions and behaviors like lack of expression of emotions, reduced feelings of pleasure, difficulty starting and completing activities, reduced speaking.
Schizophrenia affects how a person thinks, feels and behaves. A person with schizophrenia experiences changes in their thought content, thought process, emotions, and behavior. Symptoms include positive symptoms, negative symptoms, and cognitive symptoms. Positive symptoms are when a person may 'lose touch' with parts of reality like having hallucinations, delusions, thought disorders, and movement disorders. Cognitive symptoms include decreased ability to understand information and make decisions, difficulty focusing, and trouble with working memory.
NIMH states that in order to be diagnosed with schizophrenia, a person must experience two or more of the following symptoms:
Brief psychotic disorder consists of experiencing one positive symptom. A person changes from a non-psychotic state to a psychotic state within the span of two weeks. The psychotic episodes lasts at least a day, but no longer than a month. The person is able to regain a premorbid level of functioning.
Schizophreniform disorder is identical to Schizophrenia. The key difference between the two disorders is the duration of the symptoms. Schizophreniform disorder lasts at least one month, but no more than six months.
Delusions are beliefs that do not change despite contradicting evidence. Delusions may include a person believing that external forces control thoughts, behaviors, and feelings, that certain remarks, events, or objects are personally significant, or that they have special powers, have a calling, or are God. Delusional disorder includes one (or more) delusion(s) over a month where behavior is not noticeably odd other than delusions.
NAMI defines schizoaffective disorder as a combination of schizophrenia symptoms, such as hallucinations or delusions, and mood disorder symptoms, such as mania and depression. People with schizoaffective disorder are often wrongly diagnosed with bipolar disorder or schizophrenia due to the overlapping symptoms. Depressive and bipolar are two different types of schizoaffective disorder. Depressive type includes major depressive episodes. Bipolar type includes mania and sometimes major depression.
A diagnosis of schizoaffective disorder requires a period of major mood disorder (depression or mania) overlapping with schizophrenia symptoms (at least two of the following: delusions, hallucinations, disorganization, or "negative" symptoms). In addition, a person must have had delusions or hallucinations for two or more weeks in the absence of a mood episode. Finally, the mood symptoms must be present for most of the duration of your illness.
Personality disorders include patterns of behavior, feelings and thinking that interfere with a person's personal life, create difficulty at work and school, and cause problems in relationships. A person may be stable over a period of time.
SAMHSA states that people with borderline personality disorder struggle with intense and painful emotions related to relationships. They often battle with self-image, impulses, emotional responses, and problems with loved ones. In addition to borderline personality disorder, people often have depression, anxiety, post-traumatic stress, substance abuse, and eating disorder. There is a high rate of self-harm, suicide attempts, and suicide for people with borderline personality disorder."
Borderline Personality Disorder is characterized by the following symptoms:
Other personality disorders can be found in Diagnostic and Statistical Manual of Mental Disorders, fifth Edition (DSM-5).
| Personality Disorder | Description | Diagnosis Criteria |
| Paranoid Personality Disorder | People with paranoid personality disorder distrust and are suspicious of others' motives, and interpret motives as malevolent. Symptoms of schizoid personality disorder are not symptoms of schizophrenia, bipolar disorder, or depressive disorder with psychotic symptoms. | To diagnosis a person with paranoid personality disorder, the person must be experiencing four or more of the following criteria: |
| Schizoid Personality Disorder | People with schizoid personality disorder are detached from social relationships and express limited emotions. Symptoms of schizoid personality disorder are not symptoms of schizophrenia, bipolar disorder, or depressive disorder with psychotic symptoms. | To diagnosis a person with schizoid personality disorder, the person must be experiencing four or more of the following criteria: |
| Schizotypal Personality Disorder | People with schizotypal personality disorder experience discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior. Symptoms of schizotypal personality disorder are not symptoms of schizophrenia, bipolar disorder, or depressive disorder with psychotic symptoms. | To diagnosis a person with schizotypal personality disorder, the person must be experiencing four or more of the following criteria: |
| Antisocial Personality Disorder | People with antisocial personality disorder are indifferent to, and violate, the rights of others. Symptoms of antisocial personality disorder are not symptoms of schizophrenia, bipolar disorder, or depressive disorder with psychotic symptoms. A person must be 18, and have proof of conduct disorder prior to the age of 15 to be diagnosed with antisocial personality disorder. | To diagnosis a person with antisocial personality disorder, the person must be experiencing four or more of the following criteria: |
| Histrionic Personality Disorder | People with histrionic personlality disorder demonstrate attention seeking and emotionality characteristics. | To diagnosis a person with histrionic personality disorder, the person must be experiencing four or more of the following criteria: |
| Narcissistic Personality Disorder | People with narcissistic personality disorder exhibit grandiosity, need for admiration, and lack of empathy. | To diagnosis a person with narcissistic personality disorder, the person must be experiencing four or more of the following criteria: |
| Avoidant Personality Disorder | People with avoidant personality disorder experience feeling self-conscious in social situations, feelings of inadequacy, and hypersensitivity to negative judgment. | To diagnosis a person with avoidant personality disorder, the person must be experiencing four or more of the following criteria: |
| Dependent Personality Disorder | People with dependent personality disorder express submissive and clinging behavior due to a need to be taken care of. | To diagnosis a person with dependent personality disorder, the person must be experiencing four or more of the following criteria: |
| Obsessive-compulsive Personality Disorder | People with obsessive-compulsive personality disorder demonstrate preoccupation with orderliness, perfection, and control. | To diagnosis a person with obsessive-compulsive personality disorder, the person must be experiencing four or more of the following criteria: |
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