Mental Health

Disorders
Table Of Contents
SR NO. TOPICS

01 Therapeutic
Communication

02 Personality disorders
(Cluster A, B, C)

03 Eating
Disorders

Anxiety
04 Disorders

Attention-
05 Deficit/Hyperactivity
Disorder (ADHD)

06 Schizophrenia
 Therapeutic
Communication
 Therapeutic Communication
Therapeutic communication is a collection of techniques that prioritize
the physical, mental, and emotional well-being of patients. Nurses provide
patients with support and information while maintaining a level of
professional distance and objectivity. With therapeutic communication,
nurses often use open-ended statements and questions, repeat
information, or use silence to prompt patients to work through problems
on their own.

Therapeutic Communication Techniques

There are a variety opens of therapeutic communication techniques
nurses can incorporate into practice.
Using Silence Active Listening Voicing Doubt
Accepting Seeking Clarification Confronting
Giving Recognition Making Observations Sharing Empathy
Offering Self Reflecting Sharing Hope
Giving Broad Openings Offering Hope and Humor
Focusing Encouraging Comparisons
Sharing Humor Sharing Feelings

Using Silence Accepting

At times, it’s useful to not speak at
all. Deliberate silence can give
both nurses and patients an
opportunity to think through and
process what comes next in the
conversation. It may give patients
the time and space they need to
broach a new topic. Nurses should
always let patients break the
silence.
Sometimes it’s necessary to
acknowledge what patients say and
affirm that they’ve been heard.
Acceptance isn’t necessarily the
same thing as agreement; it can be
enough to simply make eye contact
and say “Yes, I understand.”
Patients who feel their nurses are
listening to them and taking them
seriously are more likely to be
receptive to care.
 Giving Recognition
Recognition acknowledges a
patient’s behavior and highlights it
without giving an overt
compliment. A compliment can
sometimes be taken as
condescending, especially when it
concerns a routine task like
making the bed. However, saying
something like “I noticed you took
all of your medications” draws
attention to the action and
encourages it without requiring a
compliment.
Offering Self
Recognition acknowledges a
patient’s behavior and highlights it
without giving an overt
compliment. A compliment can
sometimes be taken as
condescending, especially when it
concerns a routine task like making
the bed. However, saying
something like “I noticed you took
all of your medications” draws
attention to the action and
encourages it without requiring a
compliment.

Giving Broad Openings Active Listening

Therapeutic communication is
often most effective when patients
direct the flow of conversation and
decide what to talk about. To that
end, giving patients a broad
opening such as “What’s on your
mind today?” or “What would you
like to talk about?” can be a good
way to allow patients an
opportunity to discuss what’s on
their mind.
Seeking Clarification
By using nonverbal and verbal cues
such as nodding and saying “I see,”
nurses can encourage patients to
continue talking. Active listening
involves showing interest in what
patients have to say,
acknowledging that you’re listening
and understanding, and engaging
with them throughout the
conversation. Nurses can offer
general leads such as “What
happened next?” to guide the
conversation or propel it forward.

Similar to active listening, asking patients for clarification when they say
something confusing or ambiguous is important. Saying something like
“I’m not sure I understand. Can you explain it to me?” helps nurses ensure
they understand what’s actually being said and can help patients process
their ideas more thoroughly.
 Making Observations
Observations about the
appearance, demeanor, or
behavior of patients can help draw
attention to areas that might pose
a problem for them. Observing
that they look tired may prompt
patients to explain why they
haven’t been getting much sleep
lately; making an observation that
they haven’t been eating much
may lead to the discovery of a new
symptom.
Summarizing
It’s frequently useful for nurses to
summarize what patients have
said after the fact. This
demonstrates to patients that the
nurse was listening and allows the
nurse to document conversations.
Ending a summary with a phrase
like “Does that sound correct?”
gives patients explicit permission
to make corrections if they’re
necessary.
Voicing Doubt
Voicing doubt can be a gentler way
to call attention to the incorrect or
delusional ideas and perceptions of
patients. By expressing doubt,
nurses can force patients to
examine their assumptions.
Encouraging Comparisons
Often, patients can draw upon
experience to deal with current
problems. By encouraging them to
make comparisons, nurses can help
patients discover solutions to their
problems.
Reflecting
Patients often ask nurses for advice
about what they should do about
particular problems or in specific
situations. Nurses can ask patients
what they think they should do,
which encourages patients to be
accountable for their own actions
and helps them come up with
solutions themselves
Focusing
Sometimes during a conversation,
patients mention something
particularly important. When this
happens, nurses can focus on their
statement, prompting patients to
discuss it further. Patients don’t
always have an objective
perspective on what is relevant to
their case; as impartial observers,
nurses can more easily pick out the
topics to focus on.
 Confronting
Nurses should only apply this
technique after they have
established trust. It can be vital to
the care of patients to disagree
with them, present them with
reality, or challenge their
assumptions. Confrontation, when
used correctly, can help patients
break destructive routines or
understand the state of their
situation.
Sharing Hope–
Communicating a “sense of
possibility” to others.
Encouragement when appropriate
and positive feedback. Example “I
believe you will find a way to face
your situation, because I have seen
your courage in the past”.
Sharing Feelings
– Nurses can help clients express
emotions by making observations,
acknowledging feelings, and
encouraging communication,
giving permission to express
“negative” feelings and modeling
healthy anger
Offering Hope and Humor
Because hospitals can be stressful
places for patients, sharing hope
that they can persevere through
their current situation and
lightening the mood with humor
can help nurses establish rapport
quickly. This technique can keep
patients in a more positive state of
mind.
Sharing Empathy
The ability to understand and
accept another person’s reality, to
accurately perceive feelings, and to
communicate understanding.
Example “It must be very
frustrating to know what you want
and not be able to do it”.
Sharing Humor
Contributes to feelings of
togetherness, closeness and
friendliness. Promotes positive
communication in the following
ways; prevention, perception,
perspective.
 Personality
Disorders
(Cluster A, B, C)
Personality disorders (Cluster A, B, C)
The concept of personality disorders dates back to 1801, when
psychiatrist Philippe Pinel described a condition in which patients had
outbursts of rage without psychosis. By the end of the 1800s, mental
health professionals pinpointed seven antisocial personality traits and
described what was then known as “psychopathic personality.”
In the years since, the understanding of personality disorders has evolved
to include 10 different conditions. While each personality disorder has
different symptoms and traits, professionals sort them into three
clusters: A, B, and C. The disorders within each cluster share important
characteristics.

Cluster A – Eccentric, Odd

People with these disorders exhibit behavior that others perceive as

strange or erratic. These unusual behaviors lead to social difficulties.
The disorders in Cluster A are:

Paranoid Personality Disorder: People with this disorder have difficulty

trusting others, even without any reasonable suspicion. They may hold
grudges for long times, refuse to confide in others, and perceive
mundane remarks as slights against them.

Schizotypal Personality Disorder: Patients with this disorder often hear

voices, believe everyday occurrences are really hidden messages for
them, and believe that their thoughts can influence people and events
in their lives. They may also feel uncomfortable with close personal
relationships.

Schizoid Personality Disorder: This disorder makes people reluctant to

be around others, making them seem cold and unapproachable to
others. People with schizoid personality disorder cannot pick up on
social cues, find happiness in everyday activities, or express emotion.
 Cluster B – Erratic, Dramatic

People with these types of personality disorders display unpredictable

behaviors and react dramatically to seemingly mundane events.. The
four types of Cluster B personality disorders are:

Antisocial Personality Disorder: People with this disorder have little to

no regard for the needs and emotions of others. They may also not think
much about the safety of themselves or others. Because of this, people
with antisocial personality disorder often lie, cheat, steal, and con
others in order to get their ways. Furthermore, their impulsive
behaviors often violate the rights of others and can even turn
aggressive. Even when they commit violent acts against others, people
with antisocial personality disorder do not feel remorse. When
laypeople refer to sociopaths, they often mean people with this
disorder.

Borderline Personality Disorder: People with this Cluster B personality

disorder have fragile egos and believe that the people they love will
abandon them. This combination can lead to unstable relationships,
both with romantic partners and others. When they sense any slight or
downturn in a relationship, the person with borderline personality
disorder may act out with threats of self-harm, anger outbursts, and
paranoia.

Histrionic Personality Disorder:

This disorder is marked by a constant need for attention. People with
histrionic personality disorder will resort to things like dramatic
outbursts and sexual promiscuity to get the attention they need. They
often speak in hyperbole and experience quick, dramatic shifts in their
emotions. People with this disorder may think their relationships are
deeper than the other person believes.
 Narcissistic Personality Disorder: People with this Cluster B
personality disorder believe their needs and feelings are more
important than others’. They may fantasize about power, lie about
their accomplishments, and expect lots of praise from others. People
around them often call people with this disorder arrogant.

Cluster B – Erratic, Dramatic

People with Cluster C personality disorders are afraid of specific things

and avoid confronting those fears. This behavior leads to trouble in
interpersonal relationships. The Cluster C disorders are:

Avoidant Personality Disorder: This disorder makes people terrified of

rejection or any criticism. Because of these fears, they avoid contact
with others at work and social events. These patients often feel
unattractive and unworthy of affection.

Dependent Personality Disorder: People with this condition are

motivated by the fear of having to take care of themselves or make
decisions. As such, they depend on others to take care of their needs,
make decisions, and give them constant approval. People with this
disorder are at risk of staying in abusive relationships and are typically
terrified of confrontation.

Obsessive-compulsive Personality Disorder: People with this disorder

take perfectionism to extreme levels. They may obsess over rules,
cleanliness, and order. They fear that if they do not complete certain
tasks, something terrible will happen. Their rigidity sometimes hinders
their relationships and always keeps them from living their full lives.
Personality disorders affect both the person who has the condition and
those around them. The professionals at LifeStance Health can help all
those affected by personality disorders. Contact a therapy clinic near
you today to book an appointment
 Eating
Disorders
 Eating Disorders
Overview

There is a commonly held misconception that eating disorders are a

lifestyle choice. Eating disorders are actually serious and often fatal
illnesses that are associated with severe disturbances in people’s eating
behaviors and related thoughts and emotions. Preoccupation with food,
body weight, and shape may also signal an eating disorder. Common
eating disorders include anorexia nervosa, bulimia nervosa, and binge-
eating disorder.

Signs and Symptoms

Anorexia nervosa

Anorexia nervosa is a condition where people avoid food, severely restrict

food, or eat very small quantities of only certain foods. They also may
weigh themselves repeatedly. Even when dangerously underweight, they
may see themselves as overweight.
There are two subtypes of anorexia nervosa: a restrictive subtype and a
binge-purge subtype.

Restrictive: People with the restrictive subtype of anorexia nervosa

severely limit the amount and type of food they consume.

Binge-Purge: People with the binge-purge subtype of anorexia nervosa

also greatly restrict the amount and type of food they consume. In
addition, they may have binge-eating and purging episodes—eating large
amounts of food in a short time followed by vomiting or using laxatives or
diuretics to get rid of what was consumed.
 Symptoms include
Symptoms include:
Extremely restricted eating
Extreme thinness (emaciation)
A relentless pursuit of thinness and unwillingness to maintain a
normal or healthy weight
Intense fear of gaining weight
Distorted body image, a self-esteem that is heavily influenced by
perceptions of body weight and shape, or a denial of the seriousness of
low body weight
Other symptoms may develop over time, including:
Thinning of the bones (osteopenia or osteoporosis)
Mild anemia and muscle wasting and weakness
Brittle hair and nails
Dry and yellowish skin
Growth of fine hair all over the body (lanugo)
Severe constipation
Low blood pressure
Slowed breathing and pulse
Damage to the structure and function of the heart
Brain damage
Multiorgan failure
Drop in internal body temperature, causing a person to feel cold all
the time
Lethargy, sluggishness, or feeling tired all the time
Infertility

Bulimia nervosa
Bulimia nervosa is a condition where people have recurrent and frequent
episodes of eating unusually large amounts of food and feeling a lack of
control over these episodes. This binge-eating is followed by behavior that
compensates for the overeating such as forced vomiting, excessive use of
laxatives or diuretics, fasting, excessive exercise, or a combination of
these behaviors. People with bulimia nervosa may be slightly
underweight, normal weight, or over overweight.
 Symptoms include
Symptoms include:
Chronically inflamed and sore throat
Swollen salivary glands in the neck and jaw area
Worn tooth enamel and increasingly sensitive and decaying teeth as a
result of exposure to stomach acid
Acid reflux disorder and other gastrointestinal problems
Intestinal distress and irritation from laxative abuse
Severe dehydration from purging of fluids
Electrolyte imbalance (too low or too high levels of sodium, calcium,
potassium, and other minerals) which can lead to stroke or heart
attack

Binge-eating disorder
Binge-eating disorder is a condition where people lose control over their
eating and have reoccurring episodes of eating unusually large amounts
of food. Unlike bulimia nervosa, periods of binge-eating are not followed
by purging, excessive exercise, or fasting. As a result, people with binge-
eating disorder often are overweight or obese. Binge-eating disorder is
the most common eating disorder in the U.S.
 Binge-eating disorder
Symptoms include:
Eating unusually large amounts of food in a specific amount of time,
such as a 2-hour period
Eating even when you're full or not hungry
Eating fast during binge episodes
Eating until you're uncomfortably full
Eating alone or in secret to avoid embarrassment
Feeling distressed, ashamed, or guilty about your eating
Frequently dieting, possibly without weight loss

Risk Factors
Eating disorders can affect people of all ages, racial/ethnic backgrounds,
body weights, and genders. Eating disorders frequently appear during
the teen years or young adulthood but may also develop during
childhood or later in life.
Researchers are finding that eating disorders are caused by a complex
interaction of genetic, biological, behavioral, psychological, and social
factors. Researchers are using the latest technology and science to better
understand eating disorders.
One approach involves the study of human genes. Eating disorders run
in families. Researchers are working to identify DNA variations that are
linked to the increased risk of developing eating disorders.
Brain imaging studies are also providing a better understanding of eating
disorders. For example, researchers have found differences in patterns of
brain activity in women with eating disorders in comparison with
healthy women. This kind of research can help guide the development of
new means of diagnosis and treatment of eating disorders.

Treatment
Treatment plans are tailored to individual needs and may include one or
more of the following:
Individual, group, and/or family psychotherapy
Medical care and monitoring
Nutritional counseling
Medications
 Anxiety
Disorders
 Anxiety disorders
Overview
Experiencing occasional anxiety is a
normal part of life. However, people
with anxiety disorders frequently
have intense, excessive and
persistent worry and fear about
everyday situations. Often, anxiety
disorders involve repeated episodes
of sudden feelings of intense anxiety
and fear or terror that reach a peak
within minutes (panic attacks).
These feelings of anxiety and panic interfere with daily activities, are
difficult to control, are out of proportion to the actual danger and can
last a long time. You may avoid places or situations to prevent these
feelings. Symptoms may start during childhood or the teen years and
continue into adulthood.
Examples of anxiety disorders include generalized anxiety disorder,
social anxiety disorder (social phobia), specific phobias and separation
anxiety disorder. You can have more than one anxiety disorder.
Sometimes anxiety results from a medical condition that needs
treatment.

Symptoms
Common anxiety signs and symptoms include:
Feeling nervous, restless or tense
Having a sense of impending danger, panic or doom
Having an increased heart rate
Breathing rapidly (hyperventilation)
Sweating
Trembling
Feeling weak or tired
Having difficulty controlling worry
 Trouble concentrating or
thinking about anything
other than the present
worry
Having trouble sleeping
Experiencing
gastrointestinal (GI)
problems
Having the urge to avoid
things that trigger anxiety

types of anxiety disorders

Panic disorder Selective mutism

involves repeated episodes of
sudden feelings of intense anxiety
and fear or terror that reach a peak
within minutes (panic attacks). You
may have feelings of impending
doom, shortness of breath, chest
pain, or a rapid, fluttering or
pounding heart (heart palpitations).
These panic attacks may lead to
worrying about them happening
again or avoiding situations in which
they've occurred.
Specific phobias
are characterized by major anxiety
when you're exposed to a specific
object or situation and a desire to
avoid it. Phobias provoke panic
attacks in some people.
is a consistent failure of children
to speak in certain situations,
such as school, even when they
can speak in other situations, such
as at home with close family
members. This can interfere with
school, work and social
functioning.
Substance-induced anxiety disorder
is characterized by symptoms
of intense anxiety or panic that
are a direct result of misusing
drugs, taking medications,
being exposed to a toxic
substance or withdrawal from
drugs.
Separation anxiety disorder
is a childhood disorder
characterized by anxiety that's
excessive for the child's
developmental level and related to
separation from parents or others
who have parental roles
Agoraphobia
(ag-uh-ruh-FOE-be-uh) is a type of
anxiety disorder in which you fear
and often avoid places or
situations that might cause you to
panic and make you feel trapped,
helpless or embarrassed.

Anxiety disorder due to a medical condition

includes symptoms of intense anxiety or panic that are directly caused
by a physical health problem.

Generalized anxiety disorder

includes persistent and excessive anxiety and worry about activities or
events — even ordinary, routine issues. The worry is out of proportion to
the actual circumstance, is difficult to control and affects how you feel
physically. It often occurs along with other anxiety disorders or
depression.

Social anxiety disorder (social phobia)

involves high levels of anxiety, fear and avoidance of social situations due
to feelings of embarrassment, self-consciousness and concern about being
judged or viewed negatively by others.

Substance-induced anxiety disorder

is characterized by symptoms of intense anxiety or panic that are a direct
result of misusing drugs, taking medications, being exposed to a toxic
substance or withdrawal from drugs.

Other specified anxiety disorder and unspecified anxiety disorder

are terms for anxiety or phobias that don't meet the exact criteria for any
other anxiety disorders but are significant enough to be distressing and
disruptive.
 Attention-
Deficit/Hyperactivity
Disorder (ADHD)
 Attention-Deficit/Hyperactivity
Disorder (ADHD)
Overview
Attention-deficit/hyperactivity disorder (ADHD) is marked by an ongoing
pattern of inattention and/or hyperactivity-impulsivity that interferes
with functioning or development. People with ADHD experience an
ongoing pattern of the following types of symptoms:

Inattention
means a person may have difficulty staying on task, sustaining focus, and
staying organized, and these problems are not due to defiance or lack of
comprehension.

Hyperactivity
means a person may seem to move about constantly, including in
situations when it is not appropriate, or excessively fidgets, taps, or talks.
In adults, hyperactivity may mean extreme restlessness or talking too
much.

Impulsivity
means a person may act without thinking or have difficulty with self-
control. Impulsivity could also include a desire for immediate rewards or
the inability to delay gratification. An impulsive person may interrupt
others or make important decisions without considering long-term
consequences.
 Signs and Symptoms
Some people with ADHD mainly have symptoms of inattention. Others
mostly have symptoms of hyperactivity-impulsivity. Some people have
both types of symptoms.
Many people experience some inattention, unfocused motor activity,
and impulsivity, but for people with ADHD, these behaviors:
Are more severe
Occur more often
Interfere with or reduce
the quality of how they function
socially, at school, or in a job

Inattention
People with symptoms of inattention may often:
Overlook or miss details and make seemingly careless mistakes in
schoolwork, at work, or during other activities
Have difficulty sustaining attention during play or tasks, such as
conversations, lectures, or lengthy reading
Not seem to listen when spoken to directly
Find it hard to follow through on instructions or finish schoolwork,
chores, or duties in the workplace, or may start tasks but lose focus
and get easily sidetracked
Have difficulty organizing tasks and activities, doing tasks in
sequence, keeping materials and belongings in order, managing time,
and meeting deadlines
Avoid tasks that require sustained mental effort, such as homework,
or for teens and older adults, preparing reports, completing forms, or
reviewing lengthy papers
Lose things necessary for tasks or activities, such as school supplies,
pencils, books, tools, wallets, keys, paperwork, eyeglasses, and cell
phones
Be easily distracted by unrelated thoughts or stimuli
 Hyperactivity-Impulsivity
People with symptoms of hyperactivity-impulsivity may often:
Fidget and squirm while seated
Leave their seats in situations when staying seated is expected, such
as in the classroom or the office
Run, dash around, or climb at inappropriate times or, in teens and
adults, often feel restless
Be unable to play or engage in hobbies quietly
Be constantly in motion or on the go, or act as if driven by a motor
Talk excessively
Answer questions before they are fully asked, finish other people’s
sentences, or speak without waiting for a turn in a conversation
Have difficulty waiting one’s turn
Interrupt or intrude on others, for example in conversations, games,
or activities.

Conditions Associated with ADHD

Schizophrenia
 Schizophrenia
Schizophrenia is a chronic, severe mental disorder that affects the way a
person thinks, acts, expresses emotions, perceives reality, and relates to
others. Though schizophrenia isn’t as common as other major mental
illnesses, it can be the most chronic and disabling.
People with schizophrenia
often have problems doing
well in society, at work, at
school, and in relationships.
They might feel frightened
and withdrawn, and could
appear to have lost touch
with reality. This lifelong
disease can’t be cured but can
be controlled with proper
treatment.
Contrary to popular belief, schizophrenia is not a split or multiple
personality. Schizophrenia involves a psychosis, a type of mental illness
in which a person can’t tell what’s real from what’s imagined. At times,
people with psychotic disorders lose touch with reality. The world may
seem like a jumble of confusing thoughts, images, and sounds. Their
behavior may be very strange and even shocking. A sudden change in
personality and behavior, which happens when people who have it lose
touch with reality, is called a psychotic episode.
How severe schizophrenia is
varies from person to person.
Some people have only one
psychotic episode, while others
have many episodes during a
lifetime but lead relatively
normal lives in between. Still
others may have more trouble
functioning over time, with
little improvement between
full-blown psychotic episodes.
 Types
The classifications and types of schizophrenia have changed over the
years. Previously, health professionals may have classified schizophrenia
as one of the following five types:
Paranoid type
Disorganized type
Catatonic type
Undifferentiated type
Residual type

Signs and Symptoms

Positive Symptoms
In positive symptoms, a person loses touch with reality and experiences
another world created in his mind. Several disorders which are included as
psychotic symptoms are:
Hallucination: a person may see, hear, smell, feel or even taste the things
which actually do not exist. Hearing different voices is the most common
one.
Delusion: a person having strong beliefs which may seem strange and
irrational to others. For example, believing that they are in danger and
others are trying to hurt them results in them being paranoid.
Thought disorder: When a person is unable to express their thoughts
normally, they may have disorganized thoughts leading to them saying or
writing things that do not make sense.
Movement disorder: It can also slow or reduce movement. People with a
movement disorder can sometimes be jumpy, and sometimes, they may
stay perfectly still for hours.

Negative Symptoms
Negative symptoms of schizophrenia are somewhat similar to symptoms
of depression and other mental illnesses.
Feeling low and having a lack of motivation.
Becoming less expressive in terms of talking or facial expressions.
Poor hygiene and bad grooming habits.
Struggling with basic daily activities like shopping, organizing
things, taking bath, etc.
Unwillingness to enjoy life.

Cognitive symptoms
These symptoms infect how our brain holds memories, concentrates and
focuses. These symptoms make it really hard to function in the
workplace, schools and colleges. The symptoms include:
Trouble learning new things or language.
Trouble staying focused or paying attention to something.
Unable to make decisions.