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Mental Health 101WLDF Session 1

April 3, 2018

Diagnoses

Session 1

Mood Disorders

Major Depressive Disorder

Bipolar Disorder

Eating Disorders

Schizophrenia and Psychotic

Disorders

Psychosis

Schizophrenia

Session 2

Anxiety Disorders

Generalized Anxiety Disorder (GAD)

Post Traumatic Stress Disorder

(PTSD)

Panic Disorder

Obsessive Compulsive Disorder

(OCD)

Co-occurring Substance Use

Disorders

Agenda: Session 1

Check In

Basics about Mental Illness

Stigma

Mood Disorders


Bipolar Disorder

Eating Disorders

Anorexia Nervosa

Bulimia Nervosa

Binge Eating Disorder

Schizophrenia and Psychotic Disorders

Psychosis

Schizophrenia

Empathy Exercise

Check-in

What things come to mind when you think of or hear “mental illness”?

What is mental illness?

Mental Illnesses Are:

Biological brain disorders that interfere with normal brain chemistry.

Genetic factors may create a predisposition in some people, and life

stressors may trigger the onset of symptoms.

Very common. In any given year, approximately 57.7 million American

experience a mental health disorder. 1 in 17 people live with a serious

mental illness such as schizophrenia, major depressive disorder, or

bipolar disorder. About 1 in 10 children live with a serious mental or

emotional disorder.

Equal opportunity diseases, striking people from all walks of life,

regardless of age, race, income, religion, or education.

Treatable! Appropriate medical care and rehabilitation enable many

people to recover enough to live productive lives.

Mental Illnesses Are Not

Anybody’s fault. They are not caused by weak character or poor

parenting.

Preventable or curable at this time. Great advances have been made

in understanding brain functioning, but not enough is known yet to

prevent or cure serious brain disorders (mental illnesses).

Hopeless. These illnesses present difficult challenges, but help is

available. Support, education, and a community of friends who

understand can make everyone’s lives satisfying and meaningful again.

All Mental Illnesses are on a Continuum

--------------------------------------------------------------------------------------------------------------

Some people Some people fluctuate Though rare, some

experience mild from less to more severe people are seriously ill

symptoms and may stay that way

their entire lives

How a person does, depends on many factors including:

Biological severity of the mental illness

Social stressors

Personal stressors

Resources the person has: support system, finances, access to care, etc.

Participation in treatment

Success of treatment

Diagnosis takes time…

Many times symptoms of one mental

illness can overlap with symptoms of

another mental illness.

Anxiety disorders and depression often

co-occur.

A person may have more than one

illness at the same time and only be

getting treatment for one, which can

delay or prevent recovery.

…and can be complex

Diagnostic categories can change and are

periodically revised.

It is common to be improperly diagnosed

at least once, and maybe several times,

before arriving at something that makes

sense.

Certain mental illnesses include a “lack of

insight” meaning that a person’s brain

blocks the ability to recognize responses

and behaviors as different from others

(unable to “see” symptoms).

Recovery is possible and complex

No one can predict the path and outcome for a person.

Hope is not only reasonable, but it is essential.

Believing in the possibility of recovery has been proven to make

recovery more likely, even when all other things remain the same.

With serious mental illnesses, medication is often key, HOWEVER…

…medication alone is NOT a treatment plan: it is part of a treatment

plan.

Effective treatment plans are customized to the

individual’s needs and may include a number of things

such as:

• Psychoeducation

• Family involvement

• Supported employment

• Housing

• Talk therapy (psychotherapy)

• Behavioral therapy

• Diet and exercise

• Meditation and yoga

Mood Disorders


Affects about 6.7% of the population (21.6 million people in the U.S.).

Individuals who are between 18 and 29 years of age experience higher

rates of major depression.

Females, beginning as early as adolescence, present these symptoms at a

rate of 1.5 to 3 times higher than males.

Without treatment, the number of episodes and severity of each episode

of major depressive disorder tend to increase over time.

60% of people with major depressive disorder experience anxiety or panic.

Major depressive disorder is the leading cause of disability in the U.S.

and many other developed countries.

Symptoms of Depression

Persistently sad or irritable mood

Pronounced changes in sleep, appetite, and energy

Difficulty thinking, concentrating, and remembering

Lack of interest in or pleasure from activities that were once enjoyed

Low self-esteem

Feelings of guilt, worthlessness, hopelessness, and emptiness

Recurrent thoughts of death or suicide

Movement changes; either “slowed down” or overly activated and agitated

Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain.

What Depression Looks Like In The

Workplace:

Increasing frequency of sick days or tardiness

Loss of motivation

Memory difficulties

Incomplete duties or tasks

Fatigue, tiredness, excessive yawning

Sluggish movements

Irritability

Treatment For Depression

Medications often effectively control the serious symptoms of

depression. It generally takes two to four weeks for antidepressant

medication to have their full effect.

Psychotherapy:

Cognitive behavioral therapy (CBT)

Interpersonal therapy (IPT)

Acceptance and commitment therapy (ACT)

Problem-solving therapy

Psychodynamic therapy

Options For Treatment Resistant Depression

Meaning that medications and therapy have not been

successful and the person experiences severe or life

threatening depression, including:

Electroconvulsive therapy (ECT)

Vagus Nerve Stimulation (VNS)

Repetitive Transcranial Magnetic Stimulation (rTMS)

Depression

Nick:

“During a deep depression things just feel really dark. I get real tired, like things are in a deep hole. I don’t have much energy. I either eat a lot or very little. I used to isolate, especially when I lived alone without a husband and family. It was easier to be alone. I didn’t want to bring anyone into my world because it seemed so dark. Usually when I am severely depressed I don’t work, or I miss a lot of work. I was also hospitalized a lot, which made it hard to hold a job.”

Let’s Talk About It…

What is something new you learned about Major Depressive Disorder?

Was there anything that surprised you?

How will this information be useful to your work?

Bipolar Disorder

Affects about 2.6% of the adult population (8.4 million people in the

U.S.).

Most often begins in adolescence or early adulthood, but occasionally

develops during childhood.

The illness affects both men and women equally.

A medical condition that causes extreme shifts in mood, energy, and

functioning. These changes may be subtle or dramatic and typically

vary greatly over the course of a person’s life.

Bipolar Disorder is characterized into episodes of mania and episodes

of depression.

Symptoms of Bipolar Disorder

Symptoms of Mania:

Either an elated, happy mood or an irritable, angry, unpleasant mood

for an extended period of time

Increased physical and mental activity and energy

Racing thoughts and flight of ideas

Increased talking, more rapid speech than normal

Ambitious, over confidence, inflated self-esteem; often grandiose

plans

Engaging in risk taking behaviors and impulsive activities such as

spending sprees, sexual indiscretions, and alcohol abuse

Decreased sleep without experiencing fatigue

What Bipolar Looks Like In The

Workplace:

Accelerated periods of productivity

Irritability

Rapid speech

Inability to interact productively with others

Inflated self esteem

Difficulty staying on topic

Same signs as depression as well as:

Treatment For Bipolar

Effective treatment plans for Bipolar Disorder usually include

medication, psychotherapy, education, self-management strategies,

and external supports such as family, friends, and formal support

groups.

The most useful psychotherapies include:

Cognitive Behavioral Therapy (CBT)

Interpersonal and Social Rhythm Therapy (IPSRT)

Family Focused Therapy (FFT) was originally created for family members of

people living with Bipolar but has since been expanded to all types of mental

health conditions.

Bipolar Disorder

Lisa:

“Sometimes ideas come to me so quickly that I feel incredibly smart, to the point of thinking ‘I am the perfect person for this task,’ as if no one else can do it as well as I can. I also spend money, and I justify it by saying ‘I deserve this,’ or ‘I’ll be beautiful in this.’ It is very egocentric. In addition to the mania, I also deal with hypomania. It’s hard not to love it, because I get a lot done. On the other side, when I’m depressed I tend to isolate. I feel that I am a burden to others, and it is hard to do the things I need to do to get by.”


What is something new you learned about Bipolar Disorder?



Eating Disorders

Eating disorders

The three most common eating disorders:

Anorexia Nervosa (0.6%)

Bulimia Nervosa (0.6%); and

Binge-eating Disorder (2.85%), affect about 12.7 million

Americans.

Obsessions with food, body weight, and body shape may also signal an

eating disorder.

Eating disorders frequently co-occur with depression, substance

abuse, and anxiety disorders.

Anorexia Nervosa has the highest mortality rate of any psychiatric

disorder.

Symptoms of Anorexia Nervosa

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:

Muscle wasting and weakness

Growth of fine hair all over the body (lanugo)

Low blood pressure, slowed breathing and pulse

Multi-organ damage and possibly failure

Drop in internal body temperature, causing a person to feel cold all the time

Lethargy, sluggishness, or feeling tired all the time

Symptoms of Bulimia Nervosa

Recurring episodes of binge eating including BOTH of the following:

Eating in a specific amount of time (e.g. within a 2 hour period) large amounts of

food

A sense of lack of control over eating during this time-period. Feeling like one

cannot stop eating or control what or how much one is eating.

Recurring inappropriate behaviors to prevent weight gain (e.g. purging)

A person’s sense of self is overly based on body shape and weight.

Other symptoms may develop over time, including:

Chronically inflamed and sore throat

Worn tooth enamel and increasingly sensitive and decaying teeth as a result

of exposure to stomach acid

Acid reflux disorder and other gastrointestinal problems

Severe dehydration

Symptoms of Binge-eating DisorderEpisodes of binge eating

Eating within a specific amount of time (e.g. within a 2 hour period) large amounts of food

A sense of lack of control over eating during this time-period. Feeling like one cannot stop eating or control what or how much one is eating.

Binge-eating episodes can involve the following:

Eating must faster than normal

Eating until feeling uncomfortably full

Eating large amounts of food when not feeling physically hungry

Eating alone because of embarrassment over how much one is eating

Feeling disgusted with oneself, depressed, or very guilty afterwards

The binge-eating is not connected with the unique symptoms of another eating disorder (e.g. purging afterwards – which is indicative of bulimia nervosa)

What Eating Disorders Look Like In The

Workplace:Dresses in layers

Preoccupation with weight, food, calories, dieting

Refuses to eat certain foods

Makes frequent comments about feeling “fat”

Denies feeling hungry

Makes excuses to avoid mealtimes or situations involving food

Strong need for control

Shows inflexible thinking

Feels ineffective

Treatment for Eating Disorders

Adequate nutrition, reducing excessive exercise, and stopping purging

behaviors are the foundations of 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; and/or Medications.

Psychotherapies:

Nutritional counseling


Interpersonal Therapy

Dialectical Behavioral Therapy

Eating Disorders

Eric:

“I am a man who battled against bulimia. It all started in high school. I was quiet, walked with my head down, and didn’t engage in any activities or social outings. But food was always around, easily accessible and I found comfort subliminally in it. I have always wanted to be an actor, but when I’d share my dream, I received the same response; “Nobody wants to hire the fat kid”. So I innocently started to work out and eat better. After the compliments started coming in, I had the love and respect from my peers that I had always wanted. At this point, I began engaging in dangerous lengths to become thing. I was frail and everyone around me thought I was using drugs. I would rather have them think that about me than admit I was a boys with an eating disorder. All the research I did talked about female self-help groups, tips for young women, and you’d hear about female celebrities admitting their issues. So as bad as I wanted and needed the help, I hid my disorder. When I finally spoke up, it was hard but so worth it. A scale number does not define me or my talents.”


What is something new you learned about Eating Disorders?



Psychosis

Psychosis

Delusions: believing in things that are not real or true (or outside of

cultural norms)

Belief that a person can read my thoughts or the thoughts of others

Belief that people are plotting against me

Belief that others are secretly monitoring or in some way threatening me

Belief that others can control my mind or the minds of others

Hallucinations: hearing, seeing, or feeling things that are not real

Seeing something that isn’t really there

Hearing something that isn’t really there (includes “voices”)

Smelling something that isn’t really there

Feeling something that isn’t really there

Schizophrenia

Affects about 1% of the adult population (3.2 million people in the

U.S.)

An estimated 40% of individuals with schizophrenia go untreated

Can interfere with a person’s ability to think clearly, distinguish

reality from fantasy, manage emotions, make decisions, and relate to

others

It is severe in how it affects the brain; it affects more domains of the

brain than any other mental illness.

The first signs of Schizophrenia typically emerge in the teenage years

or early twenties, often later for females.

The signs and symptoms of schizophrenia have been noticed for

centuries and are universal.

Symptoms of Schizophrenia

Positive Symptoms: These are mental experiences that are imposed on

the person, or behaviors that are added to the person that were not

there before the illness.

Delusions

Hallucinations

Negative Symptoms: This refers to valuable aspects to the person’s

personality that have been taken away by the illness.

Emotional flatness

Lack of expression

Inability to start and/or follow through

Lack of pleasure or interest in life

Symptoms of Schizophrenia

Cognitive Symptoms: These are symptoms related to thinking processes.

Difficulty prioritizing tasks, memory, and organizing things

Anosognosia (ano·sog·no·sia \ˌa-nō-ˌsäg-ˈnō-zh(ē-)ə\), or lack of insight,

being unaware of having an illness

Disorganized speech or an inability to generate a logical sequence of ideas

What Schizophrenia Looks Like In The

Workplace:

Difficulty with multitasking

Suspiciousness or uneasiness with others

Inability to think clearly or concentrate

Seeing or hearing something that no one else does

Decline in hygiene

Sudden decline in work performance

Treatment for Schizophrenia

The treatment of schizophrenia requires an all-encompassing

approach that includes medication, therapy, and psychosocial

rehabilitation. Medication is often an important part of symptom

management.

Antipsychotic medication often helps to relieve the hallucinations,

delusions, and to a lesser extent, the thinking problems people can

experience.

Psychotherapy:

Cognitive Behavioral Therapy for Psychosis (CBTp)

Cognitive Enhancement Therapy (CET)

Psychosocial rehabilitation

Schizophrenia

Ellen:

“When my schizophrenia was full blown, I suffered a lot. Every day felt like a year to me. I heard voices and I saw things that weren’t there. I couldn’t be by myself. I needed people near me. It felt like my head was really heavy and like I was seeing through tinted glasses. There was a lot of chatter in my head with all those voices and I shut myself off and didn’t communicate.”


What is something new you learned about Schizophrenia?



Empathy Exercise

Mental Health 101WLDF Session 2

April 5, 2018

Agenda: Session 2

Quiz

Stigma

The Power of Language

Anxiety Disorders

Generalized Anxiety Disorder

Panic Disorder



Co-occurring Substance Use Disorders

Check In

Survey

Fact or Fiction?

Mental health disorders are like other medical conditions.

Fact: Brain disorders, like heart disease are legitimate medical illnesses. Research shows that there are genetic and biological causes for psychiatric disorders and they can be treated effectively.

People with serious mental illness, such as schizophrenia, are usually dangerous and violent.

Fiction: Individuals with a mental illness are far more likely than those without to be victims of violence. Some psychiatric conditions if left untreated may have a higher incidence of violence but only 3-5% of all violence (including but no limited to firearm violence) is attributed to serious mental illness.

People can recover from mental illness

Fact: The best treatments for serious mental illnesses today are highly effective; between 70 and 90 percent of individuals have significant reduction of symptoms and improved quality of life with a combination of pharmacological and psychosocial treatments and supports.

Fact or Fiction?

Mental illness usually strikes individuals in the prime of their lives.

Fact: Symptoms often begin during adolescence and young adulthood. All ages are susceptible but the young and old are especially vulnerable.

Mental illness is passed on genetically.

Fact, well partially: Having a family history of mental illness makes a person more susceptible but some people who develop a mental illness have no family history. Causes of mental illness are highly complicated and can include: genetics, environmental exposures before birth, brain chemistry, childhood trauma or loss, etc.

I can’t do anything for a person with a mental health problem.

Fiction: Only 38% of adults with diagnosable mental health problems receive needed treatment. Teachers, family, friends, and support networks are key to encouraging an individual to seek treatment and services.

Stigma: a mark of disgrace that sets a person apart.

Stigma erodes confidence that mental disorders are real, treatable health

conditions.

Avoidance of seeking help or treatment

Fear, mistrust, and violence against people living with mental illness and their families

Family and friends turn their backs on people with mental illness

Prejudice and discrimination

Poor funding for and inadequate mental health services

Limited insurance coverage for mental health services

Why is this important?

Only 38% of people who need help actually get it.

Social (and self-) stigma,

Fear of repercussions at work or at school, and

Lack of access to quality, affordable treatment.

Early detection and intervention lead to a significantly

improved trajectory of mental health across the lifespan.

Language Matters in Mental Health:

Language shapes how we see the world. The words we choose

and the meanings we attach to them influence our feelings,

attitudes and beliefs. Our language choices have a powerful

effect on how we view mental health and people living with

mental health conditions.

Labelling can be harmful, but in some circumstances it may be

necessary. It is important that we use respectful language,

which literally means putting reference to the person first in a

phrase. For example, instead of calling someone “mentally ill”

a more respectful, people-first way of phrasing it is to say “a

person living with a mental health condition.”

Language Matters:

Don’t Say This:

That’s crazy, psycho, insane, nuts

It drives me crazy

He is a schizophrenic

She’s OCD

Suffering from mental illness

Consumer

Mentally Ill

Say This When Necessary:

That’s wild, bizarre, odd, eccentric

It annoys me

He has schizophrenia

She has obsessive-compulsive

disorder

Living with (or experiencing)

mental illness

Person living with a mental illness

Person living with a mental health

condition

Anxiety

Disorders

Anxiety Disorders are the most common mental

health disorder

Generalized Anxiety

Disorder (GAD)

Post Traumatic Stress

Disorder (PTSD)

Panic Disorder

Obsessive Compulsive

Disorder (OCD)

28%Of the total population

suffer from a form of

anxiety.

Generalized Anxiety Disorder (GAD)

Affects about 3% of the adult population (9.7 million people in the

U.S.).

Women are twice as likely to experience GAD as men.

The average age of onset is 31 years old.

Common to experience excessive worry about everyday things (money,

health, family, work, or other issues).

60% of people with major depressive disorder experience anxiety or

panic.

Symptoms of GAD

Excessive worry about everyday things (unable to control feelings)

Constant apprehension

Muscle tension

Fatigue

Restlessness

Difficulty sleeping

Irritability

Edginess

What Generalized Anxiety Disorder

Looks Like In The Workplace:

Appears distracted

Psychomotor agitation: tapping, biting finger nails, hair pulling, etc.

Preoccupation over fear instead of focusing on work

Turning down assignments because of fear of failure

Memory problems

Treatment for GAD

Effective treatments for GAD include psychotherapy and/or

medication. In most cases, a combination of therapy and

medications is beneficial for people with GAD. Two types of

medications are commonly used to treat GAD—anti-anxiety

medications and antidepressants.

Psychotherapy:

Cognitive-behavioral therapy (CBT)


Problem-solving therapy (PST)


Generalized Anxiety Disorder

Danielle:

“I feel a lot of confusion, oversensitivity, and insecurity. Sometimes it feels like I want to run away from where I am. There are times that I want to be with people, but then I feel nervous to be around them – anxious – so it is like feeling trapped. There’s a lot of confusion. My heart beats fast, I get headaches, and sometimes by body feels really hot. These feelings can come on suddenly and I might have no knowledge of what the reason is. It comes and goes on its own schedule.”


What is something new you learned about Generalized Anxiety

Disorder?



Panic disorder Affects about 2% of the adult population (6.8 million people in the U.S.)

Women are almost twice as likely to experience Panic Disorder as men.

Panic attacks often begin in late adolescence or early adulthood, but not

everyone who experiences panic attacks will develop panic disorder.

The occurrence of panic attacks with other mental illnesses are so common

that the DSM-5 (diagnostic manual used by mental health professionals to

make mental health diagnoses) has an option for clinicians to add a “panic

attack specifier”.

A panic attack is an uncontrollable panic response to ordinary, non-

threatening situations. It typically reaches a peak within a few minutes then

begins to subside, but a person may feel anxious and jittery for many hours

after experiencing a panic attack. As you look at the checklist below it

becomes easy to understand why so many people fear they are having a heart

attack, as so many physical symptoms are involved.

Symptoms of Panic Disorder

Chest pain or discomfort

Nausea or abdominal distress

Feeling dizzy, unsteady, light-headed or faint

Chills or heat sensations

Trembling or shaking

Fear of dying or losing control

Sensations of shortness of breath or smothering

Palpitations, pounding heart or accelerated heart rate

Sweating

What Panic Disorder Looks Like In The

Workplace:

Avoiding situations that may trigger an attack such as public speaking and deadlines.

Have a panic attack during work

Fear and anxiety

Trouble concentrating

Treatment for Panic Disorder Effective treatments for panic disorder include psychotherapy and/or

medication. Stress management techniques, meditation, self-help groups,

support groups, family, and friends are all important elements to living in

recovery with panic disorder.

Psychotherapy:



Exposure therapy

psychodynamic therapy

In most cases, a combination of therapy and medication is beneficial for

people with panic disorder. Two types of medications are commonly used to

treat panic disorder are anti-anxiety medications and antidepressants.

Panic Disorder

Cameron:

“Sometimes a panic attack comes out of nowhere and other times it will be triggered by something. One trigger is being in a situation where I’ve had a previous attack. Another is being in a situation where I don’t feel in control – like if an elevator stops between floors, or a train stops in the middle of a tunnel, or a plane goes through turbulence. My heart starts racing, and I feel like electrical charges or flashes are moving throughout my body. It also feels like my mind is outside of my body – as if my mind and body are two different things.”


What is something new you learned about Panic Disorder?



Post Traumatic Stress Disorder (PTSD)

Over a lifetime, approximately 8.7% of individuals living in the U.S.

will be diagnosed with PTSD (27.8 million people in the U.S.).

Rates of PTSD are higher among veterans and members of the military

as well as others whose vocations increase their risk of traumatic

exposure (like police, fire fighters, and emergency personnel).

PTSD can occur at any age, beginning after the first year of life.

Symptoms usually begin within the first 3 months after the trauma,

but there may be a delay of months or even years before the

diagnostic requirements are met.

Symptoms of PTSD

Persistent re-experiencing of the event:

Recurrent, involuntary and intrusive memories of the traumatic event (including flashbacks and dreams)

Psychological distress and/or physiological reactions when exposed to cues that resemble any aspect of the traumatic event

Negative changes in thoughts and moods:

Inability to remember an important aspect of the trauma

Persistent and exaggerated negative beliefs about oneself, others, or the world (“I am bad”, “no one can be trusted”, “the world is completely dangerous”)

Persistent, distorted thoughts about the cause or consequences of the trauma that lead to blame

Persistent negative emotional state (fear, horror, anger, guilt, or shame)

Feelings of detachment or estrangement from others

Symptoms of PTSD

Persistent avoidance:

Avoidance or efforts to avoid memories, thoughts, or feelings associated with

the trauma

Avoidance or efforts to avoid activities, places, or people that are reminders

of the trauma

Increased arousal and reactivity:

Difficulty falling asleep or staying asleep

Outbursts of anger/irritability

Difficulty concentrating

Hyper-vigilance

Exaggerated startle responses

What PTSD Looks Like In The Workplace:

Memory problems and difficulty retaining information

Lack of concentration on tasks

Fear and anxiety

Physical difficulties

Unreasonable reactions to situations that trigger memories

Trouble staying awake

Panic attacks

Treatment For PTSD

Psychotherapy: that includes structured intervention and is very supportive

seems to work best for people with PTSD.

Cognitive Behavioral Therapy (CBT)

Exposure Therapy and Eye Movement Desensitization and Reprocessing (EMDR)


exposure therapy

psychodynamic therapy

Group therapy with other survivors of trauma is supportive and uplifting.

Service dogs and Animal-assisted Therapy are becoming increasingly

common, especially for veterans.


Robert:

“Summer is the worst time of year for me. Because of my Vietnam War experience I don’t like loud sudden noises, and this is the time of year there are severe thunderstorms. When the flash of lightning and clap of thunder are almost simultaneous, it is similar to the sound and sight of an explosive going off. It rings my bell every time. I never know how I am going to react. This has a major impact on my quality of life during the summer months. I might be invited to an event somewhere, but if there is a chance of a thunderstorm that day I may not show up because I don’t want to freak out in front of a lot of people.”


What is something new you learned about Post Traumatic Stress

Disorder?



Obsessive Compulsive Disorder (OCD) Affects about 2% of the adult population (6.8 million people in the U.S.) and

over 400,000 children have OCD

Most people are diagnosed by about age 19, typically with an earlier age of

onset for boys than in girls, but onset after age 35 does happen.

People with Obsessive-Compulsive Disorder (OCD) experience:

Obsessions recurrent, persistent thoughts, urges, or images that are intrusive,

unwanted, and won’t go away.

Compulsions: repetitive behaviors or mental acts in response to the tension

associated with the obsessions.

Obsessions and the rituals connected to them can interfere greatly with a

person’s quality of life. In general, people with OCD may spend several hours

per day thinking about obsessions or acting out compulsions.


Obsessions

Fear of contamination

Excessive concern about objects “having to be” in a certain order

Thinking one has injured someone else

Fear of having left something turned on or even unlocked

Frightening impulses to hurt a loved one

Gross sexual imagery

Compulsions

Compulsive hand washing or showering

Excessive arranging

Repeated checking and re-checking

Repetitive counting

Touching and activity rituals

What OCD Looks Like In The Workplace:

Preoccupation with details, rules, lists, schedules etc

Perfectionism that interferes with completing tasks

Excessive devotion to work and productivity to the exclusion of leisure activities

Difficulty delegating tasks

Reluctant to work with others unless they submit to exactly their way of doing things

Shows rigidity and stubbornness

Treatment for OCD

Antidepressants are the most commonly prescribed medication to

help reduce OCD symptoms.

Psychotherapies are the most effective for people with OCD.

Research shows that two types of


Exposure and response prevention (EX/RP)

Habit reversal training

Exposure therapy



Candice:

“When I have symptoms of OCD it can take me a half an hour to get to my car in the morning to go to work. I have to check the door, the lights, the stove, everything. Sometimes I don’t leave the house because I don’t want to have all the checking before leaving. The ironic thing is that I never have trouble with difficult things. After all, I went to law school. At the same time, I have a lot of trouble just mailing an envelope because of the checking.”


What is something new you learned about Obsessive Compulsive

Disorder?



Co-Occurring Substance Use Disorders

(formerly Dual Diagnosis)

Co-Occurring Substance Use Disorders

Affects about 2.5% of the adult population (7.9 million people in the U.S.).

People with a mental health disorder are more likely to experience an alcohol

or substance use disorder. Approximately 31% of people living with a serious

mental illness have a co-occurring substance use disorder (13% of people

diagnosed with a substance use disorder have a co-occurring mental health

condition).

This may occur because both mental and substance use disorders can have

biological, psychological, and social components.

The consequences of undiagnosed, untreated, or undertreated co-occurring

disorders can lead to a higher likelihood of experiencing homelessness,

incarceration, medical illnesses, suicide, or even early death.

People with co-occurring disorders respond less well to treatment, due to the

complications added on by the substance use.

Symptoms of Co-occurring Substance Use Disorders

Developing a tolerance to the drug.

Experiencing withdrawal after stopping use.

Consuming more of the drug than originally planned

Worrying about stopping or consistently failed efforts to control use

Spending a lot of time using drugs, or doing whatever is needed to get

them

Craving the drug

Repeatedly unable to carry out major obligations at work, school, or

home due to drug use

Continued use despite health problems caused by or worsened by it.

Continued use despite its having negative effects on relationships.

Repeated use of the drug in a dangerous situation.

What Co-occurring Substance Use

Disorders Look Like In The Workplace:

Erratic mood change

Disappearing for periods of time

Unexplained behavior

Tired all the time

Frequent accidents or injuries

Increased tardiness or absenteeism

Isolating

Treatment for Co-occurring Disorders

A major complication to treatment is that the mental health service

system is generally not prepared to work with people who have co-

occurring disorders. Often only one of the two problems is identified;

they may want to treat the substance use disorder and not the mental

illness, or vice versa.

Integrated Dual Disorder Treatment, where the same clinician or

treatment team treats both the mental illness and the substance use

disorder at the same time.

There are also 12-step programs help with the road to recovery from

addictions. One of the best known is Alcoholics Anonymous (AA).

Because AA is focused on sobriety and not the co-occurring mental

illness, there are also groups called Double Trouble in Recovery,

which were specifically created for people with co-occurring mental

health and substance use disorders.

Co-occurring Disorders

Carlos:

“I felt powerless, alone and sad, and experienced deep despair and feelings of worthlessness. I just wanted to get rid of those feelings – to escape – so I used to overeat, steal, have unhealthy relationships, and then started drinking alcohol and taking drugs. There was a sense of belonging and having less pain when I did those things, but in actuality it didn’t help. It wasn’t lasting. It didn’t have any true meaning or long lasting value.”


What is something new you learned about Co-occurring Substance Use

Disorders?



Check-in

What things come to mind when you think of or hear “mental illness”?

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