Psychological and Emotional Disorders

In today's society, mental illness is on the rise. It is estimated that at least 10% of the general population experiences some kind of disability from mental illness. Therefore, massage therapists need an understanding and familiarity with common mental health conditions that enable them to know when to involve a mental health professional. This chapter provides a brief review of the common symptoms of the most significant mental disorders to help you determine when to refer a client back to his or her physician for follow-up.

Depression-disorder characterized by a combination of symptoms that interfere with the ability to work, study, sleep, eat, and enjoy one's usual pleasurable activities. Depressive disorders come in different forms and types, with variations in the number of symptoms, their severity, and persistence. Mild depression may only be slightly debilitating, while major depression can be very disabling. Major depression may occur only once but more commonly occurs several times in the lifetime of an individual.

Symptoms of major depression include:

  • Persistent sad and/or anxious mood
  • Hopelessness and/or pessimism
  • Guilt
  • Loss of interest or pleasure in hobbies and activities that were once enjoyed
  • Decreased libido (sex drive)
  • Insomnia, early morning awakening, or oversleeping
  • Restlessness and irritability
  • Appetite and/or weight loss or overeating and weight gain
  • Thoughts of death or suicide; suicide attempts
  • Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain

Dysthymia-a less severe type of depression; involves long-term, chronic symptoms that do not disable but keep one from functioning well or from feeling good. Many people with dysthymia also experience major depressive episodes at some times in their lives.

Bipolar disorder-less common type of depression; characterized by cycling mood changes from severe highs (mania) to sever lows (depression). When in the depressed cycle, an individual can exhibit any or all of the symptoms of depressive disorder. When in the manic cycle, the individual's thinking, judgment, and social energetic or jubilant and may make up grand plans, such as expensive shopping sprees or travel plans. Mania, symptoms of manic phase include:

  • Abnormal
  • Unusual irritability
  • Decreased need for sleep
  • Grandiose notions
  • Increased talking
  • Racing thoughts
  • Increased sexual desire
  • Markedly increased energy
  • Poor judgment
  • Inappropriate social behavior

Anxiety disorder-characterized by 6 months or more of chronic, severe worry and tension that is exaggerated or inappropriate. People with this disorder usually expect the worst; they worry excessively about money, health, family, or work, even when there are no signs of trouble. They are unable to relax and often suffer from insomnia. Many people with general anxiety disorder also have physical symptoms such as fatigue, trembling, muscle tension, headaches, irritability, or hot flashes. Many kinds of anxiety disorders exist, including post-traumatic stress disorder, obsessive-compulsive disorder, panic disorder, and all types of phobias.

Post-traumatic stress disorder (PTSD)-an anxiety disorder that can develop following a traumatic or terrifying event in which grave physical harm occurred or was threatened. Often a person with PTSD has persistent frightening thoughts and memories of the ordeal and feels emotionally numb, especially with people once considered close. Whatever the source of the problem, a person with PTSD may repeatedly relive trauma in the form of nightmares and disturbing recollections during the day. Other sleep problems, feeling detached or numb, and being startled easily are also common with PTSD. A person with the disorder may lose interest in things that used to bring them enjoyment and may have trouble feeling affectionate. Feeling irritable and more aggressive than before, or even violent, often occurs. Things that remind the person with PTSD of the trauma may be very distressing, which could lead the person to avoid certain places or situations that bring back those memories. Anniversaries of the traumatic event are often difficult.

Obsessive compulsive disorder- is a mental disorder characterized by intrusive thoughts that produce anxiety, by repetitive behaviors aimed at reducing anxiety, or by combinations of such thoughts (obsessions) and behaviors (compulsions). The symptoms of this anxiety disorder range from repetitive hand-washing and extensive hoarding to preoccupation with sexual, religious, or aggressive impulses. These symptoms can be alienating and time-consuming, and often cause severe emotional and economic loss. Although the acts of those who have OCD may appear paranoid and come across to others as psychotic, OCD sufferers often recognize their thoughts and subsequent actions as irrational, and they may become further distressed by this realization.

Panic disorders-an anxiety disorder that is characterized by unexpected and repeated episodes called panic attacks, which produce intense fear or worry and are accompanied by physical symptoms such as sweating, chest pain, nausea, heart palpitations, shortness of breath, dizziness, or abnormal distress. Panic disorder does not include any situations caused by the direct effects of drug abuse or medications.

Phobias-a persistent fear or unreasonable anxiety brought on by a situation or an object. This fear is intense enough to interfere with a person's daily routine or normal daily functioning, and sometimes, when faced with the situation or object of the phobia, the person becomes virtually paralyzed. The two major types of phobias are social phobia and specific phobia.

            Social phobia-an overwhelming and disabling fear of scrutiny, embarrassment, or humiliation in social situations; prevents people from participating in many enjoyable and meaningful activities because of the intense fear of being watched or judged by other people. Examples of social phobia are fears of public places, eating in front of others, or being around the opposite sex.

            Specific phobia-an extreme, disabling, and irrational fear of something that poses little or no actual danger; the fear leads to avoidance of objects or situations an can cause people to limit their lives unnecessarily. Examples of specific phobia are fears of animals, insects, public transportation, heights, or bodies of water.

Attention deficit disorder (ADHD)-one of the most common mental disorders that develop in children; produces impaired functioning in multiple settings, including home, school, and in relationships with peers. If untreated, ADHD can have long-term adverse effects throughout an individual's lifespan. Symptoms can appear over the course of many months and include impulsiveness, hyperactivity, and excessive talking. Many individuals with ADHD daydream, lack the ability to focus, and are easily distracted by what is going on around them.

Addiction/substance abuse-One of the most common mental health problems; includes the addiction to or abuse of substances like alcohol, nicotine, illegal drugs, and prescription medications. Alcoholism is the most prevalent type of addiction; some research shows that between 17 million and 34 million Americans abuse alcohol.

Symptoms of alcoholism include:

  • Denial of a problem with alcohol
  • Irritability
  • Finding excuses to drink
  • Decreased interest and participation in social activities
  • Memory loss
  • Redness of the skin
  • Enlarged capillaries of the eyes

Eating disorders-serious disturbances in eating behavior, such as extreme and unhealthy reduction of food intake or severe overeating, as well as feelings of distress or extreme concern about body shape or weight. These disorders are considered real behavioral disorders and medical illnesses that can and should receive treatment. Very often, eating disorders coexist with other behavioral disorders including depression and substance abuse. Without medical intervention, these diseases can lead to heart problems or kidney failure. The two main types of eating disorders are anorexia and bulimia.

            Anorexia nervosa-is a psychiatric illness that describes an eating disorder characterized by extremely low body weight and body image distortion with an obsessive fear of gaining weight. Individuals with anorexia nervosa are known to control body weight commonly through the means of voluntary starvation, excessive exercise, or other weight control measures such as diet pills or diuretic drugs. While the condition primarily affects adolescent females approximately 10% of people with the diagnosis are male. Anorexia nervosa, involving neurobiological, psychological, and sociological components, is a complex condition that can lead to death in the most severe cases.

            Bulimia nervosa-is an eating disorder characterized by recurrent binge eating, followed by compensatory behaviors. The most common form-practiced by more than 75% of people with bulimia nervosa-is self-induced vomiting, sometimes called purging; fasting, the use of laxatives, enemas, diuretics, and over exercising are also common.

Abuse (effects of)-though not specifically a mental disorder, abuse very often causes mental and physical problems. Abuse can affect every aspect of the victim's life, especially self-esteem. How much abuse damages a person depends on the circumstances surrounding the abuse, how often and how long the abuse occurs, and the age of the person who was abused by the people they love to feel upset and confused. The abused person may feel guilty and embarrassed or even take blame for the abuse, especially if it was sexual abuse. For teens, the effects of abuse often manifest as problems with sleeping, eating, and concentrating. Abused teens may show signs of anger or distrust, or they may become depressed or even engage in self-destructive behavior, such as cutting themselves, or abusing alcohol or drugs. Sometimes they may even attempt suicide. Regardless of their age, it is important to help persons who were or are being abused understand that it is not their fault, no matter how much the abusers try to blame it on them.

Trauma (effects of)-much like abuse, trauma can cause mental and physical problems. Trauma can come from carious situations, including war, violent personal assaults, natural disasters, terrorist attacks, motor vehicle accidents, rape, physical and/or sexual abuse, and violent crime. The effects of trauma may last for years. Traumatized people can have trouble functioning in their jobs and personal relationships. Traumatized children have difficulty in school, often isolate themselves from others, and sometimes revert to bedwetting. See also past-traumatic stress disorder (PTSD).