Last week I wrote about 8 Symptoms that should not always be labeled a mental illness. Life is life. We are all going to experience the worst of it and the best of it. We should not be so quick to label ourselves “disordered” until we evaluate every aspect of what could be happening to us. Clinicians and mental health professionals should also be careful not to quickly pathologize every client that comes through their doors. But sadly, there are way too many people in the world, including some mental health professionals, who either downplay orexaggerate mental health symptoms. There is often no in-between. Although we all would like to maintain the idea that most people are mentally healthy and well adjusted, we cannot ignore the fact that there are millions of people (children, adolescents, adults) who are struggling with mental health symptoms every single day of their lives. They are struggling with mild, moderate, and severe symptoms that seem to make their future grim. This article will discuss symptoms that should never be ignored or downplayed and possibly be evaluated by a mental health professional.

Unfortunately, the field of psychiatry and psychotherapy lacks a manual that would provide concrete direction on how to identify mental illness. Of course, we are all familiar with the DSM (and ALL of its many versions and revisions) but this is certainly not enough for the perplexities of life. The DSM provides minimal guidelines to help guide mental health professionalsand to help them communicate, using a common language, more appropriately. But the manual does not provide the concrete answers many people seek about their lives and their health. Making a diagnosis using the DSM often includes a mediocre process of elimination. Sometimes this process is completely on point, while at other times is is completely off point. As a result, determining when a symptom (or constellation of symptoms) is a problem, can take a lifetime. For those individuals who are insightful about their psychiatric andemotional needs, deciding to pursuemental health treatment is often an easy process. But for those individuals who are often in denial, struggle with acceptance of reality, orlack a great deal of insight into themselves, pursuing mental health treatment is not something they are willing to do or even talk about. That’s why it’s important that others (family, friends, spouses, etc.) become knowledgeable about the symptoms and behaviors that signal that there is a very big problem.

Because it’s very difficult for many of us, primarily those without a clinical background, to identify when a symptom or behavior might indicate that psychiatric treatment is needed, I have compiled a list of symptoms and behaviors that should always prompt us to either seek treatment ourselves or encourage another person to seek treatment. This list is a list I often provide to parents and families who see me. Some of the problematic behaviors and symptoms include:

  1. Frequent and dangerous sexual acting out: I have previously worked with juvenile delinquents within a mental health/juvenile agency. Most of these youths presented with high levels of anxiety, extreme traumatic histories, and frequent sexual acting out. Sadly, the children weren’t the only individuals sexually acting out. Many of their parents also engaged in similarbehaviors such as sending nude pictures of themselves using their cell phone or Facebook accounts (“sexting”), prostituting, entertaining multiple partners, or maintaining an open marriage or relationship (without boundaries or sexual precautions). Although we are human beings who should not be ashamed of our sexuality, we must be appropriate, respect ourselves, and have some insight into how our sexuality affects our lives. For individuals who lack insight, there is a problem. The problem could be psychological (looking for approval, feeling rejected, etc), emotional (looking for love or companionship), or trauma-based (the result of a traumatic and abusive past).
  2. Physical/Verbal aggression that is frequent: Some individuals are born with a difficult temperament that causes them to be easily triggered by minor things. Some individuals also have bad tempers that they just cannot control. However, an individual who frequently lashes out at others without considering the consequences of their behavior(s), puts others in harms way, is abusive (verbally, physically, or sexually), and jeopardizes their employment or living conditions, has a problem. There is something going on under the surface that causes the aggression. A mental health professional would be able to provide what is called a bio-psycho-social assessment to look at all aspects of the individual’s life. Biological/genes, social components, and psychological factors would all be assessed.
  3. Self harm or suicidal thoughts with a plan and intent: Sadly, many of our youths today engage in self-injurious behaviors which include but are not limited to: cutting their arms, legs, thighs, or stomach with blades, knives, or other sharp object as a stress releaser or a way to fit in with others. Other kids engage in verbalizing a great deal of suicidal threats such as “I will kill myself,” “I want to leave this place,” or “I would be better off dead.” These kind of statements are known as passive death wishes because no mention of a plan has occurred and level of intent may be low. ALL suicidal statements should be taken seriously and evaluated, but the most severe form of suicidal thoughts are those that include a high degree of intent (on a scale from 1-10; 10=highest, an “8”) and a plan such as jumping off of a bridge tomorrow at 5:00 when people are too distracted to notice. If an individual (primarily children and teens) express both intent and give you an example of how they would complete the suicide, mental health attention is medically necessary. This is sufficient information to have this person 302’d or hospitalized.
  4. Extreme fatigue or depressed mood: Life is hard and sometimes it simply gets you down. For many people in today’s fast-paced society where competition and callousness seems to have taken over, depression is likely to occur. Sleep and appetite disturbance, low self-esteem, hopelessness and helplessness, low mood, lack of interest in activities once enjoyed, irritability, weight loss or weight gain, and poor concentration are all symptoms of depression. Symptoms that interfere with daily life, result in job or relationship loss, and makes each day feel harder to navigate, will require therapy and possibly medication management. A mental health evaluation that screens for depression will be helpful.
  5. Intensemigraine headaches or bodily aches and pains: Some mental health disorders affect all aspects of our bodies. In many cases, mental health conditions can trigger medical conditions and vice versa. A mental health evaluation can help rule out psychological conditions so that you can focus on what the true issue is. For example, depression often triggers a lot of physiological symptoms such as headaches, bodily aches and pains, weight loss or weight gain, nausea or vomiting, arthritis or fibromyalgia, etc. However, some medical conditions such as thyroid disease can trigger depressed mood as well. So being able to get a mental health screening or evaluation will be important to ruling out conditions that may not be affecting your symptoms.
  6. Extreme preoccupation with physical appearance, sex, money, or crime: Today’s society has become extremely narcissistic and self-focused. Most modern and popular movies, music videos, and songs include money, sex, crime, or some other illegal and immoral activity. Despite this fact, it’s important to understand when narcissism has turned into full blown clinical narcissism that interferes with daily life as a result of impulsivity (which can lead to risky sexual behaviors, substance abuse, gambling, infidelity, etc), immaturity, extreme vanity (which includes a lack of empathy for others and extreme preoccupation with physical appearance and self-importance), and a sense of grandiosity that appears delusional and unrealistic. Many of my previous colleagues worked with narcissism and anti-social personality disorder (sociopathy) and found that many of these clients have a delusional view of themselves which includes an unrealistic self-importance and grandiose perception of life in general. Someone like this can truly jeopardize your safety or harm you in some fashion. A mental health evaluation will help rule out any other mental health disorders that may be contributing to the behavior (such as oppositional defiant disorder for youths, ADHD, or bipolar disorder) and provide some direction on where to seek therapeutic intervention.
  7. Terrible nightmares/night terrors or flashbacks: For young children, having nightmares (sometimes nightly) is not abnormal. Their little minds are hard at work trying to re-organize the world and make sense out of everything in life. But for individuals, including children and teens, who have experienced a traumatic history (abuse, neglect, rape, etc) or witnessed a traumatic event, flashbacks and nightmares are likely to occur. Flashbacks can feel very real to the person and affect the body and mind as if the trauma were happening all over again. For example,research studies have shown that during Eye Movement Desensitization and Reprocessing (EMDR) the individual who previously experienced a trauma will begin to show physiological signs of re-experiencing the trauma. The heart rate increases, the eyes may frequently blink, the body begins to shake, thoughts begin to race, and the person shows symptoms of not being able to tolerate the flashback or EMDR experience. Anyone can experience flashbacks or what is known as secondary trauma. You do not have to have a trauma history or be a veteran to experience flashbacks or nightmares/night terrors. A single incidentsuch as witnessing your aging motherfall down the stairs, sustain a concussion, and struggle to recover can be traumatizing enough. Any of the above symptoms should be evaluated by a mental health professional who can rule out PTSD (Post Traumatic Stress Disorder) or secondary trauma.
  8. Emotional lability, changeable moods, risky behaviors, and intense emotional reactions: Individuals who exhibit frequent changes in mood, struggles with emotion regulation and distress tolerance, engages in high risk behaviors and (substance abuse, gambling, infidelity, refusing to take necessary medications, sexually inappropriate behaviors, shallow and unstable romantic relationships, etc.) can all be possible signs of either borderline personality disorder or bipolar disorder. It’s important, because both disorders are identical in some ways, that a mental health evaluation be pursued so that a correct diagnosis and treatment can be obtained.

Sadly, it isn’t until a behavior, action, or symptom has gotten WAY out of control that psychiatric treatment is ever considered. This is mainly because of a fear of stigma, but the other piece of this puzzle involves a fear of reality. Some peoplethink “Really…? How could this be me? I have always been active, strong, and self-sufficient. I couldn’t be depressed.” Others say things such as “My mother has worked all her life and is a very strong woman. How could she have borderline personality disorder?” Because of our habit of going into denial when it comes to mental illness, we miss the signs and symptoms that are often right in front of our faces screaming for us to pay attention.

All of the categories above must interfere in some way with daily life and prevent healthy social interactions. Can you think of a few “symptoms” or behaviors that might signal that there is a need for a psychiatric evaluation, medication management, or therapy? If you were to recommend psychiatric treatment or suggest that someone attend therapy, what symptoms would you point out? What would make you think the person would need professional intervention?

As always, I wish you well.