It is possible to live well with difficult mental illness diagnoses …

As a Christian therapist, I serve people who are wrestling with some of life’s most pressing challenges, including diagnoses of difficult mental illnesses. The good news is, I can consistently deliver a message of real hope for them.

That hope comes in two forms. The first is that they have a Creator who loves them and cares about them, and He is able to either deliver them from or through whatever trials they may face. The second is that there is also help for them in the form of treatment for their mental illness. Research, and my own experience counseling people, show that most people can overcome or at least live and function well with the mental illness they experience. Data routinely shows that therapy such as Cognitive-Behavioral Therapy (CBT), or medication, or often a combination of the two, can significantly help people with most mental illnesses.

That good news of effective treatment isn’t limited just to people experiencing the more common maladies of stress or anxiety, but also includes some of the more difficult diagnoses, such as borderline personality disorder, bipolar disorder, schizophrenia, and dementia. Let’s take a moment to gain a little better understanding of these more difficult diagnoses.

BORDERLINE PERSONALITY DISORDER
Borderline Personality Disorder (BPD) is a condition characterized by difficulties regulating emotion. People who experience BPD feel emotions intensely and for extended periods of time, and it is harder for them to return to a stable baseline after an emotionally triggering event. This difficulty can lead to impulsivity, poor self-image, troubled relationships, and intense emotional responses to stressors. Struggling with self-regulation can also result in dangerous behaviors such as self-harm (e.g. cutting).

According to the National Alliance on Mental Illness, people with BPD experience wide mood swings and can display a great sense of instability and insecurity. Per the Diagnostic and Statistical Manual diagnostic framework, some key signs and symptoms may include:

• • Frantic efforts to avoid real or imagined abandonment by friends and family.
  • Unstable personal relationships that alternate between idealization (“I’m so in love!”) and devaluation (“I hate her”). This is also sometimes known as “splitting.”
  • Distorted and unstable self-image, which affects moods, values, opinions, goals and relationships.
  • Impulsive behaviors that can have dangerous outcomes, such as excessive spending, unsafe sex, substance abuse or reckless driving.
  • Self-harming behavior including suicidal threats or attempts.
  • Periods of intense depressed mood, irritability or anxiety lasting a few hours to a few days.
  • Chronic feelings of boredom or emptiness.
  • Inappropriate, intense or uncontrollable anger, often followed by shame and guilt.
  • Dissociative feelings — disconnecting from thoughts or sense of identity or “out of body” type of feelings — and stress-related paranoid thoughts. Severe cases of stress can also lead to brief psychotic episodes.

Treatment for BPD can include medication and psychotherapy (often both), as well as group, peer, and family support. The National Institute of Mental Health strongly stresses the need for persons with BPD to seek and stick with treatment. NIMH-funded studies show that people with borderline personality disorder who don’t receive adequate treatment are:

• • • More likely to develop other chronic medical or mental illnesses.
    • Less likely to make healthy lifestyle choices.

Borderline personality disorder is also associated with a significantly higher rate of self-harm and suicidal behavior than the general public. People with borderline personality disorder who are thinking of harming themselves or attempting suicide need help right away.

BIPOLAR DISORDER
Also known as manic-depressive illness or manic depression, bipolar disorder is a brain disorder that causes unusual shifts in mood, energy, activity levels, and ability to carry out day-to-day tasks.

This mental illness directly affects a person’s moods, resulting in experiencing manic episodes where is a person feels “up” or elated, as well as depressive episodes where a person feels “down” or helpless. Less severe manic periods are known as hypomanic episodes.

The National Institute of Mental Health identifies four types of bipolar disorder:

• • Bipolar I Disorder — defined by manic episodes that last at least seven days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically lasting at least two weeks. Episodes of depression with mixed features (having depression and manic symptoms at the same time) are also possible.
  • Bipolar II Disorder — defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes described above.
  • Cyclothymic Disorder (also called cyclothymia) — defined by numerous periods of hypomanic symptoms as well numerous periods of depressive symptoms lasting for at least two years (one year in children and adolescents). However, the symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode.
  • Other Specified and Unspecified Bipolar and Related Disorders — defined by bipolar disorder symptoms that do not match the three categories listed above.

Proper diagnosis and treatment help people with bipolar disorder lead healthy and productive lives. Treatment for bipolar disorder can include medication and psychotherapy, education in self-management strategies, complimentary health approaches (i.e., aerobic exercise, faith, prayer), learning to live a healthy lifestyle, and having support.

SCHIZOPHRENIA
There is, unfortunately, a lot of misunderstanding and, sadly, negative stigma, still attached to the diagnoses of schizophrenia. Schizophrenia is a chronic and severe mental disorder that affects how a person thinks, feels, and behaves. People with this mental illness may seem like they have lost touch with reality. Although schizophrenia is not as common as other mental disorders, the symptoms can be very disabling.

The National Institute of Mental Health identifies the following signs and symptoms for schizophrenia:

Symptoms of schizophrenia usually start between ages 16 and 30. In rare cases, children have schizophrenia too. The symptoms of schizophrenia fall into three categories: positive, negative, and cognitive.

Positive symptoms: “Positive” symptoms are psychotic behaviors not generally seen in healthy people. People with positive symptoms may “lose touch” with some aspects of reality. Symptoms include:

• • Hallucinations.
  • Delusions.
  • Thought disorders (unusual or dysfunctional ways of thinking).
  • Movement disorders (agitated body movements).

Negative symptoms: “Negative” symptoms are associated with disruptions to normal emotions and behaviors. Symptoms include:

• • “Flat affect” (reduced expression of emotions via facial expression or voice tone).
  • Reduced feelings of pleasure in everyday life.
  • Difficulty beginning and sustaining activities.
  • Reduced speaking.

Cognitive symptoms: For some patients, the cognitive symptoms of schizophrenia are subtle, but for others, they are more severe and patients may notice changes in their memory or other aspects of thinking. Symptoms include:

• • Poor “executive functioning” (the ability to understand information and use it to make decisions).
  • Trouble focusing or paying attention.
  • Problems with “working memory” (the ability to use information immediately after learning it).

Treatment for schizophrenia is more complex and comprehensive than most other diganoses. The Mayo Clinic reports the following:

• Schizophrenia requires lifelong treatment, even when symptoms have subsided. Treatment with medications and psychosocial therapy can help manage the condition. In some cases, hospitalization may be needed.

A psychiatrist experienced in treating schizophrenia usually guides treatment. The treatment team also may include a psychologist, social worker, psychiatric nurse and possibly a case manager to coordinate care. The full-team approach may be available in clinics with expertise in schizophrenia treatment.

Medications are the cornerstone of schizophrenia treatment, and antipsychotic medications are the most commonly prescribed drugs. They’re thought to control symptoms by affecting the brain neurotransmitter dopamine.

The goal of treatment with antipsychotic medications is to effectively manage signs and symptoms at the lowest possible dose. The psychiatrist may try different drugs, different doses or combinations over time to achieve the desired result. Other medications also may help, such as antidepressants or anti-anxiety drugs. It can take several weeks to notice an improvement in symptoms.

Because medications for schizophrenia can cause serious side effects, people with schizophrenia may be reluctant to take them. Willingness to cooperate with treatment may affect drug choice. For example, someone who is resistant to taking medication consistently may need to be given injections instead of taking a pill.

Psychosocial interventions are an important part of treatment for schizophrenia. Mayo Clinic reports:

• Once psychosis recedes, in addition to continuing on medication, psychological and social (psychosocial) interventions are important. These may include:

Individual therapy. Psychotherapy may help to normalize thought patterns. Also, learning to cope with stress and identify early warning signs of relapse can help people with schizophrenia manage their illness.

Social skills training. This focuses on improving communication and social interactions and improving the ability to participate in daily activities.

Family therapy. This provides support and education to families dealing with schizophrenia.

Vocational rehabilitation and supported employment. This focuses on helping people with schizophrenia prepare for, find, and keep jobs.

During crisis periods or times of severe symptoms, hospitalization may be necessary to ensure safety, proper nutrition, adequate sleep and basic hygiene.

Most individuals with schizophrenia require some form of daily living support. Many communities have programs to help people with schizophrenia with jobs, housing, self-help groups and crisis situations. A case manager or someone on the treatment team can help find resources. With appropriate treatment, most people with schizophrenia can manage their illness.

DEMENTIA
“Dementia” is not a specific diagnosis. The Mayo Clinic explains:

• Dementia isn’t a specific disease. Instead, dementia describes a group of symptoms affecting memory, thinking, and social abilities severely enough to interfere with daily functioning.

Though dementia generally involves memory loss, memory loss has different causes. So memory loss alone doesn’t mean you have dementia.

Alzheimer’s disease is the most common cause of a progressive dementia in older adults, but there are a number of causes of dementia. Depending on the cause, some dementia symptoms can be reversed.

Dementia symptoms vary depending on the cause, but common signs and symptoms include:

Cognitive changes:

• • Memory loss, which is usually noticed by a spouse or someone else.
  • Difficulty communicating or finding words.
  • Difficulty reasoning or problem-solving.
  • Difficulty handling complex tasks.
  • Difficulty with planning and organizing.
  • Difficulty with coordination and motor functions.
  • Confusion and disorientation.

Psychological changes:

• • Personality changes.
  • Depression.
  • Anxiety.
  • Inappropriate behavior.
  • Paranoia.
  • Agitation.
  • Hallucinations.

Most types of dementia cannot be cured , but there are ways to manage symptoms, such as treatment with medication, psychotherapy, education in self-management strategies, practicing a healthy lifestyle, and receiving support.

CONCLUSION
Living with a difficult mental illness can be challenging but many learn to live well with them. An important key is getting the skilled, professional help you need, which often will include a team of professionals providing expertise in different aspects of treatment. There is great hope!

Scotty