Mental breakdown

Other names| Nervous breakdown
Specialty| Psychiatry

A mental breakdown (also known as a nervous breakdown) is an acute mental disorder. Symptoms include severe, stress-induced depression, anxiety, paranoia, and dissociation in a previously functioning individual. A nervous breakdown is often tied to psychological burnout, severe overwork, sleep deprivation, and similar problems. While temporary, a mental breakdown can last for years and a person cannot resume normal activites until the disorder is resolved.

## Contents

* 1 Definition
* 1.1 Controversy
* 2 Signs and symptoms
* 3 Causes
* 4 Treatment
* 5 Similar disorders
* 6 See also
* 7 References

## Definition

The terms "nervous breakdown" and "mental breakdown" have not been formally defined through a medical diagnostic system such as the DSM-5 or ICD-10, and are nearly absent from current scientific literature regarding mental illness.[1][2] Although "nervous breakdown" is not rigorously defined, surveys of laypersons suggest that the term refers to a specific acute time-limited reactive disorder, involving symptoms such as anxiety or depression, usually precipitated by external stressors.[1] Many health experts today refer to a nervous breakdown as a "modern mental health crisis".[3]

Specific cases are sometimes described as a "breakdown" only after the emotional and physical demands[2] on a person's life are so great as to prevent them from performing activities of daily living or, less strictly, only when those demands prevent them from performing their familial or occupational duties.[4]

Nervous breakdowns are often caused by serious ongoing mental health disorders.[2]

### Controversy

In How Everyone Became Depressed: The Rise and Fall of the Nervous Breakdown (2013), Edward Shorter, a professor of psychiatry and the history of medicine, argues for a return to the old-fashioned concept of nervous illness:

> About half of them are depressed. Or at least that is the diagnosis that they got when they were put on antidepressants. ... They go to work but they are unhappy and uncomfortable; they are somewhat anxious; they are tired; they have various physical pains – and they tend to obsess about the whole business. There is a term for what they have, and it is a good old-fashioned term that has gone out of use. They have nerves or a nervous illness. It is an illness not just of mind or brain, but a disorder of the entire body. ... We have a package here of five symptoms–mild depression, some anxiety, fatigue, somatic pains, and obsessive thinking. ... We have had nervous illness for centuries. When you are too nervous to function ... it is a nervous breakdown. But that term has vanished from medicine, although not from the way we speak. ... The nervous patients of yesteryear are the depressives of today. That is the bad news. ... There is a deeper illness that drives depression and the symptoms of mood. We can call this deeper illness something else, or invent a neologism, but we need to get the discussion off depression and onto this deeper disorder in the brain and body. That is the point.

> --Edward Shorter, Faculty of Medicine, University of Toronto.[5]

> "In eliminating the nervous breakdown, psychiatry has come close to having its own nervous breakdown."

> --David Healy, MD, FRCPsych, Professor of Psychiatry, University of Cardiff, Wales.[6]

> "Nerves stand at the core of common mental illness, no matter how much we try to forget them."

> --Peter J. Tyrer, FMedSci, Professor of Community Psychiatry, Imperial College, London[7]

> "Nervous breakdown" is a pseudo-medical term to describe a wealth of stress-related feelings and they are often made worse by the belief that there is a real phenomenom called "nervous breakdown".

> --Richard E. Vatz, co-author of explication of views of Thomas Szasz in /Thomas Szasz : "Primary Values and Major Contentions"

## Signs and symptoms

One major symptom of a mental breakdown is depression. When someone is depressed they may experience weight loss or gain (often due to changes in appetite), suicidal thoughts, loss of interest in social, family or work life, insomnia or hypersomnia, exhaustion or fatigue and feelings of hopelessness or worthlessness. Another symptom of a breakdown is anxiety, which can produce an increase in blood pressure, dizziness, trembling, or feeling sick to the stomach. Panic attacks are very similar to mental breakdowns, but can also be a symptom in some cases. Difficulty with breathing and extreme fear, alongside rapid heartbeat may occur in those who are experiencing a panic attack. In more severe cases of mental breakdown, a person may experience mood swings, hallucinations, paranoia, and flashbacks. In each of these more severe cases there can be a more serious underlying problem that caused the mental breakdown. Hallucinations may suggest schizophrenia or other disorders involving psychosis, mood swings may suggest bipolar disorder or other mood disorders (or personality disorders such as BPD), and flashbacks may suggest posttraumatic stress disorder. The severity of each of these disorders and symptoms may vary based upon the person and their background.[8]

## Causes

Causes of such breakdowns are varied. A 1996 study found that problems with intimate relationships, such as divorce or marital separation, contributed to 24% of nervous breakdowns.[9] Problems at work and school accounted for 17% of cases, and financial problems for 11%. Surveys suggest that in the United States, health problems have decreased in importance as a contributor to nervous breakdowns. Health problems accounted for 28% of nervous breakdowns in 1957, 12% in 1976, and only 5.6% in 1996.[9]

A nervous breakdown is not limited to any one type of person: anyone can have this breakdown, but if someone is under a lot of stress and has a family background of mental disorders, they can be more likely to have one.[10]

## Treatment

The medication that may be prescribed to someone who has a mental breakdown is based upon the underlying causes, which are sometimes more serious mental disorders. Antidepressants are given to treat depression. Anxiolytics are used for those with anxiety disorders. Antipsychotics are used for schizophrenia, while mood stabilizers help with bipolar disorder.

There are several different kinds of therapy that a patient can receive. The most common type of therapy is counseling, in which the patient is able to discuss whatever is on their mind without worry of being judged.

Psychotherapy addresses the current problems in someone's life and helps them to deal with them. Past experiences may also be explored.

In psychoanalysis, the main focus is exploring the patient's past experiences to enable them to confront these issues and prevent future breakdowns.

Cognitive behavioral therapy explores a patient's behavior, thought patterns, and feelings, attempting to channel any negative patterns into more balanced alternatives.

Hypnotherapy is the use of hypnosis to help the patient relax or to explore past events leading up to the breakdown, enabling the therapist to determine why a person acts or feels a certain way.

Expressive therapy focuses on the ability of the patient to express their feelings, attempting to resolve difficulties in self-expression through exploration of the arts.

Aromatherapy, employs fragrant herbs to promote relaxation and stress relief. Yoga and massage techniques aid in muscular relaxation. Meditation may also be recommended.

## Similar disorders

Rapport, Todd, Lumley, and Fisicaro suggest that the closest DSM-IV diagnostic category to nervous breakdown is Adjustment Disorder with Mixed Anxiety and Depressed Mood (Acute).[1] Adjustment disorders and nervous breakdowns are both acute reactions to stress that resolve after removal of the stressor. However, DSM-IV excludes from adjustment disorders cases secondary to bereavement, which contributes to approximately 6–8% of nervous breakdowns.[1]

Nervous breakdowns may share some features of acute stress disorder and post-traumatic stress disorder, in that these each occur in response to an external stressor, and may be marked with sleep disturbance, diminished concentration, and mood lability. However, the symptoms of nervous breakdown do not include the constellation of re-experienced trauma, dissociation, avoidance, and numbing of general responsiveness that are associated with the other two disorders, and the types of stressors linked to a nervous breakdown are generally less extreme.[1]

Nervous breakdowns may share many features of mixed anxiety-depressive disorder (MADD). However, the definition of MADD suggests a chronic condition, in contrast to the acute, short-term nature of a nervous breakdown.[1]

## See also

* Adjustment disorder
* Breaking point (psychology)
* Causes of mental disorders
* Fugue state
* Grieving
* Mental health
* Metanoia
* Neurasthenia
* Panic attack
* Psychosis
* Psychotic break
* Self-medication

## References

1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Rapport, L. J.; Todd, R. M.; Lumley, M. A.; Fisicaro, S. A. (1998). "The diagnostic meaning of 'nervous breakdown' among lay populations". J Pers Assess 71 (2): 242–252. doi:10.1207/s15327752jpa7102_11.
2. ↑ 2.0 2.1 2.2 Mayo Clinic Mental Breakdown
3. ↑ SymptomFind Signs and Symptoms of Nervous Breakdown
4. ↑ Hallowell, Edward M & John Ratey. 2005. Delivered from Distraction: Getting the Most out of Life with Attention Deficit Disorder. Ballantine Books. ISBN:0-345-44231-8
5. ↑ Edward Shorter (2013) How Everyone Became Depressed: The Rise and Fall of the Nervous Breakdown, Oxford University Press ISBN:978-0-19-994808-6
6. ↑ David Healy (2013) Pharmageddon, University of California Press ISBN:978-0520275768
7. ↑ Peter Tyrer (2013) Models for Mental Disorder, Wiley-Blackwell ISBN:978-1118540527
8. ↑ "Signs and Symptoms of a Nervous Breakdown". http://www.symptomfind.com/health/signs-and-symptoms-of-nervous-breakdown/.
9. ↑ 9.0 9.1 Swindle, R., Jr.; Heller, K.; Pescosolido, B.; Kikuzawa, S. (2000). "Responses to nervous breakdowns in America over a 40-year period. Mental health policy implications". Am Psychol 55 (7): 740–749. doi:10.1037/0003-066X.55.7.740. PMID 10916863.
10. ↑ "What is a Nervous Breakdown?". http://www.healthgrades.com/conditions/nervous-breakdown.

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