Mental Health Issues You Never Even Knew Existed

As difficult (not to mention expensive) as it is to confront physical ailments, most Americans often find it even harder to talk about complex mental health issues. Public awareness and understanding of the underlying causes are lacking even when it comes to common disorders such as generalized anxiety or major depression, let alone lesser-known conditions, which are often misdiagnosed or overlooked entirely as a result. What follows are just some examples of mental health conditions many average people don't know about, but should.

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Although it may be tempting to label it as mere denial, anosognosia is a medical disorder wherein someone with an acute mental health issue is incapable of perceiving their condition accurately, even vacillating between accepting and rejecting a medical reality that seems readily apparent to everyone else. Affecting half of people with schizophrenia and 40% with bipolar disorder as well as many with dementia, brain imaging studies indicate anosognosia is caused by injury to the frontal lobe inhibiting one's ability to update their own self-image. 

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Disruptive mood dysregulation disorder, recognized by the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders' fifth edition in 2013, affects children and adolescents over 6 who exhibit frequent irritability and intense temper tantrums out of proportion to the situation at hand — what some parents might write off as just "being moody" and neglect clinical help. Some researchers have implicated digital technology and gaming addictions as a pivotal factor in the development of DMDD. Treatment typically entails medication such as stimulants or antidepressants and/or psychotherapy.

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Also newly recognized, burnout is classed as a work-related "syndrome," characterized by "feelings of energy depletion or exhaustion; increased mental distance from one's job, or feelings of negativism or cynicism related to one's job; and reduced professional efficacy." Often caused by work-life imbalance or certain aspects of workplace culture, burnout seems to mimic depression and produces symptoms such as headaches and sleeplessness, "quickness to anger," and close-minded thinking. The official designation promises validation for people with burnout whose issues might otherwise be brushed aside by a work-centric culture, as well as the creation of more evidence-based guidelines on mental well-being in the workplace.

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Multiple mental health professionals contacted for this article pointed to the addictive use of smartphones and other digital technology as one of today's most commonly overlooked mental health issues — recently added to the World Health Organization's official disease classification. "There are massive impacts on the emotional, intellectual, and developmental trajectories of children and adolescents with these issues, and huge impacts on the adults who are vexed with a screen media dependence socially and vocationally," says George Lynn, a psychotherapist in Bellevue, Washington.

The effects may be overlooked, because video games and apps are designed to be addictive, tapping into the brain's dopamine feedback loop "so the addiction can eventually become physiological as well as psychological," says neuropsychologist Dr. Michael Kulfan. "Because the internet, gaming, and social media have become so quickly embedded into our culture and their usage is so normative ... it can be very hard to identify addiction before it has taken hold." 

Schizoaffective disorder combines elements of schizophrenia and mood disorders such as bipolar disorder into an even more commonly misunderstood and less well-studied condition. Occurring in only 0.3% of the population, it is often misdiagnosed as schizophrenia or bipolar disorder for concurrent symptoms such as delusions and disorganized thinking, or mood swings between mania and depression. Its onset may coincide with substance use or stressful life events; the condition is usually treated using a mix of mood stabilizing medications and cognitive behavioral therapies.

While post-traumatic stress disorder results typically from one specific traumatic incident, complex PTSD occurs after chronic exposure to traumatizing and abusive conditions and can affect anyone from combat veterans to survivors of domestic or childhood abuse. On top of standard but nonetheless debilitating features such as difficulty regulating emotions or psychosomatic pain including migraines, people with complex PTSD — 92% of whom also meet the diagnostic criteria for regular PTSD — may exhibit additional symptoms such as disturbances in self-perception, an inability to form relationships, and fluctuating views of one's abuser.

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As recognized by the DSM-5, this is the catch-all classification for any significant eating disorder that doesn't constitute anorexia nervosa, bulimia nervosa, or binge eating disorder. It includes conditions that can be less obvious but just as life-threatening, including atypical anorexia nervosa (wherein one's weight stays within or above the normal range), purging disorder (purging without binge eating), and night eating syndrome (excessive eating after awakening). On top of a psychological preoccupation with weight and dieting, these can lead to serious physical symptoms such as dizziness, lack of sleep, dry skin, muscular weakness, and impaired immune function.

Afflicting an estimated 2% of the general population, avoidant personality disorder is caused by a fear of rejection and low self-esteem so severe that people with this disorder routinely forgo social and professional opportunities to protect themselves from others' judgment. Though often appearing from the outside as a case of extreme shyness, the disorder is distinguished by (mostly negative) symptoms such as a lack of close friends, excessive restraint in intimate relationships, exaggeration of potential difficulties, and reluctance to be in contact with others. Such behaviors typically start in early childhood, with most people growing out of them by adolescence or adulthood.

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Many have an unconscious tendency to fidget with their hands, but some cases can become serious enough to constitute a mental pathology. Body-focused repetitive behaviors are a set of disorders wherein self-grooming behaviors become compulsive and harmful to physical appearance. Examples include trichotillomania (compulsive hair pulling), onychophagia (compulsive nail biting), and excoriation disorder (compulsive skin picking). Often interacting with anxiety, what begin as "bad habits" can escalate into sources of severe shame and emotional distress impairing their ability to function. Though estimated to affect more than 3% of children and adults, there have been almost no large-scale studies of these disorders, so treatment methods have a long-term success rate of less than 20%.

Though sometimes treated like an excuse to challenge menstruating women's judgment, premenstrual syndrome encompasses a complex variety of physical and emotional symptoms occurring in the one to two weeks before a period, sometimes escalating into more severe premenstrual dysphoric disorder. Affecting 1% to 8% of menstruating women at some point between adolescence and menopause, PMDD manifests in debilitating symptoms of severe depression, irritability, fatigue, panic attacks, binge eating, sleeplessness, and lack of focus.

Sometimes considered a situational form of depression, adjustment disorder is typified by excessive anxiety, reckless behavior, and difficulty moving on after a major life change or other stressor such as moving to a new place, losing one's job, or the death of a loved one. Though callous observers might easily write off people with adjustment disorder as weak or tell them to "get over it," the condition is serious and alarmingly common, constituting 5% to 20% of principal diagnoses among outpatients receiving mental health services and up to 50% in hospital psychiatric consultations.

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Not to be written off as mere "baby blues" affecting 80% of mothers, postpartum disorders are caused by the same hormonal changes manifesting in intense mood swings that accompany childbirth, but with symptoms persisting for multiple weeks. These include postpartum depression, which affects 13% of women post-delivery; postpartum obsessive-compulsive disorder in 3% to 5% percent; and postpartum anxiety in 9%. Though temporary and treatable, these conditions can be associated with extreme guilt and difficult to manage without support at such a pivotal time for mother and child.

Despite popular portrayals, the intrusive thoughts and compulsions that characterize obsessive-compulsive disorder aren't limited to just extreme cleanliness. In one subset of the disorder, referred to as harm OCD, the unwanted obsessions revolve around violence and aggression, so people with this form of OCD are worried constantly about causing harm to themselves or others. While 85% of the general population acknowledges having similar thoughts, the frequency of such thoughts in harm OCD leads to odd behaviors and debilitating symptoms such as hiding dangerous objects, avoidance of media triggering violent thoughts, and a fear of violent thoughts as premonitions of future harm. As with other forms of OCD, the most effective treatment is considered to be specialized cognitive behavioral therapy.

Borderline personality disorder has an estimated prevalence rate between 2% and 6% of the general population, though it's hard to pinpoint one of the most commonly misdiagnosed conditions in mental health. Usually starting in adolescence or early adulthood, BPD's main characteristic is an inability to manage one's emotions effectively, leading to reckless behavior, destabilization of personal relationships, and mood shifts between mania and depression much faster than in bipolar disorder, with which BPD is often confused. It's more than two decades behind in research compared with other disorders, according to the National Education Alliance on BPD, but new evidence-based treatment options can help cut down on the lack of awareness and shame that can push people with BPD further into emotional dysregulation.

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Thanks to a history of sensationalized media portrayals (think "Fight Club," "Shutter Island," or "Split"), dissociative identity disorder is one of the most misunderstood and controversial mental health conditions. It's also one of the rarest. Formerly known as multiple personality disorder, DID involves a fragmentation of one's identity into multiple, unintegrated personalities, usually including a passive and depressed primary personality, often as a response to severe abuse. To meet the DSM-5's diagnostic criteria, one must display at least two distinct identities, changes in sense of self, frequent gaps in memory and personal history, and a resulting impairment in social or other areas of functioning.

This is another break from one's sense of self frequently brought on by trauma or severe stress. People with dissociative amnesia suffer a loss of memories, ranging from one specific event to their entire lives, that may last minutes or years. Increasing in prevalence after war or natural disasters, most cases are temporary but increase the risk of self-harm, suicide, or dissociative fugue — a state of "bewildered wandering" when someone travels unexpectedly during a loss of identity.

Depersonalization is a feeling of being separated, like an outside observer, from one's self or surroundings, which many will experience on occasion under the influence of medication, dreams, or recreational drugs. When such feelings of detachment recur often enough to cause emotional anguish and interfere with one's life, however, it may constitute a diagnosis of depersonalization/derealization disorder, in which other symptoms include an emotional numbness and indifference to one's own actions or ordinary drives including hunger and libido. Needless to say, this sense of distance can seriously affect physical health and ability to function socially, coinciding with more recognizable mental conditions such as depression, anxiety, schizophrenia, and suicidal behavior, all making diagnosis even trickier.

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This personality disorder involves a pattern of paranoid thinking, or consistent mistrust of others without reason. People with paranoid personality disorder are always on guard and suspicious that others are trying to harm or demean them, thus alienating others and imperiling close relationships in what can become a vicious and isolating cycle. Biological factors such as a family history of schizophrenia and childhood experiences of trauma have been linked to the development of PPD, which is usually best treated, like other personality disorders, with long-term psychotherapy.

"Hoarding" is a poor shorthand for this debilitating behavioral disorder, characterized by extreme self-neglect, social withdrawal, and a compulsive attachment to collect or save seemingly random items, which can lead to accidental injury or physical health problems. Though not officially recognized by the DSM or ICD, Diogenes syndrome is often linked to more common mental conditions such as dementia, depression, OCD, schizophrenia, and alcoholism (when it is then called secondary Diogenes syndrome), most commonly occurring in people over 60. Diagnosis and treatment are complicated by the tendency of people with Diogenes syndrome to isolate themselves, persistently deny their situation, and refuse help, but support groups and behavioral therapies can have positive effects, depending on the individual's competency level.

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Associated with anxiety, stress, and depression, aboulomania is a little-studied disorder characterized by chronic and pathological indecisiveness. Influenced by age and cultural factors as well as instances of social humiliation in childhood, it can easily interfere with everyday functioning, as one can neglect responsibilities out of indecision or become paralyzed by dozens of seemingly minor decisions on their way out the door. Psychotherapy is the main form of treatment to help these individuals become more active and independent.

A bizarre testament to the power of our own perceptions, somatic symptom disorders are mental conditions that cause physical symptoms such as pain and gastrointestinal upset. People with these disorders are not "faking" and experience true distress from these symptoms. Somatic symptom disorders often appear alongside anxiety disorders. Diagnosis is a process of elimination and performing many tests that may serve to amplify patients' anxiety and psychosomatic symptoms even further. When no physical explanation can be found, patients may continue to dismiss psychological factors as a cause of the very real pain they're experiencing, making a strong doctor-patient relationship essential for encouraging treatment.

People with factitious disorders deceive others into thinking they're sick or injured — not out of fear or financial gain, but a desire to assume a patient's role. Previously known as Munchausen syndrome, it's complicated to say the least, in that people with the disorder are aware of the deception and desperate to preserve it even through self-harm, but frequently ignorant that they have a problem or of the reasons behind it. Because it involves mimicking other ailments, common symptoms include frequent hospital stays and reporting inconsistent symptoms, while treatment of the underlying disorder is little studied but should always entail a non-judgmental approach.

Affecting between 0.4% and 1% of the U.S. population, cyclothymia is most easily described as a less severe form of bipolar disorder, characterized by mood swings between mild depression and hypomania. Though easily overlooked thanks to its relative mildness and unpredictability, with months of even-keeled mood mixed in, cyclothymia can lead to substance abuse, unstable relationships, heightened suicide risk, or development of full-on bipolar disorder if left untreated.

Also known as dysthymia, persistent depressive disorder is a chronic, low-grade form of depression that often flies under the radar. Like more severe major depression, it's inspired by a complex variety of factors ranging from biological inheritance and brain chemistry to stressful life events. Feelings of hopelessness, lack of energy, and low self-esteem must persist for at least one year and interfere with daily activities significantly to constitute a diagnosis of PDD, at which point support groups and psychotherapy to restructure one's thinking offer valuable treatment routes.

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Though many could be said to have dependent personalities, those diagnosable with dependent personality disorder are completely reliant on others for their emotional and/or physical needs, including a sense of self. They are easily wounded by others' opinions and require constant reassurance usually stemming from an intense fear of abandonment and rejection. At once one of the most commonly diagnosed and least well-recognized personality disorders, a 2012 study estimated between 55% and 72% of risk for the condition is inherited from one's parents, particularly those with abusive, authoritarian, or overprotective tendencies.