 Mental illness and psychiatric disability are terms used to describe sets of  Psychological or behavioural patterns that cause distress or disability. Many of which can appear very similar to acquired brain injury.
- What is a Mental Illness?
- What causes Mental Illness?
- What are the classes of Mental illness?
- Mental illness and Acquired Brain Injury?
What is a Mental Illness?
Mental illness is a term that refers to a group of disorders that impact on a person’s thoughts, behaviour and emotions 1. To be classified as a mental illness, the condition must cause significant distress and result in a reduced ability to function psychologically, socially, occupationally or interpersonally. Examples, of mental illnesses include Depression, Anxiety disorders, schizophrenia, personality disorders, and bipolar disorder. A mental illness can vary from mild to temporary to severe and prolonged1.
A person can have a mental health issue and not have a mental illness. The difference is based on severity and duration of symptoms. Generally a mental health issue can be overcome by internal coping tools and support from others. A mental illness is more severe and chronic and requires professional treatment and support.
Someone who has a mental illness may struggle, to a greater or lesser degree, with one area or all the following:
- Coping with stress, anger and other difficult emotions.
- Difficulties performing daily activities e.g. cooking, cleaning, looking after personal hygiene, budgeting
- Undertaking family responsibilities
- Finding and retaining employment
- Having healthy relationships with others
- Structuring the day
Mental health providers define mental disorders by signs, symptoms and functional impairments. Signs are what objective observers can document, such as agitation or rapid breathing. Symptoms are subjective, or what you feel, such as euphoria or hopelessness. Functional Impairment is the inability to perform certain routine or basic daily tasks, such as bathing or going to work.
In mental illness, signs and symptoms commonly show up as:
- Behaviours, such as repeated hand washing
- Feelings, such as low mood, irritability
- Thoughts, such as negative or persecutory self-talk, paranoia
- Physiological responses, such as sweating and rapid heart beat
Signs, symptoms and functional impairments that mark specific mental illnesses are spelled out in detail in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This 2-inch-thick book classifies and describes more than 300 types of mental disorders. The book, published by the American Psychiatric Association, is used by mental health providers as a guide to diagnosing mental illness. Another widely accepted manual in assessing and classifying mental health disorders is the International Statistical Classification of Diseases and Related Health Problems (ICD).
What Causes Mental Illness?
- Thought to be caused by biological or genetic factors that create vulnerability to mental illness [1].
- Chronic stress and social change
- Drug may Trigger mental illness, particularly in those with a vulnerability to mental illness.
What are the classes of mental illness?
Our evolving understanding of genetics and how the brain works may eventually change how we classify mental illnesses. For now, we think of several main classes of mental illness:
- Mood disorders. These include disorders that change how you feel, such as persistent sadness or feelings of euphoria. They include major depression and bipolar disorder.
- Anxiety disorders. Anxiety is an emotion characterized by the anticipation of future danger or misfortune accompanied by a feeling of being ill at ease. Examples include panic disorder, obsessive-compulsive disorder, specific phobias and generalized anxiety disorder.
- Substance-related disorders. These include problems associated with the misuse of alcohol, nicotine, caffeine and illicit drugs.
- Psychotic disorders. These disorders impair your sense of reality. The most notable example of this is schizophrenia, although other classes of disorders can be associated with psychosis at times.
- Cognitive disorders. These disorders influence your ability to think and reason. They include delirium, dementia and memory problems. Perhaps the most well-known of these disorders is Alzheimer's disease.
- Developmental disorders. This category covers a wide range of problems that usually first begin to make themselves known in infancy, childhood or adolescence. They include Autism, attention-deficit/hyperactivity disorder and Learning disabilities. But just because they're all grouped in this category doesn't necessarily mean they share a common cause or that there's a relationship among the disorders.
- Personality disorders. A personality disorder is an enduring pattern of inner experience and behaviour that is dysfunctional and leads to distress or impairment. Examples include borderline personality disorder and antisocial personality disorder.
- Other disorders. These include disorders of impulse control, sleep, sexual functioning and eating. Also included are dissociative disorders, in which a person's sense of self is disrupted, and somatoform disorders, in which there are Physical symptoms in the absence of a clear physical cause, such as hypochondriasis4.
Mental Illness and Acquired Brain Injury
Mental illness can occur at the same time as an acquired brain injury and is known as a Dual Diagnosis or co-morbidity. A mental illness may have been present prior to an acquired or Traumatic Brain Injury or a person may have a history of mental illness prior to acquiring a brain injury.
- According to a recent publication released by the Australian Institute of Health and Welfare, 42% of people with an ABI surveyed had a psychiatric disability [2].
- Research has indicated that traumatic brain injury is linked to the development of mental illness 3.
The commonly cited difference between an acquired brain injury and a mental illness is that an acquired or traumatic brain injury is an observable abnormality in brain structure and functioning. An acquired brain injury can be assessed with an x-ray or, in some cases, only with a more sensitive MRI or contrast CT Scan. A mental illness is characterised by alterations in thinking, mood or behaviour. Generally, it can’t be spotted with a CT scan or an MRI scan that looks at physiology, however relies on other assessment of behaviours, thought patterns and emotions. The two conditions have different causes or etiologies resulting in changes in mental and emotional functioning.
Separating the symptoms of a mental illness and an acquired brain injury is a difficult task. The symptoms of ABI and a mental illness can be extremely similar, causing problems for diagnoses and therefore access to appropriate treatment.
Signs that a mental illness may be developing following brain injury, include;
- A gradual decline in ability to perform everyday tasks
- Decline in ability to cope with every day stressors
- Increased irritability and behavioural issues e.g. anger, Frustration, agitation
- Exaggeration of the effects of the acquired brain injury
If a mental illness is suspected it is important to seek advice from a qualified mental health professional or local GP. Qualified professionals include neuropsychologists, clinical psychologists and psychiatrists.
If a mental illness is suspected please contact your state Brain Injury Association or Mental Illness Fellowship for an appropriate referral.
Further information
For more information, contact the Mental Health Association in your state, via http://www.mentalhealth.org.au/.
[1] Mental Illness Fellowship of Victoria (2008). Frequently asked questions about mental illness. Accessed 5 August 2009, from http://www.mifellowship.org/documents/FrequentlyAskedQuestions_001.pdf
[2] Australian Institute of Health and Welfare (2007). Bulletin 55: Disability In Australia: acquired brain injury. Accessed 5 August 2009, from http://www.aihw.gov.au/publications/aus/bulletin55/bulletin55.pdf
[3] Can Traumatic Brain Injury Cause Psychiatric Disorders? http://neuro.psychiatryonline.org/cgi/content/abstract/12/3/316
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What is Mental Illness?