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WTC Health Program | Mental Health Definitions

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Mental Health Definitions

 
 
 
 
Trauma & Stressor Related Conditions
 
The common feature of these conditions/disorders is that exposure to a traumatic or stressful event is a critical part of the diagnosis. Psychological distress following exposure to a traumatic or stress event varies widely amongst individuals. Some individuals will exhibit anxiety or fear based symptoms, others will shut down or disconnect, and still others may express anger or aggression. It is also common for some individuals to experience a combination of these symptoms.
 
 
 
 
Acute Stress Disorder
 
Acute Stress Disorder is prevalent directly after a traumatic event. To be diagnosed, one must have symptoms that persist from three days to one month. The disturbance causes significant distress or impairment in social, occupational, or other important areas of functioning and cannot be attributable to the effects of a substance such as medication or alcohol or another medical condition.
 
This disorder can occur if one (or more) of the following ways:
Directly experiencing the traumatic event.
Witnessing, in person, the events as it occurred to others.
Learning that the event occurred to a close family member or close friend (in cases of actual or threatened death, the event(s) must have been violent or accidental).
Experiencing repeated or extreme exposure to aversive details of the traumatic event (e.g. first responders collecting human remains, police officers and social workers exposed to details of child abuse). Note: does not apply to media exposure unless work related.
 
This disorder can occur if one (or more) of the following ways:
Directly experiencing the traumatic event.
Witnessing, in person, the events as it occurred to others.
Learning that the event occurred to a close family member or close friend (in cases of actual or threatened death, the event(s) must have been violent or accidental).
Experiencing repeated or extreme exposure to aversive details of the traumatic event (e.g. first responders collecting human remains, police officers and social workers exposed to details of child abuse). Note: does not apply to media exposure unless work related.
One must also have nine or more of the following symptoms from any of the five categories of intrusion, negative mood, dissociation, avoidance, and arousal, beginning or worsening after the traumatic event(s) occurred:
 
Intrusion Symptoms
1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event (Note: in children, repetitive play may occur in which aspects of the traumatic event are expressed).
2. Recurrent distressing dreams in which the content and/or affect is related to the event(s). (Note: In children, there may be frightening dreams without recognizable content).
3. Dissociative reactions (e.g., flashbacks) in which one feels or acts as if the traumatic event is recurring.
4. Intense or prolonged psychological stress or physiological reactions in response to internal or external cues that resemble an aspect of the traumatic event(s).
 
Negative Mood
5. Persistent inability to experience positive emotions.
 
Dissociative Symptom
6. An altered sense of the reality of one's surroundings or oneself (e.g., being in a daze, time slowing, etc.).
7. Inability to remember an important aspect of the traumatic event(s).
 
Avoidance Symptoms
8. Efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
9. Efforts to avoid external reminders (people places, conversations, activities, objects, etc.) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
 
Arousal Symptoms
10. Sleep disturbance.
11. Irritable behavior and angry outbursts.
12. Hypervigilance (being on high alert, constantly trying to detect threats).
13. Problems with concentration.
14. Exaggerated startle response.
Note: Symptoms typically begin immediately after the trauma but persistence for at least 3 days and up to a month is needed to meet the criteria for Acute Stress Disorder.

 
 
 
 
Adjustment Disorders
 
Adjustment Disorders can develop as emotional or behavioral symptoms in response to an identifiable stressor (event, activity) occurring within three months of the onset of the stressor. (Once the stressor or its consequences have ended, the symptoms do not continue for more than six months.)
 
Adjustment Disorders can be identified by one or both of the following symptoms or behaviors (that are not otherwise normal bereavement or an exacerbation of a preexisting mental disorder):
Marked distress that is out of proportion to the severity or intensity of the stressor.
Significant impairment in social, occupational, or other important areas of functioning.
 
Adjustment Disorders can occur with some of the following specifications:
With depressed mood.
With anxiety.
With mixed anxiety and depressed mood.
With disturbance of conduct.
With mixed disturbance of emotions and conduct

 
 
 
Posttraumatic Stress Disorder ("PTSD")
 
PTSD (Posttraumatic Stress Disorder) is a condition that may develop after you have been experienced a traumatic event like an assault, a disaster, an accident, or combat. PTSD often co-occurs with other conditions such as depression, substance abuse, and traumatic brain injury. After the traumatic event, you may feel afraid and nervous. You may have upsetting thoughts, memories, or nightmares of the event. You may feel numb or cut off from other people or easily agitated. You may also avoid things that remind you of the event. These symptoms can disrupt your life, making it hard to continue with your daily activities, and even change/shape your view of the world. If these feelings or experiences do not go away over time or they get worse, you may be diagnosed with PTSD.
 
In diagnosing PTSD, a clinician will evaluate your circumstances and symptoms using the criteria listed below (applies to adults, adolescents, and children older than 6 years):
 
A. The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in one of the following ways:
1. Direct exposure.
2. Witnessing, in person.
3. Indirectly, by learning that a close relative or close friend was exposed to trauma. If the event involved actual or threatened death, it must have been violent or accidental.
4. Repeated or extreme indirect exposure to aversive details of the event(s), usually in the course of professional duties (e.g., first responders, collecting body parts; professionals repeatedly exposed to details of child abuse).
 
Note: This does not include indirect exposure through electronic media, television, movies or pictures, unless this exposure is work related.
 
B. Presence of one (or more) of the following Intrusion (unwanted, excessive) symptoms associated with the traumatic event(s) beginning after the event occurred:
1. Recurrent, involuntary and intrusive distressing memories of the traumatic event.
2. Recurrent distressing dreams in which the content and/or affect (feeling or mood) of the dream are related to the event. (Note: In children, there may be frightening dreams without recognizable content).
3. Dissociative reactions (e.g., flashbacks) in which one feels or acts as if the traumatic event is recurring, which may occur on a continuum from brief episodes to complete loss of consciousness.
4. Intense or prolonged psychological (mental/emotional) stress or physiological (bodily) reactions in response to internal or external cues (reminders) that resemble an aspect of the traumatic event(s).
5. Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic events.
 
C. Persistent avoidance of stimuli associated with the traumatic event(s) beginning after the event occurred:
1. Avoidance of or efforts to avoid distressing memories, thoughts, or feeling about or closely associated with the traumatic event.
2. Avoidance of or effort to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feeling about or closely associated with the traumatic event(s).
 
D. Negative alterations in cognitions and mood that are associated with the traumatic event, beginning after the traumatic event occurred, to include two (or more) of the following:
1. Inability to recall key features of the traumatic event (usually dissociative amnesia; not due to head injury, alcohol or drugs).
2. Persistent (and often distorted) negative beliefs and expectations about oneself or the world (e.g. "I am bad," "the world is completely dangerous").
3. Persistent distorted blame of self or others for causing the traumatic event or for resulting consequences.
4. Persistent negative trauma-related emotions (e.g. fear, horror, anger, guilt, or shame).
5. Markedly diminished interest in (pre-traumatic) significant activities.
6. Feeling alienated from others (e.g. detachment or estrangement).
7. Persistent inability to experience positive emotions.
 
E. Alterations in arousal and reactivity that are associated with the traumatic event beginning or worsening after the traumatic event occurred, to include two (or more) of the following:
1. Irritable or aggressive behavior.
2. Self-destructive or reckless behavior.
3. Hypervigilance.
4. Exaggerated startle response.
5. Problems in concentration.
6. Sleep disturbance.
 
F. Persistence of symptoms (in Criteria B, C, D and E) for more than one month.
G. Significant symptom-related distress or functional impairment.
H. Rule out that disturbance is not due to the physiological effects of a substance or medical condition.
 
 
 
ANXIETY CONDITIONS/DISORDERS
The common feature of these disorders is excessive fear and anxiety and related behavioral disturbances (e.g., avoiding situations). Some individuals with anxiety disorders overestimate the danger in situations they fear or avoid. Anxiety disorders differ from one another in the types of objects or situations that induce fear, anxiety, or avoidance behavior. Many of the anxiety disorders develop in childhood and tend to persist if not treated.
 
 
 

Generalized Anxiety Disorder
 
Generalized anxiety disorder presents as chronic, constant and often unsubstantiated worry. Unlike "typical" worrying, individuals with Generalized Anxiety Disorder ("GAD") have excessive anxiety and worry that causes significant distress and impairment in social occupational, or other important areas of life. They often find concerns overwhelming and their worries have a longer duration than those with non-pathological anxiety. Their concerns are constant and cover a range of life circumstances (e.g., finances, children's safety, job performance, etc.). Additionally, these persistent worries are more likely to be accompanied by physical symptoms including muscle tension, irritability, fatigue, edginess/restlessness, sleep difficulties. Many individuals with GAD report that they have felt anxious and nervous all of their lives.
 
All of the below features must be present in order to meet the clinical diagnosis of GAD:
1. Excessive anxiety and worry, occurring more days than not for at least 6 months, concerning a number of events or activities.
2. The individual finds it difficult to control the worry.
3. The anxiety and worry are associated with at least three of the following six symptoms occurring for more days than not for the past six months (only one item required in children).
4. Restlessness, feeling keyed up or on edge.
5. Being easily fatigued.
6. Difficulty concentrating or mind going blank.
7. Irritability.
8. Muscle tension.
9. Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep).
10. The anxiety, worry or physical symptoms cause clinically significant distress or impairment in important areas of functioning.
11. The disturbance is not due to the physiological effects of a substance or medical condition.
12. The disturbance is not better explained by another medical disorder.
 
Note: It is critical to note that many of the symptoms of GAD overlap with depression, complicating the diagnosis of either disorder.

 
 
 
 
Panic Disorder
 
Panic Disorder refers to recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes. These attacks are recurrent and unanticipated by the patient. The attack can occur during a time of anxiety but can also begin during a calm state, such as while relaxing, sleeping or while engaging in an enjoyable activity. Panic disorder can cause a variety of interpersonal and occupational problems. Individuals with recurrent panic may avoid social situations or going out in public altogether in an effort to avoid a potentially embarrassing attack. This can lead to withdrawal from friends and family, avoiding all physical exertion, and generally restricting daily life including absence from work and school.
 
The most prominent criteria for diagnosing panic disorder is recurrent unexpected panic attacks during which time four (or more) of the following symptoms occur: 
1. Palpitations, pounding heart, accelerated heart rate.
2. Sweating.
3. Trembling or shaking.
4. Sensations of shortness of breath or smothering.
5. Feelings of choking.
6. Chest pain or discomfort.
7. Nausea or abdominal distress.
8. Feeling dizzy, unsteady, light-headed, or faint.
9. Chills or heat sensations.
10. Paresthesias (numbness or tingling sensations).
11. Derealization (feelings of unreality) or depersonalization (being detached from oneself).
12. Fear of losing control or "going crazy".
13. Fear of dying.
 
Additionally
Each one of the attacks has been followed by 1 month of one or both of the following:
1. Persistent concern or worry about additional panic attacks.
2. A significant maladaptive (unhelpful) change in behavior related to the attacks (e.g., avoidance of exercise or unfamiliar situations).
 
Note: This diagnosis must first rule out the physiological effects of a substance or a medical condition.

 
 
 
Anxiety Disorder (Not Otherwise Specified)
 
This category applies to individuals who present with symptoms that are typical of an anxiety disorder and those symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning (family, work, school, etc.) but do not meet all the criteria listed in the other anxiety disorders diagnosis descriptions. This diagnosis may be applied in situations where the clinician chooses not to specify the reasons that criteria are not met for a specific anxiety disorder, including situations where there is not sufficient information to make a more specific diagnosis, for example, in an emergency room setting.
 
 
DEPRESSIVE CONDITIONS/DISORDERS
The common feature of all of these disorders is the presence of sad, empty, or irritable mood, accompanied by somatic (physical) and cognitive (perception/memory/judgment) changes that significantly affect the individual's capacity to function. What differs among them are issues of duration, timing, or presumed etiology (cause).

 
 
 
 
Persistent Depressive Disorder (Dysthymia)
 
Persistent Depressive Disorder is diagnosed as being in a depressed mood for most of the day, for more days than not, for at least two years (one year for children and adolescents). The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Additionally, there has never been a manic episode and/or symptoms are not better explained by the physiological effects of a substance, other medical condition, or other mental health conditions (e.g., schizoaffective disorder, delusional disorder, schizophrenia, etc.).
 
Two or more symptoms must be present (while depressed):
1. Poor appetite or overeating.
2. Insomnia or hypersomnia.
3. Low energy or fatigue.
4. Low self-esteem.
5. Poor concentration or difficulty making decisions.
6. Feelings of hopelessness.
 
Note: No more than two months can pass without experiencing the symptoms outlined above to meet the criteria for this diagnosis.

 
 
 
Major Depressive Disorder
 
Major Depressive Disorder occurs when symptoms (outlined below) have been present during a two-week period and represent a change from previous functioning. At least one of these symptoms must be either depressed mood or loss of interest or pleasure. These symptoms must cause significant distress or impairment in social, occupational, or other important areas of functioning. Additionally, there has never been a manic episode and/or symptoms are not better explained by the physiological effects of a substance, other medical condition, or other mental health conditions (e.g., schizoaffective disorder, delusional disorder, schizophrenia, etc.).
 
Five or more of the following symptoms must be present:
1. Depressed mood most of the day, nearly every day (e.g., feel sad, empty, hopeless). (Note: In children and adolescents, can be irritable mood).
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
3. Significant weight loss when not dieting or weight gain (change of more than 5% of body weight in a month) or a decrease or increase in appetite nearly every day.
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day.
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day.
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day
9. Recurrent thoughts of death, recurrent suicidal ideation (thoughts) without a specific plan, or a suicide attempt or a specific plan for committing suicide.
Five or more of the following symptoms must be present:
1. Depressed mood most of the day, nearly every day (e.g., feel sad, empty, hopeless). (Note: In children and adolescents, can be irritable mood).
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
 
Certain sub-categories of Major Depressive Disorder can occur, which include:
With anxious distress.
With mixed features.
With melancholic features.
With atypical features.
With mood-congruent psychotic features.
With mood-incongruent psychotic features.
With catatonia.
With peripartum onset.
With seasonal pattern
 
 
Note: Responses to a significant loss, such as bereavement, may include feelings of intense sadness, rumination, insomnia, poor appetite, etc. In distinguishing grief from Major Depressive Disorder ("MDE"), one should consider the primary focus of grief is feelings of emptiness and loss whereas with MDE, it is depressed mood and inability to anticipate happiness or pleasure. In grief, self-esteem is generally preserved whereas in MDE feelings of worthlessness are common. If a bereaved person thinks about death and dying, they generally focus on the deceased and "joining them" vs. in MDE the focus is on feeling worthless, being unable to cope with symptoms of depression, etc.

 
 
 
 
Depression (not otherwise specified)
 
This diagnosis may be assigned to an individual with symptoms characteristic of a depressive disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but they do not meet the full criteria for any of the disorders in the depressive disorders diagnostic class (e.g., Major Depressive Disorder, Dysthymia, etc.).
 
The unspecified depressive disorder category is used in situations in which the clinician chooses not to specify the reason that the criteria are not met for a specific depressive disorder, and includes presentations for which there is insufficient information to make a more specific diagnosis (e.g., in emergency room settings).

 
 
 
 
Substance Abuse
 
Substance Use/ Abuse
 
Substance Use Disorder(s) that develop after a traumatic event often coexist with other disorders, such as PTSD, anxiety, panic disorder or depression. Individuals may "self-medicate" to cope with the emotional impact of the event(s) and resulting symptoms. A traumatic event can also amplify prior substance use, creating the risk of abuse and dependence. The diagnosis of a substance use disorder is based on a pathological pattern of behaviors related to the use of the substance. An important characteristic of substance use disorders is an underlying change in brain circuits that may persist beyond detoxification, particularly in individuals with severe disorder. This can manifest itself in intense craving when exposed to the substance and in repeated relapses.
 
Depending on severity, an individual may:
Express a persistent desire to cut down or regulate substance use and may report multiple unsuccessful efforts to decrease or discontinue use.
Take substance in larger amounts or over a longer period than originally intended.
Spend a great deal of time obtaining the substance, using the substance, recovering from its effects.
Experience an intense desire or urge for the substance at any time.
Continue substance use despite having persistent or recurrent social or interpersonal problems caused by, or exacerbated by, effects of the substance.
Miss or choose to not attend important social, occupational, or recreational activities because of substance use.
Withdraw from family activities and hobbies in order to use the substance.
Continue substance use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely caused by the substance.
 
Some of the commonly used/abused substances include:
Alcohol
Caffeine
Cannabis
Hallucinogens
Inhalants
Opiates
Sedatives, hypnotics, or anxiolytics
Stimulants
Tobacco
There is also non-substance related use/abuse (such as gambling) that can occur.
 
 
 
 
 
 
 

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