I am often told I have severe mental illness or serious mental illness. I have also been told my illnesses are acute, chronic, prone to exacerbation and “high risk.” Today has been a thinking day, which you can probably tell by my multiple posts. So I decided to do some research and find out exactly what constitutes a severe or serious mental illness and which ones specifically fit into that category. Here is what I found out, links follow specific quotes and information.
My first two sources are well known associations on mental health/illness.
Q: What mental disorders are the most severe?
A: The mental disorders with the highest proportion of seriously disabling 12-month cases are: bipolar disorder (83 percent); drug dependence (57 percent); and obsessive-compulsive disorder (51 percent). Interestingly, impulse-control disorders, which have been neglected in most previous epidemiological studies of adults, have a greater proportion at the serious level than either anxiety disorders or substance use disorders.
Q: What makes a disorder “severe,” as opposed to “moderate” or “mild?”
A: Severe disorders were defined as cases which had any of the following: suicide attempt within the preceding 12 months with serious lethality intent; work disability or substantial limitation due to a mental or substance disorder; psychosis; bipolar I or II disorder; substance dependence with serious role impairment (as defined by disorder-specific impairment questions); an impulse-control disorder with repeated serious violence; or any disorder that resulted in an inability to function in a particular social role for 30 or more days in the year. Cases were defined as moderate if they had any of the following: suicide gesture, plan or ideation; substance dependence without serious role impairment; at least moderate work limitation due to a mental or substance disorder; or any disorder with at least moderate role impairment in two or more domains of the Sheehan Disability Scales. All other cases were classified mild
From National Institute of Mental Health (NIMH)
So this information surprised me and also made me frustrated. For the first question the answers were bipolar, drug dependence, and OCD. What bothered me is that they threw in that these illnesses were at a more “serious level than either anxiety disorders.” I have dealt with anxiety and probably never had it in an extreme form. But I know for a fact anxiety can be disabling causes some people to even refuse to leave their house, unable to be employed or be around other people. Of course anxiety can be milder just as depression and even bipolar disorder, but to add that sentence at the end seemed like a slap in the face, especially considering the source. For the next question, it answer my question of severe verses not severe disorders. So severe= serious suicide attempt, work disability, psychosis, either bipolar disorder, substance dependence, impulse control with violence, or any disorder which causes an inability to function in a social role for a month. Alright, so the only specific disorder they specify here are bipolar I and II and substance dependence. A suicide attempt is not a disorder but a symptom and also one that doesn’t necessarily indicate mental illness anyways. Also frustrating is it has to be “with serious lethality intent.” Work disability can be given for stress here in the US, stress is also not a disorder and some people with serious mental illnesses do not receive work disability for various reasons. Psychosis again not a disorder but a symptom and again not necessarily indicates mental illness. Impulse control is not seen as a disorder either but a symptom and in NIMH’s opinion it must be tied to violence. And as for the last example I am curious what they mean by “social role.” Next it moves to what makes a disorder moderate: suicide gesture, plan or ideation; substance dependence that doesn’t impair functioning; moderate work limitation; and moderate role impairment on some scale I do not know about. All other are mild. As for this definition of “moderate” I wonder if not serious suicide attempt fits as “suicidal gesture,” since it is not stated in any other severity of the disorder. I know people dependent on substances that would not consider themselves to have a disorder. And for the last two I guess it is up to the physician, psychiatrist, GP, PCP, or insurance companies to define “moderate” in regard to work functioning and the other scale. So many things in the answers to these two questions make me angry.
Serious mental illnesses include major depression, schizophrenia, bipolar disorder, obsessive compulsive disorder (OCD), panic disorder, post traumatic stress disorder (PTSD) and borderline personality disorder. The good news about mental illness is that recovery is possible.
Mental illness falls along a continuum of severity. Even though mental illness is widespread in the population, the main burden of illness is concentrated in a much smaller proportion-about 6 percent, or 1 in 17 Americans-who live with a serious mental illness.
The U.S. Surgeon General reports that 10 percent of children and adolescents in the United States suffer from serious emotional and mental disorders that cause significant functional impairment in their day-to-day lives at home, in school and with peers
From National Alliance for the Mentally Ill (NAMI)
So this information is a little better in my opinion then that from the NIMH. First off that it includes depression, OCD, panic disorder (a variety of anxiety disorders), PTSD, and BPD. It also included bipolar which is mentioned by NIMH and schizophrenia which is what most people think when they hear psychosis. I also like the fact that they speak of mental illness of a continuum and included children and adolescents in those that can be affected. The only really issue I have with this source is that they don’t give examples of severity such as functioning in work, social or other situations.
What is serious mental illness?
Serious mental illness includes diagnoses which typically involve psychosis (losing touch with reality or experiencing delusions) or high levels of care, and which may require hospital treatment. Here we look at two of the most common severe mental illnesses: schizophrenia and bipolar disorder (or manic depression)
From Mental Health Wales
This is just a quick description looking at two disorders. The website goes on to describe bipolar disorder and schizophrenia. I like that they refer to “two of the most common severe mental illnesses” which indicates that there are more. Also there is high level of care which also shows room for other reasons that are not specific which could indicate other disorders.
Severe and persistent mental illness, or SPMI, is the term mental health professionals use to describe mental illnesses with complex symptoms that require ongoing treatment and management, most often varying types and dosages of medication and therapy
A Cyclical Illness
Severe mental illness typically does not level off and remain at a steady state. Rather, symptoms come and go in relation to stress. As a result, people with SPMI may be able to function independently for periods of time but may need intensive support with housing, school, work, social functioning, and other everyday life concerns when they experience a stressful event.
Common SPMI Illnesses
- Schizoaffective disorder
- Delusional disorder, psychosis not-otherwise-specified, and other psychotic disorders
- Bipolar disorder, also known as manic-depression
- Severe depression that resists treatment and impacts ability to function
- Personality disorders that are severe enough to prevent functioning
From UNC Center for Excellence in Community Mental Health
From this source I like that it mentions treatment and included therapy and not just medication. I also appreciate how they view severe mental illness as cyclical, since there are times of functioning that are better than others, and it mentions stressful events as sometimes increasing severity. Many of the common disorders are those mentioned in the earlier sources.
As a whole… I want to mention that these four sources were on the first search from Google. Two are from well known reputable associations that are related to mental illness. Looking at these descriptions under ALL 4, I met the criteria. I have Schizoaffective- bipolar type and borderline personality disorder. As for the first source, I have bipolar disorder in the sense that it goes along with schizophrenic symptoms making the label schizoaffective, I also deal with psychosis, and have work disability. As for NAMI’s description I have Schizoaffective disorder which encompasses the first three disorders listed major depression, schizophrenia, bipolar disorder and the BPD. The third source also talks about psychosis and hospitalization, I’ve experienced both. And specifies schizophrenia which I won’t mention again are aspects of my first diagnosis. The last source actually mention schizoaffective disorder and says “Personality disorders that are severe enough to prevent functioning” which most people consider my BPD to be; as mentioned earlier I like the cyclic view.