Understanding Mental Disorders

By Scott M. Helfrich, M.S.
Area Coordinator, Bloomsburg University

More and more young adults are entering into college today diagnosed with many different psychological disorders. These students may or may not be taking prescribed psychotropic medications, which subsequently can cause unique challenges for residence life staff members.

This article will give a brief introduction to the nature of some of the typical psychological disorders encountered within the residence halls. Some basic tips will be included for helping students who have psychological disorders.

Mental Disorders Defined

Mental disorders are defined and classified by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders, typically known as the DSM-IV (the “IV” indicates the version of the manual.) The DSM-IV defines a mental disorder as a “clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress…or disability…or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom” (p. xxi).

The Surgeon General’s Report of Mental Health defines mental disorders as “health conditions that are characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress and/or impaired functioning.”

These disorders are placed into 17 different classifications in the DSM-IV depending upon the types of symptoms experienced. These classifications include mood, anxiety, eating, adjustment, and personality disorders to name just a few. Within these classifications, there are many different types of disorders. For example, there are three different types of eating disorders, which include anorexia nervosa and bulimia nervosa.

To be diagnosed with a specific disorder, you must fulfill certain symptomatic criteria, which is listed in the DSM-IV. If someone isn’t experiencing any and/or all of the symptoms listed, they probably don’t have that particular disorder. Please note that there are many subtleties with different criteria so only trained mental health professionals should make diagnoses.

Disorders Encountered

Students today come to colleges and universities diagnosed (and even undiagnosed) with the full range of mental disorders, including everything from schizophrenia and anorexia to major depression and posttraumatic stress disorder. In a recent study by Dr. Ronald Kessler from Harvard University, it was found that 37% of people aged 15-24 years old have a diagnosable mental illness. Most of college students today fit within this age bracket.

It is also very prevalent for someone to have more than one type of disorder at any one time. This is what is referred to as “comorbidity.” A student could be diagnosed with major depressive disorder as well as anorexia nervosa. Another example would include a student diagnosed with alcohol dependence as well as borderline personality disorder.

Also, some of the presenting symptoms in some students may be more severe than others. Furthermore, some students may be seeking treatment for these symptoms while others may not.

Understand that each school’s student population is completely different so staff members at one school may encounter more and different types of disorders than their counterparts at other schools.

According to the National Institute of Mental Health, here are the most prevalent mental disorders and the number of adult Americans, aged 18 and over, diagnosed with them in a given year:

• Major Depressive Disorder: 9.9 million
  
• Dysthymic Disorder: 10.9 million
  
• Posttraumatic Stress Disorder: 5.5 million
  
• Social Phobia: 5.3 million
  
• Generalized Anxiety Disorder: 4.0 million
  
• Obsessive-Compulsive Disorder: 3.3 million
  
• Panic Disorder: 2.4 million
  
• Bipolar Disorder: 2.3 million
  
• Schizophrenia: 2.2 million
  

Given the previous statistics, it is understandable that a residence life staff member may encounter a student presenting symptoms of a mood or anxiety disorder. The symptoms for each of these types of disorders are very unique and can be readily treated with proper medication and psychotherapy.

Mood Disorders

Mood disorders, for the most part, are characterized by symptoms that are exclusively of elevated mood episodes, depressed mood episodes, or the going back-and-forth between elevated and depressed. The length of time and severity of the symptoms will indicate what kind of disorder a person has.

Symptoms to be on the lookout for a major depressive episode include:

• Depressed mood most of the day, nearly every day
  
• Loss of pleasure or interest in activities
  
• Weight loss or gain or decrease or increase in appetite
  
• Insomnia or hypersomnia everyday
  
• Feelings of worthlessness or excessive or inappropriate guilt
  
• Inability to think or concentrate or indecisiveness
  
• Recurrent thoughts of death or suicide ideation
  

Symptoms to be on the lookout for a manic episode include:

• Inflated self-esteem or grandiosity
  
• Decreased need for sleep
  
• More talkative than usual
  
• Flight of ideas or racing thoughts
  
• Distractibility
  
• Increased goal-directed activity
  
• Excessive involvement in pleasurable activities that can have negative consequences
  

Anxiety Disorders

Anxiety disorders are characterized by the symptoms related to panic attacks or panic-like symptoms. The DSM-IV defines a panic attack as: “a discrete period in which there is the sudden onset of intense apprehension, fearfulness, or terror, often associated with feelings of impending doom. During these attacks, symptoms such as shortness of breath, palpitations, chest pain, or discomfort, choking or smothering sensations, and fear of “going crazy” or losing control are present (p. 393).

Other anxiety disorders manifest symptoms as the result of the presence of a certain stimuli. For example, people with Posttraumatic Stress Disorder can exhibit symptoms if presented with stimuli that remind them of a traumatic event that occurred within their life such as being raped or being in a car accident. The same holds true for a Specific Phobia such as the fear of heights or snakes.

Medications

People seeking treatment for psychological disorders may be prescribed various medications to help alleviate the symptoms of their disorder.

It is important to know that taking these medications won’t instantly make someone better or alleviate all symptoms. Most of these medications take anywhere from 4-6 weeks to build up in the body for an effect to take place.

You may encounter students who are not “med-complaint” because there is a stigma attached to mental illness and with taking medications. Once the person feels better, they may incorrectly choose not to take the medication anymore because they feel that they don’t need it. Unfortunately, they soon find out that their symptoms quickly return.

Tips for Helping Students with Disorders

• Use language carefully while interacting with your residents. Words such as “crazy,” “nuts”, and “weird” have no place for inviting students with disorders into the residence hall community.
  
  
• You should never attempt to diagnose a student. If you see a student who appears to be in crisis, speak with your supervisor about this individual and work together to determine an appropriate course of intervention.
  
  
• Be careful not able to label someone with “eccentric” behaviors as someone who has a psychological disorder. Just because a student acts differently than the group doesn’t necessarily mean that they have a mental illness. Maybe that’s just the way they are and that’s all right!
  
  
• Know the campus and community resources; know your limits; and know when to refer students!
  

Conclusion

Many students in colleges and universities today have many different kinds of psychological disorders for which they may, or may not, be seeking treatment. While the goal of this article is to help you begin to understand the issue, it is also of critical importance that you understand your limitations. As an R.A you are very in tune to the behaviors and personalities of your residents, and you play a critical role in their well being.

Remember this critical point. Never attempt to diagnose! Always share your observations and information as appropriate with your supervisor.

About the Author

Scott is currently the area coordinator of Montour and Schuylkill Halls at Bloomsburg University of Pennsylvania. He also serves as the university's advisor to the Residence Hall Advisory Board. Scott completed his undergraduate work at Lock Haven University of Pennsylvania. He earned a clinical master's degree in Mental Health Counseling at Nova Southeastern University in Ft. Lauderdale, FL where he was a Graduate Assistant in Student Life. He then went on to work as the Assistant Coordinator of Student Activities at Broward Community College's South Campus and then served as a resident director at the University of Pittsburgh.

Scott has presented at regional and national conferences including NACURH at the University of Oklahoma, CAACURH at Carnegie Mellon, and FJCSGA (Florida Junior College Student Government Association) in Tampa, FL. He has also been published in "Student Leader" and "Campus Activities" magazines.