What you’ll learn to do: describe mental health, mental illness, the eight dimensions of wellness, symptoms of common mental disorders, and suicide warning signs

It is only in sorrow bad weather masters us; in joy we face the storm and defy it.

—Amelia Barr, author

By the end of this section, you will be able to describe mental health basics and strategies for imporving mental health.  You will be able to describe depression, eating disorders, and anxiety disorders. You will also be able to identify suicide warning signs and identify resources for further information about mental health issues.

Mental Health and Wellness

Knowing how to take care of your mental health when you’re in college is just as important as maintaining your physical health. In fact, there’s a strong link between the two: doctors are finding that positive mental health can actually improve your physical health.

What is mental health? Mental health can be defined as a state of well-being in which the individual realizes their own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to their community. Having good mental health doesn’t necessarily mean being happy or successful all the time. Most people feel sad, lonely, or anxious now and then, but those with good mental health can take these feelings in stride and overcome them. When such feelings or moods persist and interfere with a person’s ability to function normally, though, it may be a sign of a more serious mental health problem and time to seek help.

The term mental illness refers to mental disorders or health conditions characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress and/or impaired functioning. Depression is one of the most common mental illnesses, affecting more than 264 million people worldwide. It’s also one of the leading causes of disability globally, contributing to the overall burden of disease^[1].

Evidence has shown that mental disorders, especially depressive disorders, are strongly linked to the occurrence and course of many chronic diseases—including diabetes; cancer; cardiovascular disease; asthma; obesity; and many risk behaviors for chronic disease, such as physical inactivity, smoking, excessive drinking, and insufficient sleep. In other words, if your mental health is poor, you may be at greater risk for disease and poor physical health.

Mental Health Indicators

In the public health arena, more emphasis and resources have been devoted to screening, diagnosing, and treating mental illness than mental health. Little has been done to protect the mental health of those who are free from mental illness. There are some known indicators of mental health, including the following:

• emotional well-being: life satisfaction, happiness, cheerfulness, and peacefulness.
• psychological well-being: self-acceptance, personal growth including openness to new experiences, optimism, hopefulness, purpose in life, control of one’s environment, spirituality, self-direction, and positive relationships.
• social well-being: social acceptance, belief in the potential of people and society as a whole, personal self-worth and usefulness to society, and a sense of community.

The former surgeon general suggests that there are social determinants of mental health—just as there are social determinants of general health—that need to be in place to support mental health. These determinants include adequate housing, safe neighborhoods, equitable jobs and wages, quality education, and equity in access to quality health care.

There are also some common-sense strategies that you can adopt to support and improve your emotional, psychological, and social health. Not surprisingly, they are very similar to the strategies one uses to cope with stress:

• Eat a balanced diet.
• Get enough sleep.
• Get regular physical activity.
• Stay socially connected with friends and family.
• Make smart choices about alcohol and drugs.
• Get help if you are anxious or depressed.

The Eight Dimensions of Wellness

When we think about our health, there are many aspects that contribute to our overall wellness. A popular model revolves around the eight dimensions of wellness pictured here:SAMSHA, which stands for substance abuse and mental health services administration, developed a wellness initiative focusing on these areas. You may notice some aspects of wellness wheel were covered in other areas in the course. Their dimensions and brief descriptions are as follows:

Emotional: coping effectively with life and creating satisfying relationships
Spiritual: expanding our sense of purpose and meaning in life
Intellectual: using creative abilities and finding ways to expand knowledge and skills
Physical: recognizing the need for physical activity, diet, sleep, nutrition
Occupational: personal satisfaction and enrichment derived from one’s work
Financial: satisfaction with current and future financial situations
Environmental: good health by occupying pleasant, stimulating environments that support well-being
Social: developing a sense of connection, belonging, and a well-developed support system^[2][3]

Review your areas in more detail and evaluate them using the J. Flowers Health Institute Wellness Wheel Worksheet. What are some of your strengths and weaknesses? What improvements can you make to your wellness wheel to feel more balanced in life?

Depression and Loneliness

Depression

Depression is a common but serious mood disorder that’s more than just a feeling of being down in the dumps or blue for a few days. It causes severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working. To be diagnosed with depression, the symptoms must be present for at least two weeks.

If you have been experiencing some of the following signs and symptoms most of the day, nearly every day, for at least two weeks, you may be suffering from depression:

• persistent sad, anxious, or empty mood
• feelings of hopelessness or pessimism
• irritability
• feelings of guilt, worthlessness, or helplessness
• loss of interest or pleasure in hobbies and activities
• decreased energy or fatigue
• moving or talking more slowly
• feeling restless or having trouble sitting still
• difficulty concentrating, remembering, or making decisions
• difficulty sleeping, early-morning awakening, or oversleeping
• appetite and/or weight changes
• thoughts of death or suicide or suicide attempts
• aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment

Depression is one of the most common mental disorders in the United States. Current research suggests that depression is caused by a combination of genetic, biological, environmental, and psychological factors. It usually starts between the ages of fifteen and thirty, and is much more common in women. Parents can also get postpartum depression after the birth of a baby. Some people get seasonal affective disorder in the winter, when there is less natural sunlight. Depression is part of bipolar disorder.

Even the most severe cases of depressions can be treated. The earlier that treatment can begin, the more effective it is. Depression is usually treated with medications, psychotherapy, or a combination of the two.

There are days that you will feel down, especially when the demands of college get to you. These feelings are normal and will go away. If you are feeling low, try to take a break from the pressures of college and do something you enjoy. Spend time with friends, exercise, read a good book, listen to music, watch a movie, call a friend, talk to your family, or anything else that makes you feel good. FSW students should consider joining the Active Minds Club; a Registered Student Organization on campus that aims to raise awareness about mental health issues and decrease the stigma.  If you feel depressed for two weeks, or the feeling keeps coming back, visit the FSW Mental Health Care page at this link FSW Mental Health.  There, you will find immediate support to help you manage your concerns as well as resources and information on managing your long-term emotional health.

Loneliness

Most people experience occasional loneliness, and it’s an especially common experience among first-time college students, who may find themselves in an unfamiliar environment with a completely new social scene. Loneliness isn’t necessarily about being alone—you can be surrounded by people and still feel alone. It’s the feeling of being alone that counts, along with feeling empty, unwanted, or isolated.

Emery Bergmann depicts this common phenomena in a video she made about transitioning to college when she was a freshman at Cornell University. The video went viral and she eventually wrote the article “Advice from a Formerly Lonely College Student” that was published in the New York Times.

It’s important to distinguish the difference between being alone versus feeling lonely. Having solitude and enjoying one’s own company is a different experience from loneliness. It can be very useful, productive, and affirming to have the time to oneself to get things done and to reflect. Here are some examples of how one may feel in each state^[4]:

Zaid Dahhaj gives insight into how you can transform negative thoughts about alone time to more positive ones in the article, “Here’s Why You’re Confusing Alone Time with Loneliness.” He suggests you can create a love for alone time by embracing the present moment, practicing alone time, being compassionate with yourself, learning mindfulness meditation, and doing things you enjoy.

In the following Ted Talk, Sherrie Turkle describes how, in this age of near-constant digital connection, loneliness is a challenge that faces us all:

You can view the transcript for “Connected, but alone? | Sherry Turkle” here (opens in new window).

If you’re feeling lonely, try taking Turkle’s advice and start a conversation with someone. College is a great place to meet new people and develop new and interesting relationships. Others in college are new, just like you, and will welcome the chance to connect with and get to know another classmate. Try joining a campus interest group or club, play a team sport, or just ask another student if they’d like to meet for coffee or to study.

If feelings of loneliness persist, and especially if you also feel depressed, you should get help from FSW Care Services or other counselor.

Suicidal Behavior

Suicide causes immeasurable pain, suffering, and loss to individuals, families, and communities nationwide.

Suicide rates increased thirty-three percent between 1999 and 2019, with a small decline in 2019 and even greater decline in 2020 during the COVID-19 pandemic. Suicide was the twelfth leading cause of death in 2020 and claimed the lives of 44,834 people^[5]. The preliminary data from the CDC showing the sharpest decline in suicide rates in the United States in 2020 was surprising considering the increases reported in depression, anxiety, and substance abuse during this time. While more research is forthcoming, experts believe that the decline in suicides may be due to people coming together during crises like global epidemics and war. Additionally, people felt more comfortable talking about their emotions, and seeking mental health services may have been viewed as more acceptable (and for some, more accessible via telehealth) during this crisis.^[6].

Suicide can affect people of all ages. It is the second leading cause of death for people ages ten to thirty-four, the fourth leading cause among people ages thirty-four to fifty-four, and the fifth leading cause among people ages forty-five to fifty-four. Suicide rates vary by race/ethnicity, age, and other demographic factors. The highest rates are among American Indian/Alaska Native and non-Hispanic, White populations. Other Americans with higher than average rates of suicide are veterans, people who live in rural areas, and workers in certain industries and occupations like mining and construction. Young people who are lesbian, gay, or bisexual have a higher rate of suicidal ideation and behavior compared to their peers who identify as heterosexual.^[7] But suicide is preventable, so it’s important to know what to do.

Watch this TEDx talk by Jack Park where he discusses his experience with mental illness and suicidality and how he got help. One of his coping strategies for dealing with college stress was changing his to-do list to a want-to-do list. He emphasizes self-care for our mental health.

Warning Signs of Suicide

If someone you know is showing one or more of the following behaviors, they may be thinking about suicide. Don’t ignore these warning signs. Get help immediately.

• talking about wanting to die or to kill oneself
• looking for a way to kill oneself
• talking about feeling hopeless or having no reason to live
• talking about feeling trapped or in unbearable pain
• talking about being a burden to others
• increasing the use of alcohol or drugs
• acting anxious or agitated; behaving recklessly
• sleeping too little or too much
• withdrawing or feeling isolated
• showing rage or talking about seeking revenge
• displaying extreme mood swings

Get Help

If you or someone you know needs help, call the National Suicide Prevention Lifeline at 1.800.273.TALK (8255) or use their lifeline chat at 988.  Trained crisis workers are available to talk twenty-four hours a day, seven days a week. If you think someone is in immediate danger, do not leave them alone—stay there and call 911.

Finally, life saving Mental Health First Aid Training is offered throughout Southwest Florida that teaches participants how to recognize signs of mental health or substance use challenges in adults ages 18 and older.  The training teaches participants how to offer and provide initial help and subsequently guide a person toward appropriate care if necessary.    This training is available to anyone who is interested at no cost.  Check with your local Department of Health to find out when the next training is scheduled.

Additional Resources

Crisis Text Line provides free, twenty-four–seven, text-based mental health support and crisis intervention.

Eating Disorders

Eating disorders are mental health illnesses that involve emotional and behavioral disturbance surrounding weight and food issues. The most common are anorexia nervosa, bulimia nervosa, and binge-eating disorder. Eating disorders can have life-threatening consequences and can affect people of any age, gender, race, ethnicity, or socioeconomic status. Full-fledged eating disorders typically begin between eighteen and twenty-one years of age and college helps create the perfect storm for these illnesses.^[8]

Anorexia nervosa is characterized by self-starvation and extreme weight loss either through restriction or through binge-purging. According to The Diagnostic and Statistical Manual of Mental Disorders, there is a restriction of energy intake relative to requirements, in the context of age, sex, developmental trajectory, and physical health; intense fear of gaining weight or becoming fat; and disturbance in the way the one’s body weight or shape is perceived (i.e., misperceptions, evaluations, and not recognizing the seriousness of the low body weight).^[9]

Anorexia nervosa may frequently be a result of body dysmorphic disorder (a condition in which someone feels that their body looks differently than it actually does) or a result of other psychiatric complications, such as OCD or depression. Starvation can cause harm to vital organs such as the heart and brain; can cause nails, hair, and bones to become brittle; and can make the skin dry and sometimes yellow or covered with soft hair. Menstrual periods can become irregular or stop completely. There is a lot of stigma associated with eating disorders and anorexia is no different. Some mistakenly believe that they may not be thin enough to suffer from anorexia. It’s important to note that people can have atypical anorexia, which includes some of the restrictive behaviors and features of anorexia without the low weight. This is currently categorized other specified feeding and eating disorders (OSFED), which is reserved for those who don’t fit into the other categories of eating disorders. Sadly, anorexia nervosa has the highest mortality rate of any psychiatric illness^[10].

People with bulimia nervosa eat large amounts of food (also called bingeing) at least two times a week and then vomit (also called purging) or exercise compulsively. Because many people who binge and purge maintain their body weight, they may keep their problem a secret for years. Vomiting can cause loss of important minerals, life-threatening heart arrhythmia (irregular heartbeat), damage to the teeth, and swelling of the throat. Bulimia can also cause irregular menstrual periods.

People who binge without purging also have a disorder called binge-eating disorder. This disorder is frequently associated with feelings of loss of control and shame surrounding eating. People who are diagnosed with this disorder tend to gain weight, and many will have all the consequences of being overweight, including high blood pressure and other cardiac symptoms, diabetes, and musculoskeletal complaints. Binge-eating disorder is the most common eating disorder in the United States and affects people of all backgrounds.^[11]

The National Eating Disorders Association (NEDA) is the largest non-profit organization focused on supporting those impacted by eating disorders. Watch this video NEDA produced about eating disorders and some common symptoms.

While people may experiment with different diets or ways of eating, particularly in college, it doesn’t necessarily mean someone has an eating disorder. There is a spectrum of what would be considered an eating disorder versus disordered eating. “Not everyone who goes on a diet will develop a formal disorder,” explains Dr. Bunnell. “The difference is a function of latent vulnerabilities and genetics. There’s a continuum. At the high end would be anorexia, bulimia, and binge eating disorder, and at the low end you have disordered eating.”

Disordered eating behavior ranges from fad dieting, or attempts at clean eating by restricting fats, dairy, or gluten, to more severe manifestations such as over-exercising, abusing laxatives, bingeing, or purging, which are serious but don’t yet meet the criteria for an eating disorder.^[12]

If you think you might have an eating disorder, you should contact FSW Cares, your health care provider, or other counseling center and get help. Talk with your family and close friends. Going for help and talking to others about your feelings and illness can be very difficult, but it’s the only way that you’re going to get better. Many colleges have treatment programs for these conditions and trained counselors who can relate to people with an eating disorder.

Anxiety, Obsessive-Compulsive Disorder, and Post-Traumatic Stress Disorder

People with anxiety disorders respond to certain objects or situations with fear and dread. They have physical reactions to those objects, such as a rapid heartbeat and sweating. An anxiety disorder is diagnosed if a person

• has an inappropriate response to a situation.
• cannot control the response.
• has an altered way of life due to the anxiety.

Common anxiety disorders include the following.

Generalized anxiety disorder (GAD) is not just normal worry or anxiety. It’s excessive anxiety and worry that are present more days than not for at least six months about a variety of situations, such as home, work, school, and/or relationships. If you have GAD, you cannot seem to shut off the worry and intrusive thoughts. You may experience physical symptoms such as restlessness, being easily tired, difficulty concentrating, irritability, muscle tension, and/or disturbances in sleep.^[13]

Panic disorder is a kind of anxiety disorder that causes panic attacks. Panic attacks are sudden feelings of terror for no reason. You may also feel physical symptoms, such as

• fast heartbeat
• chest pain
• breathing difficulty
• dizziness.

Panic attacks can happen anytime, anywhere, and without warning. You may live in fear of another attack and may avoid places where you have had an attack. For some people, fear takes over their lives and they cannot leave their homes. Panic disorder is more common in women than men. It usually starts when people are young adults. Sometimes it starts when a person is under a lot of stress. Most people get better with treatment. Therapy can show you how to recognize and change your thinking patterns before they lead to panic. Medicines can also help.

A phobia is a strong, irrational fear of something that poses little or no actual danger. There are many specific phobias. Acrophobia is a fear of heights. You may be able to ski the world’s tallest mountains but be unable to go above the fifth floor of an office building. Agoraphobia is a fear of public places, and claustrophobia is a fear of closed-in places. If you become anxious and extremely self-conscious in everyday social situations, you could have a social phobia. Other common phobias involve tunnels, highway driving, water, flying, animals, and blood. People with phobias try to avoid what they are afraid of. If they cannot, they may experience

• panic and fear.
• rapid heartbeat.
• shortness of breath.
• trembling.
• a strong desire to get away.

Treatment helps most people with phobias. Options include medicines, therapy or both.

Other disorders that used to be classified as anxiety disorders but now are in their own respective categories in the Diagnostic and Statistical Manual of Mental Disorders are obsessive-compulsive disorder and post-traumatic stress disorder.

Obsessive-compulsive disorder (OCD) is marked by repeated, upsetting thoughts called obsessions. You do the same thing over and over again to try to make the thoughts go away. Those repeated actions are called compulsions. Examples of obsessions are a fear of germs or a fear of being hurt. Compulsions include washing your hands, counting, checking on things, or cleaning. Untreated, OCD can take over your life. Researchers think brain circuits may not work properly in people who have OCD. It tends to run in families. The symptoms often begin in children or teens. Treatments that combine medicines and therapy are often effective.

Post-traumatic stress disorder (PTSD) is a real illness. You can get PTSD after living through or witnessing a traumatic event, such as war, a hurricane, rape, physical abuse, or a bad accident. PTSD makes you feel stressed and afraid after the danger is over. It affects your life and the people around you. PTSD can cause problems like

• flashbacks, or feeling like the event is happening again.
• trouble sleeping or nightmares.
• feeling alone.
• angry outbursts.
• feeling worried, guilty, or sad.

PTSD starts at different times for different people. Signs of PTSD may start soon after a frightening event and then continue. Other people develop new or more severe signs months or even years later. PTSD can happen to anyone, even children.

Medicines can help you feel less afraid and tense. It might take a few weeks for them to work. Talking to a specially trained doctor or counselor also helps many people with PTSD. This kind of treatment is called talk therapy.