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Borderline Personaility Disorder

The following article is from the National Institute of Mental Health (NIMH). While this material has been expert-reviewed, it is not NIMH or MHANYS intention to provide specific medical advice. Both MHANYS and NIMH advise readers to consult with a qualified health care provider for diagnosis, treatment, and answers to personal questions.

What is borderline personality disorder?

Borderline personality disorder is a mental illness that severely impacts a person’s ability to manage their emotions. This loss of emotional control can increase impulsivity, affect how a person feels about themselves, and negatively impact their relationships with others. Effective treatments are available that can help people manage the symptoms of borderline personality disorder.

What are the signs and symptoms of borderline personality disorder?

People with borderline personality disorder may experience intense mood swings and feel uncertainty about how they see themselves. Their feelings for others can change quickly, and swing from extreme closeness to extreme dislike. These changing feelings can lead to unstable relationships and emotional pain.

People with borderline personality disorder also tend to view things in extremes, such as all good or all bad. Their interests and values can change quickly, and they may act impulsively or recklessly.

Other signs or symptoms may include:

  • Efforts to avoid real or perceived abandonment, such as plunging headfirst into relationships—or ending them just as quickly.
  • A pattern of intense and unstable relationships with family, friends, and loved ones.
  • A distorted and unstable self-image or sense of self.
  • Impulsive and often dangerous behaviors, such as spending sprees, unsafe sex, substance misuse, reckless driving, and binge eating. However, if these behaviors happen mostly during times of elevated mood or energy, they may be symptoms of a mood disorder and not borderline personality disorder.
  • Self-harming behavior, such as cutting.
  • Recurring thoughts of suicidal behaviors or threats.
  • Intense and highly variable moods, with episodes lasting from a few hours to a few days.
  • Chronic feelings of emptiness.
  • Inappropriate, intense anger or problems controlling anger.
  • Feelings of dissociation, such as feeling cut off from oneself, observing oneself from outside one’s body, or feelings of unreality.

Not everyone with borderline personality disorder will experience all of these symptoms. The severity, frequency, and duration of symptoms depend on the person and their illness.

People with borderline personality disorder have a significantly higher rate of self-harming and suicidal behavior than the general population.

If you or someone you know is struggling or having thoughts of suicide, call or text the 988 Suicide and Crisis Lifeline  at 988 or chat at 988lifeline.org . In life-threatening situations, call 911.

What are the risk factors for borderline personality disorder?

Studies suggest that genetic, environmental, and social factors may increase the likelihood of developing borderline personality disorder. These factors may include:

  • Family history: People who have a close family member (such as a parent or sibling) with the illness may be more likely to develop borderline personality disorder due to shared genetic factors.
  • Brain structure and function: Research shows that people with borderline personality disorder may have structural and functional changes in the brain, especially in areas that control impulses and emotion regulation. However, it is not clear whether these changes led to the disorder or were caused by the disorder.
  • Environmental, cultural, and social factors: Many people with borderline personality disorder report having experienced traumatic life events, such as abuse, abandonment, or hardship, during childhood. Others may have experienced unstable, invalidating relationships or conflicts.

How is borderline personality disorder diagnosed?

A licensed mental health professional—such as a psychiatrist, psychologist, or clinical social worker—can diagnose borderline personality disorder based on a thorough evaluation of a person’s symptoms, experiences, and family medical history. A careful and thorough medical exam can help rule out other possible causes of symptoms.

Borderline personality disorder is usually diagnosed in late adolescence or early adulthood. Occasionally, people younger than age 18 may be diagnosed with borderline personality disorder if their symptoms are significant and last at least 1 year.

What other illnesses can co-occur with borderline personality disorder?

Borderline personality disorder often occurs with other mental illnesses, such as post-traumatic stress disorder (PTSD). These co-occurring disorders can make it harder to correctly diagnose and treat borderline personality disorder, especially when the disorders have overlapping symptoms. For example, a person with borderline personality disorder also may be more likely to experience symptoms of major depression, PTSD, bipolar disorder, anxiety disorders, substance use disorder, or eating disorders.

How is borderline personality disorder treated?

With evidence-based treatment, many people with borderline personality disorder experience fewer and less severe symptoms, improved functioning, and better quality of life. It is important for people with borderline personality disorder to receive treatment from a licensed mental health professional.

It can take time for symptoms to improve after treatment begins. It is important for people with borderline personality disorder and their loved ones to be patient, stick with the treatment plan, and seek support during treatment.

Some people with borderline personality disorder may need intensive, often inpatient, care to manage severe symptoms, while others may be able to manage their symptoms with outpatient care.

Psychotherapy

Psychotherapy (sometimes called talk therapy) is the main treatment for people with borderline personality disorder. Most psychotherapy occurs with a licensed, trained mental health professional in one-on-one sessions or with other people in group settings. Group sessions can help people with borderline personality disorder learn how to interact with others and express themselves effectively.

  • Dialectical behavior therapy (DBT) was developed specifically for people with borderline personality disorder. DBT uses concepts of mindfulness or awareness of one’s present situation and emotional state. DBT also teaches skills to help people manage intense emotions, reduce self-destructive behaviors, and improve relationships.
  • Cognitive behavioral therapy (CBT) can help people with borderline personality disorder identify and change core beliefs and behaviors that come from inaccurate perceptions and problems interacting with others. CBT may help people reduce mood swings and anxiety symptoms and may reduce the number of self-harming or suicidal behaviors.

Medications

The benefits of mental health medications for borderline personality disorder are unclear and medications aren’t typically used as the main treatment for the illness. In some cases, a psychiatrist may recommend medications to treat specific symptoms or co-occurring mental disorders such as mood swings or depression. Treatment with medications may require coordinated care among several health care providers.

Medications can sometimes cause side effects in some people. Talk to your health care provider about what to expect from a particular medication. To find the latest information about medications, talk to a health care provider and visit the Food and Drug Administration website .

Therapy for caregivers and family members

More research is needed to determine how well family therapy helps with borderline personality disorder. Studies on other mental disorders show that including family members can help support a person’s treatment. Families and caregivers also can benefit from therapy.

Family therapy helps by:

  • Allowing people to develop skills to understand and support a loved one with borderline personality disorder
  • Focusing on the needs of family members to help them understand the obstacles and strategies for caring for their loved one

How can I find help for borderline personality disorder?

If you’re not sure where to get help, a health care provider can refer you to a licensed mental health professional, such as a psychiatrist or psychologist with experience treating borderline personality disorder.

The Substance Abuse and Mental Health Services Administration has an online treatment locator  to help you find mental health services in your area.

Here are some ways to help a friend or family member with borderline personality disorder:

  • Take time to learn about the illness to understand what your friend or relative is experiencing.
  • Offer emotional support, understanding, patience, and encouragement. Change can be difficult and frightening to people with borderline personality disorder, but things can improve over time.
  • Encourage your loved one in treatment for borderline personality disorder to ask about family therapy.
  • Seek counseling for yourself. Choose a different therapist than the one your relative is seeing.

Handouts

Borderline Personality Disorder EnglishEspañol   5 Action Steps for Helping Someone in Emotional Pain EnglishEspañol

FAQs About SuicideEnglishEspañol   Warning Signs of Suicide EnglishEspañol


Mental Health Association in New York State (MHANYS) has additional resources that can be accessed through its main website. These resources include links to advocacy and policy work, school-based programs, mental health wellness training programs and more.

MHANYS
mhanys.org

Advocacy and Policy
mhanys.org/advocacy-policy

Mental Health Community Partners
mhcommunitypartners.org

CarePath™
mhanys.org/carepath

SMHRT: Family Education
https://www.mentalhealthednys.org/family-education-webinar-series/


Data Source
National Institute of Mental Health: Mental Health Information Health Topics www.nimh.nih.gov/health/topics

Technology and the Future of Mental Health Treatment

The following article on Anxiety Disorders is from the National Institute of Mental Health (NIMH). While this material has been expert-reviewed, it is not NIMH or MHANYS intention to provide specific medical advice. Both MHANYS and NIMH advise readers to consult with a qualified health care provider for diagnosis, treatment, and answers to personal questions.

How is technology used for mental health treatment?

Technology has opened a new frontier in mental health care and data collection. Mobile devices like cell phones, smartphones, and tablets are giving the public, health care providers, and researchers new ways to access help, monitor progress, and increase understanding of mental well-being.

Mobile mental health support can be very simple but effective. For example, anyone with a phone or computer can call, text, or chat the 988 Suicide and Crisis Lifeline  at any time.

New technology can also be packaged into an extremely sophisticated app for smartphones or tablets. Such apps might use the device’s built-in sensors to collect information on a user’s typical behavior patterns. Then, if the app detects a change in behavior, it can signal that help is needed before a crisis occurs.

Some apps are stand-alone programs designed to improve memory or thinking skills. Other apps help people connect to a peer counselor or a health care professional.

Excitement about the huge range of opportunities technology offers for mental health treatment has led to a burst of development. Thousands of mental health apps are available in iTunes and Android app stores, and the number is growing every year. However, this new technology frontier includes a lot of uncertainty. There is very little industry regulation and very little information on app effectiveness, which can lead people to wonder which apps they should trust.

Before focusing on the state of the science and where it may lead, it’s important to look at the advantages and disadvantages of expanding mental health treatment and research into a mobile world.

What are the pros and cons of mental health apps?

Mental health apps and other technology have a lot of potential, both for people seeking mental health care and mental health professionals providing such services. Some advantages of mobile care technology include the following.

  • Convenience: Allows treatment to take place anytime and anywhere, such as at home in the middle of the night or on a bus on the way to work, making it ideal for people who have trouble getting to in-person appointments
  • Anonymity: Lets people receive treatment anonymously and privately from the comfort of their homes
  • Introduction to care: Acts as a good first step for people who have been reluctant to seek mental health care in the past
  • Lower cost: Makes care more affordable through apps that are free or cheaper than traditional in-person care
  • Greater outreach: Helps mental health professionals offer treatment to people in remote areas or to large numbers of people in times of sudden need, like after a natural disaster or traumatic event
  • Interest: Encourages people to continue therapy by making care more appealing and accessible than traditional in-person treatment
  • 24-hour service: Provides around-the-clock monitoring or intervention support
  • Consistency: Offers the same treatment program to all people
  • Support: Complements traditional therapy by extending in-person sessions, reinforcing new skills, and providing support and monitoring
  • Data collection: Collects information, such as location, movement, phone use, and other data

Mental health technology offers great opportunities but also raises concerns. Addressing potential problems will be essential to ensuring that new apps provide benefits without causing harm. Although apps are becoming more appealing and user-friendly, we need more information on their effectiveness.

The following are some limitations of the technology that researchers and developers are trying to answer questions about.

  • Effectiveness: Is the app supported by scientific evidence showing that it works and works as well as traditional in-person methods?
  • Audience: Does the app work equally well for all people it is meant to help?
  • Privacy: How does the app maker guarantee users’ privacy, considering many apps deal with sensitive personal information?
  • Guidance: How do people determine if an app is effective when no industry-wide standards exist for evaluating quality?
  • Regulation: Who should regulate mental health technology and the data it generates?
  • Overselling: Does the app promise more than it delivers and turn people away from using other, more effective therapies?

What are current trends in app development?

Research and engineering teams are combining their skills to address a wide range of mental health concerns. For instance, intervention apps may help people quit smoking; manage symptoms of anxiety, depression, eating disorders, post-traumatic stress, or insomnia; and more. Some popular areas of app development include the following.

Self-management

Self-management apps involve people putting information into the app to receive feedback. For example, they might use the app to set medication reminders or access tools for managing stress, anxiety, or sleep problems. Some software can use additional equipment to track heart rate, breathing patterns, blood pressure, and so forth to help people monitor their progress and receive feedback.

Improve thinking skills

Cognitive remediation apps help people improve their thinking skills. These apps are often designed for people with serious mental illnesses who may have distorted or unhelpful ways of thinking or hold inaccurate beliefs.

Skill training

Skill training apps may feel more like games than other mental health apps as they help people learn new coping or thinking skills. These apps might involve watching an educational video about anxiety management or the importance of social support, for example. People then pick new strategies to try and use the app to track how often they practice those new skills.

Illness management and supported care

Illness management and supported care apps provide additional support by allowing people to interact with another person. The app may connect people with peer support or send information to a trained health care provider who can offer guidance and therapy options. Researchers are working to learn how much human interaction people need for app-based treatments to be effective.

Passive symptom tracking

Symptom tracking apps collect data using the sensors built into smartphones. The sensors might record movement patterns, social interactions (such as the number of texts and phone calls), behavior at different times of day, vocal tone and speed, and more. In the future, apps may be able to analyze these data to determine a person’s real-time state of mind. Such apps may also recognize changes in behavior patterns that signal an episode of mania, depression, or psychosis before it occurs. Although an app may not replace a mental health professional, it can alert caregivers when someone needs additional help. The goal is to create apps that support a range of people, including those with serious mental illnesses.

Data collection

Data collection apps gather data without any help from the person using them. Receiving widescale information from many people at the same time can increase researchers’ understanding of mental health and help them develop better interventions.

Conducting research

Apps can help conduct research. For example, Dr. Patricia Areán’s pioneering BRIGTHEN study showed that research via a smartphone app is a reality. The BRIGHTEN study was remarkable because it used technology to both deliver treatment and conduct research. In other words, the research team used technology to recruit, screen, enroll, treat, and assess participants. BRIGHTEN was especially exciting because the study showed that technology can be an efficient way to test promising new treatments, while also highlighting the need to make those treatments engaging.

If you or someone you know is struggling or having thoughts of suicide, call or text the 988 Suicide and Crisis Lifeline  at 988 or chat at 988lifeline.org . In life-threatening situations, call 911.

Who creates mental health apps?

Developing mental health apps and other technology requires a partnership between mental health professionals and software engineers. Researchers have found that interventions are most effective when people like them, are engaged in them, and want to continue using them. Behavioral health apps work best when they combine engineers’ skills for making an app easy to use and entertaining with providers’ skills for providing effective treatment options. Researchers and engineers are developing and testing apps that do everything from manage medications to teach coping skills to predict when someone may need emotional help.

Who evaluates mental health apps?

There are no review boards, checklists, or widely accepted rules for evaluating or choosing a mental health app or other technology. Most apps do not have peer-reviewed research to support their claims, and it is unlikely that every mental health app will go through a randomized clinical research trial to test its effectiveness. One reason is that testing is a slow process, and technology evolves quickly. By the time an app has been put through rigorous scientific testing, the original technology may be outdated.

Currently, there are no national standards for evaluating the effectiveness of the hundreds of available mental health apps. People should be cautious about trusting an app. However, there are a few suggestions for finding an app that may work for you:

  • Ask a trusted health care provider for a recommendation. Some larger providers may offer several apps and collect data on their use.
  • Check to see if the app offers recommendations for what to do if symptoms get worse or there is a psychiatric emergency. Know how to get help if needed.
  • Decide if you want an app that is completely automated versus an app that offers opportunities for contact with a trained professional.
  • Search for information on the app developer, including their credentials and experience. 
  • Beware of misleading logos. The National Institute of Mental Health (NIMH) has not developed and does not endorse any apps. However, some app developers have unlawfully used the NIMH logo to market their products.
  • Search the PubMed database  offered by the National Library of Medicine. This resource contains articles on a wide range of research topics, including mental health app development.
  • If you cannot find information about a particular app, check to see if the app is based on a treatment that has been tested. For example, research has shown that internet-based cognitive behavior therapy (CBT) is as effective as conventional CBT for disorders that include depression, anxiety, social anxiety disorder, and panic disorder.
  • Try it. If you’re interested in an app, test it for a few days and decide if it’s easy to use, holds your attention, and is something you want to continue using. An app is only effective if it keeps you engaged.

Mental Health Association in New York State (MHANYS) has additional resources that can be accessed through its main website. These resources include links to advocacy and policy work, school-based programs, mental health wellness training programs and more.

MHANYS
mhanys.org

Advocacy and Policy
mhanys.org/advocacy-policy

Mental Health Community Partners
mhcommunitypartners.org

CarePath™
mhanys.org/carepath

SMHRT: Family Education
https://www.mentalhealthednys.org/family-education-webinar-series/


Data Source
National Institute of Mental Health: Mental Health Information Health Topics www.nimh.nih.gov/health/topics

Obsessive-Compulsive Disorder

The following article on Anxiety Disorders is from the National Institute of Mental Health (NIMH). While this material has been expert-reviewed, it is not NIMH or MHANYS intention to provide specific medical advice. Both MHANYS and NIMH advise readers to consult with a qualified health care provider for diagnosis, treatment, and answers to personal questions.

Overview

Obsessive-compulsive disorder (OCD) is a common, chronic, and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (“obsessions”) and/or behaviors (“compulsions”) that he or she feels the urge to repeat over and over.

Signs and Symptoms

People with OCD may have symptoms of obsessions, compulsions, or both. These symptoms can interfere with all aspects of life, such as work, school, and personal relationships.

Obsessions are repeated thoughts, urges, or mental images that cause anxiety. Common symptoms include:

  • Fear of germs or contamination
  • Unwanted forbidden or taboo thoughts involving sex, religion, or harm
  • Aggressive thoughts towards others or self
  • Having things symmetrical or in a perfect order

Compulsions are repetitive behaviors that a person with OCD feels the urge to do in response to an obsessive thought. Common compulsions include:

  • Excessive cleaning and/or handwashing
  • Ordering and arranging things in a particular, precise way
  • Repeatedly checking on things, such as repeatedly checking to see if the door is locked or that the oven is off
  • Compulsive counting

Not all rituals or habits are compulsions. Everyone double checks things sometimes. But a person with OCD generally:

  • Can’t control his or her thoughts or behaviors, even when those thoughts or behaviors are recognized as excessive
  • Spends at least 1 hour a day on these thoughts or behaviors
  • Doesn’t get pleasure when performing the behaviors or rituals, but may feel brief relief from the anxiety the thoughts cause
  • Experiences significant problems in their daily life due to these thoughts or behaviors

Some individuals with OCD also have a tic disorder. Motor tics are sudden, brief, repetitive movements, such as eye blinking and other eye movements, facial grimacing, shoulder shrugging, and head or shoulder jerking. Common vocal tics include repetitive throat-clearing, sniffing, or grunting sounds.

Symptoms may come and go, ease over time, or worsen. People with OCD may try to help themselves by avoiding situations that trigger their obsessions, or they may use alcohol or drugs to calm themselves. Although most adults with OCD recognize that what they are doing doesn’t make sense, some adults and most children may not realize that their behavior is out of the ordinary. Parents or teachers typically recognize OCD symptoms in children.

If you think you have OCD, talk to your health care provider about your symptoms. If left untreated, OCD can interfere in all aspects of life.

Risk Factors

OCD is a common disorder that affects adults, adolescents, and children all over the world. Most people are diagnosed by about age 19, typically with an earlier age of onset in boys than in girls, but onset after age 35 does happen.

The causes of OCD are unknown, but risk factors include:

Genetics

Twin and family studies have shown that people with first-degree relatives (such as a parent, sibling, or child) who have OCD are at a higher risk for developing OCD themselves. The risk is higher if the first-degree relative developed OCD as a child or teen. Ongoing research continues to explore the connection between genetics and OCD and may help improve OCD diagnosis and treatment.

Brain Structure and Functioning

Imaging studies have shown differences in the frontal cortex and subcortical structures of the brain in patients with OCD. There appears to be a connection between the OCD symptoms and abnormalities in certain areas of the brain, but that connection is not clear. Research is still underway. Understanding the causes will help determine specific, personalized treatments to treat OCD.

Environment

An association between childhood trauma and obsessive-compulsive symptoms has been reported in some studies. More research is needed to understand this relationship better.

In some cases, children may develop OCD or OCD symptoms following a streptococcal infection—this is called Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS). 

Treatments and Therapies

OCD is typically treated with medication, psychotherapy, or a combination of the two. Although most patients with OCD respond to treatment, some patients continue to experience symptoms.

Sometimes people with OCD also have other mental disorders, such as anxiety, depression, and body dysmorphic disorder, a disorder in which someone mistakenly believes that a part of their body is abnormal. It is important to consider these other disorders when making decisions about treatment.

Medication

Serotonin reuptake inhibitors (SRIs), which include selective serotonin reuptake inhibitors (SSRIs) are used to help reduce OCD symptoms.

SRIs often require higher daily doses in the treatment of OCD than of depression and may take 8 to 12 weeks to start working, but some patients experience more rapid improvement.

If symptoms do not improve with these types of medications, research shows that some patients may respond well to an antipsychotic medication. Although research shows that an antipsychotic medication may help manage symptoms for people who have both OCD and a tic disorder, research on the effectiveness of antipsychotics to treat OCD is mixed.

If you are prescribed a medication, be sure you:

  • Talk with your health care provider or a pharmacist to make sure you understand the risks and benefits of the medications you’re taking.
  • Do not stop taking a medication without talking to your health care provider first. Suddenly stopping a medication may lead to “rebound” or worsening of OCD symptoms. Other uncomfortable or potentially dangerous withdrawal effects are also possible.
  • Report any concerns about side effects to your health care provider right away. You may need a change in the dose or a different medication.
  • Report serious side effects to the U.S. Food and Drug Administration (FDA) MedWatch Adverse Event Reporting program online  or by phone at 1-800-332-1088. You or your health care provider may send a report.

Other medications have been used to treat OCD, but more research is needed to show the benefit of these options. For the most up-to-date information on medications, side effects, and warnings, visit the FDA website .

Psychotherapy

Psychotherapy can be an effective treatment for adults and children with OCD. Research shows that certain types of psychotherapy, including cognitive behavior therapy (CBT) and other related therapies (e.g., habit reversal training) can be as effective as medication for many individuals. Research also shows that a type of CBT called Exposure and Response Prevention (EX/RP)—spending time in the very situation that triggers compulsions (e.g. touching dirty objects) but then being prevented from undertaking the usual resulting compulsion (e.g. handwashing)—is effective in reducing compulsive behaviors in OCD, even in people who did not respond well to SRI medication.

As with most mental disorders, treatment is usually personalized and might begin with either medication or psychotherapy, or with a combination of both. For many patients, EX/RP is the add-on treatment of choice when SRIs or SSRIs medication does not effectively treat OCD symptoms or vice versa for individuals who begin treatment with psychotherapy.

Other Treatment Options

In 2018, the FDA approved  Transcranial Magnetic Stimulation (TMS) as an adjunct in the treatment of OCD in adults.

NIMH is supporting research into other new treatment approaches for people whose OCD does not respond well to the usual therapies. These new approaches include combination and add-on (augmentation) treatments, as well as novel techniques such as deep brain stimulation.

Finding Treatment

For general information on mental health and to locate treatment services in your area, call the Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Referral Helpline at 1-800-662-HELP (4357). SAMHSA also has a Behavioral Health Treatment Locator  on its website that can be searched by location.

Handouts

Obessive-Compulsize Disorder - When Unwanted Thoughts or Repetitive Behaviors Take OverEnglish / Español    PANDAS - Questions and Answers English / Español


Mental Health Association in New York State (MHANYS) has additional resources that can be accessed through its main website. These resources include links to advocacy and policy work, school-based programs, mental health wellness training programs and more.

MHANYS
mhanys.org

Advocacy and Policy
mhanys.org/advocacy-policy

Mental Health Community Partners
mhcommunitypartners.org

CarePath™
mhanys.org/carepath

SMHRT: Family Education
https://www.mentalhealthednys.org/family-education-webinar-series/


Data Source
National Institute of Mental Health: Mental Health Information Health Topics www.nimh.nih.gov/health/topics

HIV and AIDS and Mental Health

The following article on Anxiety Disorders is from the National Institute of Mental Health (NIMH). While this material has been expert-reviewed, it is not NIMH or MHANYS intention to provide specific medical advice. Both MHANYS and NIMH advise readers to consult with a qualified health care provider for diagnosis, treatment, and answers to personal questions.

What is HIV?

HIV, or human immunodeficiency virus, is the virus that causes AIDS (acquired immunodeficiency syndrome). HIV can be transmitted during sexual intercourse, by sharing syringes, or during pregnancy, childbirth, or breastfeeding.

HIV weakens the immune system by destroying CD4+ T cells, a type of white blood cell that is important for fighting off infections. The loss of these cells means that people living with HIV are more vulnerable to other infections and diseases.

Today, effective anti-HIV medications allow people with HIV to lead long, healthy lives. When taken as prescribed, these daily medications, called antiretroviral therapy (ART), can suppress the amount of virus in the blood to a level so low that it is undetectable by standard tests.

Why are people with HIV and AIDS at a higher risk for mental disorders?

The stress associated with living with a serious illness or condition, such as HIV, can affect a person’s mental health. People with HIV have a higher chance of developing mood, anxiety, and cognitive disorders. For example, depression is one of the most common mental health conditions faced by people with HIV.

It is important to remember that mental disorders are treatable. People who have a mental disorder can recover.

HIV and related infections can also affect the brain and the rest of the nervous system. This may change how a person thinks and behaves. Also, some medications used to treat HIV may have side effects that affect a person’s mental health.

Situations that can contribute to mental health problems for anyone: 

  • Having trouble getting mental health services
  • Experiencing a loss of social support, resulting in isolation
  • Experiencing a loss of employment or worries about being able to perform at work
  • Dealing with loss, including the loss of relationships or the death of loved ones

In addition, people with HIV include may also experience situations that negatively impact their mental health, such as: 

  • Having to tell others about an HIV diagnosis
  • Managing HIV medicines and medical treatment
  • Facing stigma and discrimination associated with HIV/AIDS

Understanding how living with HIV can affect mental health and knowing what resources are available can make it easier for people to manage their overall health and well-being.

What other complications can be caused by HIV?

HIV causes significant inflammation in the body. This inflammation can cause neurological complications by damaging the spinal cord and brain, which form the central nervous system.

Despite effective ART, people with HIV are still at risk for central nervous system diseases associated with HIV. These diseases can be neurological (affecting the nervous system) or neurocognitive (affecting cognition or mental processing).

Severe neurological impairments such as dementia, brain atrophy, and encephalitis (inflammation of the brain) are less common in people who use ART, compared to people with HIV who are not on ART. However, there are still less severe forms of central nervous system diseases associated with HIV.

Researchers are working to better understand how HIV affects the central nervous system. This information will be helpful to develop new treatments to improve the lives of people with HIV. Understanding which types of cells in the central nervous system are targeted by the HIV infection and how those cells are damaged may help shape efforts to prevent, treat, and cure HIV.

Research efforts also focus on understanding why HIV is harder to eliminate in some tissues in the body and what strategies might be more effective on those cells.

How can people with HIV improve their mental health?

Research shows that HIV treatment should begin as soon as possible after diagnosis to achieve the best health outcomes. Following a treatment plan, such as taking the medications prescribed by a health care provider, is critical for controlling and suppressing the virus.

Following the treatment plan can be difficult, but there are strategies that can help  such as following a treatment plan, creating a routine, setting an alarm, and downloading a reminder app on a smartphone.

Starting ART can affect mental health in different ways. Sometimes ART can relieve anxiety because knowing that you are taking care of yourself can provide a sense of security. However, coping with the reality of living with a chronic illness like HIV can be challenging. In addition, some antiretroviral medicines may cause symptoms of depression, anxiety, and sleeplessness and may make some mental health issues worse.

For these reasons, it is important for people with HIV to talk to a health care provider about their mental health before starting ART. These conversations should continue throughout treatment.

People with HIV should talk with their provider about any changes in their mental health , such as thinking or how they feel about themselves and life in general. People with HIV should also discuss any alcohol or substance use  with their provider.

People with HIV should also tell their health care provider about any over-the-counter or prescribed medications they may be taking, including any mental health medications, because some of these drugs may interact with antiretroviral medications.

Federal Resources

Handouts

Chronic Illness and Mental Health - Recognizing and Treating Depression (1) English / Español Tips for Talking with a Health Care Provider About Your Mental Health (1) English / Español

Depression English / Español

 


Mental Health Association in New York State (MHANYS) has additional resources that can be accessed through its main website. These resources include links to advocacy and policy work, school-based programs, mental health wellness training programs and more.

MHANYS
mhanys.org

Advocacy and Policy
mhanys.org/advocacy-policy

Mental Health Community Partners
mhcommunitypartners.org

CarePath™
mhanys.org/carepath

SMHRT: Family Education
https://www.mentalhealthednys.org/family-education-webinar-series/


Data Source
National Institute of Mental Health: Mental Health Information Health Topics www.nimh.nih.gov/health/topics

Disruptive Mood Dysregulation Disorder

The following article on Anxiety Disorders is from the National Institute of Mental Health (NIMH). While this material has been expert-reviewed, it is not NIMH or MHANYS intention to provide specific medical advice. Both MHANYS and NIMH advise readers to consult with a qualified health care provider for diagnosis, treatment, and answers to personal questions.

Overview

Disruptive mood dysregulation disorder (DMDD) is a condition in which children or adolescents experience persistent irritability and anger and frequent, intense temper outbursts. Many children go through periods of moodiness, but children with DMDD experience severe symptoms and often have significant problems at home and school. They may also struggle to interact with peers. While there is no treatment specifically for DMDD, researchers are working to improve existing treatment options and identify possible new treatments.

Signs and symptoms

Children and adolescents with DMDD experience:

  • Severe temper outbursts (verbal or behavioral), on average, three or more times per week

  • Outbursts and tantrums that have been ongoing for at least 12 months

  • Chronically irritable or angry mood most of the day, nearly every day

  • Trouble functioning due to irritability in more than one setting, such as at home, at school, or with peers

Youth with DMDD are typically diagnosed between the ages of 6 and 10. To be diagnosed with DMDD, a child must have experienced symptoms steadily for 12 or more months.

Risk factors

It is not clear how widespread DMDD is in the general population, and the exact causes of DMDD are not clear. Researchers are exploring risk factors and brain mechanisms of this disorder.

Treatment and therapies

Relatively few DMDD-specific treatment studies have been conducted to date. Treatment is often based on what has been helpful for other disorders associated with irritability, such as attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and anxiety disorders.

Treatment for DMDD generally includes certain types of psychotherapy (also called talk therapy) and sometimes medications. In many cases, psychotherapy is considered first, with medication added later if needed. However, in some cases, providers recommend that children receive both psychotherapy and medication at the start of their treatment. Parents or caregivers should work closely with their child’s health care provider to make treatment decisions that are best for their child.

The National Institute of Mental Health (NIMH) is currently funding studies focused on further improving these treatments and identifying new treatments to address irritability and temper outbursts.

Psychotherapies

Cognitive behavioral therapy (CBT) targets the relationship between thoughts, behaviors, and feelings and is often effective in treating anger and disruptive behavior. CBT for anger and disruptive behavior focuses on changing maladaptive thoughts. Researchers are also using CBT to help children increase their ability to tolerate frustration without having an outburst. This therapy teaches coping skills for controlling anger and ways to identify and re-label the distorted perceptions that contribute to outbursts.

Dialectical behavior therapy for children (DBT-C) teaches children skills that may help them regulate their emotions and avoid extreme or prolonged outbursts. In DBT-C, the clinician helps children learn skills that can help with regulating their moods and emotions.

Parent training teaches parents or caregivers more effective ways to respond to irritable behavior, such as anticipating events that might lead a child to have a temper outburst and working ahead to avert it. Training also focuses on the importance of predictable and consistent responses to a child’s outbursts and rewards for positive behavior.

Medications

Currently, no medications are approved by the U.S. Food and Drug Administration (FDA) specifically for treating children or adolescents with DMDD. However, health care providers may prescribe certain medications—such as stimulants, antidepressants, and atypical antipsychotics—to help relieve a child’s DMDD symptoms.

  • Stimulants are often used to treat ADHD, and research suggests that stimulant medications also may decrease irritability in youth.

  • Antidepressants are sometimes used to treat irritability and mood problems children with DMDD may experience. One study suggests that the antidepressant citalopram, combined with the stimulant methylphenidate, can decrease irritability in youth with DMDD. Please note: Antidepressants may increase suicidal thoughts and behaviors in youth, who should be monitored closely by their health care provider.

  • Certain atypical antipsychotic medications are used to treat children with irritability, severe outbursts, or aggression. FDA has approved these medications for the treatment of irritability associated with autism, and they are sometimes used to treat DMDD, too. However, due to the side effects associated with these medications, they are often used only when other approaches have not been successful.

All medications have side effects. Monitor and report your child’s side effects and review the medications frequently with your child’s health care provider. Visit FDA’s website  for the latest warnings, patient medication guides, and information on newly approved medications.

Handouts

Disruptive Mood Dysregulation Disorder - The Basics English/Español


Mental Health Association in New York State (MHANYS) has additional resources that can be accessed through its main website. These resources include links to advocacy and policy work, school-based programs, mental health wellness training programs and more.

MHANYS
mhanys.org

Advocacy and Policy
mhanys.org/advocacy-policy

Mental Health Community Partners
mhcommunitypartners.org

CarePath™
mhanys.org/carepath

SMHRT: Family Education
https://www.mentalhealthednys.org/family-education-webinar-series/


Data Source
National Institute of Mental Health: Mental Health Information Health Topics www.nimh.nih.gov/health/topics

Brain Stimulation Therapies

The following article on Anxiety Disorders is from the National Institute of Mental Health (NIMH). While this material has been expert-reviewed, it is not NIMH or MHANYS intention to provide specific medical advice. Both MHANYS and NIMH advise readers to consult with a qualified health care provider for diagnosis, treatment, and answers to personal questions.

What are brain stimulation therapies?

Brain stimulation therapies can play an important role in treating mental disorders. These therapies act by activating or inhibiting the brain with electricity. The electricity can be given directly through electrodes implanted in the brain or indirectly through electrodes placed on the scalp. The electricity can also be induced by applying magnetic fields to the head.

This video from the National Institute of Mental Health (NIMH) provides an overview of brain stimulation therapies and how they can be used to treat mental disorders.

This page provides basic information about brain stimulation therapies. It does not cover all forms of therapy or all mental disorders for which a therapy might be used. The information should not be used as a guide for making medical decisions. Research is ongoing to determine the best use of these therapies and if they are effective treatments for other disorders and conditions.

The page is divided into therapies that are authorized by the U.S. Food and Drug Administration (FDA) to treat specific mental disorders, including depression, bipolar disorder, and obsessive-compulsive disorder (OCD), versus therapies that are newer and still considered experimental.

The authorized therapies covered on this page are:

  • Electroconvulsive therapy
  • Repetitive transcranial magnetic stimulation
  • Vagus nerve stimulation

The experimental therapies covered on this page are:

  • Magnetic seizure therapy
  • Deep brain stimulation

Other brain stimulation therapies not discussed here may also hold promise for treating mental disorders. Information about these therapies is updated frequently. See the FDA website  for the latest information, warnings, and guidance on brain stimulation devices and announcements about new ones.

How do brain stimulation therapies work?

In most cases, brain stimulation therapy is used only after other treatments have been tried. Although brain stimulation therapies are less frequently used than medication or psychotherapy, they hold promise for people with certain mental disorders who have not responded to other treatments.

Brain stimulation therapies should be prescribed and monitored by a health care provider with specific training and expertise. A trained medical team performs the therapies. Most of the therapies involve using anesthesia to sedate the patient and a muscle relaxant to prevent them from moving. If so, an anesthesiologist will monitor breathing, heart rate, and blood pressure throughout the procedure.

A treatment plan involving brain stimulation therapy is based on a person’s individual needs and medical situation. It usually also includes medication, psychotherapy, or both. Patients will likely be advised to continue these other treatments during and after therapy to maintain clinical improvement. Patients should not stop a treatment unless specifically advised by a health care provider.

Brain stimulation therapies treat serious mental illnesses. They are often used when a person with a serious mental illness is experiencing dangerous circumstances, such as not responding to the outside world or being at risk of harming themselves. If you or someone you know is struggling or having thoughts of suicide, call or text the 988 Suicide and Crisis Lifeline  at 988 or chat at 988lifeline.org . In life-threatening situations, call 911.

Authorized therapies

The FDA determines whether foods, drugs, medical devices, and other products are safe to use. The FDA commonly gives two types of authorization to devices like brain stimulation therapies.

  • Approved means that the FDA has decided that the benefits of the device outweigh the known risks, as demonstrated by the results of clinical testing. Approval is usually required for devices that might have a significant risk of injury or illness, including devices implanted in the body.
  • Cleared means that the device is substantially equivalent to a similar device that the FDA has already cleared or approved. Clearance is usually given to lower-risk devices used outside of the body.

What is electroconvulsive therapy?

Electroconvulsive therapy (ECT) is a noninvasive procedure that treats serious mental disorders by using an electric current to induce seizure activity in the brain. It has the longest history of use for depression and is one of the most widely used brain stimulation therapies.

ECT: Why it’s done

The FDA has cleared ECT to treat severe depressive episodes  in people aged 13 years and older with depression or bipolar disorder. In some cases, ECT has also been used to treat schizophrenia, schizoaffective disorder, and mania.

ECT is usually considered only if a person’s illness has not improved after trying other treatments like medication or psychotherapy. To be eligible for ECT, a person must have severe, treatment-resistant depression or require a rapid response due to life-threatening circumstances, such as being unable to move or respond to the outside world (e.g., is catatonic), being suicidal, or being malnourished.

ECT can be effective when medications have not worked, cannot be tolerated, or are undesirable due to physical illness, which is often the case in older adults. ECT also begins working more rapidly than antidepressant medications, usually taking effect within the first week of treatment.

ECT: How it works

Before a doctor performs ECT, the patient is sedated with a short-acting general anesthetic and given an intravenous muscle relaxant to prevent movement.

During the procedure:

  • Electrodes are placed at precise locations on the patient’s head.
  • An electric current is sent through the electrodes into the brain, causing seizure activity that lasts under a minute. Anesthesia ensures that the patient does not experience pain or feel the electrical pulses. Often, a blood pressure cuff is used on an arm or leg to block the muscle relaxant and allow movement of that limb to confirm that the seizure activity is adequate.
  • The patient awakens 5–10 minutes after the procedure ends. They may feel groggy at first as the anesthesia wears off, but after about an hour, they are usually alert and can resume normal activities.

A typical course of ECT is administered three times a week until a patient’s symptoms improve (usually within 6–12 treatments). Frequently, a patient who undergoes ECT also takes antidepressant or mood-stabilizing medication.

Although ECT is effective in treating depressive episodes, follow-up treatment—either antidepressant medication or maintenance ECT —is usually required to sustain clinical improvement and reduce the chances that symptoms return. Maintenance ECT varies depending on the patient’s needs and may range from one session per week to one session every few months.

ECT: Side effects

The most common side effects associated with ECT include the following:

  • Headaches
  • Upset stomach
  • Muscle aches
  • Memory loss
  • Disorientation or confusion

Some patients may experience memory loss, especially of memories around the time of treatment. Sometimes the memory problems are more severe, but usually they improve over the days and weeks following the end of an ECT course.

Research has found that memory problems are more common  with the traditional form of ECT, known as bilateral ECT, in which electrodes are placed on both sides of the head. In comparison, unilateral ECT involves placing an electrode on only one side of the head, typically the right side, because it is opposite the brain’s learning and memory areas, with another electrode placed on top of the head. Many doctors, patients, and families prefer unilateral ECT because it is less likely to cause memory problems.

Modern ECT devices can deliver electrical signals using brief or ultra-brief pulses. These short pulses are as effective as the traditional form of ECT but are given at a lower dose, helping further reduce cognitive side effects.

What is repetitive transcranial magnetic stimulation?

Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive therapy that uses a magnet to deliver repeated low-intensity pulses to stimulate the brain. The magnetic field it creates is about the same strength as an MRI scan.

rTMS: Why it’s done

Several rTMS devices have been cleared to treat specific mental disorders. The FDA cleared the first rTMS device in 2008 for depression  in people who did not respond to at least one antidepressant medication in the current depressive episode. Although ECT is still considered the “gold standard” for treatment-resistant depression, strong clinical evidence supports the effectiveness of rTMS in reducing depressive symptoms. rTMS is now used to treat moderate-to-severe depression in cases where medications have proven ineffective or intolerable.

Since 2008, rTMS has been cleared to treat several types of depression, including depression with comorbid anxiety and depression with suicidality. In 2018, the FDA also cleared rTMS for severe OCD .

More recently, the FDA cleared a rapid-acting form of rTMS for treatment-resistant depression . Accelerated protocols that act more quickly than standard rTMS show similar effectiveness while shortening treatment length. Thus, patients benefit from receiving an entire course of treatment in much less time and getting relief from their symptoms more rapidly.

Newer forms of rTMS  involving magnetic pulses with other parameters are also under investigation to treat depression, OCD, and other mental disorders.

rTMS: How it works

Rather than electric currents, rTMS uses low-intensity magnetic pulses to stimulate the brain. Unlike ECT, in which stimulation is generalized, in rTMS, magnetic stimulation is targeted to a specific brain site. Also, in contrast to ECT, the procedure does not require anesthesia and can be performed in a clinical or office setting.

A typical rTMS session lasts 30–60 minutes. A typical course of rTMS treatment consists of daily sessions 5 days per week for 4–6 weeks.

Accelerated rTMS protocols  work much faster (within seconds to minutes). In this case, multiple sessions are delivered on a single day, with short breaks in between.

During the procedure:

  • An electromagnetic coil is held against the head near an area of the brain thought to be involved in mood regulation, cognitive control, or both. These brain areas include the left prefrontal cortex (for depression) and the dorsomedial prefrontal cortex or anterior cingulate cortex (for OCD). In deep TMS, two coils may be used to deliver more stimulation to the region and target larger structures deep in the brain.
  • Short electromagnetic pulses are repeatedly administered through the coil or coils. The patient usually feels a slight knocking or tapping on the head as the pulses are administered.
  • The magnetic pulses pass easily through the skull and cause small electric currents that stimulate nerve cells in the targeted brain region.

There is not consensus on the best way to position the coil on the head or deliver the electromagnetic pulses. It has also yet to be determined if rTMS works best when delivered as a single treatment or when combined with medication, psychotherapy, or both. Research is underway to establish the safest and most effective uses of rTMS, the optimal brain sites to target, and the best follow-up approach to sustain clinical improvement.

rTMS: Side effects

Overall, rTMS is safe and well tolerated  by patients. But, like all therapies described here, it can have side effects. These include the following:

  • Discomfort at the site on the head where the magnet is placed
  • Contraction or tingling of scalp, jaw, or face muscles during the procedure
  • Mild headaches or brief lightheadedness
  • Dizziness

Using magnetic pulses and targeting a specific brain site results in milder stimulation than in ECT, avoiding most seizure activity. Although it is possible for the procedure to cause seizures, a comprehensive review  found that the risk is rare. Most side effects appear to be mild and short-term when expert guidelines  are followed.

Long-term side effects have not been determined, and more research is needed to establish the long-term safety of rTMS.

What is vagus nerve stimulation?

Vagus nerve stimulation (VNS) is a surgical procedure that involves a device implanted under the skin. The device sends electrical pulses through the left vagus nerve that runs from the brainstem through the neck and down the side of the chest and abdomen. The nerve carries messages from the brain to the body’s major organs, including the heart, lungs, and intestines, and between areas of the brain that control mood, sleep, and other functions.

More recently, this therapy has been simplified by the introduction of noninvasive VNS (known as transcutaneous VNS [tVNS] ). tVNS uses a portable device to send electrical stimulation through the skin to activate the vagus nerve. Although tVNS is still experimental, the approach may offer advantages over surgical VNS, such as greater accessibility and affordability, while avoiding surgical complications.

VNS: Why it’s done

VNS was initially developed as a treatment for epilepsy. Research using brain scans showed that the procedure also affected areas of the brain involved in mood regulation, with favorable effects on depression symptoms.

In 2005, the FDA approved surgical VNS for depression  when the following conditions are met:

  • The patient is 18 years of age and older.
  • The depression has lasted 2 or more years.
  • The depression is severe or recurrent.
  • The depression has not eased after trying at least four other treatments.

Despite FDA approval for depression, VNS is not intended as a first-line treatment and remains infrequently used. The results of studies examining its effectiveness for depression have been mixed. Whereas a review of clinical trials  of VNS for treatment-resistant depression found a sustained reduction in depression symptoms and enhanced quality of life, other studies  did not report meaningful improvements.

Although noninvasive forms of VNS have also shown antidepressant effects , tVNS is not authorized by the FDA as a treatment for depression. However, a portable VNS device has been cleared by the FDA to treat post-traumatic stress disorder (PTSD)  under a Breakthrough Device Designation, given to medical devices with preliminary evidence of clinical effectiveness compared to other available treatments. Research is ongoing to test the efficacy and safety of tVNS for depression, PTSD, and other mental disorders.

VNS: How it works

VNS is traditionally a surgical procedure.

  • A device about the size of a stopwatch called a pulse generator is implanted in the upper left side of the chest while the patient is under anesthesia.
  • Connected to the pulse generator is an electrical lead wire, which is then connected from the generator to the left vagus nerve.
  • Typically, 30-second electrical pulses are sent every five minutes from the generator to the vagus nerve. The duration and frequency of the pulses may vary depending on how the generator is programmed.
  • The vagus nerve, in turn, delivers those electrical signals to the brain.

The pulse generator, which operates continuously, is powered by a battery that lasts around 10 years, after which it must be replaced. Patients usually do not feel pain or discomfort as the device operates.

It may be several months before a patient notices any benefits, and not all patients respond to VNS. Some patients have no improvement in symptoms, and some may get worse.

The device can be temporarily deactivated by placing a magnet over the chest where the generator is implanted. A patient may want to deactivate the device if side effects become intolerable or before engaging in strenuous activity or exercise because it can interfere with breathing. The device reactivates when the magnet is removed.

Noninvasive forms of VNS consist of a device worn around the neck or ears or a handheld device. There are many questions about the most effective stimulation sites, parameters, and protocols for tVNS, and research is ongoing to determine the optimal conditions to achieve the greatest clinical benefits.

VNS: Side effects

VNS is not without risk. There may be complications, such as infection or pain from the implant surgery, or the device may come loose, move around, or malfunction, all of which can require additional surgery to correct.

Other potential side effects include the following:

  • Discomfort or tingling in the area where the device is implanted
  • Voice changes or hoarseness
  • Cough or sore throat
  • Neck pain or headaches
  • Breathing problems, especially during exercise
  • Difficulty swallowing
  • Nausea or vomiting

If cleared by the FDA, tVNS devices may help overcome some of these surgical issues. Nonetheless, mild side effects of tVNS have been reported, including:

  • Tingling, pain, or itchiness around the stimulation site
  • Nausea or vomiting
  • Dizziness

The long-term side effects of all forms of VNS are unknown.


Experimental therapies

Other brain stimulation therapies are actively being explored for specific mental disorders. The following therapies are still considered experimental and have not yet been authorized by the FDA to treat mental disorders.

What is magnetic seizure therapy?

Magnetic seizure therapy (MST) is a noninvasive procedure that uses high-powered magnetic stimulation to induce seizures. The seizures are targeted to a specific site in the brain.

In the United States, MST is available only as part of a clinical trial or research study. NIMH has information for people interested in joining a clinical trial of MST or another brain stimulation therapy.

MST: How it works

MST combines aspects of both ECT and rTMS. Like rTMS, MST uses magnetic pulses to stimulate a specific brain site. The pulses are given at a higher intensity and frequency than in rTMS to induce a seizure. Like in ECT, the patient is anesthetized and given a muscle relaxant to prevent movement during the procedure. The goal is to retain the effectiveness of ECT while reducing the risk of cognitive side effects.

During the procedure:

  • An electromagnetic coil is held against the head, typically targeting the brain’s prefrontal area.
  • Rapidly alternating strong magnetic pulses pass through the coil into the brain to induce a seizure. Anesthesia is used to ensure that the patient does not experience pain or feel the electrical pulses.
  • The magnetic dosage is individualized for each patient by finding the patient-specific seizure threshold.

There is not agreement on MST’s optimal dosing, coil size, and stimulation site, and researchers are actively conducting studies to determine those specifications.

MST: Why it’s done

Introduced in 2001, MST is currently in the early stages of investigation and clinical use for treating mental disorders. A review of randomized clinical trials  examining MST for treatment-resistant depression showed promising results. However, more confirmatory evidence is needed to draw conclusions about MST’s effectiveness in treating depression and other mental disorders.

MST: Side effects

Like ECT, MST carries the risk of side effects caused by anesthesia and the induction of a seizure. These side effects can include the following:

  • Headaches or scalp pain
  • Dizziness
  • Nausea or vomiting
  • Muscle aches or fatigue

systematic review and meta-analysis  found that MST produced fewer memory problems and other cognitive side effects and caused less confusion and shorter seizures compared to ECT.

What is deep brain stimulation?

Deep brain stimulation (DBS) is a surgical procedure that uses electricity to directly stimulate sites in the brain.

DBS can be used to treat severe OCD or depression in patients who have not responded to other treatments. It is available for other mental disorders only as part of a clinical trial.

DBS: How it works

DBS works by sending electrical pulses to specific brain areas. It requires surgery to implant electrodes in the brain. The specific brain area depends on the disorder being treated. For depression, the brain area was initially the subgenual anterior cingulate cortex, which can be overactive in depression and other mood disorders, and now includes several brain areas. For OCD, the brain area is usually the ventral capsule/ventral striatum or the bed nucleus of the stria terminalis.

Prior to the procedure, scans of the brain are taken using MRI, which the surgeon uses as a guide to determine where to place the electrodes during surgery.

Once a patient is ready for surgery:

  • The head is numbed with a local anesthetic so the patient does not feel pain.
  • The surgeon drills one or two small holes into the patient’s head; threads a thin insulated wire, usually a pair of wires, through the hole(s) and into the brain; and places electrodes into a specific brain area.
  • The patient is awake while the electrodes are implanted to provide feedback on their placement but does not feel pain because the head is numbed and the brain itself does not register pain.
  • After the electrodes are implanted, the patient is put under general anesthesia.
  • The electrodes are attached to wires that run inside the body from the head, through the neck and shoulder, and down to the chest, where a small battery-operated generator (about the size of a pacemaker) is implanted. The pulse generator is placed under the skin in the upper chest. Whereas early DBS models used two pulse generators, one wired to each of the two implanted electrodes, most newer models use a single pulse generator to stimulate both electrodes.
  • From the pulse generator, electrical pulses are delivered through the wires to the electrodes in the brain. Stimulation is applied continuously, and its frequency and level are customized to each patient. Although it is unclear exactly how DBS works to reduce symptoms, researchers believe that the pulses help “reset” the malfunctioning area of the brain so that it works normally again.

After the procedure, the patient may be given a device-based tool (like a hand-held controller or smart phone app) to help them monitor and manage their symptoms at home or provide feedback to their clinical care team.

DBS: Why it’s done

DBS was first developed to treat movement disorders , including tremor and Parkinson’s disease.

The FDA has since cleared DBS for severe OCD under a Humanitarian Device Exemption , which is a provision for rare diseases or conditions experienced by relatively few patients among whom it has been difficult to gather evidence to demonstrate effectiveness. However, there is still much to be learned about optimizing DBS treatment. Although a systematic review  found that DBS improves OCD symptoms, other review articles  have called for more confirmatory evidence before drawing conclusions about its effectiveness.

Similarly, DBS received Breakthrough Device Designation from the FDA in 2022  to investigate its use for treatment-resistant depression. A systematic review and meta-analysis  showed favorable effects of DBS in treating depression symptoms. Nonetheless, it remains an experimental treatment for depression until more data from high-quality studies are available.

DBS: Side effects

DBS carries risks associated with any brain surgery. For example, the procedure may lead to the following:

  • Bleeding in the brain or stroke
  • Device-related discomfort, pain, or infection around the incision
  • Infection near the incision site
  • Headaches
  • Disorientation or confusion
  • Cognitive impairment
  • Lightheadedness, dizziness, nausea, or vomiting
  • Trouble sleeping, agitation, or restlessness

Because the procedure is still being studied, other side effects not yet identified are possible. Long-term benefits and side effects are unknown.

Are there other types of brain stimulation therapy?

Other types of brain stimulation therapy are in development. Most are used in combination with other therapies or treatments to optimize clinical outcomes.

One emerging therapy that shows promise for treating mental disorders is trigeminal nerve stimulation (TNS) . The FDA approved TNS to treat attention-deficit/hyperactivity disorder (ADHD)  in children, but it has not yet been approved to treat other conditions or for adults.

Other noninvasive brain stimulation therapies include, but are not limited to, the following:

  • Transcranial random noise stimulation (tRNS)
  • Transcranial direct current stimulation (tDCS)
  • Transcranial alternating current stimulation (tACS)
  • Transcranial ultrasound stimulation (TUS)

The Neuromodulation and Neurostimulation Program and Multimodal Neurotherapeutics Program at NIMH support researchers as they develop new therapies and refine existing therapies to treat mental disorders and conditions.


Mental Health Association in New York State (MHANYS) has additional resources that can be accessed through its main website. These resources include links to advocacy and policy work, school-based programs, mental health wellness training programs and more.

MHANYS
mhanys.org

Advocacy and Policy
mhanys.org/advocacy-policy

Mental Health Community Partners
mhcommunitypartners.org

CarePath™
mhanys.org/carepath

SMHRT: Family Education
https://www.mentalhealthednys.org/family-education-webinar-series/


Data Source
National Institute of Mental Health: Mental Health Information Health Topics www.nimh.nih.gov/health/topics

Autism Spectrum Disorder

The following article on Anxiety Disorders is from the National Institute of Mental Health (NIMH). While this material has been expert-reviewed, it is not NIMH or MHANYS intention to provide specific medical advice. Both MHANYS and NIMH advise readers to consult with a qualified health care provider for diagnosis, treatment, and answers to personal questions.

Overview

Autism spectrum disorder (ASD) is a neurological and developmental disorder that affects how people interact with others, communicate, learn, and behave. Although autism can be diagnosed at any age, it is described as a “developmental disorder” because symptoms generally appear in the first 2 years of life.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a guide created by the American Psychiatric Association that health care providers use to diagnose mental disorders, people with ASD often have:

  • Difficulty with communication and interaction with other people

  • Restricted interests and repetitive behaviors

  • Symptoms that affect their ability to function in school, work, and other areas of life

Autism is known as a “spectrum” disorder because there is wide variation in the type and severity of symptoms people experience.

People of all genders, races, ethnicities, and economic backgrounds can be diagnosed with ASD. Although ASD can be a lifelong disorder, treatments and services can improve a person’s symptoms and daily functioning. The American Academy of Pediatrics recommends that all children receive screening for autism. Caregivers should talk to their child’s health care provider about ASD screening or evaluation.

Signs and symptoms of ASD

The list below gives some examples of common types of behaviors in people diagnosed with ASD. Not all people with ASD will have all behaviors, but most will have several of the behaviors listed below.

Social communication / interaction behaviors may include:

  • Making little or inconsistent eye contact
  • Appearing not to look at or listen to people who are talking
  • Infrequently sharing interest, emotion, or enjoyment of objects or activities (including infrequent pointing at or showing things to others)
  • Not responding or being slow to respond to one’s name or to other verbal bids for attention
  • Having difficulties with the back and forth of conversation
  • Often talking at length about a favorite subject without noticing that others are not interested or without giving others a chance to respond
  • Displaying facial expressions, movements, and gestures that do not match what is being said
  • Having an unusual tone of voice that may sound sing-song or flat and robot-like
  • Having trouble understanding another person’s point of view or being unable to predict or understand other people’s actions
  • Difficulties adjusting behaviors to social situations
  • Difficulties sharing in imaginative play or in making friends

Restrictive / repetitive behaviors may include:

  • Repeating certain behaviors or having unusual behaviors, such as repeating words or phrases (a behavior called echolalia)
  • Having a lasting intense interest in specific topics, such as numbers, details, or facts
  • Showing overly focused interests, such as with moving objects or parts of objects
  • Becoming upset by slight changes in a routine and having difficulty with transitions
  • Being more sensitive or less sensitive than other people to sensory input, such as light, sound, clothing, or temperature

People with ASD may also experience sleep problems and irritability.

People on the autism spectrum also may have many strengths, including:

  • Being able to learn things in detail and remember information for long periods of time
  • Being strong visual and auditory learners
  • Excelling in math, science, music, or art

Causes and related factors

Researchers don’t know the primary causes of ASD, but studies suggest that a person’s genes can act together with aspects of their environment to affect development in ways that lead to ASD. Some factors that are associated with an increased likelihood of developing ASD include:

  • Having a sibling with ASD
  • Having older parents
  • Having certain genetic conditions (such as Down syndrome or Fragile X syndrome)
  • Having a very low birth weight

Diagnosing ASD

Health care providers diagnose ASD by evaluating a person’s behavior and development. ASD can usually be reliably diagnosed by age 2. It is important to seek an evaluation as soon as possible. The earlier ASD is diagnosed, the sooner treatments and services can begin.

Diagnosis in young children

Diagnosis in young children is often a two-stage process.

Stage 1: General developmental screening during well-child checkups

Every child should receive well-child check-ups with a pediatrician or an early childhood health care provider. The American Academy of Pediatrics recommends that all children receive screening for developmental delays at their 9-, 18-, and 24- or 30-month well-child visits, with specific autism screenings at their 18- and 24-month well-child visits. A child may receive additional screening if they have a higher likelihood of ASD or developmental problems. Children with a higher likelihood of ASD include those who have a family member with ASD, show some behaviors that are typical of ASD, have older parents, have certain genetic conditions, or who had a very low birth weight.

Considering caregivers’ experiences and concerns is an important part of the screening process for young children. The health care provider may ask questions about the child’s behaviors and evaluate those answers in combination with information from ASD screening tools and clinical observations of the child. Read more about screening instruments  on the Centers for Disease Control and Prevention (CDC) website.

If a child shows developmental differences in behavior or functioning during this screening process, the health care provider may refer the child for additional evaluation.

Stage 2: Additional diagnostic evaluation

It is important to accurately detect and diagnose children with ASD as early as possible, as this will shed light on their unique strengths and challenges. Early detection also can help caregivers determine which services, educational programs, and behavioral therapies are most likely to be helpful for their child.

A team of health care providers who have experience diagnosing ASD will conduct the diagnostic evaluation. This team may include child neurologists, developmental pediatricians, speech-language pathologists, child psychologists and psychiatrists, educational specialists, and occupational therapists.

The diagnostic evaluation is likely to include:

  • Medical and neurological examinations
  • Assessment of the child’s cognitive abilities
  • Assessment of the child’s language abilities
  • Observation of the child’s behavior
  • An in-depth conversation with the child’s caregivers about the child’s behavior and development
  • Assessment of age-appropriate skills needed to complete daily activities independently, such as eating, dressing, and toileting

Because ASD is a complex disorder that sometimes occurs with other illnesses or learning disorders, the comprehensive evaluation may include:

  • Blood tests
  • Hearing test

The evaluation may lead to a formal diagnosis and recommendations for treatment.

Diagnosis in older children and adolescents

Caregivers and teachers are often the first to recognize ASD symptoms in older children and adolescents who attend school. The school’s special education team may perform an initial evaluation and then recommend that a child undergo additional evaluation with their primary health care provider or a health care provider who specialize in ASD.

A child’s caregivers may talk with these health care providers about their child’s social difficulties, including problems with subtle communication. For example, some children may have problems understanding tone of voice, facial expressions, or body language. Older children and adolescents may have trouble understanding figures of speech, humor, or sarcasm. They also may have trouble forming friendships with peers.

Diagnosis in adults

Diagnosing ASD in adults is often more difficult than diagnosing ASD in children. In adults, some ASD symptoms can overlap with symptoms of other mental health disorders, such as anxiety disorder or attention-deficit/hyperactivity disorder (ADHD).

Adults who notice signs of ASD should talk with a health care provider and ask for a referral for an ASD evaluation. Although evaluation for ASD in adults is still being refined, adults may be referred to a neuropsychologist, psychologist, or psychiatrist who has experience with ASD. The expert will ask about:

  • Social interaction and communication challenges
  • Sensory issues
  • Repetitive behaviors
  • Restricted interests

The evaluation also may include a conversation with caregivers or other family members to learn about the person’s early developmental history, which can help ensure an accurate diagnosis.

Receiving a correct diagnosis of ASD as an adult can help a person understand past challenges, identify personal strengths, and find the right kind of help. Studies are underway to determine the types of services and supports that are most helpful for improving the functioning and community integration of autistic transition-age youth and adults.

Treatments and therapies

Treatment for ASD should begin as soon as possible after diagnosis. Early treatment for ASD is important as proper care and services can reduce individuals’ difficulties while helping them build on their strengths and learn new skills.

People with ASD may face a wide range of issues, which means that there is no single best treatment for ASD. Working closely with a health care provider is an important part of finding the right combination of treatment and services.

Medication

A health care provider may prescribe medication to treat specific symptoms. With medication, a person with ASD may have fewer problems with:

  • Irritability
  • Aggression
  • Repetitive behavior
  • Hyperactivity
  • Attention problems
  • Anxiety and depression

Read more about the latest medication warnings, patient medication guides, and information on newly approved medications at the Food and Drug Administration (FDA) website .

Behavioral, psychological, and educational interventions

People with ASD may be referred to a health care provider who specializes in providing behavioral, psychological, educational, or skill-building interventions. These programs are often highly structured and intensive, and they may involve caregivers, siblings, and other family members. These programs may help people with ASD:

  • Learn social, communication, and language skills
  • Reduce behaviors that interfere with daily functioning
  • Increase or build upon strengths
  • Learn life skills for living independently

Other resources

Many services, programs, and other resources are available to help people with ASD. Here are some tips for finding these additional services:

  • Contact your health care provider, local health department, school, or autism advocacy group to learn about special programs or local resources.
  • Find an autism support group. Sharing information and experiences can help people with ASD and their caregivers learn about treatment options and ASD-related programs.
  • Record conversations and meetings with health care providers and teachers. This information may help when it’s time to decide which programs and services are appropriate.
  • Keep copies of health care reports and evaluations. This information may help people with ASD qualify for special programs.

Handouts

Autism Spectrum Disorder English/Español  


Mental Health Association in New York State (MHANYS) has additional resources that can be accessed through its main website. These resources include links to advocacy and policy work, school-based programs, mental health wellness training programs and more.

MHANYS
mhanys.org

Advocacy and Policy
mhanys.org/advocacy-policy

Mental Health Community Partners
mhcommunitypartners.org

CarePath™
mhanys.org/carepath

SMHRT: Family Education
https://www.mentalhealthednys.org/family-education-webinar-series/


Data Source
National Institute of Mental Health: Mental Health Information Health Topics www.nimh.nih.gov/health/topics

Traumatic Events

The following article on Anxiety Disorders is from the National Institute of Mental Health (NIMH). While this material has been expert-reviewed, it is not NIMH or MHANYS intention to provide specific medical advice. Both MHANYS and NIMH advise readers to consult with a qualified health care provider for diagnosis, treatment, and answers to personal questions.

Coping With Traumatic Events

How do people respond to traumatic events?

A traumatic event is a shocking, scary, or dangerous experience that can affect someone emotionally and physically. Traumatic events can include experiences such as natural disasters (such as hurricanes, earthquakes, and floods), acts of violence (such as assault, abuse, terror attacks, and mass shootings), and car crashes or other accidents.

It is natural to feel afraid during and after a traumatic situation. Fear is a part of the body’s “fight-or-flight” response, which helps us avoid or respond to potential danger. People may experience a range of reactions after trauma, including:

  • Feeling anxious, sad, or angry
  • Trouble concentrating and sleeping
  • Continually thinking about what happened

Most people will recover from these symptoms, and their reactions will lessen over time. Those who continue to experience symptoms may be diagnosed with post-traumatic stress disorder (PTSD).

It is important to seek professional help if symptoms do not improve over time or begin to interfere with daily life. Some signs that a person may need help include:

  • Worrying a lot or feeling very anxious, sad, or fearful
  • Crying often
  • Having trouble thinking clearly
  • Having frightening thoughts or flashbacks, reliving the experience
  • Feeling angry, resentful, or irritable
  • Having nightmares or difficulty sleeping
  • Avoiding places or people that bring back disturbing memories and responses
  • Becoming isolated from family and friends

Physical responses to trauma may also mean that a person needs help. Physical symptoms may include:

  • Having headaches
  • Having stomach pain and digestive issues
  • Having difficulty falling asleep or staying asleep
  • Having a racing heart and sweating
  • Being very jumpy and easily startled

People who have a personal or family history of mental illness or substance use, who have had previous exposure to traumatic experiences, who face ongoing stress or trauma (such as abuse), or who lack support from friends and family may be more likely to develop more severe symptoms and need additional help.

People who experience traumatic events also may experience panic disorderdepressionsubstance use, or suicidal thoughts. Treatment for these conditions can help with recovery after trauma.

If you or someone you know is struggling or having thoughts of suicide, call or text the 988 Suicide & Crisis Lifeline  at 988 or chat at 988lifeline.org . In life-threatening situations, call 911.

How do children and teens react to trauma?

Children and teens can have extreme reactions to traumatic events, but their symptoms may not be the same as those seen in adults. In children younger than age 6, symptoms can include:

  • Wetting the bed after having learned to use the toilet
  • Forgetting how to talk or being unable to talk
  • Acting out the scary event during playtime
  • Being unusually clingy with a parent or other adult

Older children and teens usually show symptoms more like those seen in adults. They may also develop disruptive, disrespectful, or destructive behaviors. Older children and teens may feel guilt over not preventing injury or death. They may also have thoughts of revenge.

What can I do to cope after a traumatic event?

Healthy ways of coping can help reduce stress and improve well-being. Here are some things you can do to help yourself:

  • Avoid the use of alcohol or drugs
  • Spend time with trusted friends and relatives who are supportive
  • Try to maintain routines for meals, exercise, and sleep
  • Engage in exercise, mindfulness, or other activities that help reduce stress
  • Set realistic goals and focus on what you can manage

How can I find help for coping with traumatic events?

If you’re not sure where to get help, a health care provider can refer you to a licensed mental health professional, such as a psychiatrist, psychologist, or clinical social worker with experience treating people who are coping with traumatic events. 

In addition, the Disaster Distress Helpline  from the Substance Abuse and Mental Health Services Administration (SAMHSA) provides crisis counseling and support to people experiencing emotional distress related to natural or human-caused disasters. The helpline is free, multilingual, confidential, and available 24 hours a day, 7 days a week.

SAMSHA also offers an online treatment locator  to help you find mental health services in your area.

Federal resources

  • Caring for Children in a Disaster : This webpage from the Centers for Disease Control and Prevention provides fact sheets, articles, and other tools and resources on caring for children in disasters or emergency situations.
  • Disaster Preparedness, Response, and Recovery : This webpage from SAMHSA offers behavioral health resources for communities and responders that help them prepare, respond, and recover from disasters.
  • Medications for PTSD : This webpage from the U.S. Department of Veterans Affairs describes effective medications for treating PTSD and considerations for evaluating treatment options.
  • National Center for PTSD : Part of the U.S. Department of Veterans Affairs, this website has information and resources for anyone interested in PTSD, including veterans, family, friends, researchers, and health care providers. The site offers videos, apps, online programs, and other tools to help people with PTSD and their loved ones.
  • PTSD  (MedlinePlus – also en español )
  • Publications on Disaster Preparedness and Recovery : This webpage from SAMHSA lists publications and digital products on coping after a disaster, pandemic, or traumatic event.

Handouts

Post-Traumatic Stress Disorder English/Español  Helping Children and Adolescents Cope with Traumatic Events English Español 


Mental Health Association in New York State (MHANYS) has additional resources that can be accessed through its main website. These resources include links to advocacy and policy work, school-based programs, mental health wellness training programs and more.

MHANYS
mhanys.org

Advocacy and Policy
mhanys.org/advocacy-policy

Mental Health Community Partners
mhcommunitypartners.org

CarePath™
mhanys.org/carepath

SMHRT: Family Education
https://www.mentalhealthednys.org/family-education-webinar-series/


Data Source
National Institute of Mental Health: Mental Health Information Health Topics www.nimh.nih.gov/health/topics

Substance Use and Co-Occuring Mental Disorders

The following article on Anxiety Disorders is from the National Institute of Mental Health (NIMH). While this material has been expert-reviewed, it is not NIMH or MHANYS intention to provide specific medical advice. Both MHANYS and NIMH advise readers to consult with a qualified health care provider for diagnosis, treatment, and answers to personal questions.

Overview

Substance use disorder (SUD) is a treatable mental disorder that affects a person’s brain and behavior, leading to their inability to control their use of substances like legal or illegal drugs, alcohol, or medications. Symptoms can be moderate to severe, with addiction being the most severe form of SUD.

People with a SUD may also have other mental health disorders, and people with mental health disorders may also struggle with substance use. These other mental health disorders can include anxiety disordersdepressionattention-deficit hyperactivity disorder (ADHD)bipolar disorderpersonality disorders, and schizophrenia, among others. For more information, please see the National Institute on Drug Abuse (NIDA) Common Comorbidities with Substance Use Disorders Research Report .

Though people might have both a SUD and a mental disorder, that does not mean that one caused the other. Research suggests three possibilities that could explain why SUDs and other mental disorders may occur together:

  • Common risk factors can contribute to both SUDs and other mental disorders. Both SUDs and other mental disorders can run in families, meaning certain genes may be a risk factor. Environmental factors, such as stress or trauma, can cause genetic changes that are passed down through generations and may contribute to the development of a mental disorder or a substance use disorder.
  • Mental disorders can contribute to substance use and SUDs. Studies found that people with a mental disorder, such as anxiety, depression, or post-traumatic stress disorder (PTSD), may use drugs or alcohol as a form of self-medication. However, although some drugs may temporarily help with some symptoms of mental disorders, they may make the symptoms worse over time. Additionally, brain changes in people with mental disorders may enhance the rewarding effects of substances, making it more likely they will continue to use the substance.
  • Substance use and SUDs can contribute to the development of other mental disorders. Substance use may trigger changes in brain structure and function that make a person more likely to develop a mental disorder.

Diagnosis and treatment

When someone has a SUD and another mental health disorder, it is usually better to treat them at the same time rather than separately. People who need help for a SUD and other mental disorders should see a health care provider for each disorder. It can be challenging to make an accurate diagnosis because some symptoms are the same for both disorders, so the provider should use comprehensive assessment tools to reduce the chance of a missed diagnosis and provide the right treatment.

It also is essential that the provider tailor treatment, which may include behavioral therapies and medications, to an individual’s specific combination of disorders and symptoms. It should also take into account the person’s age, the misused substance, and the specific mental disorder(s). Talk to your health care provider to determine what treatment may be best for you and give the treatment time to work.

Behavioral therapies

Research has found several behavioral therapies that have promise for treating individuals with co-occurring substance use and mental disorders. Health care providers may recommend behavioral therapies alone or in combination with medications.

Some examples of effective behavioral therapies for adults with SUDs and different co-occurring mental disorders include:

  • Cognitive behavioral therapy (CBT) is a type of talk therapy aimed at helping people learn how to cope with difficult situations by challenging irrational thoughts and changing behaviors.
  • Dialectical behavior therapy (DBT) uses concepts of mindfulness and acceptance or being aware of and attentive to the current situation and emotional state. DBT also teaches skills that can help control intense emotions, reduce self-destructive behaviors (such as suicide attempts, thoughts, or urges; self-harm; and drug use), and improve relationships.
  • Assertive community treatment (ACT) is a form of community-based mental health care that emphasizes outreach to the community and an individualized treatment approach.
  • Therapeutic communities (TC)  are a common form of long-term residential treatment that focuses on helping people develop new and healthier values, attitudes, and behaviors.
  • Contingency management (CM) principles encourage healthy behaviors by offering vouchers or rewards for desired behaviors.

Behavioral therapies for children and adolescents

Some effective behavioral treatments for children and adolescents include:

  • Brief strategic family therapy (BSFT) therapy targets family interactions thought to maintain or worsen adolescent SUDs and other co-occurring problem behaviors.
  • Multidimensional family therapy (MDFT) works with the whole family to simultaneously address multiple and interacting adolescent problem behaviors, such as substance use, mental disorders, school problems, delinquency, and others.
  • Multisystemic therapy (MST) targets key factors associated with serious antisocial behavior in children and adolescents with SUDs.

Medications

There are effective medications that treat opioid alcohol , and nicotine addiction  and lessen the symptoms of many other mental disorders. Some medications may be useful in treating multiple disorders. For more information on behavioral treatments and medications for SUDs, visit NIDA’s Drug Facts  and Treatment  webpages.

Finding help

To find mental health treatment services in your area, call the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-HELP (4357), visit the SAMHSA online treatment locator , or text your ZIP code to 435748.

For additional resources about finding help, visit:

NIMH’s Help for Mental Illnesses page

National Cancer Institute’s Smokefree.gov  website, or call their smoking quitline at 1-877-44U-QUIT (1-877-448-7848)

If you or someone you know is struggling or having thoughts of suicide, call or text the 988 Suicide & Crisis Lifeline  at 988 or chat at 988lifeline.org . In life-threatening situations, call 911.

Brochures and other educational resources


Mental Health Association in New York State (MHANYS) has additional resources that can be accessed through its main website. These resources include links to advocacy and policy work, school-based programs, mental health wellness training programs and more.

MHANYS
mhanys.org

Advocacy and Policy
mhanys.org/advocacy-policy

Mental Health Community Partners
mhcommunitypartners.org

CarePath™
mhanys.org/carepath

SMHRT: Family Education
https://www.mentalhealthednys.org/family-education-webinar-series/


Data Source
National Institute of Mental Health: Mental Health Information Health Topics www.nimh.nih.gov/health/topics

Schizophrenia

The following article on Anxiety Disorders is from the National Institute of Mental Health (NIMH). While this material has been expert-reviewed, it is not NIMH or MHANYS intention to provide specific medical advice. Both MHANYS and NIMH advise readers to consult with a qualified health care provider for diagnosis, treatment, and answers to personal questions.

What is schizophrenia?

Schizophrenia is a serious mental illness that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality, which can be distressing for them and for their family and friends. The symptoms of schizophrenia can make it difficult to participate in usual, everyday activities, but effective treatments are available. Many people who receive treatment can engage in school or work, achieve independence, and enjoy personal relationships.

What are the signs and symptoms of schizophrenia?

It’s important to recognize the symptoms of schizophrenia and seek help as early as possible. People with schizophrenia are usually diagnosed between the ages of 16 and 30, after the first episode of psychosis. Starting treatment as soon as possible following the first episode of psychosis is an important step toward recovery. However, research shows that gradual changes in thinking, mood, and social functioning often appear before the first episode of psychosis. Schizophrenia is rare in younger children.

Schizophrenia symptoms can differ from person to person, but they generally fall into three main categories: psychotic, negative, and cognitive.

Psychotic symptoms include changes in the way a person thinks, acts, and experiences the world. People with psychotic symptoms may lose a shared sense of reality with others and experience the world in a distorted way. For some people, these symptoms come and go. For others, the symptoms become stable over time. Psychotic symptoms include:

  • Hallucinations: When a person sees, hears, smells, tastes, or feels things that are not actually there. Hearing voices is common for people with schizophrenia. People who hear voices may hear them for a long time before family or friends notice a problem. 
  • Delusions: When a person has strong beliefs that are not true and may seem irrational to others. For example, individuals experiencing delusions may believe that people on the radio and television are sending special messages that require a certain response, or they may believe that they are in danger or that others are trying to hurt them. 
  • Thought disorder: When a person has ways of thinking that are unusual or illogical. People with thought disorder may have trouble organizing their thoughts and speech. Sometimes a person will stop talking in the middle of a thought, jump from topic to topic, or make up words that have no meaning. 
  • Movement disorder: When a person exhibits abnormal body movements. People with movement disorder may repeat certain motions over and over.

Negative symptoms include loss of motivation, loss of interest or enjoyment in daily activities, withdrawal from social life, difficulty showing emotions, and difficulty functioning normally.

Negative symptoms include:

  • Having trouble planning and sticking with activities, such as grocery shopping
  • Having trouble anticipating and feeling pleasure in everyday life
  • Talking in a dull voice and showing limited facial expression
  • Avoiding social interaction or interacting in socially awkward ways
  • Having very low energy and spending a lot of time in passive activities. In extreme cases, a person might stop moving or talking for a while, which is a rare condition called catatonia.

These symptoms are sometimes mistaken for symptoms of depression or other mental illnesses.

Cognitive symptoms include problems in attention, concentration, and memory. These symptoms can make it hard to follow a conversation, learn new things, or remember appointments. A person’s level of cognitive functioning is one of the best predictors of their day-to-day functioning. Health care providers evaluate cognitive functioning using specific tests.

Cognitive symptoms include:

  • Having trouble processing information to make decisions
  • Having trouble using information immediately after learning it
  • Having trouble focusing or paying attention

The Centers for Disease Control and Prevention (CDC)  has recognized that having certain mental disorders, including depression and schizophrenia, can make people more likely to get severely ill from COVID-19.

Risk of violence

Most people with schizophrenia are not violent. Overall, people with schizophrenia are more likely than those without the illness to be harmed by others. For people with schizophrenia, the risk of self-harm and of violence to others is greatest when the illness is untreated. It is important to help people who are showing symptoms to get treatment as quickly as possible.

Schizophrenia vs. dissociative identity disorder

Although some of the signs may seem similar on the surface, schizophrenia is not dissociative identity disorder (which used to be called multiple personality disorder or split personality). People with dissociative identity disorder have two or more distinct identities that are present and that alternately take control of them.

What are the risk factors for schizophrenia?

Several factors may contribute to a person’s risk of developing schizophrenia.

Genetics: Schizophrenia sometimes runs in families. However, just because one family member has schizophrenia, it does not mean that other members of the family also will have it. Studies suggest that many different genes may increase a person’s chances of developing schizophrenia, but that no single gene causes the disorder by itself.

Environment: Research suggests that a combination of genetic factors and aspects of a person’s environment and life experiences may play a role in the development of schizophrenia. These environmental factors that may include living in poverty, stressful or dangerous surroundings, and exposure to viruses or nutritional problems before birth.

Brain structure and function: Research shows that people with schizophrenia may be more likely to have differences in the size of certain brain areas and in connections between brain areas. Some of these brain differences may develop before birth. Researchers are working to better understand how brain structure and function may relate to schizophrenia.

How is schizophrenia treated?

Current treatments for schizophrenia focus on helping people manage their symptoms, improve day-to-day functioning, and achieve personal life goals, such as completing education, pursuing a career, and having fulfilling relationships.

Antipsychotic medications

Antipsychotic medications can help make psychotic symptoms less intense and less frequent. These medications are usually taken every day in a pill or liquid forms. Some antipsychotic medications are given as injections once or twice a month.

If a person’s symptoms do not improve with usual antipsychotic medications, they may be prescribed clozapine. People who take clozapine must have regular blood tests to check for a potentially dangerous side effect that occurs in 1-2% of patients.

People respond to antipsychotic medications in different ways. It is important to report any side effects to a health care provider. Many people taking antipsychotic medications experience side effects such as weight gain, dry mouth, restlessness, and drowsiness when they start taking these medications. Some of these side effects may go away over time, while others may last.

Shared decision making  between health care providers and patients is the recommended strategy for determining the best type of medication or medication combination and the right dose. To find the latest information about antipsychotic medications, talk to a health care provider and visit the U.S. Food and Drug Administration (FDA) website .

Psychosocial treatments

Psychosocial treatments help people find solutions to everyday challenges and manage symptoms while attending school, working, and forming relationships. These treatments are often used together with antipsychotic medication. People who participate in regular psychosocial treatment are less likely to have symptoms reoccur or to be hospitalized.

Examples of this kind of treatment include types of psychotherapy such as cognitive behavioral therapy, behavioral skills training, supported employment, and cognitive remediation interventions.

Education and support

Educational programs can help family and friends learn about symptoms of schizophrenia, treatment options, and strategies for helping loved ones with the illness. These programs can help friends and family manage their distress, boost their own coping skills, and strengthen their ability to provide support. 

Coordinated specialty care

Coordinated specialty care (CSC) programs are recovery-focused programs for people with first episode psychosis, an early stage of schizophrenia. Health care providers and specialists work together as a team to provide CSC, which includes psychotherapy, medication, case management, employment and education support, and family education and support. The treatment team works collaboratively with the individual to make treatment decisions, involving family members as much as possible.

Compared with typical care, CSC is more effective at reducing symptoms, improving quality of life, and increasing involvement in work or school.

Assertive community treatment

Assertive community treatment (ACT)  is designed especially for people with schizophrenia who are likely to experience multiple hospitalizations or homelessness. ACT is usually delivered by a team of health care providers who work together to provide care to patients in the community.

Treatment for drug and alcohol misuse

It is common for people with schizophrenia to have problems with drugs and alcohol. A treatment program that includes treatment for both schizophrenia and substance use is important for recovery because substance use can interfere with treatment for schizophrenia.

How can I find help for schizophrenia?

If you’re not sure where to get help, your health care provider is a good place to start. Your health care provider can refer you to a qualified mental health professional, such as a psychiatrist or psychologist who has experience treating schizophrenia.

The Substance Abuse and Mental Health Services Administration (SAMHSA) has an online treatment locator  to help you find mental health services in your area. SAMHSA also has an Early Serious Mental Illness Treatment Locator for finding mental health treatment facilities and programs .

It can be difficult to know how to help someone who is experiencing psychosis.

Here are some things you can do:

  • Help them get treatment and encourage them to stay in treatment.
  • Remember that their beliefs or hallucinations seem very real to them.
  • Be respectful, supportive, and kind without tolerating dangerous or inappropriate behavior.
  • Look for support groups and family education programs.

If you or someone you know is struggling or having thoughts of suicide, call or text the 988 Suicide & Crisis Lifeline  at 988 or chat at 988lifeline.org . In life-threatening situations, call 911.

Research and statistics

Statistics: Schizophrenia: This webpage provides the statistics currently available on the prevalence and treatment of schizophrenia among people in the United States.

Handouts

Schizophrenia English/Español  Understanding Psychosis English /Español


Mental Health Association in New York State (MHANYS) has additional resources that can be accessed through its main website. These resources include links to advocacy and policy work, school-based programs, mental health wellness training programs and more.

MHANYS
mhanys.org

Advocacy and Policy
mhanys.org/advocacy-policy

Mental Health Community Partners
mhcommunitypartners.org

CarePath™
mhanys.org/carepath

SMHRT: Family Education
https://www.mentalhealthednys.org/family-education-webinar-series/


Data Source
National Institute of Mental Health: Mental Health Information Health Topics www.nimh.nih.gov/health/topics

Psychotherapies

The following article on Anxiety Disorders is from the National Institute of Mental Health (NIMH). While this material has been expert-reviewed, it is not NIMH or MHANYS intention to provide specific medical advice. Both MHANYS and NIMH advise readers to consult with a qualified health care provider for diagnosis, treatment, and answers to personal questions.

Overview

Psychotherapy (sometimes called talk therapy) refers to a variety of treatments that aim to help a person identify and change troubling emotions, thoughts, and behaviors. Most psychotherapy takes place when a licensed mental health professional and a patient meet one-on-one or with other patients in a group setting.

You might seek out psychotherapy for many reasons, including the following:

  • Dealing with severe or long-term stress from a job or family situation, the loss of a loved one, or relationship or family problems
  • Having symptoms with no physical explanation, such as changes in sleep or appetite, low energy level, lack of interest or pleasure in activities you once enjoyed, persistent irritability, excessive worry, or a sense of discouragement or hopelessness that won’t go away
  • A health care provider suspecting you have or diagnosing you with a mental disorder that is interfering with your life
  • Supporting a family member or child who has been diagnosed with a condition affecting their mental health

First being examined by a health care provider can help ensure that there is no physical health issue that would explain symptoms. This step is important because sometimes symptoms, like a change in mood or trouble concentrating, are due to a medical condition.

Psychotherapy and other treatment options

Psychotherapy can be used as an alternative to or alongside medication and other treatment options. Choosing the right treatment plan should be based on a person’s individual needs and medical situation and occur under the guidance of a mental health professional.

Even when medication relieves symptoms, psychotherapy can help a person address specific issues. These might include self-defeating ways of thinking, irrational fears, problems interacting with other people, or difficulty coping with situations at home, school, or work.

Elements of psychotherapy

A variety of psychotherapies and interventions have shown effectiveness in treating mental health disorders. Often, the type of treatment is tailored to the specific disorder. For example, the treatment approach for someone who has obsessive-compulsive disorder is different than the approach for someone who has bipolar disorder. Therapists may use one primary approach or incorporate other elements depending on their training, the disorder being treated, and the needs of the person receiving treatment.

Elements of psychotherapy can include:

  • Helping a person become aware of automatic ways of thinking that are inaccurate or harmful (for example, having a low opinion of their abilities) and then finding ways to question those thoughts, understand how the thoughts affect their emotions and behavior, and change self-defeating patterns, in an approach known as cognitive behavioral therapy (CBT)
  • Identifying ways to cope with stress and developing specific problem-solving strategies
  • Examining a person’s interactions with others and teaching social and communication skills
  • Applying mindfulness and relaxation techniques, such as meditation and breathing exercises
  • Using exposure therapy (a type of CBT) for people with anxiety disorders, in which a person spends brief periods in a supportive environment learning to tolerate the distress caused by certain items, ideas, or imagined scenes until, over time, the fear associated with those things dissipates
  • Tracking emotions and behaviors to raise awareness of their impact on each other
  • Using supportive counseling to help a person explore troubling issues and receive emotional support
  • Creating a safety plan to help a person who has thoughts of self-harm or suicide recognize warning signs and use coping strategies, such as contacting friends, family, or emergency personnel

Note that there are many different types of psychotherapy. Therapies are often variations of an established approach, such as CBT. There is no formal approval process for psychotherapies like there is for medications by the U.S. Food and Drug Administration.

However, for many therapies, research involving large numbers of patients has provided evidence that the treatment is effective. These evidence-based therapies have been shown to reduce symptoms of depression, anxiety, and other mental disorders. 

What to look for in a therapist

Therapists have different professional backgrounds and specialties. This section and the next have information that can help you find out about a therapist’s credentials and find resources for locating therapists.

The approach a therapist uses depends on the disorder being treated and the training and experience of that therapist. Therapists may combine and adapt elements of different approaches.

Once you have identified one or more possible therapists, a preliminary conversation can help you understand how treatment will proceed and decide if you feel comfortable with the therapist. Rapport and trust are essential. Discussions in therapy are deeply personal, and it’s important that you feel comfortable with the therapist and have confidence in their expertise. These preliminary conversations may happen in person, by phone, or virtually. Consider trying to get answers to the following questions:

  • What are the credentials and experience of the therapist? Do they have a specialty?
  • What approach will the therapist take to help you? Do they practice a particular type of therapy? What is the rationale for the therapy and its evidence base?
  • Does the therapist have experience in diagnosing and treating the age group (for example, a child) and the specific condition for which treatment is being sought? If the patient is a child, how will parents or caregivers be involved in treatment?
  • What are the goals of therapy? Does the therapist recommend a specific time frame or number of sessions? How will progress be assessed, and what happens if you (or the therapist) feel you aren’t starting to improve?
  • Are medications an option? Is this therapist able to prescribe medications?
  • Are meetings confidential? How is confidentiality assured? Are there limits to confidentiality?

Finding a therapist

Many types of professionals offer psychotherapy. Examples include psychiatrists, psychologists, social workers, counselors, and psychiatric nurses. Information on providers’ credentials is available from the National Alliance on Mental Illness.

Your health insurance provider may have a list of mental health professionals participating in your plan. When talking with a prospective therapist, ask about treatment fees, whether the therapist participates in insurance plans, and whether there is a sliding scale for fees according to income.

The following professional organizations have directories or locators on their websites for mental health care professionals:

National advocacy organizations provide information on finding a mental health professional, and some have practitioner locators on their websites. Examples include:

Note: MHANYS does not evaluate the professional qualifications and competencies of individual practitioners listed on these websites. These resources are provided for informational purposes only. They are not comprehensive lists, and an organization’s inclusion does not constitute an endorsement by MHANYS, NIMH, the National Institutes of Health, the U.S. Department of Health and Human Services, or the U.S. government.

University or medical school-affiliated programs may offer treatment options, including training clinics. Search the website of local university health centers for their psychiatry or psychology departments. You can also go to your state or county government website and search for the health department for information on mental health-related programs within your state.

The goal of therapy is to gain relief from symptoms, maintain or improve daily functioning, and improve quality of life. If you have been in therapy for what feels like a reasonable amount of time and are not getting better, talk to your therapist or explore other mental health professionals or approaches.

Digital health options

The telephone, internet, and mobile devices have created new opportunities to provide more readily available and accessible treatment, including in areas where mental health professionals may not be physically available. Some of these approaches involve a therapist providing help at a distance. Still, others, such as web-based programs and mobile apps, are designed to provide immediate information and feedback in the absence of a therapist. 

Federal resources

Health hotlines

  • 988 Suicide & Crisis Lifeline : The Lifeline provides free and confidential emotional support to people in suicidal crisis or emotional distress 24 hours a day, 7 days a week, across the United States. Call or text 988 to connect with a trained crisis counselor. Support is also available via live chat at 988lifeline.org . Para ayuda en español, llame al 988.
  • Disaster Distress Helpline : People affected by any disaster or tragedy can call this helpline, sponsored by SAMHSA, to receive immediate counseling. Call or text 1-800-985-5990 to connect with a trained professional from the closest crisis counseling center within the network.
  • Veterans Crisis Line : This helpline is a free, confidential resource for veterans of all ages and circumstances. Call 1-800-273-8255 and press 1, text 838255, or chat online  to connect with 24/7 support.
  • More NIH Health Information Lines 

Handouts

Children and Mental Health - Is This Just a StageEnglish/Español    My Mental Health - Do I Need Help English / Español 

Tips for Talking with a Health Care Provider About Your Mental Health English/Español    What Is Telemental Health  English/Español  


Mental Health Association in New York State (MHANYS) has additional resources that can be accessed through its main website. These resources include links to advocacy and policy work, school-based programs, mental health wellness training programs and more.

MHANYS
mhanys.org

Advocacy and Policy
mhanys.org/advocacy-policy

Mental Health Community Partners
mhcommunitypartners.org

CarePath™
mhanys.org/carepath

SMHRT: Family Education
https://www.mentalhealthednys.org/family-education-webinar-series/


Data Source
National Institute of Mental Health: Mental Health Information Health Topics www.nimh.nih.gov/health/topics

Post-Traumatic Stress Disorder – PTSD

The following article on Anxiety Disorders is from the National Institute of Mental Health (NIMH). While this material has been expert-reviewed, it is not NIMH or MHANYS intention to provide specific medical advice. Both MHANYS and NIMH advise readers to consult with a qualified health care provider for diagnosis, treatment, and answers to personal questions.

What is post-traumatic stress disorder (PTSD)?

Post-traumatic stress disorder (PTSD) is a disorder that develops in some people who have experienced a shocking, scary, or dangerous event.

It is natural to feel afraid during and after a traumatic situation. Fear is a part of the body’s “fight-or-flight” response, which helps us avoid or respond to potential danger. People may experience a range of reactions after trauma, and most people recover from initial symptoms over time. Those who continue to experience problems may be diagnosed with PTSD.

Who gets PTSD?

Anyone can develop PTSD at any age. This includes combat veterans and people who have experienced or witnessed a physical or sexual assault, abuse, an accident, a disaster, or other serious events. People who have PTSD may feel stressed or frightened, even when they are not in danger.

Not everyone with PTSD has been through a dangerous event. Sometimes, learning that a friend or family member experienced trauma can cause PTSD.

According to the National Center for PTSD , a program of the U.S. Department of Veterans Affairs, about six out of every 100 people will experience PTSD at some point in their lives. Women are more likely to develop PTSD than men. Certain aspects of the traumatic event and some biological factors (such as genes) may make some people more likely to develop PTSD.

What are the signs and symptoms of PTSD?

Symptoms of PTSD usually begin within 3 months of the traumatic event, but they sometimes emerge later. To meet the criteria for PTSD, a person must have symptoms for longer than 1 month, and the symptoms must be severe enough to interfere with aspects of daily life, such as relationships or work. The symptoms also must be unrelated to medication, substance use, or other illness.

The course of the disorder varies. Some people recover within 6 months, while others have symptoms that last for 1 year or longer. People with PTSD often have co-occurring conditions, such as depression, substance use, or one or more anxiety disorders.

After a dangerous event, it is natural to have some symptoms. For example, some people may feel detached from the experience, as though they are observing things rather than experiencing them. A mental health professional who has experience helping people with PTSD, such as a psychiatrist, psychologist, or clinical social worker, can determine whether symptoms meet the criteria for PTSD.

To be diagnosed with PTSD, an adult must have all of the following for at least 1 month:

  • At least one re-experiencing symptom
  • At least one avoidance symptom
  • At least two arousal and reactivity symptoms
  • At least two cognition and mood symptoms

Re-experiencing symptoms include:

  • Experiencing flashbacks—reliving the traumatic event, including physical symptoms such as a racing heart or sweating
  • Having recurring memories or dreams related to the event
  • Having distressing thoughts
  • Experiencing physical signs of stress

Thoughts and feelings can trigger these symptoms, as can words, objects, or situations that are reminders of the event.

Avoidance symptoms include:

  • Staying away from places, events, or objects that are reminders of the traumatic experience
  • Avoiding thoughts or feelings related to the traumatic event

Avoidance symptoms may cause people to change their routines. For example, some people may avoid driving or riding in a car after a serious car accident.

Arousal and reactivity symptoms include:

  • Being easily startled
  • Feeling tense, on guard, or on edge
  • Having difficulty concentrating
  • Having difficulty falling asleep or staying asleep
  • Feeling irritable and having angry or aggressive outbursts
  • Engaging in risky, reckless, or destructive behavior

Arousal symptoms are often constant. They can lead to feelings of stress and anger and may interfere with parts of daily life, such as sleeping, eating, or concentrating.

Cognition and mood symptoms include:

  • Having trouble remembering key features of the traumatic event
  • Having negative thoughts about oneself or the world
  • Having exaggerated feelings of blame directed toward oneself or others
  • Having ongoing negative emotions, such as fear, anger, guilt, or shame
  • Losing interest in enjoyable activities
  • Having feelings of social isolation
  • Having difficulty feeling positive emotions, such as happiness or satisfaction

Cognition and mood symptoms can begin or worsen after the traumatic event. They can lead a person to feel detached from friends or family members.

If you or someone you know is struggling or having thoughts of suicide, call or text the 988 Suicide and Crisis Lifeline  at 988 or chat at 988lifeline.org . In life-threatening situations, call 911.

How do children and teens react to trauma?

Children and teens can have extreme reactions to trauma, but some of their symptoms may not be the same as those seen in adults. In children younger than age 6, these symptoms can include:

  • Wetting the bed after having learned to use the toilet
  • Forgetting how to talk or being unable to talk
  • Acting out the scary event during playtime
  • Being unusually clingy with a parent or other adult

Older children and teens usually show symptoms more like those seen in adults. They also may develop disruptive, disrespectful, or destructive behaviors. Older children and teens may feel guilty for not preventing injury or deaths. They may also have thoughts of revenge.

What are the risk factors for PTSD?

Not everyone who lives through a dangerous event develops PTSD—many factors play a part. Some of these factors are present before the trauma; others become important during and after a traumatic event.

Risk factors that may increase the likelihood of developing PTSD include:

  • Being exposed to previous traumatic experiences, particularly during childhood
  • Getting hurt or seeing people hurt or killed
  • Feeling horror, helplessness, or extreme fear
  • Having little or no social support after the event
  • Dealing with extra stress after the event, such as loss of a loved one, pain and injury, or loss of a job or home
  • Having a personal or family history of mental illness or substance use

Resilience factors that may reduce the likelihood of developing PTSD include:

  • Seeking out support from friends, family, or support groups
  • Learning to feel okay with one’s actions in response to a traumatic event
  • Having a coping strategy for getting through and learning from the traumatic event
  • Being prepared and able to respond to upsetting events as they occur, despite feeling fear

How is PTSD treated?

It is important for anyone with PTSD symptoms to work with a mental health professional who has experience treating PTSD. The main treatments are psychotherapy, medications, or a combination of psychotherapy and medications. A mental health professional can help people find the best treatment plan for their symptoms and needs.

Some people with PTSD, such as those in abusive relationships, may be living through ongoing trauma. In these cases, treatment is usually most effective when it addresses both the traumatic situation and the symptoms of PTSD. People who experience traumatic events or who have PTSD also may experience panic disorderdepressionsubstance use, or suicidal thoughts. Treatment for these conditions can help with recovery after trauma. Research shows that support from family and friends also can be an important part of recovery.

Psychotherapy

Psychotherapy (sometimes called talk therapy) includes a variety of treatment techniques that mental health professionals use to help people identify and change troubling emotions, thoughts, and behaviors. Psychotherapy can provide support, education, and guidance to people with PTSD and their families. Treatment can take place one on one or in a group and usually lasts 6 to 12 weeks but can last longer.

Some types of psychotherapy target PTSD symptoms, while others focus on social, family, or job-related problems. Effective psychotherapies often emphasize a few key components, including learning skills to help identify triggers and manage symptoms.

One common type of psychotherapy, called cognitive behavioral therapy, can include exposure therapy and cognitive restructuring:

  • Exposure therapy helps people learn to manage their fear by gradually exposing them, in a safe way, to the trauma they experienced. As part of exposure therapy, people may think or write about the trauma or visit the place where it happened. This therapy can help people with PTSD reduce symptoms that cause them distress.
  • Cognitive restructuring helps people make sense of the traumatic event. Sometimes people remember the event differently from how it happened. They may feel guilt or shame about something that is not their fault. Cognitive restructuring can help people with PTSD think about what happened in a realistic way.

Medications

The U.S. Food and Drug Administration (FDA) has approved two selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant medication, for the treatment of PTSD. SSRIs may help manage PTSD symptoms such as sadness, worry, anger, and feeling emotionally numb. Health care providers may prescribe SSRIs and other medications along with psychotherapy. Some medications may help treat specific PTSD symptoms, such as sleep problems and nightmares.

People should work with their health care providers to find the best medication or combination of medications and the right dose. To find the latest information about medications, talk to a health care provider and visit the FDA website .

How can I find help for PTSD?

If you’re not sure where to get help, a health care provider can refer you to a licensed mental health professional, such as a psychiatrist or psychologist with experience treating PTSD. 

The Substance Abuse and Mental Health Services Administration has an online treatment locator  to help you find mental health services in your area.

Here are some things you can do to help yourself while in treatment:

  • Talk with your health care provider about treatment options and follow your treatment plan.
  • Engage in exercise, mindfulness, or other activities that help reduce stress.
  • Try to maintain routines for meals, exercise, and sleep.
  • Set realistic goals and focus on what you can manage.
  • Spend time with trusted friends or relatives and tell them about things that may trigger symptoms.
  • Expect your symptoms to improve gradually, not immediately.
  • Avoid the use of alcohol or drugs.

How can I help a friend or relative who has PTSD?

If you know someone who may be experiencing PTSD, the most important thing you can do is to help that person get the right diagnosis and treatment. Some people may need help making an appointment with their health care provider; others may benefit from having someone accompany them to their health care visits.

If a close friend or relative is diagnosed with PTSD, you can encourage them to follow their treatment plan. If their symptoms do not get better after 6 to 8 weeks, you can encourage them to talk to their health care provider. You also can:

  • Offer emotional support, understanding, patience, and encouragement.
  • Learn about PTSD so you can understand what your friend is experiencing.
  • Listen carefully. Pay attention to the person’s feelings and the situations that may trigger PTSD symptoms.
  • Share positive distractions, such as walks, outings, and other activities.

Federal resources

  • National Center for PTSD : Part of the U.S. Department of Veterans Affairs, this website has information and resources for anyone interested in PTSD, including veterans, family, friends, researchers, and health care providers. The site offers videos, apps, online programs, and other tools to help people with PTSD and their loved ones.
  • Medications for PTSD : This webpage from the U.S. Department of Veterans Affairs describes effective medications for treating PTSD and considerations for evaluating treatment options. PTSD  (MedlinePlus – also en español )

Handouts

Post-Traumatic Stress Disorder English/Español  Helping Children and Adolescents Cope with Traumatic Events English / Español 


Mental Health Association in New York State (MHANYS) has additional resources that can be accessed through its main website. These resources include links to advocacy and policy work, school-based programs, mental health wellness training programs and more.

MHANYS
mhanys.org

Advocacy and Policy
mhanys.org/advocacy-policy

Mental Health Community Partners
mhcommunitypartners.org

CarePath™
mhanys.org/carepath

SMHRT: Family Education
https://www.mentalhealthednys.org/family-education-webinar-series/


Data Source
National Institute of Mental Health: Mental Health Information Health Topics www.nimh.nih.gov/health/topics