Mental breakdown

A mental breakdown (also known as a nervous breakdown) is an acute, time-limited mental disorder that manifests primarily as severe stress-induced depression, anxiety, or dissociation in a previously functional individual, to the extent that they are no longer able to function on a day-to-day basis until the disorder is resolved. A nervous breakdown is defined by its temporary nature, and often closely tied to psychological burnout, severe overwork, sleep deprivation, and similar stressors, which may combine to temporarily overwhelm an individual with otherwise sound mental functions.

Definition
The terms "nervous breakdown" and "mental breakdown" have not been formally defined through a medical diagnostic system such as the DSM-5 or ICD-10, and are nearly absent from current scientific literature regarding mental illness. Although "nervous breakdown" is not rigorously defined, surveys of laypersons suggest that the term refers to a specific acute time-limited reactive disorder, involving symptoms such as anxiety or depression, usually precipitated by external stressors. Many health experts today refer to a nervous breakdown as a "modern mental health crisis."

Specific cases are sometimes described as a "breakdown" only after the emotional and physical demands on a person's life are so great as to prevent him or her from performing activities of daily living or, less strictly, only when those demands prevent him/her from performing his/her familial or occupational duties.

Nervous breakdowns are often caused by serious ongoing mental health disorders.

Controversy
In How Everyone Became Depressed: The Rise and Fall of the Nervous Breakdown (2013), Edward Shorter, a professor of psychiatry and the history of medicine, argues for a return to the old-fashioned concept of nervous illness: "About half of them are depressed. Or at least that is the diagnosis that they got when they were put on antidepressants. ... They go to work but they are unhappy and uncomfortable; they are somewhat anxious; they are tired; they have various physical pains – and they tend to obsess about the whole business. There is a term for what they have, and it is a good old-fashioned term that has gone out of use. They have nerves or a nervous illness. It is an illness not just of mind or brain, but a disorder of the entire body. ... We have a package here of five symptoms–mild depression, some anxiety, fatigue, somatic pains, and obsessive thinking. ... We have had nervous illness for centuries. When you are too nervous to function ... it is a nervous breakdown. But that term has vanished from medicine, although not from the way we speak. ... The nervous patients of yesteryear are the depressives of today. That is the bad news. ... There is a deeper illness that drives depression and the symptoms of mood. We can call this deeper illness something else, or invent a neologism, but we need to get the discussion off depression and onto this deeper disorder in the brain and body. That is the point."

- Edward Shorter, Faculty of Medicine, University of Toronto.

""In eliminating the nervous breakdown, psychiatry has come close to having its own nervous breakdown.""

- David Healy, MD, FRCPsych, Professor of Psychiatry, University of Cardiff, Wales.

""Nerves stand at the core of common mental illness, no matter how much we try to forget them.""

- Peter J. Tyrer, FMedSci, Professor of Community Psychiatry, Imperial College, London

""Nervous breakdown" is a pseudo-medical term to describe a wealth of stress-related feelings and they are often made worse by the belief that there is a real phenomenom called "nervous breakdown.""

- Richard E. Vatz, co-author of explication of views of Thomas Szasz in /Thomas Szasz : "Primary Values and Major Contentions."

Signs and symptoms
One major symptom of a mental breakdown is depression. When someone is depressed they may experience weight loss or gain (often due to changes in appetite), suicidal thoughts, loss of interest in social, family or work life, insomnia or hypersomnia, exhaustion or fatigue and feelings of hopelessness or worthlessness. Another symptom of a breakdown is anxiety, which can produce an increase in blood pressure, dizziness, trembling, or feeling sick to the stomach. Panic attacks are very similar to mental breakdowns, but can also be a symptom in some cases. Difficulty with breathing and extreme fear, alongside rapid heartbeat may occur in those who are experiencing a panic attack. In more severe cases of mental breakdown, a person may experience mood swings, hallucinations, paranoia, and flashbacks. In each of these more severe cases there can be a more serious underlying problem that caused the mental breakdown. Hallucinations may suggest schizophrenia or other disorders involving psychosis, mood swings may suggest bipolar disorder or other mood disorders (or personality disorders such as BPD), and flashbacks may suggest posttraumatic stress disorder. The severity of each of these disorders and symptoms may vary based upon the person and their background.

Causes
Causes of such breakdowns are varied. A 1996 study found that problems with intimate relationships, such as divorce or marital separation, contributed to 24% of nervous breakdowns. Problems at work and school accounted for 17% of cases, and financial problems for 11%. Surveys suggest that in the United States, health problems have decreased in importance as a contributor to nervous breakdowns. Health problems accounted for 28% of nervous breakdowns in 1957, 12% in 1976, and only 5.6% in 1996.

A nervous breakdown is very similar to a panic attack. Stress is a major cause in both cases and they are both temporary. During a nervous breakdown, a person's emotional state of being shifts from an ability to cope with life stresses to a state of being totally overwhelmed to a point that normal functioning is disrupted. Excessive worry, nervousness, fear, anxiety are symptomatic. These states of being are accompanied by a variety of uncomfortable feelings often summarized as bad or sad. If these feelings become so intense they are perceived as life-threatening, the defense system blocks awareness. These mechanisms while protective can also be limiting to successful living. Overwhelming stress, therefore, is causative. Whether that stress is self-created or external requires different approaches and has different implications to the individual.

A nervous breakdown is not limited to any one type of person: anyone can have this breakdown, but if someone is under a lot of stress and has a family background of mental disorders, they can be more likely to have one.

Treatment
The medication that may be prescribed to someone who has a mental breakdown is based upon the underlying causes, which are sometimes more serious mental disorders. Antidepressants are given to treat depression. Anxiolytics are used for those with anxiety disorders. Antipsychotics are used for schizophrenia and mood stabilizers help with bipolar disorder. Depending upon what caused a person’s mental breakdown, any of these treatments can be helpful for them.

There are several different kinds of therapy that a patient can receive. The most common type of therapy is counseling. This is where the patient is able to talk about whatever is on their mind without worrying about any judgments. Psychotherapy is a very common type of therapy that addresses the current problems in someone’s life and helps them to deal with them. Past experiences may also be explored in this type of therapy. In psychoanalysis therapy, the main focus is a patient’s past experiences so that they can confront these issues and prevent breakdowns in the future. Cognitive behavioral therapy explores how a person behaves and what they are thinking and feeling. If there is anything negative in these three different categories, then this therapy will try to turn them around into positives. Hypnotherapy is where hypnosis is performed and used to help the patient relax. Hypnosis can also be used to figure out why a person acts or feels a certain way, by examining past events that may have caused the breakdown. Expressive therapy focuses on how the patient is able to express their feelings. If the patient has a hard time doing this, expression through the arts is highly recommended. There is also aromatherapy, which consists of herbs to help the patient relax and to try and relieve stress. Yoga and massage may also be included in this therapy that will help the muscles to relax. All of these therapies help a person to relax and de-stress and also help to prevent future breakdowns.

Similar disorders
Rapport, Todd, Lumley, and Fisicaro suggest that the closest DSM-IV diagnostic category to nervous breakdown is Adjustment Disorder with Mixed Anxiety and Depressed Mood (Acute). Adjustment disorders and nervous breakdowns are both acute reactions to stress that resolve after removal of the stressor. However, DSM-IV excludes from adjustment disorders cases secondary to bereavement, which contributes to approximately 6–8% of nervous breakdowns.

Nervous breakdowns may share some features of acute stress disorder and post-traumatic stress disorder, in that these each occur in response to an external stressor, and may be marked with sleep disturbance, diminished concentration, and mood lability. However, the symptoms of nervous breakdown do not include the constellation of re-experienced trauma, dissociation, avoidance, and numbing of general responsiveness that are associated with the other two disorders, and the types of stressors linked to a nervous breakdown are generally less extreme.

Nervous breakdowns may share many features of mixed anxiety-depressive disorder (MADD). However, the definition of MADD suggests a chronic condition, in contrast to the acute, short-term nature of a nervous breakdown.