Updated: Mar 10
While public perception and the understanding of mental health has gradually improved, research by Time to Change shows that there’s still much to be done, especially with regards to lesser-known disorders. 27% of people with less common mental health disorders feel that discrimination against them has increased in the last decade, and 84% of people with less common mental health disorders don’t believe there has been an improvement in public perception of these conditions. Complementary to their sentiments, a vast majority of the general public (84%) said that they know at least a little bit about depression, a disorder that is extremely common and highly talked about. This number, however, drops dramatically for less common mental health disorders: Only 50% of people claim to know about borderline personality disorder, and 35%, even less, about schizophrenia. The lack of public knowledge and understanding around 'less common' mental health disorders continues to stigmatize those who suffer, necessitating further education and awareness. Until 'I have schizophrenia' elicits the same response as 'I have depression', we need to continue having this conversation.
What Causes Mental Health Disorders?
Different mental health disorders are caused by a slew of factors. We covered the most prominent ones in our ‘The Mental Health Conversation We Need to be Having’ article: supernatural, somatogenic (of the body), and psychogenic (of the mind). And we highlighted the importance of a fourth one, the social determinants of health (of the environment).
During the pandemic, these factors become even more pronounced as people have been laid off jobs and others have needed to adjust drastically to working from home—where the line is blurred between home and work. In fact, lifestyle columnist James Gonzales suggests that working remotely could lead to burnout and isolation. Gonzales says the pressure on remote workers to “always be on” depletes their social battery, leading to further withdrawal. Indeed, sheltering from home requires people to take an active role in caring for their mental wellness, such as lifestyle changes to incorporate mental health breaks, and reaching out to their support systems. These adjustments become even more important for people with lesser-known mental health disorders, as they rarely get the same level of support and understanding as those with more common diagnoses.
Depression and anxiety are two of the most common mental health disorders worldwide–by a huge margin. According to the World Health Organization, globally, in 2017, an estimated 264 million people were affected by depression, while an estimated 284 million people were affected by anxiety disorders.
While it is understandable that depression and anxiety are spoken about more frequently, and in more detail, than others mental health disorders, the stigma associated with lesser known mental health disorders still persists. I have outlined some 'commonly uncommon' disorders, including Borderline Personality Disorder (BPD), Schizophrenia, Eating Disorder, Obsessive Compulsive Disorder (OCD), Depersonalization/Derealization, and Dissociative Identity Disorder (DID). I have included accompanying in-depth videos from six different channels that highlight the subtleties and nuances of these disorders.
Borderline Personality Disorder (BPD)
Despite affecting more than 4 million Americans, BPD is still lesser-known than other mental disorders like Bipolar Disorder, which affects only about 2.3 million Americans. BPD is a psychological condition that’s characterized by unstable and erratic moods, emotions, self-image, relationships, and behaviours. As such, it’s common to misdiagnose BPD as Bipolar Disorder. The key difference between BPD and Bipolar Disorder is that Bipolar Disorder is a mood disorder (a category of disorders distinguished by serious changes in mood, including depression), while BPD is a personality disorder (PD). PDs are characterized by divergent ways of thinking, feeling, and behaving which cause distress and dysfunction.
One method for 'treating' BPD is dialectical behavioral therapy (DBT), which is a form of evidence-based psychotherapy that was developed specifically for BPD. DBT combines acceptance and mindfulness of one’s emotional state with coping skills for these emotions.
Schizophrenia is one of the leading causes of disability in the U.S., and approximately 3.5 million people are diagnosed in the country. Schizophrenia is a 'thought disorder' that involves psychosis, meaning that individuals experiencing it may lose touch with reality, have auditory and visual hallucinations, and think that their lives are at risk or that people are trying to hurt them. Other times, schizophrenia may manifest in negative symptoms like blunted emotions, apathy, social withdrawal, and poverty of speech and thought. The disorder makes it especially difficult for them to maintain consist employment or take care of themselves.
A common misconception about those who suffer from schizophrenia is that they perpetrate violence. However, according to Simon Rego, PsyD, chief psychologist at Montefiore Medical Center and Associate Professor of Psychiatry and Behavioral Sciences at Albert Einstein College of Medicine, it is actually rare for someone with schizophrenia to be violent. This study explains that an individual with schizophrenia is much more likely to be the victim of violence rather than the perpetrator.
Eating Disorders (EDs)
According to the National Eating Disorders Association, an estimated 30 million Americans have struggled with an ED at least once in their lives. There are three types of EDs: Binge-eating, Bulimia Nervosa, and Anorexia Nervosa. The main symptom of Binge-eating Disorder is overeating to the point of discomfort, often leading to feelings of shame, guilt, and distress. Bulimia Nervosa may also have periods of binge-eating, but it’s always followed by a purge—either through throwing up forcibly or by using laxatives. Binge-eaters and bulimics may be either underweight, normal weight, or overweight. Anorexia Nervosa is a disorder that leads people to avoid or severely restrict food intake, with most anorexics becoming dangerously underweight.
It is common for people with an eating disorder to have one or more co-occuring conditions. One study found that 71% of people with an eating disorder were also diagnosed with an anxiety or mood disorder.
Obsessive-Compulsive Disorder (OCD)
OCD affects adults and children alike. About 2 to 3 million American adults and 500,000 children and teens are diagnosed with OCD every year. For scale, the number of adults with OCD in the country roughly equals the entire population of Houston; the number of kids struggling with the disorder is about the same as those who have diabetes.
OCD is beyond just the obsession with cleanliness as portrayed in popular culture. The disorder leads people to have recurring, uncontrollable thoughts, ideas, or obsessions that compel them to do something repetitively (compulsions) which could lead to severe distress or anxiety. These compulsions are meant to reduce anxiety and make those with OCD believe that they’re necessary to prevent bad things from happening.
Common fears, or obsessions, in people with OCD include: fear of germs or contamination, fear of committing a crime, fear of harming themselves or others, fear of a loved one dying, fear of certain numbers, colours, words, etc., and a fear of becoming a sexual predator.
A specific form of therapy that has been shown to be effective in treating OCD is called Exposure and Response Prevention (ERP). ERP is a type of behavioral therapy that exposes patients to situations and scenarios that provoke their obsessions and the resulting distress while helping them prevent their compulsive responses. The goal is to free people from their obsessions and compulsions so they can live fuller lives.
Depersonalization/ Derealization Disorder (DPDR)
3 in every 4 adults have had a dissociative episode in their lives, but only 2% meet the criteria for DPDR, according to the National Alliance on Mental Illness. Also referred to as Depersonalization/ Derealization Syndrome, DPDR is a condition embodied by two distinct aspects: depersonalization and derealization. Depersonalization makes one experience a persistent feeling of being outside of the body as if viewing oneself on a movie screen; derealization is the sensation of being detached from the environment, as well as the people, and objects within it, possibly distorting vision and other senses.
Severe stress, anxiety, and depression are common triggers of DPDR. Often, people with DPDR have experienced trauma at some point in their lives. This can include emotional or physical abuse or neglect in childhood, having a loved one die unexpectedly, or witnessing domestic violence. DPDR is one of four types of dissociative disorders, another being Dissociative Identity Disorder (DID).
Dissociative Identity Disorder (DID)
While DID may share some symptoms of other mental health disorders, such as depersonalization, its main distinction is the marked presence of two or more distinct personalities within a sole individual. Previously called Multiple Personality Disorder, DID is relatively rare, affecting only 0.1% to 1% of the general population. The chronic dissociation seen in DID leads to the creation of different identities or alters.
Several mental health professionals theorize that a history of trauma could lead to the development of DID, trauma severe enough that the only way for individuals to cope is to strongly dissociate. This theory is strongly supported by historical data which claims that approximately 90% of those with DID have a history of past abuse and trauma.
As WHO Director-General Dr. Tedros Adhanom Ghebreyesus said, “Good mental health is absolutely fundamental to overall health and well-being.” In order to help create a healthier community, everyone must do their part to raise awareness on these mental health disorders and give support however they can.
Written exclusively for Twentytwentyarts.com by Arcy Crowley Arcy Crowley is a mental health advocate and freelance writer. She is passionate about helping people understand mental health issues. She enjoys jogging in the local park.