Common Mental Health Disorders

Why This Matters

As a social worker, you'll encounter mental health disorders in virtually every practice setting—whether you're working in child welfare, healthcare, criminal justice, or community services. Understanding these conditions isn't just about memorizing symptoms from the DSM-5; you're being tested on your ability to recognize how disorders manifest differently across populations, which evidence-based treatments align with which conditions, and how co-occurring disorders complicate assessment and intervention. The biopsychosocial framework you've learned comes alive when you can identify how biological vulnerabilities, psychological patterns, and social determinants intersect in each disorder.

Your exams will push you beyond simple identification toward differential diagnosis, treatment matching, and person-in-environment thinking. A client presenting with low mood might have Major Depressive Disorder—or they might be experiencing a depressive episode of Bipolar Disorder, grief, or trauma response. Knowing the distinguishing features matters for ethical, effective practice. Don't just memorize symptoms—know what underlying mechanism each disorder represents and which interventions the research supports.

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Mood Disorders: When Emotional Regulation Goes Awry

Mood disorders involve disruptions to a person's baseline emotional state that persist over time and impair functioning. The key mechanism is dysregulation of mood—either stuck in one extreme or cycling between them.

Major Depressive Disorder

• Persistent depressed mood or anhedonia lasting at least two weeks—these are the two cardinal symptoms, and at least one must be present for diagnosis
• Neurovegetative symptoms include sleep disturbances, appetite changes, fatigue, and psychomotor changes—these physical manifestations distinguish clinical depression from ordinary sadness
• High comorbidity with anxiety disorders—approximately 60% of people with depression also experience anxiety, making thorough assessment essential

Bipolar Disorder

• Defined by manic or hypomanic episodes, not depression—many clients are misdiagnosed with MDD before a manic episode reveals the full picture
• Manic episodes involve elevated or irritable mood, decreased need for sleep, grandiosity, and risky behavior lasting at least 7 days (or any duration if hospitalization is required)
• Medication is typically first-line treatment—mood stabilizers like lithium are essential; antidepressants alone can trigger manic episodes

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Anxiety-Based Disorders: The Fear Response in Overdrive

These disorders share a common thread: the brain's threat-detection system activates inappropriately or excessively, causing distress that far exceeds any actual danger. Understanding the specific trigger pattern helps distinguish between them.

Generalized Anxiety Disorder

• Excessive worry about multiple life domains (work, health, family) occurring more days than not for at least 6 months—the worry feels uncontrollable
• Physical symptoms include muscle tension, restlessness, fatigue, and sleep difficulties—the body stays in chronic low-level fight-or-flight
• CBT and SSRIs are first-line treatments—relaxation training and cognitive restructuring help clients challenge catastrophic thinking patterns

Obsessive-Compulsive Disorder

• Obsessions are intrusive, unwanted thoughts that cause marked anxiety; compulsions are repetitive behaviors performed to neutralize that anxiety
• The compulsion-relief cycle reinforces the disorder—temporary anxiety reduction strengthens the compulsive behavior, creating a self-perpetuating loop
• Exposure and Response Prevention (ERP) is the gold-standard treatment—clients face feared stimuli while resisting compulsions, breaking the cycle

Post-Traumatic Stress Disorder

• Develops after exposure to actual or threatened death, serious injury, or sexual violence—the trauma criterion is specific and must be met
• Four symptom clusters: intrusion (flashbacks, nightmares), avoidance, negative alterations in cognition/mood, and hyperarousal—all four must be present
• Trauma-focused therapies like EMDR and Prolonged Exposure are evidence-based treatments—general talk therapy without trauma focus is less effective

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Psychotic and Severe Disorders: Disrupted Reality Testing

These conditions involve fundamental disruptions to thought processes, perception, or sense of self. The underlying mechanism often involves neurobiological differences that require medication as a core intervention component.

Schizophrenia

• Positive symptoms include hallucinations (usually auditory), delusions, and disorganized speech—these are "additions" to normal experience
• Negative symptoms include flat affect, avolition, and social withdrawal—these "subtractions" from normal functioning are often more disabling long-term
• Antipsychotic medication is essential for symptom management; psychosocial interventions like supported employment improve functioning and quality of life

Borderline Personality Disorder

• Pervasive pattern of instability in relationships, self-image, and emotions, with marked impulsivity beginning by early adulthood
• Intense fear of abandonment drives many symptoms—frantic efforts to avoid real or imagined abandonment often create the very rejection clients fear
• Dialectical Behavior Therapy (DBT) is the evidence-based treatment—teaches distress tolerance, emotion regulation, interpersonal effectiveness, and mindfulness

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Behavioral and Developmental Patterns

These disorders involve patterns of behavior or development that diverge from typical trajectories. The focus shifts from internal emotional states to observable behavioral patterns and their functional impacts.

Attention-Deficit/Hyperactivity Disorder

• Neurodevelopmental disorder with onset before age 12—symptoms must be present in multiple settings (home, school, work)
• Three presentations: predominantly inattentive, predominantly hyperactive-impulsive, or combined—presentation type guides intervention strategies
• Multimodal treatment combining behavioral interventions, environmental modifications, and often stimulant medication produces best outcomes

Substance Use Disorders

• Defined by impaired control, social impairment, risky use, and pharmacological indicators (tolerance, withdrawal)—severity ranges from mild to severe
• Chronic brain disorder involving changes to reward, stress, and self-control circuits—understanding this reduces stigma and informs treatment
• Evidence-based approaches include Motivational Interviewing, CBT, contingency management, and Medication-Assisted Treatment (MAT) for opioid and alcohol use disorders

Eating Disorders

• Anorexia nervosa involves restriction and fear of weight gain; bulimia nervosa involves binge-purge cycles; binge-eating disorder involves recurrent binges without compensatory behaviors
• Highest mortality rate of any mental health disorder—medical monitoring is essential, especially for anorexia
• Treatment requires multidisciplinary approach—medical stabilization, nutritional rehabilitation, and therapies like CBT-E (Enhanced) or Family-Based Treatment for adolescents

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Quick Reference Table

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Self-Check Questions

1. A client presents with depressive symptoms and reports a period last year when they slept only 3 hours a night, started multiple business ventures, and felt "on top of the world." Which disorder should you assess for, and why does this history change treatment considerations?

2. Compare and contrast GAD and PTSD: What symptoms overlap, and what key features distinguish them in assessment?

3. Which two disorders on this list have the strongest evidence base for Cognitive-Behavioral Therapy as a primary intervention? What makes CBT particularly effective for these conditions?

4. A client with Borderline Personality Disorder and a client with Schizophrenia both express paranoid thoughts. How would you expect these presentations to differ, and why does this matter for intervention?

5. Identify three disorders from this list where medication is typically considered essential (not just helpful) for effective treatment. What does this suggest about the underlying mechanisms of these conditions?