Sara Klimek

When most people think about the word ‘illness,’ it usually revolves around physical impairments and challenges.  When you have the flu, you have an illness. If you have Crohn's Disease, you have an illness. But if you have a depressive disorder- do you actually have an illness?

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Believe it or not, downgrading mental illnesses; such as anxiety, depression, and obsessive compulsive disorder (OCD); to merely ‘temporary conditions’ has reverberating effects to everyone who has the disease.  It can cause people to forfeit treatment because they are convinced that the illness can heal itself, or that the illness will only last as long as they are in X situation.  In reality, however, mental illnesses can last an entire lifetime and require a variety of treatments in order to curb the symptoms.

According to the National Institute of Health and Johns Hopkins Medical Center, 1 in 4 Americans will suffer from mental illness within a given year.  Among those statistics, 9.5% of Americans will develop a depressive illness each year while 18% of people will develop some sort of anxiety disorder.

But what about the mental illnesses that don’t fit into the categories of depression or anxiety?  Certainly these diseases may be less common, but don’t they deserve some kind of statistic?

Therein lies the problem with mental illness and statistics.  If not everyone can identify their illness clearly, how can we know what percent of the population has the illness?  We can’t. You’d also have to factor in the many people who are misdiagnosed or grouped into the wrong category of mental illness.

I was one of those people - partly. I was diagnosed with Depression at around fifteen years old and started taking medication for dysthymia (long-term depressive disorder) a year later. My doctor just figured that my symptoms were part of the ‘growing up blues.’  Adjusting to a post-pubescent body, fitting into the social class in high school- these were all factors that situationally contributed to depressive episodes.  What many doctors, parents, and even the people suffering don’t realize is that Depression physically manifests itself in the brain.  Major Depressive Disorder (MDD) in particular is shown to shrink the size of the brain’s hippocampus and prefrontal cortex, which stems from a production of increased cortisol (a stress hormone). Abnormal brain activity can cause a person to have altered sleep/wake cycles and memory-retention issues later in life.

The symptoms of Depression can vary from person-to-person. Some people won’t notice dramatic changes in appetite or have suicidal ideation, but rather feel a steady ‘lull’ in mood and behavior. Certainly I fit this description, but was there more to the picture than I was seeing?

It wasn’t until I started doing research that I realized mental illness can be much more specific than ‘anxiety’ or ‘depression.’ I actually found that many of my specific symptoms linked up to a mental illness called ‘borderline personality disorder’ or BPD. For years, BPD was deemed a ‘wastebasket’ diagnosis, meaning that its exact symptoms lacked continuity among people that were diagnosed; researchers characterized the disease by being on the border of psychosis and neurosis. It wasn’t until 1938 that American psychoanalyst Adolph Stern defined what borderline personality disorder was and what kinds of psychotherapy work best to combat it. It took nearly 50 years for medical professionals to realize that borderline personality disorder produced similar cognitive impairments to depression. These similarities gave doctors the indication that BPD, because of its physical manifestation, may coexist with other mental illnesses such as Post-Traumatic Stress Disorder (PTSD), depression, anxiety, bulimia, and schizophrenia, meaning that a person with BPD can easily be misdiagnosed.

Within the past decade, we have seen an emergence of advocacy groups towards borderline personality disorder. The National Alliance on Mental Illness (NAMI) listed BPD as one of its highest priority mental disorders. New support groups are forming for people who have decided to undergo psychotherapy, which is regarded as one of the most successful treatment options.

But what actually is BPD?  According to the National Institute of Health, BPD is characterized by erratic thoughts and self-injurious behavior, most of which starts in early adolescence. Although not specific, a high proportion of those diagnosed with BPD have a history of sexual trauma and abuse; these experiences can stimulate feelings of hopelessness, loneliness, and attachment issues characteristic of the disease. Contemporary science is in somewhat of an agreement about the biological, social, and psychological causes of the disease. Similar to depressive disorders, BPD changes the brain’s release of serotonin hormones, which can manifest into aggression and impulsive behavior in the individual. These symptoms are often regulated using selective serotonin reuptake inhibitors (SSRIs), which may not always work. I was on an SSRI for nearly 2 years before noticing that the medication wasn’t impacting any of my symptoms. Patients can also be treated with anxiolytic or neuroleptic drugs in the short-term. While these medications may relieve impulsivity, immediate anxiety, and perceptual impairment, doctors recognize that there is little to no long-term remedy for BPD.

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Nearly 12 million Americans who seek outpatient care are misdiagnosed annually.

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Don’t get me wrong, I do trust my doctors (you don’t go through years of studying for the MCAT for nothing). But, if we know that many mental illnesses like BPD manifest with forms of other illnesses (e.g. depression and anxiety), should we be so quick to diagnose?  If we were to look at an example of a physical illness like Hand-Foot-Mouth Disease (which I had the absolute pleasure of contracting this summer), we recognize that body-aches, headaches, and fever may in fact be symptoms of the flu.  But what if there was something more behind that? According to the BioMedical Journal, nearly 12 million Americans who seek outpatient care are misdiagnosed annually. In my run-in with HFMD, I was given some ibuprofen and told to go home and rest- little did I know that I was contagious to those around me.

A 95% accuracy rate may be good enough for a history test, but it’s not good enough when people’s lives are at stake.  Misdiagnosis of a physical or mental illness can have serious consequences. But do we consider them both as equally serious?

 

Sara is a managing editor at bSmart and Environmental Law student at the University of Vermont. Outside of her studies, she enjoys spending time with her horses, doing yoga, and cooking.

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