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Are You Normal? The Difference Between Quirks and Mental Illness

crazy-woman-funny-face-sepiaby Scott Haltzman, M.D.

You've been feeling anxious. Should you see a psychiatrist? Your friend's such a perfectionist. Does she have OCD?

Awareness about mental-health problems has increased, but figuring out whether you have one is another story. Just what is the difference between the blues and depression?

Here are four fictional people with stories like the real ones I hear all the time as a psychiatrist. See if you can tell who needs treatment, and in the process, pick up a few clues for your own life. (Click on the titles or scroll down to see my diagnoses.)



woman in darkLately, when I'm at home just hanging out, I get a terrible sense of fear and begin to feel like the walls are closing in on me. Once, I actually thought I was having a stroke, the physical sensation was so intense. I think I may have panic attacks, but my husband says I'm just overreacting. Maybe he's right and those sensations are just my imagination working overtime. After all, I'm a healthy 35-year-old, and I really don't have that much to worry about. What do you think is going on?


whispering-voices-earSometimes, as I'm falling off to sleep, I hear voices. I know there's no one in the room, and I'm pretty sure it's not a dream. I've had family members who were treated for hearing voices. Am I schizophrenic?


neat-manI'm a neat freak, and I like everything to be in the right place. My friends tell me I have OCD because all my sweaters are stacked by color, my slacks are evenly spaced on their hangers, and my toothpaste has to be in the same spot every morning. But my orderliness makes me happy and helps me stay on top of things. Do I need medication?






Ever since my daughter was born, I've been feeling down. She's now 3 months old, and I feel like I have no energy. I'm up all night worried about her. I've lost some weight, but that's normal, right, since I put on 40 pounds during the pregnancy? Everyone says it's postpartum blues, but between my crying and exhaustion, I just don't know. If this is what mothering is about, I'm ready to throw in the towel!

Do you think these people need to see a psychiatrist? Scroll down for my opinions.



woman-panic-attackJEANNIE'S STORY

Jeannie, I hate to take sides between husband and wife, but it sounds like this time you're right; more than likely you are suffering from panic attacks.

Many people, like your husband, believe that panic attacks happen when people worry too much or are under high stress. Sometimes that's true. But often, people have them when they're as mellow as the month of May.


Panic attacks are a normal physical and mental reaction that happens at an abnormal time.
Humans have a built-in alarm system, known as the fight-or-flight response. This prepares the body for a confrontation with danger by sending extra blood to the muscles, widening our eyes, dulling our sensation to pain, and increasing our breathing and heart rate. This results in a rapid heartbeat, shortness of breath, blurred vision, dry mouth, numbness and tingling sensations.

While our ancestors may have needed this reaction when a lion was at the mouth of the cave, today you're more likely to feel the fight-or-flight response when you meet with the boss to discuss why a whole shipment of PlayStation 3s disappeared from the stock room on your shift. Your body feels like it's not its own. But that's perfectly normal.


The hallmark of panic attacks is that the flooding of the body's fight-or-flight symptoms happens in the absence of any specific scary event to bring it on. It's like the alarm system gets triggered for no reason, but your body goes into full-court press, with all the sensations you'd have if there were a lion at your door. You get chest pains, palpitations, light-headedness, numbness in the fingers and toes and a wave of nausea in a matter of minutes. When these symptoms hit—and they do, like a sledgehammer—your level of, and you begin to think, "There must be some threat around," for why else would you be feeling this way? At this point, rising levels of mental anxiety lead you to try to figure out the cause of your panic. People often look to their environment for a reason. That's why, Jeannie, you thought, "It must be a stroke." Other people will say they think they are having a heart attack or going crazy.


One of the biggest risks of panic attacks is becoming fearful of going out to stores or driving, or even leaving your home. When people have repeated panic attacks, or restrict their activities because of fear that they'll have another episode, we classify that as a panic disorder.

Panic attacks often show up for the first time in women even younger than you, Jeannie, but they can happen to any sex at any age.

Many people will have one or two attacks and never have them again.
But if they continue, you should see your doctor to rule out an underlying medical condition, such as an overactive thyroid, high blood pressure or an irregular heart rate.

The good news is that there are many good treatments for panic disorder—with and without medications.


whispering-voices-earJIM'S STORY

No need to worry, Jim. The state of consciousness just before falling asleep is called hypnagogia. Up to 30 percent of people experience weird mental and bodily sensations during that time. If you see or hear things that aren't there, it's probably just a hypnagogic hallucination, a perfectly normal event. It's understandable that you're worried, though, because you do have a family history of people who have suffered from hearing voices, and some mental illnesses run in families.


When a person begins to hear or see things that aren't there, and actually believe these things are real, he or she may be in the state of psychosis.

Psychotic episodes can be a symptom in many disorders, including depression, substance abuse and Alzheimer's disease. When the psychosis is coupled with persistent difficulties interrelating to people, disorganized speech, or lack of initiative that persists over time, that might be evidence of schizophrenia.


neat-man-ocdJAMIL'S STORY

Jamil, you probably don't have obsessive-compulsive disorder, but that knowledge won't make you less uptight about how your closet looks!

OCD is an illness of excessive orderliness, yes, but one of its most prevalent features is the person's belief that he never quite gets things right. When someone with true OCD needs to keep his closets neat, he must take down and restack his sweaters four or five times because he doesn't feel he's done it well enough each time. Then, when he's all done, he'll go to bed asking himself, "Did I stack the sweaters right?" only to get back up and start the whole process over again.

In addition to orderliness, people with OCD may worry about germs (leading to excessive handwashing), catastrophes (leading to checking the gas on the stove) or other potential bad experiences.


OCD often needs to be treated with medication (particularly the SSRIs, such as Prozac, Zoloft, Paxil or Lexapro) in combination with cognitive-behavioral therapy.

Jamil, it sounds like you're able to put things in their place the first time around, and, rather than be crippled by your preoccupations, they help you stay on top of things. That more-or-less rules out OCD, but it doesn't eliminate the possibility that you have obsessive-compulsive personality disorder.

OCPD differs from OCD in that it is a pervasive personality style that affects the way a person interacts with the world. With OCD, a person often knows that the compulsion to do things makes no sense, and often feels driven crazy by meaningless rituals. OCPD, in contrast, may not bother the sufferer in the least; it's just others who are bothered by his actions.

I'd have to know more about you, Jamil, to help you figure out whether you have a personality disorder, but one of my first questions would be whether your style of living causes stress in your relationships with others.

People with OCPD tend to be miserly. They may refuse to throw away meaningless things, and they are so preoccupied with rules and regulations that they miss the point of the activity in the first place. Their tendency to be overly conscientious leads to feeling disappointed or judging others' haphazard ways. They're just not that much fun to be around.

OCPD doesn't respond to meds all that well, although SSRIs (a type of antidepressant) may be somewhat helpful.

The bottom line is that if you have high expectations for orderliness for yourself but are content to let the rest of us be slobs, you've got nothing to worry about.

woman-postpartum-depressionMELISSA'S STORY

Melissa, you probably do have postpartum depression, and it's important to get treatment as soon as possible.

The symptoms of postpartum depression don't differ from those of regular depression. They include a persistently down or low mood, with additional symptoms such as lack of energy, low interest, poor concentration, changes in sleep and appetite, excessive guilt, or thoughts of death. Hopelessness, like you describe, can make you a high risk for suicide.

Postpartum blues are very common and often occur in the first week following the birth of a child. But when symptoms persist beyond two weeks, there's a high likelihood that it could be depression.

One reason it's important to seek immediate treatment is postpartum depression presents a risk for you and your new baby. If you're not at your level best, you can't provide the kind of nurturing environment your new bambino needs.

A doctor needs to examine you to figure out whether there is a medical cause for your depression (such as an underactive thyroid gland) and also to rule out any psychotic symptoms that often complicate this kind of depression.newsletter-graphic

There are many medication and therapy options that will help. Most importantly, don't lose hope.

Board-certified psychiatrist SCOTT HALTZMAN, M.D., wrote The Secrets of Happily Married Men. He's a professor at Brown University and medical director of NRI Community Services, a behavioral-health provider in Woonsocket, Rhode Island.

For information on other disorders, visit Mental Health America or the National Institute of Mental Health.


Last updated and/or approved: June 2010.
Original article appeared in spring 2007 former print magazine. Bio current as of spring 2007. This article is not meant as individual advice. Please see our disclaimer.
Comments (5)add comment
written by Laura , February 12, 2012

Hi im Laura and i am 12 yrs old lately i have been suffering from chest pain and heart racing been to see lots of doctors about this on going problem but just now i have had the most terrible thing happen to me in my life what happened wasi was asleep and i suddenly woke up and it was like i almost went mental no (problems in the past)and my eyes rolled to the back of my head and it was almost like having a mental fit (never had one)and i was thinking about everything in my head speeding throw my head and i just felt like i was going to fall over then my heart was racing and i had bad bad chest pain worsted i have ever had it plz help me i dont no what this is and iam very scared knowing its happened at this time it is now 5:58am i dont feel tired like i did before i woke up plz help!
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Re: Anxious mom
written by Leigh Ann , May 12, 2011

Thank you for your comment. Please check out this article, which may help alleviate your fears:
3 Myths and Facts About Antidepressants (addresses the withdrawal rumor)

If you want more information, you may find this article interesting:
How Antidepressants Work (Lexapro is an SSRI; that class of medicines is covered with in this article)

And, since your daughter is young, you may find this enlightening:
Antidepressants and Suicide: Do Medicines Increase Your Risk?

Finally, I'd like to offer my personal thoughts. These are my own and do not represent

I applaud your proactiveness in your daughter's care. But I urge everyone with all my heart to listen to a doctor's advice if he or she recommends treatment for a mental disorder. Panic attacks are hell on Earth (and I don't say that flippantly), and antidepressants can fix them.

There are so many scary stories online about antidepressants that are based on rumor, misinformation and misunderstanding of the science. I have often said that antidepressants must be the most undeservedly vilified medications out there.

If you have concerns, please talk to your doctor about them. He or she can give you the facts. As far as your fears go about your daughter taking antidepressants for the rest of her life, this may not be necessary. If it is, to my knowledge, that will be due to the fact that she continues to have panic attacks without them, not due to withdrawal. If she does need them long-term, this is immeasurably preferable to continuing to have panic attacks. I view antidepressants as a blessing, not something to be feared. If you have to take them for the rest of your life, it's a life-long blessing so that you don't have to go through the hell of a mental disorder. What a wonderful mother to recognize the symptoms early on.

Again, the above does not reflect this website; it's my personal opinion, and please talk to your doctor; it's not meant as individual advice to replace a doctor's. (I am not a doctor.) I would urge that the doctor conversation happen ASAP because antidepressants can take a couple of weeks to kick in. I wish the best of luck to you and your daughter.

Leigh Ann Otte
Managing Editor

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written by Anxious mom , May 12, 2011

my 12yr old daughter was diagnosis with anxiety a year ago since her first attac in past year she may have had an panic attack 2 or three times. Her doctor prescribed her seroquel to help her sleep ans lexapro for the anxiety but i decided against them both because she bagan to sleep well and was not having the attacks very often. Today she had a panic attack and says as she was having the attack that she hears a voice calling her name she said it was faint and then got very loud and this frighten her and made her go deeper into her attack. This frightened me because I am thinking she may have schzophrenia. I do not have a trace of mental behavior in my family and I ask her dad he he says neither does he. I donot want to put her on meds if I don't have too because I read post saying the ugly effects of withdrawal and I don't want her on any meds that she will have to depend on for the rest of her life, but I want her to live a normal healthy life...What do I do? Her dad feel!
s the same way I do..I have taught her how to talk her self out of anxiety attacks but I am so afraid for ger where I am afraid to leave her home or anywhere alone for fear of her not being able to handle it because her very first attack a yr ago she said she heard voices(calling her name) and went into a panic and ran outside screaming...WHAT DO I DO PLEASE HELP!

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Thank you
written by Leigh Ann Otte , June 28, 2010

Thank you for the feedback, Judy. I'm glad you found it illuminating.

Leigh Ann Otte
Managing Editor

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Really helpful in a sea of mis-information
written by Judy Rodman , June 24, 2010

Thanks so much for this illuminating article. This information can relieve people or move them to needed action instead of vacillating on the not-sure fencepost. Musicians are notorious for being a bit abnormalsmilies/smiley.gif Thanks again for the clarifications.
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