Mental Health Conditions (Anxiety, Depression, Trauma, PTSD, Schizophrenia, Bipolar Disorders, & Personality Disorders

What are the biological factors for mental health?

genetics and family history, neurobiological processes, hormonal and physiological influences, physical health conditions

What are the psychological factors for mental health?

cognitive and emotional processes, coping strategies, learning and behavioral patterns, previous experience and trauma

What are the social and environmental factors for mental health?

family and community relationships, financial stability and employment, discrimination and chronic stress, access to healthcare and social support

depressive disorders

mood disorders characterized by persistent sadness, emptiness, or irritability; loss of interest or pleasure in previously enjoyed activities; fatigue and decreased energy; changes in sleep and appetite; difficulty concentrating or making decisions; feelings of worthlessness or excessive guilt; social withdrawal

What are the types of depressive diroders?

major depressive disorder (MDD), persistent depressive disorder (PDD), disruptive mood dysregulation disorder (DMDD), MDD with peripartum onset

major depressive disorder (MDD)

five or more qualifying symptoms, with at least one of the two core symptoms (depressed mood most of the day, nearly every day; markedly diminished interest or pleasure in activities); symptoms occur for at least two weeks and may vary in severity; may occur as a single or recurrent episode

persistent depressive disorder (PDD)

at least two associated symptoms in addition to depressed mood; persists for at least two years in adults and 1 year in children (more chronic presentation); symptoms may be perceived as part of everyday functioning

What are the biological factors for depression?

genetic vulnerability, neurobiological processes, hormonal changes, chronic illness and inflammation-related processes

What are the psychological factors for depression?

negative cognitive patterns, previous depressive episodes, adverse childhood experiences, trauma and prolonged stress

What are the social and environmental factors for depression?

financial insecurity, social isolation, discrimination, relationship difficulties, limited access to resources

How does structural inequality impact depression?

• racial and ethnic disparities → access and quality of care

• cultural expectations and stigma → how symptoms are described, decision to seek support

• financial / insurance barriers → delayed treatment

• gender-related expectations → recognition of symptoms

• chronic exposure to discrimination and socioeconomic stress → psychological distress

How is depression treated?

cognitive behavioral therapy (CBT), interpersonal psychotherapy, behavioral activation, antidepressant medications, other biological treatments (especially for severe or treatment-resistant types)

What is OT’s role in depression?

supporting engagement in meaningful activities; addressing disruptions in daily routines and habits; supporting participation in self-care, work, education, and social roles; exploring environmental barriers and available supports; promoting occupational balance and opportunities for participation

anxiety disorders

mental health disorders that involve excessive fear, anxiety, or related behavioral disturbances that interfere with daily functioning

generalized anxiety disorder (GAD)

excessive anxiety and worry across multiple activities or events; symptoms occur more days than not for a least six months; anxiety and worry associated with at least three of six symptoms in adults; difficulty controlling worry, restlessness, difficulty concentrating, irritability, muscle tension, sleep disturbance

panic disorder

anxiety disorder characterized by recurrent, unexpected panic attacks; symptoms may include palpitations, sweating, trembling, shortness of breath, dizziness, or fear of dying; at least one attack is followed by one month or more of persistent concern about additional attacks or maladaptive behavioral changes

social anxiety disorder

anxiety disorder characterized by marked fear or anxiety related to social situations involving possible scrutiny or negative evaluation; avoidance or endurance of social situations with intense anxiety; fear is disproportionate to the actual threat and sociocultural context; symptoms usually persist for at least six months

What is the etiology for anxiety?

genetic vulnerability and temperament, neurobiological processes, learned fear and avoidance responses, trauma and stressful experiences, chronic environmental stress, health disparities and structural influences (discrimination, chronic exposure to stress, cultural expectations, limited access to culturally responsive care, financial insecurity)

How is anxiety treated?

cognitive behavioral therapy, exposure-based psychotherapy, SSRIs and SNRIs, psychoeducation and supportive strategies

What is OT’s role in anxiety?

understanding how it affects occupational participation, supporting daily routines and engagement in meaningful activities, identifying environmental factors that influence participation, supporting development and application of coping and self-management strategies, collaborating with interdisciplinary treatment team

obsessive-compulsive disorder (OCD)

involves obsessions, compulsions, or both; symptoms are time-consuming, often taking more than one hour per day, or cause clinically significant distress or impairment; insight varies among individuals; common presentations include contamination concerns, checking, symmetry or ordering, or intrusive thoughts involving harm or taboo themes

obsessions

recurrent, persistent, intrusive, and unwanted thoughts, urges, or images; often produce significant anxiety or distress

compulsions

repetitive behaviors or mental acts performed in response to obsessions or rigid rules; intended to reduce distress or prevent a feared event; behaviors are excessive or not realistically connected to the feared outcome

What is the etiology for OCD?

genetic and familial influences, neurobiological factors, learning and behavioral processes, stressful experiences may influence symptom onset or severity

How is OCD treated?

exposure and response prevention (ERP) (specialized form of CBT), SSRIs, interdisciplinary care when indicated

What is OT’s role in OCD?

recognizing how obsessions and compulsions disrupt occupations, supporting meaningful participation and routines, collaborating with providers, avoiding approaches that unintentionally reinforce compulsions

eating disorders

mental health conditions involving disturbances in eating behaviors and related thoughts or emotions; commonly presents as restrictive eating, binge eating episodes, compensatory behaviors, distress related to weight/shape/eating, changes in social participation and daily routines

anorexia nervosa

eating disorder characterized by restriction of energy intake, intense fear of gaining weight, and disturbance in body image or recognition of illness severity; presents as restricting type or binge-purge type

What are the potential medical complications from anorexia nervosa?

bradycardia and hypotension, electrolyte abnormalities, bone loss, malnutrition and organ dysfunction

bulimia nervosa

recurrent episodes of binge eating involving eating an objectively large amount of food and a sense of loss of control followed by inappropriate compensatory behaviors (e.g., self-induced vomiting, misuse of laxatives or diuretics, fasting, excessive exercise); these behaviors occur at least once weekly for three months

What are the potential medical complications from bulimia nervosa?

electrolyte imbalances, dental erosion, gastrointestinal complications, cardiac complications

binge eating disorder

recurrent binge eating episodes involving an objectively large amount of food and loss of control; associated with at least three of the following: eating rapidly, eating until uncomfortably full, eating when not physically hungry, eating alone because of embarrassment, feeling disgusted/guilty/depressed after

What is the etiology for eating disorders?

genetic and biological vulnerability, psychological factors and emotion regulation difficulties, sociocultural pressures and weight-related stigma, trauma and stressful experiences, environmental and interpersonal influences

How are eating disorders treated?

medical monitoring and stabilization when necessary, nutritional rehabilitation, evidence-based psychotherapy, family-based treatment, medication for co-occurring symptoms, interdisciplinary care

What is OT’s role in eating disorders?

supporting participation in daily routines and meaningful occupations; exploring how disordered behaviors influence social participation, education, work, and leisure; supporting participation in mealtime-related occupations within the treatment plan; addressing occupational identity and balance; collaborating with medical, nutritional, and mental health professionals

occupational justice

recognizes that social and structural conditions influence opportunity for meaningful occupational participation; encourages consideration of barriers related to poverty, discrimination, disability, and access to resources

trauma-informed care

prioritizes physical and psychological safety; recognizes the potential influence of trauma; emphasizes collaboration, choice, and empowerment; seeks to avoid retraumatization

culturally-responsive practice

recognizes individual and cultural differences; avoids assumptions based on identity or diagnosis; considers how cultural experiences influence healthcare interactions

acute trauma

exposure to a single distressing event

chronic trauma

repeated or prolonged exposure to trauma

complex trauma

multiple, often interpersonal traumatic experiences, sometimes beginning in childhood

secondary traumatic stress

trauma-related reactions associated with indirect exposure to others’ experiences

What are the physiological signs of a stress response?

increased heart rate, dilated pupils, increased breathing, blood flow to certain areas increases

window of tolerance

optimal zone for occupational performance; ventral vagal response characterized by being calm and alert, regulated, able to learn, and engaged in occupations; NOT the absence of stress

hyperarousal

sympathetic response characterized by fight or flight, anxiety, being overwhelmed, impulsivity, and “too much energy”

hypoarousal

dorsal vagal response characterized by feeling shutdown, fatigue, numbness, disengagement, and “too little energy”

How does trauma impact the brain?

it switches it from learning mode to survival mode; not able to take in new information, non-essential processes shut down; it can rewire it

adverse childhood experiences (ACEs)

concept created from a study done in California where childhood traumatic events were found to be linked with negative health outcomes (stress hormones, decreased immune system, increased risk of chronic illness and developmental delay); associated with difficulty in school, difficulty with peer relationships, and negative behaviors due to decreased tolerance for stress

What are the six key principles of trauma-informed care?

1. safety

2. trustworthiness and transparency

3. peer support

4. collaboration and mutuality

5. empowerment, voice, and choice

6. cultural, historical, and gender considerations

How can trauma-informed care be applied to OT?

• explain interventions before beginning

• offer meaningful choices

• ask permission before physical contact

• respect boundaries and signs of distress

• collaboratively establish goals

• avoid unnecessarily requiring clients to recount traumatic experiences

post-traumatic stress disorder (PTSD)

disorder that develops following exposure to actual or threatened death, serious injury, or sexual violence; diagnosis requires trauma exposure, one symptom each from the intrusion and avoidance clusters, and two symptoms each from the negative changes in cognition and mood and alterations in arousal and reactivity clusters; symptoms must persist for more than one month and cause clinically significant distress or impairment

intrusion symptom cluster (PTSD)

unwanted memories, nightmares, flashbacks

avoidance symptom cluster (PTSD)

avoiding trauma-related thoughts, feelings, people, places, or situations

negative changes in cognition and mood symptom cluster (PTSD)

persistent guilt, negative beliefs, emotional detachment, reduced interest in activities

alterations in arousal and reactivity symptom cluster (PTSD)

hypervigilance, irritability, exaggerated startle response, sleep and concentration difficulties

What are common OT interventions for PTSD?

establishing predictable routines, sleep hygiene and rest management, sensory and environmental modifications, grounding and self-regulation strategies, graded re-engagement in meaningful activities, social participation and community reintegration, stress management during ADLs and IADLs

schizophrenia

chronic psychiatric disorder characterized by disturbances in thinking, perception, emotional expression, and behavior; must show at least two of the following: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, or negative symptoms; must cause a continuous disturbance for at least six months, with at least one month of active-phase symptoms

hallucinations

perceptual experiences occurring without a corresponding external stimulus; can involve hearing, seeing, smelling, tasting, or feeling; may affect concentration, sleep, and task engagement

delusions

fixed beliefs that are not changed despite clear contradictory evidence; may involve persecutory, grandiose, referential, somatic, or other themes; may influence trust, decision-making, and social participation

What are positive symptoms in schizophrenia?

symptoms that are added on to typical functioning; include hallucinations, delusions, disorganized speech, and disorganized behavior

What are negative symptoms in schizophrenia?

symptoms that take away from / reduce typical functioning; include avolition, reduced emotional expression, alogia (reduced speech output), anhedonia, and asociality

What are the cognitive difficulties associated with schizophrenia?

working memory difficulties, impaired attention, executive functioning difficulties, slower processing speed, and difficulty planning and organizing

What are common OT interventions for schizophrenia?

ADL and IADL skills training, cognitive compensatory strategies, environmental modifications, establishment of daily routines, supported employment and education, social participation skills, community living and independent living skills, collaborative goal setting and recovery-oriented practice

What are some clinical considerations for hallucinations and delusions?

• remain calm and respectful

• acknowledge the person’s emotional experience

• avoid arguing about or reinforcing the belief

• assess how symptoms affect participation and safety

• reduce environmental stressors when appropriate

• coordinate with the interdisciplinary team

schizoaffective disorder

mental health disorder characterized by symptoms of psychosis (hallucinations, delusions) combined with significant mood episodes (depression or mania); can be bipolar type or depressive type

What is the difference between schizophrenia and schizoaffective disorder?

in schizoaffective disorder, major mood episodes occupy the majority of the illness duration, ad psychosis occurs independently of mood episodes

bipolar disorders

mental health conditions characterized by changes in mood, energy, activity, and functioning; may involve mania, hypomania, or depression; changes in sleep, judgment, activity, and occupational participation may occur

mania

elevated, expansive, or irritable mood with markedly increased energy; characterized by impulsive and risky behavior and marked impairment in functioning; usually lasts for at least a week

hypomania

elevated or irritable mood with increased energy; characterized by increased activity, but no marked impairment in functioning; usually lasts four days to a week

bipolar I disorder

bipolar disorder with at least one manic episode; depressive episodes are common, but not required for diagnosis

bipolar II disorder

bipolar disorder with at least one hypomanic episode and one major depressive epsiode

cyclothymic disorder

bipolar disorder with chronic fluctuations involving hypomanic and depressive symptoms that do not meet the criteria for bipolar II

What is the etiology for bipolar disorders?

strong familial and heritable contributions, differences in mood regulation and related neural systems, sleep and circadian rhythm disruptions, stressful life events and environmental demands, substance use

How are bipolar disorders treated?

mood-stabilizing medications and selected antipsychotics, psychotherapy and psychoeducation, sleep and circadian rhythm stabilization, relapse prevention and early warning sign recognition, family and social support

What are common OT interventions for bipolar disorders?

consistent daily routines and sleep patterns, activity pacing and occupational balance, financial and health management strategies, executive functioning supports, meaningful occupational engagement, collaborative safety planning and interdisciplinary care

personality disorders

disorders involving enduring patterns of inner experience and behavior that differ markedly from cultural expectations, affect cognition / emotional responses / interpersonal functioning / impulse control, are inflexible and occur across multiple contexts, cause significant distress or functional impairment, and are relatively stable over time (with onset traceable to adolescence or early adulthood)

cluster A personality disorders

odd or eccentric patterns; include paranoid, schizoid, and schizotypal

cluster B personality disorders

dramatic, emotional, or erratic patterns; include antisocial, borderline, histrionic, and narcissistic

cluster C personality disorders

anxious or fearful patterns; include avoidant, dependent, and obsessive-compulsive

paranoid personality disorder

cluster A personality disorder characterized by persistent distrust and suspicion of others

schizoid personality disorder

cluster A personality disorder characterized by detachment from social relationships and restircted emotional expression

schizotypal personality disorder

cluster A personality disorder characterized by interpersonal difficulties, unusual beliefs or perceptions, and eccentric behavior

antisocial personality disorder

cluster B personality disorder characterized by a disregard for and violation of others’ rights

borderline personality disorder

cluster B personality disorder characterized by instability in relationships, self-image, affect, and impulsivity; may also include intense fear of abandonment, chronic feelings of emptiness, recurrent self-harm or suicidal behaviors, and/or stress-related paranoia or dissociative symptoms

histrionic personality disorder

cluster B personality disorder characterized by excessive emotionality and attention-seeking patterns

narcissistic personality disorder

cluster B personality disorder characterized by grandiosity, a need for admiration, and difficulties with empathy

What is the difference between bipolar disorder and borderline personality disorder?

in borderline personality disorder, the behavioral, emotional, and cognitive shifts are more rapid (change over hours vs weeks); there is also less of a sleep disturbance component in borderline personality disorder, and psychotherapy is central as opposed to medication

avoidant personality disorder

cluster C personality disorder characterized by social inhibition, feelings of inadequacy, and sensitivity to criticism

dependent personality disorder

cluster C personality disorder characterized by an excessive need for reassurance and difficulty making independent decisions

obsessive-compulsive personality disorder

cluster C personality disorder characterized by preoccupation with order, perfectionism, and control

What is the difference between OCD and OCPD?

OCD involves obsessions and/or compulsions, whereas OCPD involves a pervasive pattern of perfectionism, orderliness, and control

How are personality disorders treated?

structured psychotherapy, dialectical behavioral therapy (particularly for BPD), cognitive behavioral and other evidence-based psychotherapies, treatment of co-occurring mental health conditions, and collaborative safety planning when indicated

What are common OT interventions for personality disorders?

emotional regulation during meaningful occupations; consistent routines and occupational balance; interpersonal communication and social participation; establishing clear and respectful therapeutic boundaries'; supporting identity, autonomy, and meaningful roles; client-centered and trauma-informed practice