Hope you had a good week! Ok, let’s review some basics. Lately I’m hearing more and more people mix up clinical terms with everyday language. “He’s psycho!” Or “she’s totally OCD” (speaking about a very neat person…) or “she’s totally borderline, or bipolar…” without any understanding of what that means clinically, or the differences. Or even that there are differences. 

I don’t mean to be literal. And I know that when people say they’re having a “panic attack because my kids are making a mess with the toys” they often don’t mean a clinical panic attack, (though, of course, sometimes they do mean that.) So, I do want to discuss different types of mental health issues, so we all become a little bit smarter. And also, a little bit more sensitive to those of us among us who are truly suffering with our mental health. (Which is more than you think.) 

Let’s review three different categories in mental health: 

Neurosis 

Psychosis 

Personality Disorders

Here is an explanation of the differences - in the most simplistic and basic understanding. I will use an Ice Cream Truck as an example, because … that is what is taking up a lot of our time, brain space (and money!) nowadays. This is simply for illustrative purposes - but to be clear these stories below do not indicate disorders. 

A child who is very sad and mad and annoyed when his mother says he can’t buy ice cream - would be in a neurotic state. He understands reality, but is having a hard time managing and dealing with it. He is symptomatic, he is distressed, he isn’t functioning well, but his reality is intact. 

A child who swears the ice cream truck is right here… right in front of his eyes and he’s running to get some, and yelling at the driver to wait for his mother to come pay, even when there is no ice cream truck in sight, is in a psychoticstate. He is in an alternate reality. He is not as symptomatic necessarily, he is simply out of touch. There has been a glitch in his brain and he is not in touch with reality. 

And the child who is yelling at their mother over and over for being the worst mother ever and never giving them anything and carrying on for hours, even though they just got ice cream this morning and their claims are untrue, may have a personality disorder. He is very distressed, because of all the terrible things that Mother has done to him. Whether they are true or not - this is what he believes and his reactivity is based on his own interpretation of reality and his emotional instability. 

Now, again, this is actually, just for explanation purposes because we don’t diagnose children with psychosis or a personality disorder before the age of 18. (However, exceptions can be made for adolescents in severe cases.) 

The critical difference between neurosis and psychosis is the individual’s connection with reality. 

In neurosis, the person maintains a clear sense of what is real, despite their distress and their inability to deal with it. Depression, anxiety, panic attacks and OCD all fall under the category of neurosis. Typically, psychotherapy and often medication too, and lifestyle changes when necessary, help a person feel better and function beautifully. 

Psychosis involves delusional thinking, hallucinations and disorganized behavior. They are dealing with an entirely alternate reality. We treat psychosis with anti-psychotic medication and managed care, psychotherapy and support.  Often when in a psychotic state, there can be severe impact on functioning. There is hope though - when managed well, these individuals can lead a very fulfilling life. 

When one has a Personality Disorder, generally their reality testing is intact, but their patterns and behaviors are maladaptive and typically turn the people close to them off because of their lack of trust, suspiciousness and paranoia. These traits make them incredibly difficult to have a relationship with. Personality Disorders are usually chronic and pervasive and they are present across many relationships and situations.   

Ok folks! That is the quick, one-page summary of important info. In the future, I hope to delve more deeply into the different categories and diagnoses. The more we are all educated and aware, the healthier we will be as individuals and as a community. 

💕, Shifi