Mental health: What's normal, what's not

What's the difference between normal mental health and mental disorders? Sometimes the answer is clear, but often the distinction isn't so obvious. For example, if you're afraid of giving a speech in public, does it mean you have a mental health disorder or a run-of-the-mill case of nerves? Or, when does shyness become a case of social phobia?

Here's help understanding how mental health conditions are identified.

What is mental health?

Mental health is the overall wellness of how you think, regulate your feelings and behave. Sometimes people experience a significant disturbance in this mental functioning. A mental disorder may be present when patterns or changes in thinking, feeling or behaving cause distress or disrupt a person's ability to function. A mental health disorder may affect how well you:

• Maintain personal or family relationships
• Function in social settings
• Perform at work or school
• Learn at a level expected for your age and intelligence
• Participate in other important activities

Cultural norms and social expectations also play a role in defining mental health disorders. There is no standard measure across cultures to determine whether a behavior is normal or when it becomes disruptive. What might be normal in one society may be a cause for concern in another.

How are mental health disorders defined?

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a guide published by the American Psychiatric Association that explains the signs and symptoms of several hundred mental health conditions, including anxiety, depression, eating disorders, post-traumatic stress disorder and schizophrenia.

The DSM provides criteria for making a diagnosis based on the nature, duration and impact of signs and symptoms. It also describes the typical course of the disorder, risk factors and common co-existing conditions.

Another commonly used diagnostic guideline is the International Classification of Diseases (ICD) from the World Health Organization.

Health insurance companies use the diagnostic coding system of the DSM and ICD in determining coverage and benefits and to reimburse mental health professionals.

How do mental health professionals diagnose disorders?

A diagnosis of a mental health condition may be made by a psychiatrist, psychologist, clinical social worker or other mental health professional. Your primary care doctor may also be involved in a diagnostic assessment or make referrals to a mental health specialist.

A diagnosis may be based on the following:

• A medical history of physical illness or mental health disorders in you or in your family
• A complete physical to identify or rule out a condition that may be causing symptoms
• Questions about your current concerns or why you're seeking help
• Questions about how recent events or changes in your life — trauma, relationships, work, death of a friend or relative — have affected how you think, feel or behave
• Questionnaires or other formal tests that ask for your feedback on how you think, feel or behave in typical situations
• Questions about past and current alcohol and drug use
• A history of trauma, abuse, family crises or other major life events
• Questions about past or current thoughts about violence against yourself or others
• Questionnaires or interviews completed by someone who knows you well, such as a parent or spouse

When is an evaluation or treatment needed?

Each mental health condition has its own signs and symptoms. In general, however, professional help might be needed if you experience:

• Marked changes in personality, eating or sleeping patterns
• An inability to cope with problems or daily activities
• Feeling of disconnection or withdrawal from normal activities
• Unusual or "magical" thinking
• Excessive anxiety
• Prolonged sadness, depression or apathy
• Thoughts or statements about suicide or harming others
• Substance misuse
• Extreme mood swings
• Excessive anger, hostility or violent behavior

Many people who have mental health disorders consider their signs and symptoms a normal part of life or avoid treatment out of shame or fear. If you're concerned about your mental health, don't hesitate to seek advice.

Consult your primary care doctor or make an appointment with a psychiatrist, psychologist or other mental health professional. It may be important for you to find a professional who is familiar with your culture or who demonstrates an understanding of the cultural and social context that's relevant to your experiences and life story.

With appropriate support, you can identify mental health conditions and receive appropriate treatment, such as medications or counseling.