Stress, or more?

May 19, 2020

Am I stressed, or do I have a mental health disorder?

by Ricky Caliendo, LMHC

It was 2014, a fresh box of tissues sat on the coffee table and steam dissipated into the air above a warm cup of coffee. A screech from the opening of the lobby door traveled into my office as a wave of anxiety set in. Immediately, I remembered a not-so-encouraging joke that my clinical psychology professor overused throughout one semester: “Every student should prepare a sorry card for their first patient.” Why was it that this poorly placed joke has found itself cornered into my thoughts as my first patient eagerly waits outside my office?

A professional, middle-aged man sat down across from me, looked at the box of tissues, and offered me a cunning grin. He understood that I was younger than him. Nonetheless, I sipped my coffee and started the session. After obtaining informed consent, and just about finished reviewing the laundry list of office policies, he stopped me with a distinct purpose. He said, “All I want to know is if I am just stressed out or actually going crazy?” I jokingly assured him that there is a thin line between the two. He gave a small chuckle as we both felt the ice in the room breaking. He eased back into the couch and began to disclose the recent detour his life had taken. Between a divorce, cancer diagnosis, and his mother’s deteriorating health, I thought to myself that he had a lot more resilience in him than he realized.

Through the years in practice, and navigating through diagnostic and treatment recommendations with colleagues, the answer to the question that my first patient had has changed. Although humor has sustained, with a more sincere explanation now, I would not jokingly hint toward this line between stress and mental health disorders as thin; on the contrary, the line is thick yet permeable.

Is stress common? Definitely. We all experience good stress, such as excitement, and then there is stress that challenges us. This is a normal part of life.

Do mental health disorders exist? Of course. Mental illness can mean many different symptoms and experiences, but we do have a way of capturing the range of mental illness through diagnoses.

Making a diagnosis is very important in guiding evidence-based interventions and psychopharmacology. However, the person, and their uniqueness, exists before the diagnosis. A diagnosis can blind the individual differences in patients. Understanding the person, their experience, unique stressors, and even more importantly, how they respond to those stressors, will always exceed the importance of a diagnosis.

Our body and mind have a fundamental response to uncomfortable internal or external conditions. Stress is the umbrella of responses that can occur in relation to this, although this experience is hardly uniform. And, while every human being on this earth has experienced stress, everyone has not experienced a mental health disorder. So, what is the real difference?

Rather than dissecting the 5th edition of the Diagnostic Statistical Manual of Mental Disorders and providing a quiz at the end of this blog, let’s look at this in a different way. The size of the stressor may influence the size of the response. For example, a global pandemic that creates media hysteria, economic crisis, broken routines, and social isolation is likely to create a more persistent and intensified stress response compared to running late for work and burning your toast. However, there are variables — such as genetics, traumatic occurrences, and biological influences — that can make these stress responses less predictable and proportional, and even alter the likelihood of developing a mental health condition.

Given that we have already established that everyone has experienced stress, one may imagine that there are some shared manifestations of stress. Trouble with sleep, concentration, appetite, drive and motivation toward pleasurable activities, and irritability are some common internalization responses to stress. The intermittent slam of the door or giving someone the silent treatment may be common externalized responses. These can also be signs of depression. But the severity — how it impacts your functioning — and other symptoms need to be considered before naming a mental illness. Some of the more concerning symptoms related to clinical depression may include hopelessness, trouble with memory, increased alcohol and substance use, and suicidal ideation, to just name a few more concerning experiences. Certain things like good self-care, support, and treatment, can impact the degree of permeability of the line between mental health disorders and stress.

Remember, if you’re having a bad day, or your environment is providing you with an extra stressful situation, it is normal to not be at your best. Allow yourself to have a stress response and remind yourself that this is uncomfortable, but it is normal, and there are coping techniques that can help reduce your stress. If persistent, disproportioned emotional or behavioral responses continue — with a negative influence on your quality of life, relationships, and functioning — it may be time to dig a little deeper to explore support for your mental health.

For Mental Health Awareness Month, we wanted to bring attention to this important distinction between stress and mental health disorders, and remind our partners and communities that there is help and support available for both. Connecting with a behavioral health professional — such as a counselor, psychologist, therapist, or psychiatrist — can help you determine if what you’re experiencing is stress or a mental health disorder. Additionally, your primary care provider will be able to support your whole-person health needs, including your mental health. Many primary care offices are homes to behavioral health professionals, and providers work together as a team to deliver whole-person health. You may be able to speak with a behavioral health clinician right at your primary care office!            

We hope you all are staying safe at home and in the community. Take time to care for yourself and your loved ones. Feel free to explore our resources and blog posts related to Mental Health Awareness month.

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