types of mental health presentation

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List of Common Types of Mental Illness

Symptoms and Treatments for Mental Disorders

Anxiety Disorders

Bipolar and related disorders, depressive disorders.

• Dissociative Disorders

Feeding and Eating Disorders

Gender dysphoria, neurocognitive disorders.

• Neurodevelopmental Disorders

Obsessive-Compulsive and Related Disorders

Personality disorders, schizophrenia spectrum and other psychotic disorders, sleep-wake disorders, substance-related and addictive disorders, trauma- and stressor-related disorders.

A mental illness is a health condition involving changes in thinking, emotion, or behavior that leads to distress or problems functioning in social, work, or family activities.

Mental illness is quite common: In 2021, more than one in five adults in the U.S.—nearly 58 million people—experienced some form of mental illness. About one in 20 U.S. adults experienced serious (severe) mental illness.

There are many different types of mental illness—sometimes referred to as mental disorders—with different causes, symptoms, and treatments. Some may involve a single episode, while others can relapse or persist.

Mental disorders are diagnosed based on criteria outlined in the " Diagnostic and Statistical Manual of Mental Disorders, 5 th Edition" (DSM-5) issued by the American Psychiatric Association. The DSM-5 categorizes major types of mental disorders into categories by Diagnostic Criteria and assigns codes to each diagnosis.

This article will go through the most common categories of mental illness—such as anxiety disorders, depressive disorders, neurodevelopmental disorders, and sleep disorders—with examples of conditions for each category. It will then discuss how mental illness is diagnosed, as well as some common treatment options.

Theresa Chiechi / Verywell

Anxiety disorders are the most common mental health concern in the United States, affecting 19.1% of the population. People with anxiety disorders experience excessive fear, anxiety, and related behavioral disturbances. Anxiety symptoms can worsen over time, interfering with people's ability to function in their daily lives. People with anxiety may also attempt to avoid situations or triggers that worsen symptoms.

Anxiety disorders are a group of related conditions, each having unique symptoms. Types of anxiety disorder include:

• Generalized anxiety disorder 
• Panic disorder
• Social anxiety disorder
• Specific phobia

Bipolar disorder causes dramatic shifts in a person’s mood, energy, and ability to think clearly. People with this disorder experience extremely high and low moods, known as mania and depression. They may have distinct manic or depressed states, or they may have long periods without symptoms.

A person with bipolar disorder can also experience mixed manic and depressive symptoms. Bipolar disorder affects 2.8% of the U.S. population, and 83% of cases are classified as severe.

Bipolar disorders can be categorized into four types, including:

• Bipolar I disorder 
• Bipolar II disorder 
• Cyclothymic disorder or cyclothymia
• Bipolar disorder, “other specified” and “unspecified”

People with depressive disorders, commonly referred to as simply depression, experience a sad, empty, or irritable mood accompanied by physical and cognitive changes that are severe or persistent enough to interfere with daily functioning. Some will only experience one depressive episode in their lifetime, but for most, depressive disorder recurs. Without treatment, episodes may last a few months to several years.

Those with depression lose interest or pleasure in activities and experience excessive fatigue, appetite changes, sleep disturbances, indecision, and poor concentration. Suicidal thinking or behavior can also occur.

There are many types of depressive disorders, including:

• Major depressive disorder
• Prenatal depression (during pregnancy) and postpartum depression (after childbirth)—together known as perinatal depression
• Persistent depressive disorder (also known as dysthymia )
• Seasonal affective disorder (SAD)
• Major depressive disorder with symptoms of psychosis
• Premenstrual dysphoric disorder

Dissociative Disorders 

Dissociation refers to a disconnection between a person’s thoughts, memories, feelings, actions, or sense of who they are. Symptoms of dissociative disorders can potentially affect every area of mental functioning. Dissociative disorders involve disruptions in memory, identity, emotion, perception, behavior, and sense of self.

Examples of dissociative symptoms include the experience of detachment or feeling outside of your body, as well as loss of memory or amnesia. Dissociative disorders are frequently associated with previous experiences of trauma. It is believed that dissociation helps a person tolerate what might otherwise be too difficult to bear.

There are three types of dissociative disorders:

• Dissociative identity disorder
• Dissociative amnesia
• Depersonalization/derealization disorder

People with feeding and eating disorders experience severe disturbances in their eating behaviors and related thoughts and emotions. They may become so preoccupied with food and weight issues that they find it harder and harder to focus on other aspects of their life.

Over time, these behaviors can significantly impair physical health and psychosocial functioning. Eating disorders affect several million people at any given time, most often women between the ages of 12 and 35.  

There are three main types of eating disorders:

• Anorexia nervosa 
• Bulimia nervosa 
• Binge eating disorder 

Gender dysphoria refers to psychological distress that results from a difference between one’s sex assigned at birth and one’s gender identity . It often begins in childhood, but some people may not experience it until after puberty or much later.

Transgender people are individuals whose sex assigned at birth does not match their gender identity. Some transgender people experience gender dysphoria, and they may or may not change the way they dress or look to align with their felt gender.

Neurocognitive disorders lead to a decline in cognitive function from a previously obtained level. People with this condition may experience noticeable memory loss, difficulty communicating, significant problems handling daily tasks, confusion, and personality changes.

Neurocognitive disorders can be caused by a wide range of conditions, including Alzheimer’s disease, vascular disease, traumatic brain injury, HIV infection, Parkinson’s disease, and Huntington’s disease .

Types of neurocognitive disorders include:

• Major neurocognitive disorder
• Mild neurocognitive disorder

Neurodevelopmental Disorders 

Neurodevelopmental disorders have an onset in the developmental period, with the development of the central nervous system disturbed. This can produce impairments in personal, social, and academic functioning.

Types of neurodevelopmental disorders include:

• Autism spectrum disorder
• Attention-deficit/hyperactivity disorder (ADHD)
• Neurodevelopmental motor disorders
• Specific learning disorders
• Communication disorders
• Intellectual disability

Obsessive-compulsive disorder (OCD) is a disorder in which people have recurring, unwanted thoughts, ideas, or sensations (obsessions) that make them feel driven to do something repetitively (compulsions). These repetitive behaviors can significantly interfere with a person’s daily activities and social interactions. Not performing the behaviors commonly causes great distress.

People with OCD have difficulty disengaging from the obsessive thoughts or stopping the compulsive actions. This disorder is estimated to affect 2% to 3% of U.S. adults.

Disorders related to OCD include:

• Hoarding disorder
• Body dysmorphic disorder 
• Body-focused repetitive behaviors like excoriation (skin-picking) disorder and trichotillomania (hair-pulling disorder)

People with personality disorders have persistent patterns of perceiving, reacting, and relating that are inappropriate and rigid, causing distress and functional impairments. The pattern of experience and behavior begins by the time of late adolescence or early adulthood.

People with personality disorders may have trouble dealing with everyday stressors and problems, and they often have difficult relationships with other people.

There are 10 types of personality disorders:

• Antisocial personality disorder
• Avoidant personality disorder
• Borderline personality disorder
• Dependent personality disorder
• Histrionic personality disorder
• Narcissistic personality disorder
• Obsessive-compulsive personality disorder
• Paranoid personality disorder
• Schizoid personality disorder
• Schizotypal personality disorder

People with schizophrenia spectrum and other psychotic disorders lose touch with reality and experience a range of symptoms that may include hallucinations, delusions, disorganized thinking and speech, and disorganized or abnormal behavior. Schizophrenia affects less than 1% of the U.S. population.

Other psychotic disorders include:

• Brief psychotic disorder
• Delusional disorder 
• Schizoaffective disorder
• Substance-induced psychotic disorder

Sleep-wake disorders, also known as sleep disorders, involve problems with the quality, timing, and amount of sleep, which result in daytime distress and impairment in functioning. They often occur along with medical conditions or other mental disorders, such as depression, anxiety, or cognitive disorders.

There are several types of sleep-wake disorders:

• Obstructive sleep apnea
• Parasomnias
• Restless leg syndrome

This category includes substance use disorders (often referred to as substance abuse). They occur when a person continues the use of alcohol or another drug or substance despite significant substance-related problems.

People with substance abuse disorders have an intense focus on using certain substances to the point where their ability to function in day-to-day life may become impaired.

These disorders occur after exposure to a stressful or traumatic event, which can include exposure to physical or emotional violence or pain, abuse, neglect, or a catastrophic event. Trauma-related disorders are characterized by a variety of symptoms, including intrusion symptoms (flashbacks), avoidance, changes in mood such as anhedonia , dysphoria (dissatisfaction with life), anger , aggression, and dissociation.

Types of trauma-related disorders include:

• Post-traumatic stress disorder
• Acute stress disorder
• Adjustment disorder
• Reactive attachment disorder
• Disinhibited social engagement disorder

Mental Illness and Suicide

If you experience symptoms of a mental illness, try to see a healthcare provider or mental health professional as soon as you can. It is estimated that 46% of people who die by suicide have a diagnosed mental health condition and 90% of individuals who die by suicide have experienced symptoms of a mental health condition.

There are many treatment options for mental illnesses. A prompt diagnosis can lead to significant improvements in your quality of life.

Many people develop a mental illness early on in life, with 50% of all lifetime mental illnesses beginning by age 14 and 75% by age 24.

Doctors and other mental health professionals diagnose mental illness by using the criteria outlined in the DSM-5. Many conditions require all criteria to be met before a diagnosis can be made. Others, like borderline personality disorder, require only a set number of criteria from a larger list to be met. 

Many disorders are further classified by severity and specifications that can help doctors determine the appropriate course of treatment for an individual patient. For example, someone being diagnosed with OCD will also be categorized based on their level of insight as to whether their OCD-related beliefs are true and whether or not they present with a current or past history of a tic disorder.

It is common for people to have more than one mental illness at a time. By some estimates, about half of people with one mental illness have a comorbid (co-occurring) substance use disorder present at the same time or sequentially.  As such, the likelihood of a mental health and substance use disorder dual diagnosis is high. This may be due to common risk factors and the fact that having one condition predisposes a person to the other. 

Other common comorbidity examples include: 

• Borderline personality disorder : Major depressive disorders, bipolar disorders, anxiety disorders, and eating disorders
• Social anxiety disorder : Other anxiety disorders, major depressive disorders, and alcohol use disorder
• Eating disorders : Anxiety disorders, substance use disorders, obsessive-compulsive disorder, depressive disorders, and post-traumatic stress disorder

Primary care physicians and mental health professionals should work together because a diagnosis as defined by the DSM-5 requires exclusion of other possible causes, including physical causes and other mental disorders with similar features. For example, paranoid delusions in older adults can be caused by Huntington’s disease, Parkinson’s disease, strokes, Alzheimer’s disease, and other forms of dementia.

Due to the wide variety of mental illnesses, many different health professionals may be involved in the treatment process, including:

• Psychologists
• Social workers
• Psychiatrists
• Primary care and other medical physicians 
• Pharmacists

Treatment may include one or more of the above professionals and one or more methods (e.g. psychotherapy combined with medication). Disorders that resist initial treatment may require further interventions.

Psychotherapy

Psychotherapy, also known as talk therapy, is used to treat and support a broad range of mental illnesses by helping a person build self-esteem; reduce anxiety, depression, and other symptoms; cope with their illness; and improve overall functioning and well-being. 

Common types of psychotherapy include:

• Cognitive behavioral therapy (CBT) : Helps you identify and change maladaptive behaviors
• Dialectical behavioral therapy (DBT) : Uses aspects of CBT along with other strategies, like mindfulness , to help you regulate emotions, as well as teaches new skills to change unhealthy and disruptive behaviors
• Supportive therapy : Helps you build self-esteem while reducing anxiety, strengthening coping mechanisms, and improving social functioning

Medications may be used to reduce symptoms and restore functioning. They are often used in conjunction with psychotherapy.

Four major types of psychotropic drugs include:

• Antidepressants such as SSRIs, SNRIs, and bupropion are used to treat symptoms of depression, anxiety, pain, and insomnia.
• Anxiolytics are anti-anxiety medications used in the acute (in-the-moment) treatment of anxiety-related symptoms ranging from panic attacks to feelings of agitation.
• Antipsychotics are used to treat symptoms of psychosis including delusions and hallucinations. Additionally, they may be used to treat certain mood and other psychiatric disorders.
• Mood stabilizers such as lithium can be used to treat bipolar disorder and mood swings associated with other disorders. They can also help with certain depressive disorders.

Neurotherapeutic procedures like electroconvulsive therapy (ECT), transcranial magnetic stimulation, and vagus nerve stimulation are used in cases of treatment-resistant and severe depression.

During ECT, electrodes are placed on the head to deliver a small amount of electrical stimulation to the brain to induce brief seizures while the patient is under anesthesia. For transcranial magnetic stimulation, magnets are used to stimulate areas of the brain associated with mood regulation.

Ketamine infusion or nasal spray therapy offers another option for people with treatment-resistant major depression. It may work rapidly and help reduce suicide ideation.

Lifestyle changes help promote overall well-being. You may benefit from:

• Exercising for at least 20 minutes a day
• Practicing mindfulness in meditation or yoga
• Avoiding smoking
• Avoiding substance use (including alcohol)
• Eating a well-rounded diet that limits fats and refined sugars
• Having a support system 
• Maintaining a regular seven- to nine-hour sleep routine
• Practicing positive thinking

If you or someone you know are having suicidal thoughts, dial  988  to contact the  988 Suicide & Crisis Lifeline  and connect with a trained counselor. If you or a loved one are in immediate danger, call 911 .

For more mental health resources, see our National Helpline Database .

Mental illness refers to a broad range of conditions that affect thinking, emotions, and behavior. They fall into many categories, such as anxiety disorders, depressive disorders, gender dysphoria, neurodevelopmental disorders, and sleep disorders. Criteria from the DSM-5 are typically used to diagnose mental illnesses.

Treatments are available to relieve symptoms and manage emotions, thinking, and behavior. Common options include psychotherapy (such as CBT or DBT), medications (such as antidepressants or anxiolytics ), and neurotherapeutic procedures (such as ECT or transcranial magnetic stimulation). You may also benefit from lifestyle adjustments.

National Institute of Mental Health. Mental illness.

National Alliance on Mental Illness. Anxiety disorders .

American Psychiatric Association. What are anxiety disorders?

National Alliance on Mental Illness. Bipolar disorder .

National Institute of Mental Health. Depression.

American Psychiatric Association. What are dissociative disorders?

American Psychiatric Association. What are eating disorders?

American Psychiatric Association. What is obsessive-compulsive disorder?

American Psychiatric Association. What is schizophrenia?

American Psychiatric Association. What are sleep disorders?

National Alliance on Mental Illness. Mental health by the numbers .

Substance Abuse and Mental Health Services Administration. Impact of the DSM-IV to DSM-5 changes on the National Survey on Drug Use and Health [Internet] . Rockville (MD): Substance Abuse and Mental Health Services Administration (US); Table 3.13, DSM-IV to DSM-5 Obsessive-Compulsive Disorder Comparison.

National Institute on Drug Abuse.  Comorbidity: substance use disorders and other mental illnesses .

National Institute of Mental Health. Borderline personality disorder . 

Koyuncu A, İnce E, Ertekin E, Tükel R. Comorbidity in social anxiety disorder: diagnostic and therapeutic challenges . Drugs Context . 2019 Apr 2;8:212573. doi:10.7573/dic.212573

National Eating Disorder Association. Co-occurring conditions & special issues .

National Institute on Mental Health. Mental health medications .

Harvard Health Publishing. Ketamine for major depression: new tool, new questions .

By Michelle Pugle Pulge is a freelance health writer focused on mental health content. She is certified in mental health first aid.

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Matter over mind: How mental health symptom presentations shape diagnostic outcomes

Mental health disorders face less stigma today than in the past, yet they continue to be misdiagnosed and at times improperly treated. One account for this problem is that physicians rely exclusively on a verbal interview of patients for diagnosis. Because this diagnostic method is likely to be shaped by the way patients present their symptoms, it is critical that we examine whether and how patients’ communication practices shape diagnostic and treatment outcomes. This study examines a sample of 14 encounters involving mental health-related symptoms from a dataset of adult primary care visits. Using conversation analytic methods, I show that when patients present mental health symptoms by simply describing the symptoms, primary care physicians exhibit a preference for providing a physical health diagnosis. Conversely, when patients provide a concrete link between their symptoms and the way the symptoms are disrupting their everyday lives, primary care physicians typically provide a mental health diagnosis.

Introduction

Studies have focused on the stigmatization of mental illness since the mid-twentieth century ( Goffman, 1963 ; Link and Phelan, 2001 ; Martin et al., 2007 ). The stigma associated with mental illness has remained largely unchanged despite its increasing awareness due to more research, public campaigns, and mental health education ( Phelan and Link, 1998 ). Attitudes toward mental illness continue to engender negative stereotypes and discrimination ( Phelan, 2005 ). However, evidence points to some improvement in perceptions of mental illness. The public’s orientation to mental illness has become more tolerant ( Phelan et al., 2000 ). Furthermore, those with mental health symptoms are seeking treatment more frequently ( Kessler et al., 1999 ). Research has reported that when patients seek care for mental health issues, they do so largely from their primary care provider (PCP) ( Wang et al., 2006 ).

Despite this increase in help-seeking for mental health concerns, there still appears to be bias against diagnosing mental health disorders as current estimates suggest that the majority of those with mental health issues remain untreated ( Boyer and Lutfey, 2010 ). Conversely, there is another complication to the treatment of mental health disorders which is a concern that they are actually over-pathologized and over-diagnosed ( Kutchins and Kirk, 1997 ). Why are these medical issues the subject of such fraught treatment perspectives? This article suggests that the answer to this question lies in the moment-to-moment interaction between PCPs and patients. Specifically, the way patients characterize their mental health symptoms to their PCPs can condition how PCPs take up and treat those symptoms as indicative of a mental health disorder or not. At the same time, the way that patients talk about their symptoms with their PCP will likely be complicated by the stigma associated with mental health disorders.

This pilot study investigates the ways patients present their mental health-related symptoms and the relationship between patient symptom presentations and physician orientation to those symptoms in diagnosis. I show that PCPs are biased against mental health diagnoses and treat mental health symptoms only in contexts where patients go beyond a basic presentation of symptoms to show that their lifeworld ( Mishler, 1984 ) has been disrupted. This is true even when the symptoms being presented are essentially the same.

Diagnosing mental health problems in primary care

Longitudinal data suggest that most people experiencing mental health issues are not receiving treatment for their symptoms despite an increase in help-seeking for such problems ( Kessler et al., 2005 ). Most individuals in the USA who pursue help do so in primary care rather than seeking out a specialist for treatment. This is thought to be because patients feel more comfortable communicating to a provider with whom they have a relationship ( Glazier et al., 2015 ). However, there may also be structural bases for this, such as insurance requirements that primary care physicians serve as gatekeepers to specialty care including mental healthcare ( Forrest, 2003 ). Overall, the literature suggests that mental illness remains undertreated despite increased visits for related symptoms, which demonstrates evidence for an institutional bias against diagnosing and treating mental illness.

Yet, studies document both underdiagnosis and overdiagnosis of mental illnesses. Kutchins and Kirk (1997) argue that changing requirements of treatments reimbursable by health insurance companies have caused physicians to inappropriately diagnose their patients with a mental illness for compensation. Others argue that mental health diagnosis categories are too broad, therefore physicians too frequently diagnose mental illness and overprescribe ( Dowrick and Frances, 2013 ). Many critics blame the drug industry for promoting the medicalization of emotions and thus the overdiagnosis of mental illness ( Horwitz and Wakefield, 2007 ; Karp, 2009 ). Overdiagnosis is particularly problematic because medications indicated for treatment of mental health problems can have adverse consequences including drug dependency, more severe mental health symptoms, and suicide ( Bezchlibnyk-Butler et al., 2013 ; Karp, 2009 ).

However, underdiagnosis is also problematic leading to improper treatment of depressive and anxiety disorders ( Bet et al., 2013 ). Researchers have called for interventions to improve detection and treatment in specific medical settings ( Gilbody et al., 2003 ), and underscore that while major depression is often properly diagnosed and treated, moderate depression or anxiety are underdiagnosed and under treated ( Kroenke et al., 2007 ; Thompson et al., 2001 ).

The complexity of diagnosing mental health problems

One account for how mental health symptoms can be both over and under-diagnosed is that the mental health diagnostic process is particularly multifaceted with opaque boundaries and contingencies. This complexity contradicts the straightforward guidelines for primary care treatment of problems like depression, which follow a biomedical treatment model comprised of psychotropic drug prescription and referral to a mental health specialist ( Gelenberg, 2010 ). Some have argued that this “one size fits all” approach is inappropriate for primary care patients in particular, who present with an array of symptoms that do not necessarily fit within the biomedical treatment model ( Nutting et al., 2002 ). Different from other medical issues which include clear signs that physicians can see, hear, or feel, the detection and treatment of mental health problems are entirely reliant on information patients provide, and this information is conditioned by the physicians’ diagnostic interview. This context may make for a ripe environment for doctor–patient inter- action in shaping diagnostic outcomes.

Previous research suggests that patients’ behavior in the medical encounter can shape both the diagnosis and treatment of medical issues. In studying pediatric acute care, Stivers (2002) found that the ways parents presented their children’s symptoms had direct implications for physician uptake of those symptoms—what Stivers terms symptoms-only and candidate diagnosis presentations. While the former lists just the symptoms (e.g. “She has a scratchy throat”), the latter includes a suspected diagnosis (e.g. “We think she has strep because she has a fever and a scratchy throat”). When examining physician uptake of each presentation type, Stivers established that following a symptoms-only presentation, physicians simply moved to investigate the problem further, while following a candidate diagnosis presentation, physicians moved to either confirm—or disconfirm—the existence of the diagnosis proposed by the family.

Other research also suggests that how patients communicate can shape outcomes. A randomized controlled trial conducted by Kravitz et al. (2005) using standardized patients found that the ways in which patients with mental health symptoms requested psychotropic drugs (no request for medication vs general request for medication vs specific brand request) shaped how physicians treated their symptoms. Patients who made either a general request or a brand-specific request for medication received a psychotropic drug prescription and/or referral to a mental health specialist significantly more frequently than those who provided just their symptoms but no medication request. An exploratory investigation into decision-making for depression treatment in primary care found that patients who presented their symptoms in line with diagnostic criteria received prescriptions for antidepressants, while patients who presented their symptoms as the result of a situational problem were unlikely to receive such a remedy ( Karasz et al., 2012 )

Studies point to several reasons why presented symptoms may not be properly addressed in the physician-patient encounter. Some findings demonstrate that in contrast with a clear symptom presentation at the outset of the primary care visit, failure to topicalize all symptoms related to all medical concerns early in the visit is associated with the symptoms being less likely to be properly taken up (see Robinson, 2003 ). This has implications for proper diagnosis and treatment of the problem. Moreover, some believe that primary care physicians are over diagnosing mental health problems while others believe there is an underdiagnosis problem. Others point to constraining diagnostic guidelines which shift PCP’s orientations toward diagnosing and treating depressive disorders involving a particular set of symptoms ( Karasz et al., 2012 ). Despite work thus far, it is still unclear what in the interactional machinery of these visits leads some studies to arrive at different conclusions about the outcome of primary care visits that treat mental health-related symptoms. I propose a conversation analytic (CA) pilot investigation of the moment-to-moment interactional practices of US patients and their PCPs, specifically exploring how patients present mental health-related symptoms and whether this impacts subsequent diagnoses.

The data used for this investigation are video-recorded US adult acute primary care visits from clinics in Southern California collected from 1997 to 2004. Study procedures were approved by the institutional review board (IRB). All participants provided written informed consent. A corpus of 240 encounters was examined for inclusion of mental health-related symptoms in the encounter. Surprisingly, just fourteen cases were identified in which the patient discussed mental health-related symptoms. Thus, this study acts as a pilot investigation of the phenomenon. Inclusion criteria were determined based on the symptoms indicated in the Mental Health Inventory ( Hays, 1994 ). The Mental Health Inventory (MHI) is a 38-item survey from core measures of emotional well-being from the Medical Outcomes Study. Patients who mentioned one or more of the adverse symptoms as indicated on the MHI during their visit met inclusion criteria.

Each visit was manually transcribed by the author using standard CA conventions and notations as detailed in Hepburn and Bolden (2012) . These notations are crucial for understanding not only what participants said, but how they said it. Data analysis was guided by CA practices (see Heritage, 1984 ; Sidnell and Stivers, 2012 ). The CA approach to studying medical interaction hinges on the idea that the medical encounter involves commonsense reasoning (see Garfinkel, 1967 ) and a distinct interaction order (see Goffman, 1983 ). CA offers a novel and important lens through which the interaction order plays out in medicine and how physicians and patients work to co-construct a medical visit ( Heritage and Maynard, 2006 ). Through CA’s implementation, patterns in clinical interactions are evaluated turn-by-turn which can then be shown to be ordered and systematic in usage within and across medical contexts, known as a conversational practice. Such conversational practices are meaningful on an institutional level because interactions are couched in larger activities and end-goals to which the institutional figures are oriented ( Drew and Heritage, 1992 ).

Patient presentations of mental health concerns

I am concerned with the ways in which patients characterize symptoms that may indicate a mental health disorder. Drawing on Stivers’ aforementioned work on problem presentations, I reviewed data for any consistent pattern in symptom presentation. What emerged was a two-way distinction between “symptoms-only” presentations as Stivers identified and presentations that provided an additional causal link between mental health-related symptoms and an everyday life disruption (e.g. “I can’t do household chores because I’m so anxious”). I identify the latter as “Lifeworld Disruption” presentations. Although the actual symptoms presented are nearly identical in both presentation types, the different presentation formats lead to distinct diagnostic outcomes. I examine how these different problem presentations affect the way physicians diagnose and treat this information in clinical interactions.

Symptoms-only problem presentations

In 57% (n = 8) of cases in the sample, patients presented symptoms related to a mental health concern and nothing more. An instance of this is shown in Extract 1. At the beginning of the visit, this patient believes something is not right with him. At the outset of his turn in Extract 1a, it is unclear whether he is moving into the territory of mental health as he speaks about his family’s diabetic history and his own symptoms, which he thinks may be related. He discusses family members who have had complications with diabetes and that he feels like “something is going do:wn” on him (line 04). He analogizes this feeling to how he feels on an empty stomach (line 06):

After more narrative about a feeling that he cannot quite describe, the patient becomes more concrete in Extract 1b by referencing a feeling similar to tension or nerves (lines 01–02):

The patient equates his feelings with tension or nervousness in lines 01–02, “It’s it’s: (.) kind of uhm like uh (0.2) when you’re tense or ner- nerv- in my nerves” which signals a relationship to a mental health issue. The patient’s first mention of depression in lines 03–04 seems to be related to the weather outside, as the patient points to the window when saying “ days like this de press me.” Next the patient mitigates his prior assertion of depression by questioning his feelings in lines 04–05, “ why do I feel de pression if I gotta nice family,.” He continues to provide evidence of discomfort (lines 05–06): “I feel uncomfortable mayn it’s something weird that I’ve never felt befo:re.” which is a nebulous description of his symptoms. In this presentation, he outlines symptoms of nervousness, tension, discomfort, and depression on certain days. However, he does not link these symptoms to disrupting his everyday life.

In this example, we see that one way patients present mental health problems is to describe just symptoms. These symptoms-only presentations allow for the possibility that there could be a physical health diagnosis or that the symptoms are not in need of immediate treatment. This problem presentation type contrasts with one that includes the provision of a causal link between mental health symptoms and a disruption to the patient’s lifeworld.

Lifeworld disruption problem presentations

Here, I examine problem presentations involving mental health symptoms that are causally linked to concrete lifeworld disruptions. When patients do this, they treat the problem as in need of immediate treatment. In Extract 2, the interaction begins with an understanding by both physician and patient that something bad happened the day before. What that is, however, we do not initially see. Instead, the patient discusses stress and provides situational evidence as causation in Extract 2a:

The mutual understanding between physician and patient that something has happened is indicated in the first exchange. When the physician walks in and asks, “How are you doing?” (line 01) he indexes knowledge of some already known medical issue ( Coupland et al., 1994 ). It is clear from the patient’s response, “I’m much better toda:y than yesterday,” (line 02) that she orients to this question as a reference to medical business to be covered ( Heritage and Robinson, 2006 ). Next the physician asks, “Wha- .hh what happened yesterday” (line 05). Rather than responding to this, the patient indicates that she has difficulty falling asleep, attributes this to her experiencing stress, and discusses situational instances– her mother’s health– that she interprets as causing her stress. At this point, the presentation is a symptoms-only presentation.

Subsequently, the physician asks whether this occasioned her recent visit to the emergency room (line 01), thus requesting confirmation of an implicit causal link between the mental health symptoms and emergency room visit. The patient does not provide this link initially:

In lines 04–05, the patient offers a pre-announcement ( Terasaki, 2004 ) to the doctor about the nature of her high blood pressure, and in lines 09–10 this is expanded, specifically that the blood pressure continued to increase which caused her to panic. So far, this patient has described her mental health-related symptoms and indicated that she visited the emergency room but she has not made an explicit link between her symptoms and the lifeworld disruption. This comes in Extract 2c:

In lines 03, 08, and 10, the patient causally links her symptoms to a lifeworld disruption, that she called her physician’s emergency number because she was “just too afraid” about her increasing blood pressure.

While symptoms-only presentations include symptoms of feeling unusual, depressed, or down without provision of a causal link to a lifeworld disruption, these problem presentation types contrast with those that do provide the addition of a causal link between mental health symptoms and a disruption to the patient’s lifeworld. These latter presentations reflect a patient orientation toward a problem in need of treatment, which contrasts with how symptoms only presentations are made even though actual symptoms are effectively the same. The question to which I now turn is whether the design of the problem presentation conditions physician response.

Physician uptake of mental health concerns

The two presentation practices employed by patients–symptoms-only and lifeworld disruption— have consequences for physician response. In this section, I show that questions pursued by physicians are implicitly biased and move toward different diagnostic trajectories depending on the problem presentation. Specifically, following symptoms-only presentations physicians primarily pursue physical health diagnoses, while in the context of lifeworld disruption presentations physicians primarily pursue mental health diagnoses. This result suggests that amid nearly identical symptoms, physicians generally show bias toward physical health diagnoses when only mental health symptoms are presented, but once patients provide the addition of a causal link between their symptoms and a lifeworld disruption, physicians orient to the symptoms as indicative of a mental health problem.

The symptoms-only context: setting aside a mental health diagnosis

A primary way that physicians show a bias toward a physical health diagnosis in the symptoms-only context is to directly acknowledge a patient’s mental health issue but then set it aside in favor of the physical health issue. This is illustrated in Extract 3. The patient presents with cold symptoms and then suggests that there may be a connection between depression and the colds she has been getting (lines 01–02). This presentation is symptoms-only:

Following a question that receives no uptake by the physician in lines 01–02, the patient provides an account for her question (lines 04–07). Here, she collateralizes her suspicion of depression symptoms with situational evidence. The core of this interaction unfolds in line 09, where the physician makes an assessment about the patient’s appearance, “= You don’t look depressed but you feel sad all the time or,=.” In telling the patient that she does not physically look depressed, this physician counters the patient’s implied diagnosis. However, in the same turn, this physician asks a polar question which is biased toward a mental health problem (see Heritage, 2010 ): “but d’you feel sad all the time or,=“ (line 09). Yet, because the physician in his professional opinion has communicated a clear stance that the patient does not look depressed prior to asking about her feeling sad, based on his assessment we might assume that she would minimize any response about feeling sad moving forward in her symptom narrative.

Following this sequence, the patient continues with opaque symptoms of feeling “blue” and tired in the mornings, which get no uptake. After the patient has completed her narrative, the physician offers a still stronger counter-diagnosis of no depression:

In this extract, the physician shuts down potentially more discussion about the patient’s symptoms as related to depression. In lines 01–02, his diagnosis that the patient is not depressed is done under the guise of answering the patient’s question from (3a): whether depression can cause colds. In the next few lines of talk, he states that should she present with sadness, no desire to have fun, the inability to sleep, and frequent crying— in that case, he would consider a depression diagnosis. When, in lines 13–14, she says “Okay no I’m pretty much up for doing anything .hh if something comes up,” he responds with an assessment, “Good” in line 17 and then discusses treatment of her fatigue and cold symptoms.

This physician sets aside the issue of depression because he briefly inquires about the depression in line 09 of Extract 3a following her initial suggestion that depression may be the cause of her colds, “= You don’t look depr e ssed but d’you feel sad all the time or,=,” yet pursues a physical health diagnosis in line 17 when he recommends more exercise. The patient could have further pushed the issue of her symptoms or been prompted to be clearer had the physician moved toward a mental health concern. Instead, she did not orient to her mental health concerns as problematic because her physician dismissed those concerns. This physician moves toward a physical health diagnosis, yet here he acknowledges and sets the potential mental health diagnosis aside in favor of a physical health one. Like in Extract 1 of the previous section, we see depression symptoms being described but without a concrete provision linking these symptoms to disrupting the patient’s lifeworld. Notably, the patient provides information about her lifeworld as a potential cause for these symptoms but does not causally link these symptoms to a disruption in her lifeworld.

In this case shown, the patient uses a symptoms-only mental health problem presentation. In this type of presentation, once patients provide mental health-related symptoms that could be taken up by physicians as indicative of a mental health issue, physicians in these data instead move toward physical health diagnoses by setting aside mental health- related diagnoses. This is done via tilting questions to a physical health diagnosis by being problem-attentive ( Stivers, 2007 ) toward a physical ailment. Although this is a small dataset, this pattern is consistent.

The lifeworld disruption context: physician uptake of mental health symptoms

When patients include a causal link to a lifeworld disruption, physicians are more likely to orient to the problem as a mental health one. Specifically, in the context of lifeworld disruption problem presentations, physicians pursue a mental health diagnosis instead of a physical health one. In Extract 4, the patient presents with situational depression due to stress from her job and personal issues. She has noted that she went to urgent care because she was likely having a panic attack. She continues to indicate that her symptoms are due to stress and includes a concrete link between her symptoms and an everyday life disruption in lines 05–06:

The physician responds to the patient’s example of a disruption with the question, “are you crying easily? °Or-°” (line 09). The problem-attentive nature of this question is in marked contrast to the prior cases insofar as it is biased in favor of a mental health problem. Here, the physician orients to this disruption as problematic and provides an opportunity for the patient to further expand her symptoms. Notably, it is only when the patient makes the causal connection between symptoms of sleeplessness, headaches, tension, and the inability to do jobs around the house (a lifeworld disruption) that the physician actively pursues additional mental health-related symptoms. As a result of the physician’s active search for additional symptoms, the patient’s illness presentation becomes more granular ( Schegloff, 2000 ).

A pattern in these data is apparent: physicians pursue questioning biased toward a physical diagnosis when patients present symptoms-only mental health concerns and physicians pursue questioning biased toward a mental health-related diagnosis when patients provide a causal connection between a concrete lifeworld disruption and their symptoms. This pattern holds for 12 out of the 14 total cases. However, two cases do not fit this pattern. In what follows, I show that the ways in which a departure from the pattern nonetheless supports the broader analysis.

A deviant case

How do we account for a symptoms-only mental health presentation that results in the pursuit of a mental health diagnosis? Such an instance arose in the dataset as shown in Extract 5. The patient in this case presents with persistent fatigue. Her problem presentation begins below:

The patient explains that she had visited this office twice before with the same complaint and was given a pregnancy test during one visit and a thyroid test during another. Next, the physician reassures her about her thyroid and continues with diagnosis:

The physician in this case also references these past visits and the physical tests conducted in lines 01–03 and again in lines 08–09. At these past visits where this patient initially presented with the same symptoms, the physician did as the analysis in this article would predict: pursued a physical health diagnosis. During this visit, however, the physician pursues a mental health-related diagnosis, a “neurochemical imbalance,” in line 10.

On the surface, this visit does not fit with the rest: the patient used a symptoms-only presentation yet a mental health diagnosis follows. Note, however, that the physician makes clear that he is only pursuing this diagnosis in the context of previous physical diagnoses that he is now able to rule out: “When you’ve been in fatigue as long as you can remember (.) and your blood counts are all right (.) and your thyroid’s all right you’re not pregnant it makes think (.) that you have a neurochemical imbalance” (lines 07–10). Purely because the two physical health diagnoses did not solve the symptoms of fatigue does this physician now move toward a mental health diagnosis. This provides further support that physicians are biased against a mental health diagnosis initially. The physician continues:

This physician’s account further demonstrates that he is arriving at this mental health-related diagnosis in the context of physical diagnoses that have still left the patient with the complaint (lines 01–05). He labels the neurochemical imbalance diagnosis a “diagnosis of exclusion” (line 03), which effectively concludes how he arrived at this particular diagnosis without a concrete lifeworld disruption. This outcome therefore can be explained because it was a diagnosis made following two failed physical-health diagnoses. Furthermore, we have evidence for the physician’s behavior on two prior visits that the default orientation was to a physical health diagnosis before a mental health one. It took extra work—a third visit from the patient—in order to secure a mental health diagnosis.

Why does the addition of causal link make the difference for physicians’ treatment orientations? One explanation for this could be how we understand biographical disruption in chronic illness ( Bury, 1982 ). In studying patients with rheumatoid arthritis, Bury investigates the way chronic illness is conceptualized—as a disruptive event. He writes,

… illness, and especially chronic illness, is precisely that kind of experience where the structures of everyday life and the forms of knowledge which underpin them are disrupted … it brings individuals, their families, and wider social networks face to face with the character of their relationships in stark form, disrupting normal rules of reciprocity and mutual support. (169)

Chronic illness, therefore, represents a disruption of our taken-for-granted lifeworld (see Schutz, 1967 ). Barker (2009) argues that because our sense of self is rooted in our bodies’ daily functioning, an interruption of that functioning which restricts our everyday life performances threatens our fundamental selves. It is perhaps our orientation to this threat of our selves before illness which makes lifeworld disruption salient to us– and consequently to physicians– who take up these issues as indicators of an issue beyond a physical ailment. Once symptoms are presented, the addition of a lifeworld disruption tips the scales.

This article outlines two approaches patients take to present their mental health– related symptoms in the primary care setting. Taken one step further, this dichotomy is matched to two distinct physician responses and thus holds consequences for diagnosis. When patients use a symptoms-only problem presentation to articulate their mental health symptoms, physicians orient to such complaints as indicative of a physical health problem and therefore pursue questioning biased in favor of a physical health diagnosis. In contrast, when patients provide the addition of a causal link between their mental health symptoms and a lifeworld disruption in their problem presentation, termed lifeworld disruption presentations, physicians align to the symptoms as indicating a mental health issue and subsequently pursue questioning biased in favor of a mental health diagnosis. This pattern holds in the majority of cases in the sample. While two of the cases in the sample deviated from this initial pattern, they still provided evidence for the pattern: that without the addition of a causal link between mental health symptoms and an everyday life disruption, physicians will demonstrate bias toward a physical health problem even when they initially topicalize a potential mental health problem.

In the medical encounter, physicians typically initiate actions while patients typically respond, resulting in an interactional asymmetry ( Robinson, 2003 ). What underlies a medical diagnosis is not just information that patients provide to their physicians; it is also the ways in which physicians can shape patients’ symptoms through the interactional sequence. This can affect how patients explain their illness and whether physicians adequately hear patients’ experience of illness ( Gill and Maynard, 2006 ). While this analysis primarily examines how patients’ descriptions of symptoms conditions physicians’ diagnoses, it is important to also note that the ways in which physicians guide patients through the symptom presentation conditions how those symptoms get explained in the first place.

Mental illness continues to be a fundamental problem in society today. It is estimated that approximately half of American adults will experience at least one mental health disorder in their lifetime and 25% will have an ongoing mental health disorder at any given time ( Kessler et al., 2005 ). When compared with other illness categories including cancer and heart disease, the World Health Organization (WHO) concludes that mental health disorders account for the highest incidence of disability in developed nations ( WHO, 2004 ). Moreover, mental health disorders are associated with a reduction in quality of life, social functioning ( Saarni et al., 2007 ), and impairment in carrying out daily tasks ( Knudsen et al., 2013 ). These disorders also play a significant role in morbidity and mortality in the United States and are positively associated with the incidence of other chronic health problems ( Chapman et al., 2005 ).

As Parsons (1951) theorized, illness is a form of social deviance, and by nature this deviance disrupts the normal, everyday functioning of those who are sick. Furthermore, the responsibility of remediating this deviance lies in the physician’s domain. As far as the data presented in this article is concerned, we can see evidence for today’s physicians closely following a Parsonian script in the pursuit of mental health diagnoses. If patients are not showing functional incapacity, their physicians are not taking their symptoms up as indicative of a mental health issue and instead are orienting the diagnosis to a physical problem, echoing prior work which suggests that PCPs frequently address medically ambiguous and/or complex symptoms with somatic interventions ( Ring et al., 2005 ). These data further show that patients must not only strongly assert their mental health symptoms but assert them as unquestionably tied to the inability to carry out everyday life tasks. If patients query, mitigate, or collateralize these symptoms, they are consistently treated as insufficient evidence to indicate a potential mental health problem and instead get taken up as indicative of a physical health issue.

The concern from many in the medical community regarding the misdiagnosis of mental health issues is unsurprising given what this pilot study suggests. Current literature is split on whether this problem of misdiagnosis could be one of underdiagnosis or over diagnosis. A possible explanation for these diagnostic errors can be deduced from the data presented. Potentially, problems of underdiagnosis can be associated with patients who provide a symptoms-only problem presentation but who also have underlying mental health issues. Based on the data in this article, such patients will not get treatment for those underlying mental health issues because they have not demonstrated a disruption to their lifeworld. Importantly, when mental health symptoms are provided as just symptoms, there appears to be bias in the medical community toward providing a physical health before a mental health one.

This preliminary analysis may also help account for the problems of overdiagnosis. Overdiagnosis of mental health problems could be correlated with patients who do not actually have underlying mental health issues, but who over-catastrophize their symptoms by indexing their symptoms as causally linked to a lifeworld disruption. As is shown by the data analyzed, when patients do the extra work to provide a causal link between mental health symptoms and a lifeworld disruption, whether it is indicative of a mental health issue, a mental health diagnosis is often the result. Thus, there is suggestive evidence of an association between the way patients present their mental health symptoms and the misdiagnosis of underlying mental health problems in primary care.

Limitations and future research

Related studies have found that patients who include situational problems in their symptom narrative are actually less likely to receive a psychotropic drug prescription ( Chew-Graham et al., 2002 ; Karasz et al., 2012 ). Yet in these studies, patients causally linked their lifeworld to their symptoms, rather than causally linking their symptoms to disrupting their life- world, as this study has found. An overlapping concern among these investigations is what happens to patients with these complex symptom narratives, who go improperly diagnosed or leave without a diagnosis, after they exit the clinic. Further research on a larger scale could follow patients with mental health symptoms longitudinally from diagnosis to follow-up. This could help us begin to uncover the medically complicated root cause of their symptoms through following treatment outcomes over time.

Patient and physician self-reported demographic variables, such as gender, race/ethnicity, socioeconomic status, and education level are not available for analysis in this study. This is a limitation of the study and would undoubtedly offer an important level of explanatory power for the findings. As we know, patients from underrepresented groups receive inadequate treatment for mental healthcare ( Alegría et al., 2008 ) which can be attributed to a variety of interrelated social forces ( Link and Phelan, 1995 ). For instance, research has shown that ethnicity and gender both impact how pain gets perceived by clinicians ( Al-Hashimi et al., 2015 ; Norman, 2018 ). This study hopes to lay groundwork on which health disparities research can be built, where patterns in physician uptake of patient-presented mental health symptoms could be explored for diagnostic biases and differential treatment of patients from marginalized groups.

Acknowledgments

The author(s) disclosed receipt of the following financial support for the research, authorship and/or publication of this article: This article was supported by the National Research Service Award under grant award 5TL1TR002388 (PI: David Meltzer, MD, PhD). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of NCATS/NIH.

Author biography

Alexandra Tate is a Postdoctoral Fellow in the Department of Medicine at The University of Chicago. She received her MA and PhD in Sociology from the University of California, Los Angeles, and her BA in Sociology from the Northwestern University. Her research explores the US healthcare system and engages theories of ethnography and conversation analysis to inform her findings. Her interests lie in the complexities of doctor–patient interaction and implications for patient care, focusing primarily on the physician-patient relationship in oncology, primary care, and palliative care settings.

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Types of Mental Health Professionals

Know the warning signs.

Learn the common signs of mental illness in adults and adolescents.

Mental health conditions

Learn more about common mental health conditions that affect millions.

Find Your Local NAMI

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Many types of mental health care professionals can help you achieve your recovery goals. These professionals work in inpatient facilities, such as general hospitals and psychiatric facilities, and outpatient facilities, such as community mental health clinics, schools and private practices.

Health care professional job titles and specialties can vary by state. The descriptions below give an overview of what to look for and what credentials to expect from a mental health professional. Finding the right professional is easier when you understand the different areas of expertise and training.

The NAMI HelpLine can provide information on how to find various mental health professionals and resources in your area. Please note that we are unable to provide specific recommendations to individual providers as we are unable to speak to the quality of their care.

Assessment and Therapy

Therapists can help someone better understand and cope with thoughts, feelings and behaviors. They can also offer guidance and help improve a person’s ability to achieve life goals. These mental health professionals may also help assess and diagnosis mental health conditions.

Psychologists

Psychologists hold a doctoral degree in clinical psychology or another specialty such as counseling or education. They are trained to evaluate a person’s mental health using clinical interviews, psychological evaluations and testing. They can make diagnoses and provide individual and group therapy. Some may have training in specific forms of therapy like cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT) and other behavioral therapy interventions.

Degree requirements: Doctor of Philosophy (Ph.D.) in a field of psychology or Doctor of Psychology (Psy.D.). Licensure & credentials: Psychologists are licensed by licensure boards in each state.

Counselors, Clinicians, Therapists

These masters-level health care professionals are trained to evaluate a person’s mental health and use therapeutic techniques based on specific training programs. They operate under a variety of job titles—including counselor, clinician, therapist or something else—based on the treatment setting. Working with one of these mental health professionals can lead not only to symptom reduction but to better ways of thinking, feeling and living.

Degree requirements: master’s degree (M.S. or M.A.) in a mental health-related field such as psychology, counseling psychology, marriage or family therapy, among others. Licensure & Certification: Varies by specialty and state. Examples of licensure include:

• LPC, Licensed Professional Counselor
• LMFT, Licensed Marriage and Family Therapist
• LCADAC, Licensed Clinical Alcohol & Drug Abuse Counselor

Clinical Social Workers

Clinical social workers are trained to evaluate a person’s mental health and use therapeutic techniques based on specific training programs. They are also trained in case management and advocacy services.

Degree requirements: master’s degree in social work (MSW). Licensure & credentials: Examples of licensure include:

• LICSW, Licensed Independent Social Workers
• LCSW, Licensed Clinical Social Workers
• ACSW, Academy of Certified Social Workers

Prescribe and Monitor Medication

The following health care professionals can prescribe medication . They may also offer assessments, diagnoses and therapy.

Psychiatrists

Psychiatrists are licensed medical doctors who have completed psychiatric training. They can diagnose mental health conditions, prescribe and monitor medications and provide therapy. Some have completed additional training in child and adolescent mental health, substance use disorders or geriatric psychiatry.

Degree requirements: Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO), plus completion of residency training in psychiatry. Licensure & credentials: Licensed physician in the state where they are practicing; may also be designated as a Board Certified Psychiatrist by the Board of Neurology and Psychiatry.

Psychiatric or Mental Health Nurse Practitioners

Psychiatric or mental health nurse practitioners can provide assessment, diagnosis and therapy for mental health conditions or substance use disorders. In some states, they are also qualified to prescribe and monitor medications. Requirements also vary by state as to the degree of supervision necessary by a licensed psychiatrist.

Degree requirements: Master of Science (MS) or Doctor of Philosophy (Ph.D.) in nursing with specialized focus on psychiatry. Licensure & credentials: Licensed nurse in the state where they are practicing. Examples of credentials include, but are not limited to:

• NCLEX, National Council Licensure Examination
• PMHNP-BC, Board Certification in psychiatric nursing through the American Academy of Nurses Credentialing Center

Primary Care Physicians

Primary care physicians and pediatricians can prescribe medication, but you might consider visiting someone who specializes in mental health care. Primary care and mental health professionals should work together to determine an individual’s best treatment plan.

Degree requirements: Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (DO). Licensure & credentials: Licensed physician in the state where they are practicing.

Family Nurse Practitioners

Family nurse practitioners (FNP) can provide general medical services like those of a primary care physician, based on each state’s laws. Like primary care physicians, they can prescribe medication, but you might consider visiting someone who specializes in mental health care. Family nurse practitioners and mental health professionals should work together to determine an individual’s best treatment plan.

Degree requirements: Master of Science (M.S.) or Doctor of Philosophy (Ph.D.) in nursing. Licensure & credentials: Licensed nurse in the state where they are practicing. Examples of credentials include:

• FNP-BC, Family Nurse Practitioner Board Certified

Psychiatric Pharmacists

Psychiatrist pharmacists are advanced-practice pharmacists who specialize in mental health care. They can prescribe or recommend appropriate medications if allowed in their state and practice setting. They are skilled at medication management—meaning they evaluate responses and modify treatment, manage medication reactions and drug interactions, and provide education about medications. Many have completed additional training in child/adolescent psychiatry, substance use disorders or geriatric psychiatry. Degree requirements:  Doctor of Pharmacy (PharmD). Completion of residency training in psychiatric pharmacy is not required, but is common. Licensure & credentials:  Licensed pharmacist in the state where they practice; may also be designated a Board Certified Psychiatric Pharmacist by the Board of Pharmacy Specialties.

Other Professionals You May Encounter

Certified peer specialists.

These specialists have lived experience with a mental health condition or substance use disorder. They are often trained, certified and prepared to assist with recovery by helping a person set goals and develop strengths. They provide support, mentoring and guidance.

Social Workers

Social workers (B.A. or B.S.) provide case management, inpatient discharge planning services, placement services and other services to support healthy living.

Pastoral Counselors

Pastoral counselors are clergy members with training in clinical pastoral education. They are trained to diagnose and provide counseling. Pastoral counselors can have equivalents to a doctorate in counseling.

Updated April 2020

What is ADHD?

Signs and symptoms.

• Managing Symptoms

ADHD in Adults

More information.

ADHD is one of the most common neurodevelopmental disorders of childhood. It is usually first diagnosed in childhood and often lasts into adulthood. Children with ADHD may have trouble paying attention, controlling impulsive behaviors (may act without thinking about what the result will be), or be overly active.

It is normal for children to have trouble focusing and behaving at one time or another. However, children with ADHD do not just grow out of these behaviors. The symptoms continue, can be severe, and can cause difficulty at school, at home, or with friends.

A child with ADHD might:

• daydream a lot
• forget or lose things a lot
• squirm or fidget
• talk too much
• make careless mistakes or take unnecessary risks
• have a hard time resisting temptation
• have trouble taking turns
• have difficulty getting along with others

Learn more about signs and symptoms

Get information and support from the National Resource Center on ADHD

There are three different ways ADHD presents itself, depending on which types of symptoms are strongest in the individual:

• Predominantly Inattentive Presentation: It is hard for the individual to organize or finish a task, to pay attention to details, or to follow instructions or conversations. The person is easily distracted or forgets details of daily routines.
• Predominantly Hyperactive-Impulsive Presentation: The person fidgets and talks a lot. It is hard to sit still for long (e.g., for a meal or while doing homework). Smaller children may run, jump or climb constantly. The individual feels restless and has trouble with impulsivity. Someone who is impulsive may interrupt others a lot, grab things from people, or speak at inappropriate times. It is hard for the person to wait their turn or listen to directions. A person with impulsiveness may have more accidents and injuries than others.
• Combined Presentation: Symptoms of the above two types are equally present in the person.

Because symptoms can change over time, the presentation may change over time as well.

 Learn about symptoms of ADHD, how ADHD is diagnosed, and treatment recommendations including behavior therapy, medication, and school support.

Causes of ADHD

Scientists are studying cause(s) and risk factors in an effort to find better ways to manage and reduce the chances of a person having ADHD. The cause(s) and risk factors for ADHD are unknown, but current research shows that genetics plays an important role. Recent studies link genetic factors with ADHD. 1

In addition to genetics, scientists are studying other possible causes and risk factors including:

• Brain injury
• Exposure to environmental risks (e.g., lead) during pregnancy or at a young age
• Alcohol and tobacco use during pregnancy
• Premature delivery
• Low birth weight

Research does not support the popularly held views that ADHD is caused by eating too much sugar, watching too much television, parenting, or social and environmental factors such as poverty or family chaos. Of course, many things, including these, might make symptoms worse, especially in certain people. But the evidence is not strong enough to conclude that they are the main causes of ADHD.

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Deciding if a child has ADHD is a process with several steps. There is no single test to diagnose ADHD, and many other problems, like anxiety, depression, sleep problems, and certain types of learning disabilities, can have similar symptoms. One step of the process involves having a medical exam, including hearing and vision tests , to rule out other problems with symptoms like ADHD. Diagnosing ADHD usually includes a checklist for rating ADHD symptoms and taking a history of the child from parents, teachers, and sometimes, the child.

Learn more about the criteria for diagnosing ADHD

In most cases, ADHD is best treated with a combination of behavior therapy and medication. For preschool-aged children (4-5 years of age) with ADHD, behavior therapy, particularly training for parents, is recommended as the first line of treatment before medication is tried. What works best can depend on the child and family. Good treatment plans will include close monitoring, follow-ups, and making changes, if needed, along the way.

Learn more about treatments

Managing Symptoms: Staying Healthy

Being healthy is important for all children and can be especially important for children with ADHD. In addition to behavioral therapy and medication, having a healthy lifestyle can make it easier for your child to deal with ADHD symptoms. Here are some healthy behaviors that may help:

• Developing healthy eating habits  such as eating plenty of fruits, vegetables, and whole grains and choosing lean protein sources
• Participating in daily  physical activity based on age
• Limiting the amount of daily screen time from TVs, computers, phones, and other electronics
• Getting the recommended amount of sleep each night based on age

If you or your doctor has concerns about ADHD, you can take your child to a specialist such as a child psychologist, child psychiatrist, or developmental pediatrician, or you can contact your local early intervention agency (for children under 3) or public school (for children 3 and older).

The Centers for Disease Control and Prevention (CDC) funds the National Resource Center on ADHD , a program of CHADD – Children and Adults with Attention-Deficit/Hyperactivity Disorder. Their website has links to information for people with ADHD and their families. The National Resource Center operates a call center (1-866-200-8098) with trained staff to answer questions about ADHD.

For more information on services for children with special needs, visit the Center for Parent Information and Resources.  To find the Parent Center near you, you can visit this website.

ADHD can last into adulthood. Some adults have ADHD but have never been diagnosed. The symptoms can cause difficulty at work, at home, or with relationships. Symptoms may look different at older ages, for example, hyperactivity may appear as extreme restlessness. Symptoms can become more severe when the demands of adulthood increase. For more information about diagnosis and treatment throughout the lifespan, please visit the websites of the National Resource Center on ADHD  and the National Institutes of Mental Health .

• National Resource Center on ADHD
• National Institute of Mental Health (NIMH)
• Faraone, S. V., Banaschewski, T., Coghill, D., Zheng, Y., Biederman, J., Bellgrove, M. A., . . . Wang, Y. (2021). The World Federation of ADHD International Consensus Statement: 208 evidence-based conclusions about the disorder. Neuroscience & Biobehavioral Reviews. doi:10.1016/j.neubiorev.2021.01.022

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