Anxiety disorders may develop from a complex set of risk factors, including genetics, brain chemistry, personality, and life events. According to the Anxiety Disorders Association of America (2003), anxiety disorders are categorized as:
- Generalized Anxiety Disorder (GAD). GAD is characterized by excessive, unrealistic worry that lasts six months or more. In adults, the anxiety may focus on issues such as health, money, relationships, or career. In addition to chronic worry, GAD symptoms include trembling, muscular aches, insomnia, abdominal upsets, dizziness, and irritability.
- Obsessive-Compulsive Disorder (OCD). In OCD, individuals are plagued by persistent, recurring thoughts (obsessions) that reflect exaggerated anxiety or fears. Typical obsessions include worry about being contaminated or fears of behaving improperly or acting violently. The obsessions may lead an individual to perform ritual or routine behaviors (compulsions) such as repetitive counting or hand washing.
- Panic Disorder. People with panic disorder suffer severe attacks of panic-which may make them feel like they are having a heart attack or are “going crazy” for no apparent reason. Symptoms include heart palpitations, chest pain or discomfort, sweating, trembling, tingling sensations, feeling of choking, fear of dying, fear of losing control, and feelings of unreality. Panic disorder often occurs with agoraphobia, in which people are afraid of having a panic attack in a place from which escape would be difficult, so they avoid these places.
- Post-Traumatic Stress Disorder (PTSD). PTSD can follow an exposure to a traumatic event such as a sexual or physical assault, witnessing a death, the unexpected death of a loved one, or natural disaster. There are three main symptoms associated with PTSD: 1. “Re-living” the traumatic event (such as flashbacks and nightmares); 2. Avoidance behaviors (such as avoiding places related to the trauma) and emotional numbing (detachment from others); and 3. Physiological arousal such as difficulty sleeping, irritability or poor concentration.
- Social Anxiety Disorder (Social Phobia). Social Anxiety Disorder is characterized by extreme anxiety about being judged by others or behaving in a way that might cause embarrassment or ridicule. This intense anxiety may lead to avoidance behavior. Physical symptoms associated with this disorder include heart palpitations, faintness, blushing and profuse sweating.
- Specific phobias. People with specific phobias suffer from an intense fear reaction to a specific object or situation (such as spiders, dogs, or heights); the level of fear is usually inappropriate to the situation, and is recognized by the sufferer as being irrational. This inordinate fear can lead to the avoidance of common, everyday situations.
According to the Concise Textbook of Clinical Psychiatry, Kaplan & Sadock, (1996) and the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) persons with Asperger’s Syndrome display a narrow and repetitive or obsessive pattern of interests and behaviors. To be diagnosed with Asperger's Syndome at least two of the following indications of qualitative social impairment are present:
- the failure to develop peer relationships, and/or
- the lack of social or emotional reciprocity, and/or
- an impaired ability to express pleasure in other people’s happiness,
- and/or markedly abnormal nonverbal communication gestures.
In addition, individuals with Asperger’s disorder can be highly sensitive to environmental stressors, lighting, sounds, smells or tastes.
Individuals with Asperger’s Syndrome generally have normal intelligence, normal cognitive development and normal language acquisition. However, individuals with Asperger’s Syndrome do have language deficits in that they can be extremely literal and have great difficulty understanding metaphor or the use of figurative language. They can also have difficulty using language in a social context.
The impact of the disorder can range from mild to severe. Some adults with mild Asperger’s disorder learn to compensate. Many marry, hold a job, attend college, and have children. Often talented in a specific area of interest, pursuit of a career or occupation closely aligned with that interest area can lead to success. Other individuals with this disorder live an isolated existence with continuing severe difficulties in social and occupational functioning.
Characteristics may include:
- May have difficulty understanding the feelings of others
- May be perceived as “aloof” or “quirky”
- May seem to talk “at you” versus “with you”
- May avoid eye contact
- May be insensitive to social cues or implied communications
- May be vulnerable to teasing or exploitation by others
- May fail to understand humor or sarcasm or simile
- May be very distressed by changes in routine, particularly if unexpected
- May be inappropriate in interactions with others
- May have large verbal vocabulary but use words incorrectly
Helpful Communication Hints:
- Be very concrete and precise in your communications
- Use clear directives
- Keep instructions direct and check comprehension
Attention Deficit Disorder
Attention Deficit Disorder (ADD) is characterized by poor attention, impulsivity, disorganization, or restlessness. Students with Attention Deficit Hyperactivity Disorder (ADHD) may exhibit over-activity, be easily distracted, disorganized and have difficulty completing tasks. For this diagnosis, the behaviors must be present to an excessive degree, over time, and out of sync with normal age-related behavior.
Scientists have learned more about ADD/ADHD in recent years. According to the National institute of Mental Health (1996), “They are now able to identify and treat children, adolescents, and adults who have it. A variety of medications, behavior-changing therapies, and educational options are already available to help people with ADHD focus their attention, build self-esteem and function in new ways.”
Some people with ADHD describe a sense of frustration. “Since people with ADHD are often bright and creative, they often report feeling frustrated that they’re not living up to their potential. Many also feel restless and are easily bored. Some say they need to seek novelty and excitement to help channel the whirlwind in their minds. Although it may be impossible to document when these behaviors first started, most adults with ADHD can give examples of being inattentive, impulsive, overly active, impatient and disorganized most of their lives.” (National Institute of Mental Health).
At the college level, students with ADHD often take on too much. They may take an overload of credits at the beginning of a semester, but later find that they have difficulty completing everything. Since organization and staying on task is a challenge for students with ADHD, they may want to consider taking fewer credits particularly for their first semester, until they understand how their symptoms affect their college success.
Once we understand ADHD, we can begin to look at the aspects that can be used in a positive way. For instance, “All people have natural talents and abilities. In fact, many people with ADHD feel that their patterns of behavior give them unique, often unrecognized, advantages. People with ADHD tend to be outgoing and ready for action. Because of their drive for excitement and public speaking, as well as their ability to think about many things at once, many have won acclaim as artists, and inventors. Many choose work that gives them freedom to move around and release excess energy.” (National Institute of Mental Health).
According to the National Institute of Mental Health (1996), depression is a disorder that involves the body, mood, and thought. It affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. People who have depression cannot will themselves better or “pull themselves together.” Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people who suffer from depression. At least 80% of those getting treatment will get better.
Current research indicates a dramatic increase in the number of college students with mental health problems such as stress/anxiety, depression, grief and academic and developmental problems. (Benton, 2003). With one in five people experiencing depression at some time during their lifetime, it ranks as one of the most common disorders. Some types of depression run in families; however, it can also occur in people who have no family history of depression.
There are several different forms of depression with each having variations ranging from mild to severe.
- Major Depression interferes with the ability to work, study, sleep, eat and enjoy once pleasurable activities.
- Dysthymia is a form of depression that is less severe than major depression; however, it involves long-term, chronic symptoms that do not disable but keep one from functioning well or from feeling good.
- Bipolar Disorder, also known as manic depression, is not as prevalent as the other forms of depression. Bipolar disorder is characterized by cycling mood changes; severe highs (mania) and lows (depression). Sometimes the mood switches are dramatic and rapid, but most often are gradual.
- Seasonal Affective Disorder (SAD) is associated with depressive episodes that occur during the winter months (especially in the northern climates), with symptoms subsiding during the spring and summer months. These depressive episodes are related to seasonal variations of light. The most difficult months for people with SAD are January and February.
Symptoms of Depression include:
- A persistent sad, anxious, or “empty” mood.
- Sleeping too little or sleeping too much.
- Reduced appetite and weight loss, or increased appetite and weight gain.
- Loss of interest or pleasure in activities once enjoyed.
- Restlessness or irritability.
- Persistent physical symptoms that don’t respond to treatment (such as headaches, chronic pain, or constipation and other digestive disorders.)
- Difficulty concentrating, remembering, or making decisions.
- Fatigue or loss of energy.
- Feeling guilty, hopeless or worthless.
- Thoughts of death or suicide.
Symptoms of Mania include:
- Abnormal or excessive elation.
- Unusual irritability.
- Decreased need for sleep.
- Grandiose notions.
- Increased talking and energy.
- Racing thoughts.
- Increased sexual desire.
- Poor judgment.
- Inappropriate social behavior.
Untreated depression is the number one cause of SUICIDE. Any talk of suicide by a student needs to be taken seriously and help sought immediately. Express your concern to the individual and make a referral to a Counselor, Disability Director or medical doctor, or call emergency 911.
If you or someone you know is contemplating suicide, call 1-800-SUICIDE (1-800-784-2433) or www.hopeline.com.
Individuals with eating disorders experience severe disturbances in their eating habits, including unhealthy reduction of food intake or unhealthy overeating. People with eating disorders are also overly concerned about their body shape and weight. Eating disorders commonly develop during adolescence or early childhood. Eating disorders are real, treatable illnesses. Causes of eating disorders may include: low self-esteem, peer pressure to be thin, society or cultural pressures to be thin, history of sexual abuse, or extremely controlling parents who don’t allow for expression of emotions. Anorexia Nervosa and Bulimia Nervosa are the two most common types of eating disorders.
- Anorexia Nervosa – Symptoms of Anorexia Nervosa include extreme weight loss and the belief that one is fat despite excessive thinness. Other symptoms may include:
- Eats in tiny portions of food, skips meals, won’t eat in front of others, eating in a ritualistic way.
- Eats only a few “safe” foods (low calorie or low fat).
- Loses hair, appears pale in skin color, and wears baggy clothes to hide thinness.
- Fears obesity and complains of being fat despite thinness.
- Hates all or certain parts of body.
- Excessive or compulsive exercise routine.
- Becomes socially isolated.
- Has difficulty expressing emotions, primarily anger.
- Bulimia Nervosa – Symptoms of Bulimia Nervosa include frequent acts of binge-eating and purging (vomiting, ingesting laxatives, exercising excessively) of food to prevent weight gain. Other symptoms may include:
- Binges secretively.
- Buys “binge food” (primarily junk food or high-caloric foods).
- Leaves clues including empty food packages, foul-smelling bathrooms, running water to cover the sound of vomiting, use of breath mints, poorly hidden containers of vomit.
- Uses water pills, diet pills or laxatives.
- Abuses alcohol or drugs to suppress appetite or to escape emotional hurt.
- Displays little impulse control – making poor decisions about sex, commitment, money, etc.
According to the National Center for Learning Disabilities (2004), a learning disability (LD) is a neurological disorder that affects the brain’s ability to receive, process, store, and respond to information. The term “learning disability” is used to describe the seeming unexplained difficulty a person of at least average intelligence has in acquiring basic academic skills. These skills are essential for success at school and work, and for coping with life in general.
LD is not a single disorder, but a group of disorders. Learning disabilities can affect a person’s abilities in one or more of the following areas:
- Oral expression
- Listening comprehension
- Written expression
- Basic reading skill
- Reading comprehension
- Mathematics calculations
- Mathematics reasoning
Learning disabilities involve a distinct gap between the level of achievement that is expected and what is actually being achieved. A learning disability is not a disease, so there is no cure; but there are ways to overcome the challenges it poses through identification and accommodation. Examples of Learning Disabilities include:
Dyslexia – Difficulty with reading, writing, and spelling. Characteristics are:
- Results from a genetically-based difficulty in establishing awareness of elements of linguistic structure
- Difficulty recognizing the individual sounds of words
- Interferes with development of decoding skills and visual word recognition
- Punctuation and capitalization may be poor
- Spelling is almost always compromised
- Vocabulary is often restricted
- Written vocabulary may be simplified to avoid spelling challenges
- Knowledge of phrasal and sentence structure may be very limited
Dyscalculia – Difficulty with math functions and using numbers. Characteristics are:
- Difficulty understanding concepts of place value, quantity, number lines, positive and negative value, carrying and borrowing
- Difficulty understanding and doing word problems
- Difficulty sequencing information or events
- Difficulty using steps involved in math operations
- Difficulty understanding fractions
- Difficulty recognizing mathematical patterns
- Difficulty putting language to math processes
- Difficulty understanding concepts related to time
- Difficulty organizing problems on the page
Dysgraphia – A neurological psychomotor disorder causing a person’s writing to be distorted or incorrect. Characteristics are:
- May have illegible printing and cursive writing
- Copying or writing is slow and labored
- Shows inconsistencies: irregular sizes, shapes, upper and lower case
- Has unfinished words or letters, omitted words
- Has great difficulty thinking and writing at the same time
- Shows poor spatial planning on paper
- Has cramped or unusual grip
- Difficulty with composition and spelling
Auditory Processing Disorder – Difficulty interpreting auditory information. Characteristics are:
- May seem to be off-task or inattentive as they silently process what they have heard
- Has difficulty gaining meaning from spoken language
- May misunderstand multi-step directions
- Only one or two parts of a multi-step directive may be incorporated into a completed task
- Writing tasks may take more time than expected
- Spontaneous writing samples will lack details
- Difficulty hearing clearly in noisy environments
- Poor ability to memorize information learned by listening
- Interprets words too literally
Visual Perceptual Deficit – Difficulty interpreting visual information. Characteristics are:
- Entire sentences or written directives may be misperceived
- Loses place frequently
- Cannot copy accurately
- Writing samples reflects errors in word choice or missing words
- Does not recognize an object or word if only part of it is shown
- First needs to make sense of what was read or seen before they can process
Other common psychological disabilities as defined by The National Mental Health Association (2004) and the Concise Textbook of Clinical Psychiatry by Kaplan & Sadock (1996) include:
- Borderline Personality Disorder – The symptoms can be summarized as a pervasive pattern of instability in mood, thinking, behavior, interpersonal relationships, and self-image. Chronic feeling of emptiness, shifting mood swings and an unstable sense of self are common.
Persons with this disorder typically exhibit a low tolerance for frustration and can be argumentative or show anger at one moment, be depressed the next moment and then have no feelings at another time. Because they can feel both dependent and hostile, individuals with this disorder frequently experience a pattern of unstable and intense relationships. They are highly sensitive individuals who frequently read the environment for cues they may interpret as evidence of rejection or impending abandonment. Responses to intense emotional distress are characterized as extreme and impulsive and are often associated with self-damaging behaviors such as eating or spending sprees, substance abuse, or sexual promiscuity.
Functionally, individuals with BPD distort their relationships by either idealizing or devaluing others. Persons with this disorder see others as either all good and nurturing or as all bad and threatening. Under stress, individuals with BPD may experience brief, paranoid episodes and psychotic-like symptoms. Frequently, individuals with this disorder have a history of suicidal thoughts, gestures or actual attempts.
- Dissociative Disorders – Dissociation is a mental process that causes a lack of connection in a person’s thoughts, memory and sense of identity. Many people experience a mild dissociation when “getting lost in a book” or when driving a familiar road and realizing that you don’t remember the last several miles. In the severe form of dissociation the person may experience confusion about personal identity or assume a new identity, and/or experience significant disruptions with thoughts and memories. Forms of dissociation include:
- Dissociative Amnesia – The inability to recall important information or personally significant memories. The forgotten information is usually about a stressful or traumatic event in the person’s life and cannot be explained by ordinary forgetfulness. The person can learn new information and has no evidence of an underlying brain disorder.
- Dissociative Fugue – Sudden, unexpected travel away from home or one’s customary place of work, with inability to recall one’s past, confusion about personal identity or the assumption of a new identity (partial or complete). Disturbance is not due to the effects of a substance or a general medical condition.
- Dissociative Identity Disorder or “Multiple Personality” – The person has two or more distinct identities or personalities that alternate with one another. There is an inability to recall important personal information and the disturbance is not due to the effects of a substance or a general medical condition.
- Delusional Disorders – A thought disorder, in the form of one of seven types of non-bizarre delusions, is the key symptom. Non-bizarre means the delusions involve situations that could be possible in real life, for example, delusions of having an unfaithful spouse, of being conspired against, cheated, harassed or maligned, or being loved by a famous person. Apart from the delusion(s) and its effects, behavior and functioning appears relatively normal.
- Paranoid Disorders – Paranoia involves feelings of persecution and an exaggerated sense of self-importance. Paranoia occurs in many mental disorders and is rarely an isolated mental illness. There are varying types and degrees of paranoia, including paranoid personality disorder. Symptoms may include:
- Intense or irrational mistrust.
- Feelings of rage, hatred and betrayal.
- Taking offense easily.
- Difficulty forgiving others.
- Defensive attitude in response to imagined criticism.
- Inability to relax.
- Fear of being taken advantage of.
- Argumentative behavior.
- Stubborn, self-righteous or perfectionist attitude.
- Schizophrenia – This disorder affects how a person thinks, feels and acts. People with schizophrenia may have difficulty distinguishing between what is real and what is imaginary. Others with this disorder may have difficulty behaving normally in social situations or may be withdrawn or unresponsive. Schizophrenia, however, is not split personality or multiple personality.
The vast majority of people with schizophrenia are not violent and do not pose a danger to others but are at greater risk themselves for suicide attempts or to die from suicide. In addition, persons with schizophrenia have a higher mortality rate from accidents and natural causes than do the general population due to undiagnosed and untreated concurrent medical conditions, homelessness, substance use, and other causes.
The signs of schizophrenia are different for everyone. Symptoms may develop slowly over a period of months or years or may appear suddenly. The disease may also appear in cycles of relapse and remission.
Some factors that weigh towards a good prognosis include late onset, acute onset, obvious precipitating factors, being married, having good support systems, and a history of functioning well before the onset. Behaviors or early warning signs may include:
- Hearing or seeing something that isn’t there.
- A constant feeling of being watched.
- Unusual or nonsensical manner of speaking or writing.
- Deterioration of academic or work performance.
- Change in appearance – personal hygiene.
- Increasing withdrawal from social situations.
- Irrational, angry or fearful response to loved ones.
- Inability to concentrate or sleep.
- Excessive preoccupation with religion or occult.
Symptoms of Schizophrenia may include:
- Social withdrawal.
- Delusions – false ideas.
- Hallucinations – seeing, hearing, feeling, tasting or smelling something that doesn’t exist.
- Disordered thinking and speech.
- Extreme apathy.
- Lack of drive or initiative.
- Emotional unresponsiveness.
- Tourette’s Disorder – According to the American Psychiatric Association, DSM-IV-TR (2000), the essential features of Tourette’s Disorder are multiple motor tics and one or more vocal tics. A tic is a sudden rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalization. Simple motor tics are: eye blinking, nose wrinkling, neck jerking, shoulder shrugging, or facial grimacing. Simple vocal tics are meaningless words or sounds such as, throat clearing, clicking, grunting, sniffing, snorting and coughing. Tics may occur many times a day recurrently throughout a period of more than a year. The symptoms may be lifelong, though periods of remission lasting from weeks to years may occur.
Traumatic Brain Injury
Traumatic brain injury (TBI) is typically a consequence of an accident, but can also be caused from a stroke, lack of oxygen, poisoning, tumor, or an infection. At least 1.5 million people sustain traumatic brain injuries in this country every year.
Students often display problems with attention deficit, memory and concentration.The effects of the injury are highly individual depending on the area of the brain affected. They may experience frustration and anger often characterized by a quick temper. They typically exhibit discrepancies in abilities such as reading or spelling.
Although there is great variation in the possible effects of a head injury for an individual, many students with TBI will exhibit some, but not all of them. Most injuries result in some degree of difficulties in the following functions (Association on Higher Education and Disability – TRIO Training):
- Memory – The primary difficulty is the inability to store information for immediate recall. However, long-term memory or previously acquired knowledge is usually intact.
- Cognitive/Perceptual Communication – Students may have difficulty focusing for sufficient lengths of time for learning to take place. Attention and concentration may be influenced by medication, nutrition patterns, and fatigue resulting from disturbed sleep.
- Speed of Thinking – It often takes the student longer to process information which influences reaction time, speed of responses, and quickness of data integration.
- Communication – Language function (writing, reading, speaking, or listening) may be impaired. Problems in pragmatics may include interrupting, talking out of turn, dominating discussions, speaking too loudly or rudely, or standing too close to the listener. The student may have trouble comprehending written or spoken material especially under pressure such as during exams.
- Spatial Reasoning – Refers to the ability to recognize shapes of objects, judge distances accurately, navigate, read a map, visualize images, comprehend mechanical functions, or recognize position in space.
- Conceptualization – TBI often reduces the ability to categorize, sequence, abstract, prioritize and generalize information. The student may be very concrete and stimulus-bound.
In college, students may need additional strategies to cope with new-found frustrations. They may want to discuss this with the counseling or disability services offices. These are important differences that affect the educational program of a student with TBI. In college, they may need:
- Established routines with step-by-step directions.
- Books and lectures on tape.
- Repetition or some type of reinforcement of information to be learned.