Signs and Symptoms

• Struggle to stop despite the desire to quit.
• Intense urges that dominate thoughts and actions.
• Experiencing discomfort when not using the substance.
• Putting aside responsibilities at work, school, or home.
• Pulling away from friends and activities once enjoyed.
• Engaging in dangerous behaviors while under the influence.
• Continuing despite the fallout on health and relationships.

• Support the individual in seeking help from professionals or support groups.
• Be There. Listen to understand. Remove judgment and provide a steady hand.
• Work together to spot situations or feelings that trigger substance use.
• Avoid enabling behaviors, such as covering for their mistakes, providing resources to sustain substance use, or shielding them from consequences. Support their recovery, not their addiction.
• Recognize your own limits. Dependency can create unhealthy dynamics—set boundaries to protect both yourself and the individual.

• Panic Disorder: Characterized by sudden terror attacks, usually accompanied by a pounding heart, sweatiness, weakness, faintness, or dizziness. During these attacks, people with panic disorder may flush or feel chilled; their hands may tingle or feel numb; and they may experience nausea, chest pain, or smothering sensations. Panic attacks usually produce a sense of unreality, a fear of impending doom, or a fear of losing control. According to the National Mental Institute of Mental Health, approximately 4.7% of U.S. adults experience panic disorder at some time in their lives.
• Obsessive Compulsive Disorder: Persistent, upsetting thoughts (obsessions) and behaviors (compulsions) to control the anxiety these thoughts produce. Most of the time, the behaviors end up controlling them.
• Post-Traumatic Stress Disorder: Usually develops after a terrifying event or experience. The person who develops PTSD may have been the one who was harmed, the harm may have happened to a loved one, or the person may have witnessed a harmful event that happened to loved ones or strangers.
• Phobias: Two major types of phobias are social phobia and specific phobia. People with social phobia have an overwhelming and disabling fear of scrutiny, embarrassment, or humiliation in social situations, which leads to the avoidance of many potentially pleasurable and meaningful activities. People with specific phobia experience extreme, disabling, and irrational fear of something that poses little or no actual danger (flying, water, elevators, etc.). The fear leads to avoidance of objects or situations and can cause people to limit their lives unnecessarily.
• Generalized Anxiety Disorders: Constant, exaggerated worrisome thoughts and tension about everyday routine life events and activities, lasting at least six months. Almost always anticipating the worst even though there is little reason to expect it; accompanied by physical symptoms, such as fatigue, trembling, muscle tension, headache, or nausea.

• Primary role is to offer emotional support, understanding, patience, and encouragement.
• Prepare yourself for an acute attack of anxiety by researching the above conditions.
• Offer positive reinforcement. Sensitivity is key since dismissive behavior often exacerbates the person’s phobias and anxieties. Gently encourage opportunities for fresh air and social interaction, tailored to their comfort level, as these steps can help foster a sense of normalcy and well-being.
• Plan ahead. Most people suffering from anxiety do not respond well to sudden changes or surprises. Observe and understand, to the greatest possible degree, the triggers of anxiety and avoid them at all costs.
• Maintain open communication with the sufferer’s treatment team.

Bipolar disorder can be elusive, often hiding in plain sight. It reveals itself through intense energy, racing thoughts that soar too high, and impulsive behaviors that can lead to recklessness. These symptoms may feel exhilarating, causing individuals to downplay their impact. Diagnosis is further complicated by overlapping signs that can be mistaken for other issues, such as substance abuse or workplace challenges.

Recognizing the patterns is just the beginning. A mental health professional is essential to seeing the bigger picture—accurately diagnosing bipolar disorder and creating a treatment plan tailored to the individual.

• Watch for triggers. Keep an eye out for behaviors that hint at mood shifts. Inform doctors/therapists of any changes. 
• Provide a structured, supportive, low-stress environment. Establish a routine that promotes stability. 
• Never ignore comments about suicide. Seek immediate help by contacting a crisis hotline, emergency services, or a mental health professional, and ensure these concerns are reported to their therapist or doctor.
• Arm yourself with knowledge about bipolar disorder to better understand and support your loved one.
• Encourage and support medication compliance. Work with the healthcare team to ensure the person understands the importance of their treatment plan and how it helps manage symptoms.

• Extreme highs or euphoria
• Increased energy
• Easily irritated or distracted
• Excessive energy/restlessness/racing thoughts/flight of ideas
• Increased talking/more rapid speech than normal
• Ambitious/grandiose plans/unrealistic beliefs
• Increased anxiety
• Increased risk-taking behaviors
• Impulsive behavior (i.e., excessive spending, risky sexual activities, or increased alcohol consumption)
• Decreased sleep without fatigue

• Feelings of guilt, hopelessness, helplessness, worthlessness, and/or emptiness
• Changes in appetite
• Changes in sleep patterns
• Prolonged sadness
• Decreased participation in activities normally enjoyed
• Decreased energy
• Feeling Fatigue
• Persistent physical symptoms that don’t respond to treatment
• Uncharacteristically poor judgment
• Thoughts of suicide/attempts

• Major depressive disorder is characterized by a combination of symptoms that interfere with a person’s ability to work, sleep, study, eat, and enjoy once pleasurable activities. Major depression is disabling and prevents normal functioning. An episode of major depression may occur only once in a person’s lifetime, but more often, it recurs throughout a person’s life.
• Dysthymic disorder, also called dysthymia, is characterized by long–term (two years or longer) but less severe symptoms that may not disable a person but can prevent one from functioning normally or feeling well. People with dysthymia may also experience one or more episodes of major depression during their lifetimes.
• Psychotic depression occurs when a severe depressive illness is accompanied by some form of psychosis, such as a break from reality, hallucinations, and delusions.
• Postpartum depression is diagnosed if a new mother develops a major depressive episode within one month after delivery. It is estimated that 15 percent of women experience postpartum depression after giving birth.
• Seasonal affective disorder (SAD) is characterized by the onset of a depressive illness during the winter months, when there is less natural sunlight. The depression generally lifts during spring and summer. SAD may be effectively treated with light therapy, but nearly half of those with SAD do not respond to light therapy alone. Antidepressant medication and psychotherapy can reduce SAD symptoms, either alone or in combination with light therapy.

• Offer emotional support, understanding, patience, and encouragement.
• Engage your friend or relative in conversation, and listen carefully.
• Never ignore comments about suicide. Seek immediate help by contacting a crisis hotline, emergency services, or a mental health professional, and ensure these concerns are reported to their therapist or doctor.
• Never disparage feelings that your friend or relative expresses, but point out realities and offer hope.
• Invite your friend or relative out for walks, outings and other activities. Keep trying if he or she declines, but don’t push him or her to take on too much too soon. Although diversions and company are needed, too many demands may increase feelings of failure.
• Remind your friend or relative that with time and treatment, the depression will dissipate.

• Hearing or seeing something that isn’t there
• Odd/Irrational statements
• Hostility/Fearful response to loved ones
• Inability to concentrate
• Paranoia/Feeling of being watched
• Extreme reaction to criticism
• Flat, expressionless gaze
• Strange use of words/way of speaking
• Inability to cry or express joy
• Social withdrawal
• Inappropriate laughter or crying
• Decline in personal hygiene
• Depression
• Extreme preoccupation with religion/occult
• Oversleeping or insomnia
• Inappropriate/bizarre behavior

• Positive Symptoms: disturbances that are “added” to a person’s personality.
  • • Delusions: Persistent beliefs despite clear and obvious evidence that are not true.
    • Delusions of persecution: The belief that others are conspiring against them.
    • Delusions of reference: Attributing special meaning to neutral environmental events, i.e. thinking the television is sending personalized messages.
    • Delusions of grandeur: The belief that one is a famous or important figure or has unusual powers.
    • Delusions of control: The belief that external, alien forces control one’s thoughts or actions.
    • Hallucinations: Perceptions of hearing, seeing, feeling, tasting, or smelling something that does not exist. The most common experience is hearing voices that give commands or comments to the individual.
    • Disorganized Speech: A tendency to move from one topic to another, in a nonsensical fashion. Individuals may make up their own words or sounds.

  Negative Symptoms: Capabilities that are “lost” from the person’s personality.

  • • Social withdrawal
    • Extreme apathy
    • Lack of drive or initiative
    • Emotional unresponsiveness

• A delusion will not go away by reasoning and therefore needs no discussion. Just sympathize, saying it must be upsetting to feel like that.
• Provide solitude and structure. Communication should be brief, concise, clear, and ambiguous.
• Never ignore comments about suicide. Seek immediate help by contacting a crisis hotline, emergency services, or a mental health professional, and ensure these concerns are reported to their therapist or doctor.
• Provide a structured, supportive, tolerant, low-stress environment. Have a set routine in the environment.
• Recognize changes in the person that signal they are ready for more independence or need more help. Inform doctors and therapists of changes in behavior.
• Encourage and support medication compliance. Work with the healthcare team to ensure the person understands the importance of their treatment plan and how it helps manage symptoms.
• During a crisis, do not try to reason with a psychotic episode. Remember, the person may be terrified by their loss of control. Avoid shouting, using sarcasm, and direct eye contact or touching. Decrease distractions and remain calm. Call someone for help as soon as possible.