Chronic

The causes of many chronic mental health conditions aren't clear. Researchers think that for most people, mental health disorders are caused by a combination of factors.

Heredity

Research into the potential genetic causality of chronic mental illnesses is ongoing, and advancements in genetic technology and understanding continually expand our knowledge of how mental illness and genetics may be related. For example, twin studies indicate that genetics may affect 40%-80% of individuals with severe psychiatric disorders. Research also suggests that children with a parent with a mental health condition are roughly two times more likely to have mental health problems in adulthood. 

Common chronic mental illnesses with a possible genetic link include:

• Schizophrenia
• Bipolar disorder
• Major depressive disorder
• Anxiety disorders
• Attention-deficit/hyperactivity disorder (ADHD)
• Obsessive-compulsive disorder (OCD)¹

No tests are currently designed to predict a genetic predisposition² toward mental illness accurately, and more research is required to confirm a connection before experts can establish specialized, proactive treatment methods. 

Also, individuals with a chronic mental health disorder may not have inherited it from a relative. Likewise, the fact that an individual has a relative with a mental health disorder doesn't guarantee they will inherit it. 

Brain structure and functioning of chronic mental disorders

Researchers have been searching for a connection between neurological conditions and chronic mental disorders for decades, and current scientific exploration into their relationship has yielded promising results, such as the relationship between abnormal neurotransmitter activity within the brain and major depressive disorder. 

Research suggests that some brain abnormalities implicated in the development of mental disorders such as depression, schizophrenia, anxiety, and ADHD may form before birth. These structural changes in the brain may result from extreme distress to the mother, prenatal conditions such as malnourishment, or viral infections passed from the mother in utero. 

In the future, potential connections between neurophysiology, chronic diseases, and chronic disorders may inform how mental health professionals define, diagnose, and treat patients with such disorders. 

Experiential factors for chronic mental illness

Life events and experiences often play an integral part in the etiology of chronic mental illnesses. Many circumstances may act as risk factors.

• Abuse, trauma, or neglect in childhood
• Loss of a parent, caregiver, or loved one
• Social isolation or severe loneliness
• Experiencing adversity from factors such as discrimination, socioeconomic disadvantage, or stigma
• A chronic physical health condition
• Severe stressors, such as involvement with a combat situation or exposure to extreme violence
• Unemployment or homelessness
• Domestic violence
• Substance use

The signs and symptoms of chronic mental health disorders often vary between conditions and individuals. The most recent edition of the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5) lists diagnostic criteria and treatment methods for 357 disorders. The manual also outlines the associated chronic signs, symptoms, and risk factors.

The most common categories of chronic disease, however, are fewer. While mental disorders are diverse, there are some symptomatic commonalities between the major types of disorders:

• A severe difficulty or inability to perform daily tasks
• Excessive fear or worrying without any apparent cause
• Feeling consistently sad with a low mood
• Extreme mood swings, including anger and feelings of euphoria or feeling "high"
• Difficulties with sleeping or low energy without any apparent cause
• Problems concentrating or confused thought patterns
• Avoidance of social activities and friends, difficulties connecting with others
• Changes in eating habits
• Changes in libido
• Inability to distinguish changes in one's own moods (anosognosia)
• Excessive use of substances, such as drugs or alcohol
• Difficulty with distinguishing reality, delusions, and/or hallucinations
• Physical discomfort without an apparent cause, such as headaches and stomach problems
• Thoughts of self-harm or suicide

For those with thoughts of suicide, contact the 988 Suicide & Crisis Lifeline at 988. Please also see our Get Help Now page for more immediate resources.

There are many types of chronic mental illnesses listed in the DSM-5, each with its own unique diagnostic criteria. While some aren't as well known or recognized, a few are highly common.  

Persistent depressive disorder (PDD) 

Sometimes called dysthymia, persistent depressive disorder (PDD)³ is characterized by many of the same symptoms as other depressive disorders, including:

• Low mood
• Feelings of hopelessness
• Low energy
• Poor concentration
• Apathy 
• Social avoidance
• Suicidal ideation (if a person experiences episodes of major depression)

The symptoms of PDD may be milder than those of other depressive disorders, and PDD generally lasts longer. For a diagnosis of PDD, one must experience chronic depressive symptoms for more days than not over at least two years. 

Obsessive-compulsive disorder (OCD)

Many chronic conditions fall under the umbrella of obsessive-compulsive disorder (OCD), such as hoarding disorder, body dysmorphic disorder, and trichotillomania. The disorder typically features recurring, persistent impulses, thoughts, and urges (obsessions) and excessive and repetitive behaviors (compulsions). These obsessions and compulsions typically disrupt the individual's daily life, leading to anxiety, chronic stress, and distress.  

Obsessive symptoms may include:

• A need to have objects organized in a specific way
• Fear of contamination or germs
• Aggressive thoughts
• Unsolicited, distressing thoughts that are forbidden or taboo

Compulsive symptoms may include:

• Compulsive counting
• Excessive handwashing or cleaning
• Repeated behaviors like turning the lights on and off multiple times to make sure they are off or checking the door lock numerous times to make sure it's locked
• Compulsively arranging/rearranging objects in a specific way

Personality disorders (PD)

Personality disorders are characterized by persistent dysfunctional thoughts, feelings, and behaviors that may cause damage across many aspects of an individual's life, including relationships, social interactions, professional life, school life, and other areas. The chronic symptoms of PD typically last for an extended period—with some being lifelong. 

There are several types of chronic personality disorders, each with their own symptoms and diagnostic criteria:

• 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

Generalized anxiety disorder (GAD)

GAD is one of the most common chronic mental health disorders. People with GAD typically experience chronic, disproportionate worry and anxiety about multiple things. For a GAD diagnosis, the individual must have these symptoms on more days than not for at least six months. 

Common cognitive symptoms of GAD include: 

• A tendency to anticipate worst-case outcomes and to engage in overplanning
• Difficulty coping with uncertainty
• Pervasive fear and indecision when making choices
• Decreased ability to cease worrying
• Perception of events as frightening or threatening for no tangible reason
• Pervasive feelings of restlessness and edginess
• Difficulty concentrating

Common physical symptoms of GAD include:

• Tremors and a tendency to be easily startled
• Sleep difficulties
• Fatigue and sluggishness
• Muscle aches, pains, or tension
• Profuse sweating
• Gastrointestinal discomfort

Some common disorders can be either chronic or episodic (where symptoms come and go relatively quickly, usually at irregular intervals). Unlike chronic conditions, episodic disorders typically don't require a lifetime of treatment, though they are prone to comorbidity with other disorders that may. 

Some conditions that may express episodic symptoms or a potential chronic condition include:

• PTSD
• Bipolar disorder
• Some schizophrenia spectrum disorders

Psychotherapy for chronic conditions

Psychotherapy⁴ (sometimes called talk therapy) is designed to uncover and examine an individual's thoughts and feelings that may lead to troublesome behaviors and difficulties in daily life. Psychotherapy often aims to help a person reframe unhealthy thoughts and emotions and develop more constructive behaviors. 

Talk therapy is typically facilitated by a licensed mental health professional who can provide individuals with the education and skills necessary to learn how to cope with chronic mental illness throughout their lifetimes.

Common types of psychotherapy that may be used to treat chronic disorders include:

• Cognitive behavioral therapy
• Interpersonal psychotherapy
• Couples/group/family therapy
• Dialectical behavior therapy
• Psychodynamic psychotherapy
• Person-centered therapy
• Behavior therapy
• Cognitive therapy
• Exposure therapy

Medications for chronic disorders

While psychotherapy is typically a first-line solution for most disorders, professionals may prescribe medications to help ease symptoms. In some cases, such as schizophrenia spectrum disorders, PTSD, and bipolar disorder, medications are often prescribed to help treat some of the more severe symptoms that may be involved. 

Examples of medications used to treat chronic mental illnesses include:

• Antidepressants
• Anti-anxiety medications
• Mood stabilizers
• Anti-psychotic medications

It is important to consult with a doctor or medical professional before beginning or changing any medication plan. The information provided in this article is not intended as medical advice; please consult a qualified healthcare professional for personalized guidance.   

Complementary/alternative treatment methods

Some individuals may benefit from alternative treatments when they’re used in conjunction with psychotherapy and/or medication. For example, some people with more severe conditions, such as schizophrenia or certain personality disorders, may benefit from practical skills training to help them communicate better, form solid interpersonal relationships, interact comfortably within the community, and improve functionality in school or a workplace environment.

Creativity-based treatments, such as art, music, dance, and creative arts therapies, may help individuals gain better insight and perspective while boosting confidence and self-esteem. Mindfulness-based therapies, such as meditation, yoga, guided visualizations, and controlled breathing exercises, may also ease symptoms of chronic mental health disorders. 

Self-care activities are often used to complement conventional therapeutic options. Therapists may encourage clients to develop a healthy diet and exercise plan, devise a regular sleep routine for better rest, and explore new activities that bring enjoyment and overall well-being.