Behavioral health professionals and disorders

According to the CDC, mental health encompasses our psychological, emotional, and social welfare. Our mental health influences how we behave, feel, think, handle stress, interact with others, and make choices. Over the years, the field of mental health has changed and grown. Psychiatry is the healthcare specialty that studies the brain and its effects on the body. Today, the phrase behavioral health refers to mental health, substance use, and associated physical disorders.

The following sections discuss the types of behavioral health professionals and the importance of the Diagnostic and Statistical Manual of Mental Disorders. Both topics are important for medical assistants, regardless of where they practice. Many patients seen in primary care are also seen by behavioral health professionals.

Behavioral health professionals

A psychotherapist is a general term for a healthcare professional who treats people with behavioral health conditions. This term is used for psychiatrists, psychologists, social workers, and so on. In behavioral health departments, there are people with many different credentials. Having a basic understanding of behavioral health professionals is important. The following are some of the more common behavioral health professionals:

• Psychiatrist: Trained as a medical doctor and has had 4 years of residency training in psychiatry, usually in a hospital setting. A psychiatrist assesses the mental and physical conditions related to psychological disorders. A psychiatrist treats patients with psychological disorders and can prescribe medications.
• Psychologist: Studied personality development, psychological problems, and how to diagnose mental and emotional disorders; must obtain a PhD or PsyD doctoral degree. Primarily focuses on providing psychotherapy and performing psychological testing. Most psychologists cannot prescribe medications.
• Social worker: Has a similar educational background as a psychologist but cannot provide psychological testing. The social worker provides psychotherapy. Depending on the state licensure, social workers may have different titles: licensed clinical social worker (LCSW), licensed independent clinical social worker (LICSW), and licensed social worker (LSW).
• Cognitive behavioral therapist: Specializes in cognitive behavioral therapy and helping people change the way they think and behave in order to help manage their condition (e.g., depression, relationship issues).
• Psychiatric nurse: A registered nurse who has advanced training (e.g., master’s or doctoral degree) in assessing and treating behavioral health issues.
• Substance use (or addiction) therapist or counselor: Has specialized training to treat patients with substance use disorders and other addictions.
• Mental health therapist or counselor: Trained to treat patients with behavioral health disorders (e.g., depression, anxiety).

In many states, most of these healthcare professionals need a license to practice. There are some exceptions. Some states allow unlicensed behavioral health professionals to provide treatment to patients, but their billing capacity is limited. State laws dictate the licensing and credential requirements for behavioral health professionals.

Patients with behavioral health conditions may be seen in community mental health clinics or private practice clinics. When patients are a threat to themselves or others, they may be admitted to hospitals until their behavioral health conditions stabilize. Specialty inpatient settings for people with eating disorders and addictions are also available.

Behavioral health diseases and disorders

Behavioral health diseases and disorders cause changes in the mood, behavior, or thoughts of an individual. These disorders can affect how a person functions on a day-to-day basis, at work, school, and at home.

Biological factors (e.g., genetics), life experiences, and a family history of behavioral health problems can contribute to behavioral health problems. It is important for a person to seek help immediately if signs of behavioral health disorders exist.

The following sections discuss the common signs and symptoms of behavioral health diseases and disorders, along with concerns across the life span.

Common signs and symptoms of behavioral health diseases and disorders include the following:

• Withdrawing from others, isolating oneself
• Eating or sleeping too little or too much
• Having no or low amounts of energy
• Feeling helpless, hopeless, numb, or as if nothing matters
• Having unexplained pains and aches
• Smoking, drinking alcohol, or using drugs more than usual
• Feeling unusually forgetful, on edge, angry, worried, scared, confused, or upset
• Having persistent thoughts or memories stuck in one’s head
• Thinking of harming oneself or others
• Inability to function or perform daily activities
• Hearing voices or believing things that are not true

Behavioral health diseases and disorders across a life span

Behavioral health problems are very common. Research has shown that 1 out of 7 children in the United States from ages 2 to 8 has been diagnosed with a mental, developmental, or behavioral disorder. Many times, the related factors included poverty, neighborhood concerns, parents with behavioral health issues, and childcare problems that affected the parents’ jobs.

Other studies have found that about half of all behavioral health disorders affect a person before the age of 14, and 75% of disorders begin before age 24. Less than 20% of children with a diagnosed behavioral health problem receive the treatment they need.

Behavioral health disorders in children cause changes in the way children learn, behave, or handle their emotions. This can cause problems getting through their days. Common disorders in childhood include anxiety, depression, oppositional defiant disorder, conduct disorder, attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD). Substance use and suicides are occurring in growing numbers.

The National Alliance on Mental Illness states that about 1 in 5 adults experiences a behavioral health disorder every year. About 4% of the adult population in the United States lives with a serious behavioral health condition (e.g., bipolar disorder, major depression, and schizophrenia). In 2018, about 20.3 million adults in the United States had a substance use disorder. Among older adults who have been diagnosed with heart disease, diabetes, and a stroke, research has shown that depression is more prevalent. Depression can complicate treatment and change a person’s quality of life.

Bipolar disorder

Bipolar disorder causes people to go from mania to depression. They cycle through highs and lows in their moods, with periods of normal moods. Bipolar disorder usually starts in the late teens to early adult years and lasts a lifetime.

The cause of bipolar disorder is unclear. There is a genetic link to the disorder, and abnormal brain structure and function may also be related. Bipolar disorder causes the following:

• Mania and hypomania: Euphoria and energetic feelings, decreased need for sleep, distractibility, poor decision making, and an exaggerated sense of well-being
• Major depression episode: Insomnia or sleeping too much, fatigue, feelings of worthlessness, suicidal thoughts, feelings of no pleasure, and weight gain or loss
• Moods affect relationships, school, or job performance, and even cause suicide

The provider will do a physical exam and a psychiatric assessment. Patients may be asked to chart their moods. Treatments include lifelong treatments, psychotherapy, and support groups. Medications can also be prescribed and include anticonvulsants and mood stabilizers, antidepressants, anxiolytics, and antipsychotics.

Attention deficit hyperactivity disorder (ADHD)

ADHD is a chronic condition that affects children and can continue into adulthood. With ADHD, a person is not able to focus or control behaviors, may be overactive, or any combination of these characteristics. ADHD and ADD (attention deficit disorder) are often used interchangeably, but the correct term is ADHD. Typically, symptoms begin before age 12, yet some have seen it in the toddler years. This disorder is more prevalent in males than in females.

The cause of ADHD is unknown, but possible factors include genetics, environmental factors (e.g., lead exposure), and developmental factors. Many conditions can co-exist with ADHD, including learning disabilities, anxiety, depression, bipolar disorder, and Tourette syndrome. ADHD has the following results:

• Inattention: Fails to pay close attention, has problems staying focused, appears not to listen, has difficulty following directions, has trouble with organizational skills, and is easily distracted.
• Hyperactivity and impulsivity: Fidgets, constantly moving, talking too much, difficulty waiting for their turn, and problems doing quiet activities.

Males may be more hyperactive, whereas females may be quietly inattentive. According to the diagnostic criteria, the symptoms can range from mild to severe and must last for at least 6 months, affecting school and home life. There are three subtypes of ADHD based on the symptoms: predominantly inattentive, predominantly hyperactive-impulsive, and combined (a mix of both).

There is no specific test for ADHD. The provider will do a physical exam, including vision and hearing, and ask the parents and teachers questions. Treatments for ADHD include behavioral therapy to help manage the symptoms and provide coping skills. Medications can also be prescribed:

• Stimulants: Methylphenidate (Ritalin LA, Concerta, Methylin) and amphetamine (Adzenys ER, Dyanavel XR, Evekeo). Stimulants provide a calming effect by increasing dopamine in the brain, which helps with attention and motivation.
• Nonstimulants: Atomoxetine (Strattera), guanfacine (Intuniv, Tenex), and clonidine (Catapres, Kapvay).

Conduct disorder (CD)

With conduct disorder (CD), the person demonstrates disruptive and violent behaviors. The person hurts others and destroys property. Children with CD can have behavior problems that last into adulthood. Symptoms usually start during the preteen and teen years, though they can be seen in preschool. The disorder is more common in males.

There is no single cause for CD. Having a parent with a behavioral disorder, exposure to neglect, abuse, or violence, and a high emotional reactivity can be risk factors. Conduct disorder causes:

• Aggression toward animals and people: Includes bullying, threatening, starting fights, using weapons, forcing others into sexual activity, stealing from others, and physical cruelty to people or animals.
• Destruction of property, such as setting fires.
• Deceit or theft: Includes lying to get things, breaking in and stealing items, and shoplifting.
• Serious violations of rules: Includes running away from home overnight at least twice, or once without returning for a long time, and truancy.

There is no specific test for CD, so the provider will do a complete medical history. Treatment is based on the individual’s needs and addresses co-existing diseases. Common intervention programs include parent training, behavioral family therapy, skills-based interventions, anger management, and coping skills.

Oppositional defiant disorder (ODD)

With oppositional defiant disorder (ODD), the child or teen demonstrates ongoing hostility to parents, friends, and teachers. ODD usually is diagnosed during preschool or childhood. There is no single cause for ODD. Having a parent with a behavioral disorder, exposure to neglect, abuse, or violence, and a high emotional reactivity can be risk factors. Depression and anxiety can co-exist with ODD. Oppositional defiant disorder can cause ongoing hostility, defying rules, holding grudges, and rebellious behaviors. These symptoms interfere with school and home life. There are three types of ODD:

• Angry and irritable mood: Annoyed by others easily, loses one’s temper, and has rage outbursts
• Argumentative and defiant behaviors: Argues with those in authority, defies rules, purposely annoys others, and blames others
• Vindictiveness: Being cruel, nasty, vengeful, and mean

There is no specific test for ODD, so the provider will do a complete medical history. Treatment is based on the individual’s need and addresses co-existing diseases. Common intervention programs include parent training, behavioral family therapy, and skills-based interventions, which teach the patient how to reduce behavior problems and appropriately interact with peers. Anger management and coping skills are also part of the intervention.