I think I am having a “Nervous Breakdown!”

A lot of people have requested that I provide them with a layman’s definition of a “nervous breakdown.” A nervous breakdown can be defined as a “Psychotic Break.” A psychotic break occurs when a person has impaired and or distorted reality testing. This is usually the case when a person is severely depressed or has experienced a stressor that is so overwhelming that the ego becomes vulnerable.  (recent divorce, death of a child, or death of a spouse)  The EGO is responsible for reality testing. This part of the mind (the ego) sits in both the conscious and unconscious  of man.

Another  key point is that when an individual has significant relationship problems, this can lead them to depression, anxiety and lastly a psychotic break. This is why marital therapy and counseling becomes important when there is discord in your primary relationships.  I always see each party, in a relationship, individually to be sure that neither party is psychotic before starting marital therapy.

Questions:

  1. How would I know if I am having a “nervous breakdown? ” You may began experiencing auditory and or visual hallucinations. Your thoughts can also be disorganized and you may began acting paranoid and or strange.  Occasionally your behaviors can become  disorganized.  This is a medical emergency.
  2. What should I do if I am experiencing any of the above symptoms? You should go immediately to the nearest Emergency Room. Do not attempt to wait for the next outpatient primary care appointment. You can become very paranoid and attempt to hurt yourself or others. The above symptoms should be taken very seriously.
  3. How long should an average nervous breakdown last? A psychotic break should last less than 30 days. If the episode lasts more than thirty days,  your mental health provider should consider other diagnosis. (i.e. Schizophrenia and or Bipolar Disorder with Psyshosis)
  4. Are there any diagnositic tests  to confirm this diagnosis?  At this time, the clinical interview is used to rule in or rule out this particular diagnosis.  Please be sure that you have  a competent mental health provider.  There are a couple of quick in office test, i.e. SCL-90, HAM-D, and or PHQ-9, that may be used to clarify certain mental ilnesses but psychological testing is not usually required to make a  firm mental health diagnosis.
  5. Are the any current treatments that are effective? Yes, there are a number of novel antipsychotic, antidepressant and anxiolytic medications that are effective to treat the patient who is having a “nervous breakdown.”  However, it is important to see a Psychiatrist (preferable board-certified) to develop a prudent treatment plan. Oftentimes,  non-specialist can not handle the psychotic patient.

The bottom line is that a “nervous breakdown” is a very serious medical emergency and should be treated as such. If you notice strange behaviors in family members or friends, go immediately to the nearest emergency room. There may be a little or a lot of  resistance. If the resistance is significant, you should call the police. The police has what is called “parens patriae.” This simply means that “the nation has the power.”  In essence, the government has the right to intervene or take care of persons who can not take care of themselves.

Discussion Point: Do you feel that you have a family member, supervisor or friend that is currently psychotic or experiencing a nervous breakdown? I want to hear from you and I need you to share some of your observations.

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  • Aero Engineer

    Very interesting article. So basically, a nervous breakdown is the result of a mental illness, NOT the illness itself. Just learning this point was extremely helpful.

    • admin

      @Aero Engineer Good Observation. However I would just say that a “nervous breakdown” is the manifestation of being in an overwhelmed state. Is that a little better?

  • Aero Engineer

    Thank you for further clarification regarding this definition. Many reactions of being overwhelmed do not manifest themselves into a nervous breakdown. Do individuals have a predisposition for having this type of manifestation? Such as, family history of mental illness? Is there something that differentiates those that have nervous breakdowns and those that do not when they are overwhelmed?

    • admin

      @Aero Engineer. O.K. here goes a little more clarification for you:
      Yes, family history of any form of mental illness, depression, Schizophrenia or anxiety, all can predispose one to any mental illness.

      “Overwhelmed” is a phenomena in which “reality testing” remains intact. (no delusions or hallucinations)

      “Nervous Breakdown” is a mental illness in which reality testing is lost. Therefore an individual could start hallucinating or having any of the other psychotic phenomena.

      • Aero Engineer

        Thanks for the clarification. My mother-in-law had 2 nervous breakdowns while raising her children, sometime in the 1960s. A lot of times, in those days, ANY difficulty people were having, especially women, was classified as a “nervous condition” or “nervous breakdown”. To my knowledge, and that of my husband, she did not experience any previous signs of mental illness. Then, my 26 year old daughter (her grand daughter), after exhibiting strange behavior and being taken to the hospital, was diagnosed with and is being treated for Schizophrenia. Then I learned that one of my sister-in-laws (mother-in-law’s daughter) has experienced bouts of depression. When asked by my daughter’s doctor if our family had any history of mental illness, the only thing I could report was my mother-in-law’s stated condition. Upon checking with my family, we had nothing to report. So, it appears that my husband’s family has a possible history of mental illness, as reflected by our daughter’s condition. Would this be a fair evaluation?

        • AskDrO

          @Aero Engineer. Mental Illness usually has a genetic component, especially a disease like Schizophrenia. I would recommend doing a genogram with your husband and asking the elders, from both sides, some of those tough questions about who may or may not have has a mental illness. However, please do a complete and thorough genogram before making any conclusions. This is what is safe.

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  • Jenna

    My brother is currently going through this it is so scary because it is him but then it isn’t he is seeing things and he keeps sniffing the air and asking for this one girl. First he was calling her by her first name now hes calling her by her middle name. I think she is what drove him over the edge because the night before he totally went out of reality they had a argument and broke up. I don’t know why this could have affected him in such a way because they barely started dating three days before this happened. All me and my family have been doing is praying I really hope my brother pulls through this can’t afford to lose him. Thank you so much for taking your time to write this article I have a much better understanding and so much hope that my big brother will get better thank you.

    • AskDrO

      @Jenna I really hope that your family gets your brother some medical attention. This is MOST important at this time.

  • Anonymous

    Dr: My ex-boyfriend has family history of mental illness; dominant one is schizophrenia (his mother has it). He’s acknowledged his belief in becoming the same though some denial looms. He’s had “breaks with reality” since childhood according to a very candid email he’s sent to me. In his early 20s he told me about times he felt followed, he’s levitated, felt that he wasn’t THE person doing a great job of something when complimented (feeling of unreal), and has heard people talking about him (got fired for inappropriate response). Recently, after 5 years of isolation he began dating again…nothing serious, and then he met me and wanted to turn a new leaf on having a deeper relationship. He has been haunted by very vivid and movie-like “visions” when he gets close to a woman which is what kept him out of relationships in the first place. They got worst with me and he always thought I was lying or cheating. His preoccupation with me was always sex. Nothing else. ANd partners were strange prospects to say the least.The last straw was when he finally confessed in an email the eerie “visions” and voices he’s heard with us and thru out his life. It took 9 months to get him to be that honest. Never understood why he told me early on I should think twice about being involved with him. I finally commited myself to not interacting with him unless he gets help because the emotional and verbal abuse was growing (usually in tense breakups). Well he was disappointed we’d no longer be friends but he accepted it calmly and bowed out. A week after that conversation, he send me a nasty FB message and bizarre texts calling me names, being cynical w/ smiley/sad faces, things not related to the original message and accusing me of being with his coworker that I don’t know. He told me to have fun at some event that didn’t even exist! It’s devasting to me b/c he’s blocked me on FB and I have not heard from him since those deplorable messages. I’m hurt and confused on how to look at this b/c I cannot help but take it personal. The contrast between the person that fell in love with me and the one who sent those horrible things are daunting. And he’s still writing me off like he still believes those thoughts. Will he come to his senses one day? Is he really a jerk or is this really a psychotic episode? I hate that this is the last way I will hear from him. How should I feel about/interpret this?

  • Bonny Kitchens

    Good Afternoon Dr. O,
    I am the person that is bipolar with extreme high anxieties and bipolar swings that go from one end of the spectrum to the other. I have epilepsy that has added to the mounting mental, and now, my physical problems. I have had to leave my job mid-year (teaching) and was then able to come back. Now that the new school year has started, I am again “sinking” quickly. I am overwhelmed with mindless directives from administrators, I am physically sick, and just want to sleep all of the time. I hurt. I hurt physically. I hurt emotionally. I just lost a loved one after doing CPR on her for what felt like an hour but to no avail. My husband doesn’t understand my psychy right now and I don’t know how to explain it to him. I just want to sleep. I am sick of being sick, I am sick of being tired, I am sick of hurting and I just want to sleep for a few days to get “me” back. What do I do?

About Dwight A. Owens, M.D.

As a practicing physician, Dr. Dwight A. Owens, has a respected voice in psychiatry that truly makes an impression. He keeps readers enthralled by refusing to shy away from controversial topics and pulling no punches. He also adds spice to the blog by commenting on the state of relationships at every stage, from the first encounter to the daily struggles in even the most satisfying marriages.

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