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Surgeon General's Report:
Chapter 4 : Adults and
Mental Health
By: Erica Bennett
Chapter 4
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Mental Health in Adulthood
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The successful performance of
mental function, enabling
individuals to cope with adversity
and to flourish in their educational,
vocational and personal
relationships.
This definition may be too narrow.
20% of the adult population has a
mental disorder.
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Factors of Mental Health
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PERSONALITY TRAITS:
Self-Esteem
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Self-Efficacy
Neuroticism
Avoidance
Impulsivity
Sociopathy
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Factors of Mental Health
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STRESSFUL LIFE EVENTS:
Past trauma and child sexual
abuse
Domestic Violence
Interventions for Stressful Life
Events
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Factors of Mental Health
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PERSONALITY TRAITS:
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Personality traits are important
because they are seen as being
influential to mental health.
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Can be beneficial or detrimental
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Factors of Mental Health
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SELF-ESTEEM:
Refers to a person’s belief of self
worth, competence and abilities.
Buffers individuals from adverse
life events.
Self-efficacy is the confidence in
one’s own ability to cope with
adversity independently or with
assistance from others.
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Factors of Mental Health
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NEUROTISISM:
Refers to a broad pattern of
psychological, emotional, and
psychophysiologic reactivity.
High level = worry.
Risk of early-onset of depressive
and anxiety disorders.
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Factors in Mental Health
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AVOIDANCE:
A predisposition to avoid situations
and see personal challenges as
threats.
May be inherited and associated
with shyness, anxiety and
depressive disorders.
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Factors of Mental Health
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IMPULSIVITY:
Trait associated with poor control
of emotions, especially anger,
difficulty delaying gratification and
novelty seeking.
For children, impulsivity may
predict later disorders in adulthood.
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Factors of Mental Health
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SOCIOPATHY:
Dishonest, hurtful, unfaithful and
dangerous behaviors that benefit
the individual.
DSM-IV refers to it as an antisocial
personality disorder.
Represented highly in prisons.
More common among men.
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Factors of Mental Health
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STRESSFUL LIFE EVENTS:
Most common are:
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Breakup of intimate romantic relationship.
Death of a family member or friend.
Economic hardships.
Racism and discrimination
Poor physical health
Accidental or intentional assaults on
physical safety.
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Factors of Mental Health
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POST TRAUMA AND CHILDHOOD
SEXUAL ABUSE:
Childhood trauma predicts adult mental
health.
Childhood sexual abuse is most
common.
Problems range from depression and
anxiety to the inability to socially function
or partake in relationships.
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Factors of Mental Health
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DOMESTIC VIOLENCE:
A pattern of physical and sexual abuse,
psychological abuse with verbal
intimidation and/or social isolation or
deprivation.
More likely to involve females and
children.
One of the foremost causes of serious
injury to women ages 15-44.
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Interventions for
Stressful Life Events
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Family and friends
Social support networks
Religious and spiritual endeavors
Complementary healers
Physical activities
Couple therapy
Bereavement programs
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Anxiety Disorders
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Most common and most frequently
occurring mental disorders.
Types:
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Panic attacks and Panic disorder
Agoraphobia
Specific phobias
Generalized Anxiety Disorders
Obsessive-Compulsive Disorder
Acute and Post-traumatic Disorders
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Anxiety Disorders
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Panic attack is a period of intense
fear or discomfort associated with
numerous symptoms.
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Palpitations, sweating, trembling,
shortness of breath, sensations of
choking or smothering, chest pain,
nausea, gastrointestinal distress,
dizziness or lightheadedness,
tingling sensations and chills or
blushing hot flashes.
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Panic Attacks and Panic
Disorder
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Onset is abrupt and climaxes
within 10-15 min. and usually lasts
no longer than 30min.
Distinguished from other anxiety by
the onset being sudden and
intensity.
Onset between late adolescence
and mid-adult life, rare after 50.
Twice as common for women.
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Panic Attacks and Panic
Disorder
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Diagnosis:
Must have at least four of the
symptoms previously stated.
 Must have had at least two
unexpected panic attacks and
worry of having further ones.
 Cannot be made for attacks
caused by medication, or other
medical disorders.
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Agoraphobia
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Definition: severe anxiety about
being in situations where escape is
difficult.
Outcome of repeated panic
attacks.
Twice as common in women.
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Specific Phobias
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Common conditions are characterized by
fear of specific objects or situations.
Most adults recognize fear as irrational,
but typically avoid object or situation.
Approx. 8% suffer form one or more.
Onset is in childhood with second peak
in mid 20’s.
Don’t result from one single exposure.
Runs in families (learned not genetic).
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Specific Phobias
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Most common phobias:
Fear of animals (snakes, rodents,
birds and dogs).
 Fear of insects (spiders, bees).
 Fear of heights, elevators, flying,
automobile driving, water, storms,
blood and injections.
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Social Phobias (social
anxiety disorder).
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Describes people with persistent
anxiety in social situations,
including performances and public
speaking.
Critical element of fear is possibility
of embarrassment or ridicule.
Most adults recognize fear as
being unreasonable, but dreaded
events are avoided or tolerated
with extreme discomfort.
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Generalized Anxiety Disorder
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Defined as 6 months or more of anxiety
and worry accompanied by multiple
symptoms.
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Muscle tension, easily fatigued, poor
concentration, insomnia and irritability.
Essential feature is anxiety and worry
cannot be attributed to distress
associated with other conditions.
50% starts in adolescence and
symptoms fluctuate with periods of
stress .
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Obsessive-compulsive Disorder
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Obsessions: recurrent, intrusive
thoughts, impulses or images that
are seen as inappropriate,
grotesque or forbidden.
Common obsessions:
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Contamination with germs or body
fluids, order or symmetry, or loss of
control of violent or sexual
impulses.
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Obsessive-compulsive Disorder
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Compulsions: behavior or mental
acts that reduce anxiety which
accompanies an obsession or
prevents some dreaded even from
happening.
Common compulsions:
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Hand washing, checking, and
mental acts like counting.
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Obsessive-compulsive Disorder
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Equally common is women and
men.
Begins in adolescence or young
adulthood with fluctuating
symptoms associated with stress.
Comorbid with major depression
an other anxiety disorders.
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Acute & Post Traumatic Stress
Disorders
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Acute stress: anxiety and
behavioral disturbances within 1st
month after extreme trauma.
Dissociation of mind from body is a
critical feature.
Usually have symptoms of
generalized anxiety disorder.
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Acute and Post Traumatic Stress
Disorders
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Acute if:
Less than three months
 Chronic: three or more months.
 Delayed onset: symptoms begin 6
months after trauma.
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Diagnosis of PTSD:
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Acute stress persists more than
one month and impairs normal
functioning.
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Etiology of Anxiety Disorders
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Evidence suggests a combination
of life experiences, psychological
traits and genetics are factors of
developing anxiety disorders.
Acute Stress Response:
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Increased heart rate, blood
pressure, sweating, breathing and
metabolism and tension of
muscles.
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Etiology of Anxiety Disorders
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New Views:
Fear and anxiety are associated.
 Hippocampus and amygdala
(control of emotions) fear pathways
are being destroyed to see if
anxiety is still produced.
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Etiology of Anxiety Disorders
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Neurotransmitters:
Five deal with anxiety (serotonin,
GABA, norepinephrine,
cholecystokinin and corticotropinreleasing hormone)
 Changes in one affect all others
 Serotonin and GABA are inhibitory
neurotransmitters that quiet stress
responses and are being used to
treat anxiety.
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Etiology of Anxiety Disorders
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Psychological Views of Anxiety
Psychodynamic
 Behavioral
 Cognitive
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 Cognitive
risk factor found in
women.
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Treatment for Anxiety Disorders
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Counseling and Psychotherapy
Pharmacotherapy
Benzodiazepines
 Anti-Depressants
 Buspirone
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A combination of both.
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