Severe Mental Health Disorders: Recognizing the Signs

Written by Lauren Abrams, Contributing Writer

‘Teen angst’ starts to subside in our early twenties, and we can emotionally regulate more effectively. Or, at least, that’s a general trend. In the growing national conversation and awareness of mental health, I’ve been exposed to conversations about depression and anxiety throughout my education. Many of my peers are very open to having those conversations and the academic institutions I’ve attended are more open than ever about engaging in these topics. What I didn’t realize, upon going to college, was how many people experience severe behavioral mental health disorders. 

When I went to college, I thought bipolar disorder was when you’re just really happy for a bit, and really sad for a bit. I thought schizophrenia only affected older people, who I didn’t know, and who didn’t go out much. Words like bipolar, sociopath, and narcissist get thrown around a lot, at least in my experience. I never understood these terms as real mental health complications that could be happening to my peers.

I didn’t know that “roughly half of all lifetime mental disorders in most studies start by the mid‐teens and three‐fourths by the mid‐20s. Later onsets are mostly secondary conditions. Additionally, severe disorders are typically preceded by less severe disorders that seldom are brought to clinical attention” (Kessler). 

When someone I knew had a manic episode, I was thrown. There was erratic behavior: they weren’t sleeping, there would be random periods where they would pretend I didn’t exist or send bizarre messages, and they would drive to nonsensical places in the middle of the night. I was confused. They were academically high achieving, athletic, and high functioning. How could this be happening? Sometimes when they were high strung I thought, “Maybe it’s anxiety.” Or, when they were lethargic and wouldn’t leave their dark bedroom for days at a time, even to go to the dining hall, I thought, “Maybe it might be depression.” If someone was depressed or anxious, I could at least use the limited information I had to understand what their experience might feel like or look like. 

Bipolar, like the terms, ‘psychotic,’ ‘sociopath,’ or ‘narcissist,’ get thrown around very casually. Bipolar is characterized by manic or depressive episodes. Psychotic, or psychosis is medically defined as a condition in which a person’s experience of reality is grossly impaired to the extent of being unable to meet the demands of everyday life (“Medical Definition of Psychosis”). Someone who is a legitimate sociopath would have antisocial personality disorder, and narcissistic personality disorder has its own legitimate, medical category as well. More information about the symptoms can be found in the references below. 

Bipolar is more common than you might think–1 in 100 people will be diagnosed with it in their lifetime (“Overview – Bipolar Disorder.”). In reflection, I wish the topic had been more humanized for me. At times, it can be easy to feel like you’re both overstepping and not doing enough during a loved one’s mental health crisis. Connecting the person with resources and reporting the issue, reminding the person that this is an illness rather than their character, and being supportive is usually the best course of action. 


Kessler, Ronald C et al. “Age of onset of mental disorders: a review of recent literature.” Current opinion in psychiatry vol. 20,4 (2007): 359-64. doi:10.1097/YCO.0b013e32816ebc8c 

“Medical Definition of Psychosis.” MedicineNet, MedicineNet, 3 June 2021, 

“Overview – Bipolar Disorder.” NHS Choices, NHS, 2019, 

“Personality Disorders.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 23 Sept. 2016, 54463.

Published by Counseling With Leslie

Leslie Stevens, M.Ed., LCMHC is a North Carolina and Virginia board-certified licensed professional counselor. She co-owns a successful practice in Carrboro, North Carolina. Leslie specializes in helping adults navigate stress, depression, anxiety, and perfectionism. Additionally, she is a life strategist, spiritual coach, and writer.

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