What is a Nervous Breakdown? | Is it a mental disorder?

welcome to my scientifically informed

insider look at mental health topics if

you find this video to be interesting or

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my channel well this is dr. Brown day

today's question asks what is a nervous

breakdown so this is generally

considered a colloquial term used in the

general population but the term nervous

breakdown isn't really used by the

mental health treatment community for

example it's not an official mental

disorder referred to anywhere in the

Diagnostic and Statistical Manual and

it's also not found in the research

literature really hardly ever it's not a

construct that we study so mental health

clinicians don't use the term nervous

breakdown to refer to really anything

it's not something we use now it makes

the term nervous breakdown really

interesting though is that it's so

popular with the general public and

again so unpopular with mental health

professionals this is actually really

quite unusual among mental health

related terminology so we see many

technical mental health terms that have

made their way into popular usage even

if they are used differently by the

general public than they were originally

conceptualized by the mental health

professionals for example sometimes we

see depression is used when really

sadness is what people are talking about

depression means something very specific

in the amount health treatment community

or we see the term antisocial is used to

mean avoidant

or sometimes we see the terms

schizophrenia or bipolar disorder to

mean that somebody has multiple

personalities when of course none of

those usages is technically correct in

terms of how we use them as now health

professionals so most mental health

clinicians hear the term nervous

breakdown and they think of a general

level of mental health distress but they

do not assign any specific diagnostic

meaning so for instance they wouldn't

use it to help figure out what diagnosis

somebody may have essentially it's

thought of as an amorphous term for

general emotional disturbance that has

no scientific value it's a nonspecific


so then the question becomes is this

actually true or does the term nervous

breakdown actually connect to a mental

health construct meaning when people use

the term are they using it to represent

a unitary construct does it actually

mean something at least somewhat

specific and is the intended meaning

relatively consistent so I looked for

this term nervous breakdown in the

research literature and of course as I

mentioned you won't find it referred to

very often at all they did find one

article published quite awhile ago back

in 1998 that examined this very question

does the term nervous breakdown actually

mean something is it actually an

important term and not something that

clinicians to just really discard and

not worry about and even though it is an

older paper it's actually a pretty good

paper and explain the concept and

studied it I think in a really

interesting way and I'll put the

reference that article in the

description for this video now what we

do see in the research literature does

allow us some sense of what a nervous

breakdown is before we get to this paper

I'm talking about here and it gives us

some information about how we could

define it but again not exactly so for

example we see that the term nervous

breakdown is generally considered to be

less severe than another vague term

insanity it's also considered to be

reactive in nature so if somebody

wouldn't have a nervous breakdown

because of their genetic makeup but

rather because something stressful just

happened to them we also see that many

people considered not to be chronic

rather it's time limited it's

constrained to a time range that's

closed in and narrow and not expansive

and it's not tied to personality

variables so it's not an expression of a

personality disorder for instance so

that's what we knew before this article

so now moving up to this particular

study what did they find in this study

well they found that most people tend to

use nervous breakdown to refer to a

time-limited disorders that was

consistent with we saw with prior

research and this disorder is

conceptualized mostly as having

depressed and anxious features they also

found that people tend to think of it as


reactive etiology so what that means is

that somebody's reacting to a stressor

so easy ology means what causes a

disorder and interestingly the reactive

etiology wasn't to any type of stressor

but really specifically connected to

external stressors so not something

internal but something outside of the

person so what about what's

uncharacteristic of a nervous breakdown

so what symptoms are not associated with

it well it doesn't seem to be tied to

mania so that would be an elevated mood

with like a lot of energy like what we

see with bipolar disorder not associated

with paranoia

sometimes we see paranoia with

schizophrenia sometimes with major mood

disorders we see with paranoid person is

order it's not associated with paranoia

it's not associated with psychosis so

loose nations delusions having a break

from reality it's not associated with

somatic complaints that's when somebody

experiences physical symptoms but

there's no medical explanation for those

symptoms so it's something that's

related to mental health that kind of

turns into physical pain and it's not

related to phobias so phobias would be

were somebody's afraid of something and

there are many specific phobias out

there so with all that in mind were they

able to tie it to a specific diagnostic

classification in the DSM and the answer

to this is yes it actually is fairly

close to a mental disorder named

adjustment disorder and even more

specifically adjustment disorder with

mixed anxiety and depressed mood which

interestingly is one of the most

commonly diagnosed mental disorders the

outpatient prevalence of adjustment

disorder is somewhere between five and

twenty percent and the inpatient

prevalence is near fifty percent and if

you think about it this actually makes a

lot of sense adjustment disorder

involves the development of emotional or

behavioral symptoms in response to a

stressor that can be identified

it has distress that's out of proportion

with the severity and intensity of the

stressor which really kind of implies

that a person is perceiving the stressor

in a way that's distorted and I'll talk


this more in a moment we see the

adjustment disorder is characterized by

significant impairment in social

occupational or other areas of

functioning and of course a nervous

breakdown would be as well and it's not

an exacerbation of a current mental

disorder so adjustment disorder just

like nervous breakdown is not tied to a

prior mental disorder it's not when some

of the Rd has a mental disorder and

those symptoms become worse for example

with major depressive disorder

somebody has episodes of depression and

in between those episodes they usually

feel quite a bit better that's not what

we're talking about with adjustment

disorder and not we're talking about

with the term nervous breakdown so the

findings from this study are certainly

interesting but how do I think about the

term nervous breakdown from my clinical

experience well I think I do largely

agree with the findings of the study but

I would add a few things to this I've

seen this term used a lot to refer to

someone who's simply overwhelmed and

they have no way to cope so it's when

somebody's experiencing too much stress

they're experiencing too many stimuli

too much information too many problems

they can't retreat anywhere so they

simply stop functioning they experience

a lot of depression and anxiety so

sometimes people simply cannot

compensate for all the stress so I

really think that a nervous breakdown

can happen when people are under too

much pressure so it used an example

really not even from my clinical

experience but just an analogy to

something I have done in real life so

last weekend I bought this old Toyota

Highlander I like buying old Toyota's

and fixing them up and when I bought it

I knew that it needed a timing belt and

all the other things that come with when

you change the timing belt right the

water pump the idler pulleys the cam

seals the crank seal all those things so

for me because I'm not really that good

a mechanic it takes me around 10 to 12

hours to do a timing belt and of course

the job like this involves a lot of

different steps I could stop whenever I

wanted I could take breaks I didn't need

to finish this timing belt replacement

in a particular amount of time but

imagine if things were different

imagine if I needed to finish the job in

order to have a vehicle ready to drive

to work or if I kept focusing on all the

steps at one time and serve just a step

in front of me right so when you go to

replace a timing belt you have to take

off a lot of other components as you

work closer to the engine to get that

timing belt off and then of course when

you put the new timing belt on you have

to work back and put all the pieces back

on so if you start to think about all

these things at once it can become

overwhelming start to think way ahead we

call this borrowing worried right you

start to think about the entire job and

that in itself becomes overwhelming so

if a job like that has to be finished by

a certain time or you think about the

whole job at the same time that's a lot

more pressure the job is actually the

same the steps are all the same but the

stakes are higher or the perception is

different now of course this is just an

analogy most mechanical work won't lead

to a nervous breakdown or anything like

that but it's a good analogy I think in

terms of how we conceptualize people

getting overwhelmed in situations so for

people having a nervous breakdown we

have to do more than just look at what

the stressor really is we also have to

look at how much pressure the person is

under or how much pressure they believe

that they're under sometimes people just

need an opportunity to escape the

immediate pressure or to look at the

stressor in a different way like looking

at one step at a time in that job

instead of contemplating the whole job

at once

sometimes it's helpful focus on what

needs to be done right now in order to

cope with a stressor rather than trying

to solve the entire problem with one

theory or one strategy or solving it at

one time so considering all these

factors what's the moral to the story

well even if the term nervous breakdown

isn't used in research or in clinical

practice that doesn't mean that the term

is not useful it doesn't mean that the

term doesn't mean anything many people

recognize when adjustment disorder is

manifesting but they may not know the

technical term used by mental health

clinicians so the term nervous breakdown

has really come to mean about the same

thing as adjustment disorder I can

certainly understand how clinicians are

sometimes unnerved by the use of

nonspecific terms and the misuses of

official terms I think this happens in

every profession professionals like to

use technical terms in the way that they

are supposed to be used in that

profession but that doesn't mean we

can't learn something from these terms

it doesn't mean that we should just

ignore these terms altogether so I

talked before about depression and

antisocial those terms if someone uses

the term depression to mean sadness

well sadness is still quite painful that

still means something if somebody uses

antisocial but they really mean avoidant

well there's actually a personality

disorder named avoidant personality

which causes a lot of suffering so

avoidance can be problematic

when we hear the term nervous breakdown

we need to pay attention it may not mean

anything officially to mental health

clinicians but it may mean a lot to

clients now we know whenever I talk

about terms like nervous breakdown and

all the different meanings these type of

terms can have there'll be a variety of

opinions people who agree with me and

disagree with me and have other thoughts

please put those opinions in the comment


they always generate a really

interesting dialogue as always I hope

you found this description of the term

nervous breakdown to be interesting

thanks for watching