Employer's Guide to Hidden Disabilities

Psychological Disorders

According to Mental Health: A Report of the Surgeon General, mental disorders are “health conditions that are characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress and/or impaired functioning.” About 15 percent of the U.S. adult population use some form of mental health service in any year. Having a psychological disorder does not necessarily mean a person has a disability, yet in many cases the condition is severe enough to be disabling.

The following are descriptions of some of the more prominent psychological disorders and the impact they can have in the workplace, including effects of common medications taken for the conditions. Most of the information in this section can be found on the website of the National Institute of Mental Health (www.nimh.mih.gov).

Depression / Bipolar Disorder / Seasonal Affective Disorder (SAD)

Depression is one of the most common and most serious mental health problems facing people today. This year, more than 19 million American adults (9.5% of the population) will suffer from this disorder. Major depression is manifested by a combination of symptoms that interfere with the ability to work, study, sleep, eat, and enjoy once pleasurable activities.

While the severity and number of symptoms vary from person to person, they can include the following: a persistent sad mood; loss of interest or pleasure in activities that were once enjoyed; significant change in appetite or body weight; difficulty sleeping or oversleeping; physical slowing or agitation; loss of energy; feelings of worthlessness or inappropriate guilt; difficulty thinking or concentrating; and recurrent thoughts of death or suicide.

In the workplace, symptoms of depression often may be recognized by decreased productivity, morale problems, lack of cooperation, safety risks, accidents, absenteeism, frequent statements about being tired all the time, complaints of unexplained aches and pains, and alcohol and drug abuse. Depression can affect your workers' productivity, judgment, ability to work with others, and overall job performance. The inability to concentrate fully or make decisions may lead to costly mistakes or accidents. In addition, it has been shown that depressed individuals have high rates of absenteeism and are more likely to abuse alcohol and drugs, resulting in other problems on and off the job. (NIMH, 2001)

An employee with chronic depression may need to take medication. Although some improvements may be seen in the first few weeks, antidepressant medications must be taken regularly for 3 to 4 weeks (in some cases, as many as 8 weeks) before the full therapeutic effect occurs. Side effects of medication can include dry mouth, constipation, bladder problems, blurred vision, drowsiness, headache, nausea, insomnia (trouble falling asleep or waking often during the night), and agitation (feeling jittery).

Bipolar Disorder, or what was commonly known as manic-depression, involves cyclical periods of severe depression with periods of extremely elevated or irritable mood known as mania. It affects approximately 2.3 million adult Americans—about 1.2 percent of the population. Cycles, or episodes, of depression, mania, or "mixed" manic and depressive symptoms typically recur and may become more frequent, often disrupting work, school, family, and social life.

When in the depressed cycle, an individual can have any or all of the symptoms of a depressive disorder. When in the manic cycle, the individual may be overactive, overtalkative, and have a great deal of energy. Mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. Left untreated, mania may worsen to a psychotic state. Psychotic symptoms associated with bipolar typically reflect the extreme mood state at the time. (NIMH, 2001)

A variety of medications are used to treat bipolar disorder, but even with optimal medication treatment, many people with the illness have some residual symptoms. Depending on the medication, side effects may include weight gain, nausea, tremor, reduced sexual drive or performance, anxiety, hair loss, movement problems, or dry mouth.

Seasonal Affective Disorder involves symptoms of depression that occur during the fall and winter seasons when the days are shorter and there is less exposure to natural sunlight. When the spring and summer seasons begin and there is greater exposure to longer hours of daylight, the symptoms of depression disappear.

According to the National Institute for Mental Health, approximately 10 percent of Americans currently suffer from Seasonal Affective Disorder (also known as SAD) and related disorders. SAD sufferers have the following symptoms that occur during the fall/winter months and diminish in the spring: depression, increased appetite, weight gain, inability to concentrate, depressed energy and interest, and excessive sleeping.

Anxiety Disorders

Anxiety disorders, as a group, are the most common mental illness in America. More than 19 million American adults are affected by these debilitating illnesses each year. Unlike the relatively mild, brief anxiety caused by a stressful event such as a business presentation or a first date, anxiety disorders are chronic, relentless, and can grow progressively worse if not treated.

There are a number of different types of anxiety disorders:

Panic Disorder involves repeated episodes of intense fear that strike often and without warning. Physical symptoms include chest pain, heart palpitations, shortness of breath, dizziness, abdominal distress, feelings of unreality, and fear of dying. The individual cannot predict when an attack will occur, and many develop intense anxiety between episodes, worrying when and where the next one will strike.

Obsessive-compulsive disorder (OCD) involves repeated, unwanted thoughts or compulsive behaviors that seem impossible to stop or control. Rituals such as handwashing, counting, checking, or cleaning are often performed with the hope of preventing obsessive thoughts or making them go away. Performing these rituals, however, provides only temporary relief, and not performing them markedly increases anxiety. Left untreated, obsessions and the need to perform rituals can take over a person's life.

Post-traumatic stress disorder (PTSD) is a debilitating condition that can develop following a terrifying event. Often, people with PTSD have persistent frightening thoughts and memories of their ordeal and feel emotionally numb, especially with people they were once close to.

Some people with PTSD repeatedly relive the trauma in the form of nightmares and disturbing recollections during the day. They may also experience other sleep problems, feel detached or numb, or be easily startled. They may lose interest in things they used to enjoy and have trouble feeling affectionate. They may feel irritable, more aggressive than before, or even violent.

Phobias include both Social Phobia and Specific Phobia. People with social phobia have an overwhelming and disabling fear of scrutiny, embarrassment, or humiliation in social situations, which leads to avoidance of many potentially pleasurable and meaningful activities. People with specific phobia experience extreme, disabling, and irrational fear of something that poses little or no actual danger; the fear leads to avoidance of objects or situations and can cause people to limit their lives unnecessarily.

Generalized Anxiety Disorder involves constant, exaggerated, worrisome thoughts and tension about everyday routine life events and activities, lasting at least six months. The individual is almost always anticipating the worst even though there is little reason to expect it. The disorder is often accompanied by physical symptoms, such as fatigue, trembling, muscle tension, headache, or nausea.

Both antidepressants and antianxiety medications are used to treat anxiety disorders. Drowsiness and loss of coordination are most common side effects, along with fatigue and mental slowing or confusion.


Schizophrenia is a chronic, severe, and disabling brain disease that affects about 1 percent of the population. People with schizophrenia often suffer terrifying symptoms such as hearing internal voices not heard by others, or believing that other people are reading their minds, controlling their thoughts, or plotting to harm them. These symptoms may leave them fearful and withdrawn. Their speech and behavior can be so disorganized that they may be incomprehensible or frightening to others. Medications and other treatments for schizophrenia, when used regularly and as prescribed, can help reduce and control the distressing symptoms of the illness, but most people with schizophrenia continue to suffer some symptoms throughout their lives. It has been estimated that no more than one in five individuals recovers completely. (NIMH, 1999)

Personality Disorders

Those with a personality disorder possess several distinct psychological features including disturbances in self-image; inability to have successful interpersonal relationships; inappropriate range of emotion, ways of perceiving themselves, others, and the world; and difficulty possessing proper impulse control. These disturbances come together to create a pervasive pattern of behavior and inner experience that is quite different from the norms of the individual's culture and that often tend to be expressed in behaviors that appear more dramatic than what society considers usual. Therefore, those with a personality disorder often experience conflicts with other people and vice-versa. There are ten different types of personality disorders that exist, which all have various emphases.
For more information on each of these Personality Disorders, as well as other mental health topics, visit Mental Help Net online at www.mentalhelp.net.

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Last Revised September 10, 2003.
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