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What to Do When Stress Interferes with Daily Functioning

Are you worried someone you love may be headed for a nervous breakdown, or worse, a psychotic episode? How can you tell what’s going on, and what should you do?

We talked to UNC psychiatrist Diana O. Perkins, MD, MPH, to learn more.

Extreme Stress Can Cause a Mental Disorder

First, the term “nervous breakdown” is not an actual psychiatric condition or medical diagnosis. Instead, it is a phrase used to describe symptoms associated with an underlying mental health condition that is aggravated by being extremely overwhelmed, Dr. Perkins says.

“Chronic or severe stress can trigger a mental disorder, most commonly a significant anxiety disorder and major depression,” Dr. Perkins says. “When people use the term ‘nervous breakdown’ in conversation, they are using it to describe a prolonged state of being overwhelmed that can lead to problems functioning socially or at work or school.”

Signs and symptoms include sleep disturbances, such as trouble falling asleep or waking up and being unable to go back to sleep, high anxiety or depression, a loss of interest in usual activities or thoughts of suicide.

In some cases, severe stress can trigger psychosis, a mental state characterized by a break from reality that can include delusions or hallucinations.

“Psychosis refers to the inability to understand and interpret what’s going on around you,” Dr. Perkins says.

Examples of psychosis symptoms are hearing voices or noises that aren’t really there and paranoia.

“If a person is experiencing psychosis, by definition they don’t realize it,” Dr. Perkins says. “The voices, fears or unusual ideas seem very real.”

Seek Help Immediately

When stress interferes with your loved one’s ability to function, it’s important to seek help.

“When a person’s ability to cope with stress is overwhelmed, when a person feels a high level of anxiety, depression, sleeping difficulties or is having thoughts about suicide, then it’s time to seek professional help because such symptoms are highly treatable,” Dr. Perkins says.

A primary care provider can determine if he or she can treat your loved one or needs to refer to a mental health professional.

If your loved one feels so overwhelmed that he or she thinks about suicide, call 911 or the National Suicide Prevention Lifeline at (800) 273-8255. It is available 24/7.

If you are concerned your loved one may be experiencing psychosis it is important to seek help right away, such as an emergency room. Most emergency rooms have a mental health provider available to evaluate and treat patients.

If your loved one won’t agree to seek medical services, you can petition your local magistrate for law enforcement to help get an evaluation. If you have any concerns about your loved one’s safety or your loved one has become more irritable, unpredictable or aggressive, you can call 911 directly, and police officers may be able to help get your loved one to emergency services.

“It is very important to seek help quickly because we know once a psychotic disorder emerges, the sooner the treatment, the better,” Dr. Perkins says.

With Proper Treatment, There’s Hope

Once a person is diagnosed and in treatment, medications can be very helpful for depression, anxiety and psychotic illnesses, Dr. Perkins says.

“We have medications that are available with minimal side effects, whether it’s for psychotic illness, anxiety disorder or depressive disorder,” Dr. Perkins says. “People can go into remission and remain in remission with their symptoms. There’s plenty of hope, but the sooner people get help, the more likely those treatments will benefit them.”

Psychotherapy, or counseling with a mental health professional, is also an important part of treatment, she says.

“Psychotherapy is aimed at helping people manage stress better, understand the stressors in their lives and learn how to better navigate those,” Dr. Perkins says.

Outreach and Support Intervention Services (OASIS), a clinic in the Department of Psychiatry at the UNC School of Medicine, is a specialty care program for people recovering in the early stages of a psychotic disorder. It includes psychotherapy, peer and family support groups, and vocational and educational support services.

“You can recover from psychosis and live a good life,” Dr. Perkins says.

Self-Care Is the Best Prevention

Practicing self-care can help the brain just as it helps the body.

“All these things that we’ve learned about exercising and eating right to take good care of your body are also a part of taking good care of your brain,” Dr. Perkins says.

So if your loved one seems overwhelmed or stressed, encourage him or her to follow a healthy diet, get regular exercise and manage stress either through reducing the level of stress or stress management strategies such as yoga or meditation, Dr. Perkins says.

“These strategies can prevent the overstress from cascading into a mental illness,” Dr. Perkins says. “Your brain is like any part of your body. If you overstress your elbow when playing golf or tennis, you can injure it. Your brain is the same way.”

Also, be sure to take medications as prescribed.

Mental Illness Is Not a Character Weakness

It’s important to remember that depression and anxiety affect people from all walks of life. Anxiety disorders are the most common mental illnesses in the United States. About 1 out of every 6 adults will have depression at some time in their life, and nearly one-half of those diagnosed with depression are also diagnosed with an anxiety disorder.

“Mental illnesses are not a weakness of character. Depression disorder, anxiety disorder and psychosis are symptoms of chemical imbalances in the brain,” Dr. Perkins says. “Brain dysfunction is just like heart disorder or any other disorder of organ systems. You treat high blood pressure to prevent heart disease. You treat being overstressed to prevent more serious mental illnesses.”


If you are concerned someone is showing signs of a psychotic episode, call 911. If you or someone you know is struggling with mental health issues, talk to your doctor or find one near you.