Understanding complex mental health conditions

Friday, 25 September 2020

In the past few years, a lot has changed to reduce stigma and increase understanding surrounding mental health. It’s great to see that as a society we are becoming more comfortable talking openly about our struggles and taking time to look after our mental health and wellbeing. However, when we talk about mental health conditions often depression and anxiety are the only illnesses that are discussed.

We need to shine a light on more complex mental health conditions, such as bipolar, schizophrenia and borderline personality disorder, that haven’t attained the same level of awareness and understanding. There is still a great deal of stigma surrounding these conditions due to a general lack of knowledge, misrepresentation in the media and dangerous stereotypes.

At least 800,000 Australian adults live with a complex mental illness. They can affect anyone at any stage of life. For some conditions it is possible to inherit a predisposition; others can be triggered by environmental factors and traumatic life experiences.

People living with complex mental health conditions may act in a way that is unexpected or confronting. Passing judgement on someone for their ill health is not helpful and only makes it harder for the person affected by mental illness.

In recognition of National Mental Health Month, we will be highlighting information about different complex mental health conditions in the hope that people gain a better understanding and become less judgemental.

Obsessive-compulsive disorder (OCD)

Obsessive-compulsive disorder is not just liking things to be clean and tidy or being a perfectionist. OCD is an anxiety disorder where someone experiences a cycle of obsessions and compulsions so extreme that consumes a lot of their time. It can be exhausting and significantly reduce a person’s quality of life.

Obsessions are thoughts or impulses that arise in someone’s mind repeatedly. These are unwanted thoughts that occur outside of the person’s control and are often accompanied by intense feelings of fear, disgust or doubt.

We have all experienced intrusive thoughts at one stage but for someone experiencing OCD these thoughts happen regularly, cause extreme anxiety and get in the way of day-to-day functioning.

Compulsions are the repetitive behaviour that a person uses to counteract or neutralise their obsessions. People with OCD are aware that this is only a temporary solution. Compulsions are time-consuming and may seem ‘silly’ to others but without completing them it can lead to unbearable anxiety.

Obsessions and compulsions can be about anything. There is no ‘typical’ OCD behaviour; symptoms and features can vary greatly from person to person. However, the following are some of the more common symptoms.

Common Obsessions:

  • Fear of harming self
  • Fear of harming others
  • Fear of being contaminated by germs, dirt or toxins
  • Fear of infecting others
  • Recurrent sexual or violent thoughts
  • Fear of saying certain things
  • Intrusive nonsense sounds

Common Compulsions:

  • Excessive washing
  • Checking locks, stoves, appliances and other things associated with safety
  • Repeatedly taking your own pulse, blood pressure, or temperature
  • Re-reading pages several times before moving on
  • Repeated counting or ordering of objects
  • Touching, tapping or moving in a certain way or certain number of times
  • Calling friends or family members to make sure they’re safe
  • Ritualized eating behaviours

Bipolar disorder

People living with bipolar experience intense mood changes of extreme highs (mania) and extreme lows as well as periods of ‘normal’ or levelled moods in between. How long and intense the extreme moods last vary from one person to another.

There are several types of bipolar which all involve episodes of depression and varying levels of mania. Bipolar I disorder is when someone experiences episodes of mania and severe depression whereas people living with bipolar II disorder experience episodes of hypomania (less severe than mania) and severe depression.

The difference between the symptoms of mania and hypomania is that mania lasts longer, is more disruptive and can include delusions and hallucinations. The symptoms of a low or depressed episode are the same as those for people living with depression.

When someone is experiencing a manic or hypomanic episode their thoughts and behaviour can be beyond their control. Therefore, having supportive friends, family and workmates that can notice warning signs is incredibly important.

Most people who seek treatment for bipolar recover well from episodes and lead fulfilling lives.

Symptoms of a manic or hypomanic episode:

  • Not sleeping
  • Feelings of euphoria or irritability
  • Rapid thoughts and speech
  • Inflated sense of confidence or power
  • Overactivity
  • Increased spending
  • Increased sex drive
  • Grandiose and unrealistic ideas
  • Hallucinations or delusions (mania only)

Symptoms of a depressive episode:            

  • Feeling sad, anxious or agitated for an extended period
  • Lack of energy
  • Sleeping too much or having trouble sleeping
  • Changes in appetite
  • Wanting to cry for no reason
  • Lack of motivation or loss of interest in things they usually enjoy
  • Becoming socially withdrawn
  • Suicidal thoughts or self-harming behaviour
  • Feeling hopeless or guilty without reason

Borderline personality disorder (BPD)

Borderline personality disorder impacts the way people think and feel about themselves and others. It involves issues with managing emotions, self-image, disruptive behaviours and relationships.

Living with BPD can be highly distressing for the person with the condition as well as for their friends and family.

Symptoms usually appear and are most apparent at adolescence or early adulthood. The best form of treatment is psychological therapies which help people gain a better understanding of how to manage feelings, responses and behaviours.

Symptoms of BPD:

  • Fear of abandonment
  • Unstable relationships
  • Uncertain or shifting identity/self-image
  • Impulsive, self-destructing behaviours
  • Suicidal or self-harming behaviour
  • Extreme emotional swings
  • Chronic feelings of emptiness
  • Inappropriate anger
  • Paranoia and dissociation
  • Feeling out of touch with reality

Post-traumatic stress disorder (PTSD)

Post-traumatic stress disorder is a type of anxiety disorder. People develop PTSD after experiencing a traumatic event such as a serious accident, a physical or sexual assault or a natural disaster. Some people can develop PTSD after witnessing a loved one experience trauma.

Everyone experiences trauma differently. What may be upsetting for one person may not be for another. If one person develops PTSD after an event that doesn’t mean another person who experienced the same event will also develop the disorder. People who have a history with mental illness are more likely to develop PTSD.

It is natural to have strong feelings of sadness, fear or anger after a traumatic event. However, for people with PTSD, these feelings last for a long time and become deeply distressing if left untreated. PTSD has a wide range of effects on personality, identity, memory and emotional regulation.

Symptoms of PTSD can vary but generally can be categorised into three groups:

  1. Re-experience

The person can vividly relive the event through flashbacks and nightmares. When this happens, many people experience physical symptoms like sweating, tremors and pain.

  1. Avoidance

People with PTSD try and avoid anything that may remind them of the event. This may mean avoiding certain people, places or activities. This can lead to the person becoming withdrawn and stop them from completing activities they used to love.

  1. Hyperarousal

People with PTSD are often on edge. They may be constantly checking for possible threats everywhere they go. This constant state of vigilance and anxiety can lead to irritability, sleeping problems and angry outbursts.

Complex post-traumatic stress disorder (C-PTSD)

Complex post-traumatic stress disorder is when someone has experienced severe, long-lasting, repeated trauma such as child abuse, domestic violence, war or forced sex work. In these types of events, the victim is not in control and does not have the ability to escape.

In addition to all the symptoms of PTSD, symptoms of C-PTSD include:

  • Inability to control emotions
  • Dissociation or loss of memories
  • Difficulties with sense of identity, body image or core beliefs
  • Distrust of people – isolation and withdrawal from others
  • Vulnerable to further exploitation or abuse
  • Overwhelming feelings of shame and guilt
  • Self-harm, suicidal thoughts or substance abuse


Schizophrenia is one of the most misunderstood and stigmatised conditions. There is a strong perception that people with schizophrenia are likely to be violent and to be feared. This is not the case at all. In fact, people living with schizophrenia are more likely to be victims of violence.

Schizophrenia is a type of psychosis that is categorized through distortions in thinking, perception, emotions and sense of self. It can cause someone to have an altered sense of reality which can have a huge effect on someone’s ability to work and build relationships with others.

Schizophrenia is a treatable condition and getting help as early as possible can improve the outcome.

Symptoms of Schizophrenia

  • Delusions
  • Hallucinations
  • Disruptive thoughts and speech
  • Unusual or extreme actions
  • Low motivation
  • Inability to express emotion
  • Loss of pleasure

EPIC Assist is your local Disability Employment Service provider

EPIC Assist helps people with complex mental health conditions along with people with disability, injury, and other mental health conditions find and maintain meaningful work. If you think you could benefit from our support, get in touch with us today.

National support lines

  • Suicide Call Back Service: 1300 659 467
  • Kids Helpline (up to 25 years): 1800 551 800
  • Lifeline: 13 11 14
  • Men’s Line Australia: 1300 789 978
  • Beyond Blue: 1300 224 636
  • Q-life LGBTQIA+: 1800 184 527
  • Lifeline Text (6pm-12am): 0477 131 114
  • GriefLine: 1300 845 745

Related articles