Every mental health condition can have a disruptive effect on a person’s life. But what is the hardest mental illness to live with?
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Identifying the Hardest Mental Illness to Live With
The impact that a mental illness has on a person can vary considerably depending on a host of factors, including:
- Age of symptom onset
- Type and severity of symptoms
- Exposure to stigma and/or discrimination
- Access to treatment
- Effectiveness of treatment
- Adherence to treatment plan
- Quality of personal support network
This means that there is no way to definitively answer the question of what is the hardest mental illness to live with. Even among people who have the same condition with the same severity of symptoms, those with greater financial stability, better access to treatment, and a more supportive set of friends and family members will likely have a much easier time than those with fewer resources, treatment, and support.
However, as we will discuss in the next section, certain disorders are more likely than others to have a significant negative impact on the substance and quality of a person’s life.
5 of the Hardest Mental Illnesses to Live With
Five of the hardest mental illnesses to live with are schizophrenia, borderline personality disorder, bipolar disorder, post-traumatic stress disorder, and major depressive disorder.
1. Schizophrenia
Schizophrenia is characterized by difficulties perceiving your environment and communicating with others.
To be diagnosed with this condition, a person must have at least two of the five symptoms below (one of which must be either hallucinations, delusions, or disorganized speech):
- Hallucinations – Seeing, hearing, or otherwise sensing things that do not exist
- Delusions – Clinging rigidly to beliefs that can be easily disproven or that have no basis in reality.
- Disorganized speech – Being unable to communicate in a logical, understandable manner
- Grossly disorganized behavior – Can include acting overly childish, dressing in a bizarre fashion, or holding your body in odd positions
- Negative symptoms – Examples include lack of facial expressiveness, speaking with a flat monotone voice, or showing little interest in interacting with others
To highlight the severe impact that schizophrenia can have on a person’s life, the National Institute on Mental Health (NIMH) has reported that:
- Schizophrenia is among the 15 leading causes of disability across the globe.
- About half of all people with schizophrenia also have another mental health condition.
- About 4.9% of people with schizophrenia die by suicide. Among the general public in the U.S., the suicide rate is 0.014%.
- The estimated potential lost life among individuals with suicide is 28.5 years.
2. Borderline Personality Disorder
Borderline personality disorder (BPD) is probably one of the lesser-known conditions on this list, but there is little doubt that it deserves to be considered one of the hardest mental illnesses to live with.
The dominant features of BPD are instability and impulsivity, which can manifest as:
- Frequent frantic efforts to avoid being abandoned, even if there is no credible reason to believe that this is likely to occur
- A history of intense but brief relationships, during which the person alternately idealizes and devalues their partner
- Unstable self-image
- Recurrent threats or behaviors related to self-harm and suicide
- Uncontrolled outbursts of anger, aggressiveness, and/or violence
- Episodes of paranoia or dissociation (the sense of being detached from your mind and body)
As noted in a November 2024 study in the journal Frontiers in Psychiatry, BPD affects about 1% of the general population,10% of individuals who receive outpatient mental health treatment, and 20% of those who are admitted into an inpatient psychiatric program.
Also, a September 2021 Frontiers in Psychiatry article reported that as many as 90% of people with borderline personality disorder may have histories of physical abuse, sexual assault, or other types of childhood trauma.
3. Bipolar Disorder
The primary symptoms of bipolar disorder are significant swings in mood, energy, and activity.
Depending on which type of bipolar disorder a person has (bipolar I disorder, bipolar II disorder, or cyclothymic disorder), their experience may involve:
- Manic episodes – Periods of at least a week during which they have an abundance of energy, diminished need for sleep, racing thoughts, and heightened self-esteem. During a manic episode, a person may impulsively engage in potentially harmful activities such as excessive gambling, wild spending sprees, reckless driving, substance use, and unsafe sex.
- Hypomanic episodes – Similar to manic episodes, but only lasting a minimum of four days.
- Major depressive episodes – Periods of at least two weeks during which a person struggles with poor self-esteem, pervasive sadness, low energy, and lack of motivation. Depressive episodes also typically involve abnormal sleep patterns, appetite changes, difficulty concentrating, and recurrent thoughts of death and dying.
- Recurring symptoms – People with cyclothymic disorder may have periods of mania, hypomania, and major depression that don’t last long enough for a full episode, but persist on and off for a period of at least two years.
These dramatic changes can understandably be quite disruptive to a person’s efforts to do well in school, make progress in their career, and maintain healthy relationships.
The NIMH has reported that an estimated 89.2% of people with bipolar disorder are seriously impaired as scored on the Sheehan Disability Scale. This is the highest rate of serious impairment among all mood disorders.
4. Posttraumatic Stress Disorder
Commonly referred to as PTSD, post-traumatic stress disorder is a complex mental health condition that develops in the aftermath of one or more traumatic experiences.
Types of occurrences that can preceded PTSD include physical attacks, sexual assaults, extreme neglect, life-threatening illnesses, severe automobile accidents, military combat, acts of terrorism, and being kidnapped.
People can develop PTSD after going through one or more of these experiences themselves, witnessing a traumatic event, or being frequently exposed to the aftermath of trauma (such as what might occur with firefighters, EMTs, or other first responders).
Examples of the negative impact of PTSD include:
- An August 2013 article in the Journal of the American Academy of Psychiatry and the Law found that having PTSD increases a person’s risk of being arrested, charged with a violent crime, jailed, and imprisoned.
- An October 2023 Clinical Psychology article reported that the rate of addiction among people with PTSD may be two to four times higher than among the general public.
- A September 2024 Psychiatric Services article, people with PTSD are 5.3 times more likely to die by suicide than are people who don’t have this condition.
5. Major Depressive Disorder
Depression is one of the most common mental health conditions in the U.S. and throughout the rest of the world. While many people with depression are able to manage their symptoms with medication and therapy, for others the disorder can be one of the hardest mental illnesses to live with.
Problems that have been associated with untreated or treatment-resistant depression include:
- Substandard academic performance
- Decreased income
- Increased unemployment
- Disrupted relationships
- Substance use and addiction
- Nonsuicidal self-injury (NSSI)
- Suicidal thoughts and behaviors
A 2004 article in The Primary Care Companion to the Journal of Clinical Psychiatry noted that depression has also been linked to an array of physical maladies, including pain in the limbs, back and joints; gastrointestinal problems; fatigue; abnormal sleep; and changes in appetite and psychomotor activity.
Find Mental Health Treatment in the Tampa Bay Area
If you have been struggling with one of the disorders in this list or another mental or behavioral health concern, Tampa Bay Recovery Center is here for you.
Treatment options at our center in St. Petersburg, FL, include a partial hospitalization program (PHP), intensive outpatient program (IOP), and virtual (online) care.
To learn more about how we can help you or a loved one, or to schedule a free assessment, please visit our Contact page or call us today.
