Unfortunately, many people believe they know how mental illness works or mental health conditions, but they actually are not well educated. Seeing one documentary or interview does not make you an expert on alcoholism, substance abuse, or borderline personality disorder.

Many conditions are complex in their origins, their comorbidities, and their pharmaceutical treatments or therapies. Here is a list of popular opinions people have about mental illnesses that are actually inaccurate statements:

1. Substance abuse is not an illness. It's an excuse for making poor choices.

Substance addiction is defined in the DSM-5 as "the repeated, compulsive use of a substance that continues in spite of negative consequences (physical, social, psychological, etc.)." Addiction results in tolerance, the need for increased amounts of the substance, with little effect, and a craving for the substance paired with an inability to stop using the substance.

Many factors go into addiction and tolerance, including genetics, neurobiological influences, psychological (i.e. trauma, PTSD, Bipolar Disorder), and cultural influences. To state that this mental illness is just a personality flaw or excuse is not only inaccurate but stigmatizing. These opinions prevent people from seeking treatment, sharing their stories, or opening up with even friends and family about their condition(s).

2. People with Borderline Personality Disorder are just dramatic attention-seekers.

Borderline Personality Disorder is a very serious condition defined by: unstable relationships, fear of abandonment, impulsive behaviors (i.e. sex, substance abuse, reckless driving), splitting (love/hate), self-harm or even suicidal behaviors, intense mood (lasting a few hours), chronic emptiness, intense anger, and transient paranoid ideation (DSM-5).

The causes may be due to a genetic predisposition, a family history of mood disorders, or physical/sexual abuse. This diagnosis is given primarily to females. These patients may be labeled "difficult", even for experienced MH professionals. They are not simply "attention whores". They have a personality disorder that can create difficulties in relationships due to emotional extremes, harmful behaviors, and unhealthy thinking patterns.

3. People with OCD aren't mentally ill. They are just neat freaks.

Obsessive-Compulsive Disorder (OCD) can deal with organization or cleaning, but does not have to at all. The two components are obsessions (recurrent, intrusive thoughts that cause anxiety) and/or compulsions (repetitive behaviors, i.e. checking, that reduce distress/anxiety and must be adhered to rigidly).

People do not find joy in these behaviors; they are driven to perform compulsions, with greater than 1 hour per day, interfering with the normal routine. There are also some subtypes that get overlooked, such as suicide OCD (obsessions and compulsions centered around suicide) and HOCD (obsessions and compulsions with homosexuality, despite sexual orientation of the person impacted).

Many people say "I am so OCD" when they are actually referring not to obsessions or compulsions but OCPD (Obsessive-Compulsive Personality Disorder) traits, such as a need for control, excessive perfectionism, and a high degree of organization.

4. Depression is just the same as being sad.

No. Do not confuse emotions with mood episodes. Emotions are short-lasting, while mood episodes can last days, weeks, months, even years. To meet the DSM criteria for a major depressive episode, the symptoms must last for a period of at least 2 weeks.

The symptoms include: significant weight change, hypersomnia or insomnia, psychomotor agitation or retardation, fatigue, worthlessness or guilt, problems concentrating, and recurrent thoughts of death. Depression can even cause psychosis, though such features are rare in depression.

This is due to a deficiency of neurotransmitters such as norepinephrine (NE) and serotonin (5-HT), as well as dysregulation of the HPA axis. This typically needs to be treated with antidepressants and/or therapy (such as CBT). Depression is a mental illness, not a temporary state of sadness due to something such as a recent loss or struggle. Mood disorders should be taken seriously.

5. Eating disorders are just for thin, rich, white girls.

This opinion is often about anorexia nervosa, an eating disorder featuring a patient who is terrified of gaining weight and does not maintain a minimally acceptable body weight. While anorexia is more common in industrialized societies, it can happen in any country, to females as well as males, and any social class.

Also, there are other illnesses that the category "eating disorders" includes, such as Binge Eating Disorder (BED), for which patients may not be underweight or may even be overweight. The cliche skinny, rich, white girl does not represent eating disorders.

Be careful with what you say when discussing sensitive topics such as mental illnesses. Last time I was in the hospital, I overheard an ER nurse state that psychiatric patients are basically incapable of reason. I heard a medical student refer to the psychiatric patients as "crazy". There is so much stigma around mental illnesses. Spark the conversation in an educated manner!