Mental health professionals share the 10 most challenging cases they have come across

Serious mental health conditions

Thanks to the internet and countless awareness campaigns, the world has started to take mental health more seriously. While this has helped many individuals, it has also shed light on unveiling conditions that were previously overlooked. Such conditions were either never understood or misdiagnosed before which caused many problems for individuals suffering from them. u/MeepingBad6699 asked the community, "Mental professionals of Reddit, what is the worst mental condition that you know of?" Here are 10 of the most eye-opening answers that they had to provide.

1. Cotard delusion 

Cotard delusion. I'm a nurse and had to take care of a huge man with this condition. He came in with some odd behavior and escalated to Cotard. The delusion makes you think you are actually dead. He would scream he was dead all day and night. Lived in constant terror. He was such a sweetheart but became so worn down and terrified over time he got quite dangerous and punched a nurse in the face. u/bbourke0626. I had a patient check into the ER with this once but I didn’t know the name, she just kept claiming she was dead. She got baker acted and transferred. u/Dimwit00

2. Dementia 

Dementias. Watching a person, their memories and their personality die but their body remains living and confused, is horrifying. u/Sacu_Shi_again. My grandma has dementia (she can barely talk right now, but she's still physically healthy, somewhat) and a lot of my closely related family died due to Alzheimer's. Granted they acquired it/started showing severe symptoms when already quite old (early to late 80s), but it's still a terrifying prospect to know that I'll probably die in such a way. I hope that when the time comes, and it starts to affect me in a significant way, my wishes will be respected and I'll be euthanized. Both to spare me the horrors of it and to not be a depressing burden to those around me. u/pale_sand

3. Delusion pasitosis

Delusional parasitosis comes to mind with this prompt. I’ve watched a patient go to well over a dozen doctors trying to get confirmation that they’re parasite-ridden. After countless stool samples, blood work, labs, scans, biopsies, etc., she clearly didn’t have any but remained convinced. u/Blahaj_shonk_lover. A friend of my mom's ended up with something like this after getting into the wrong kinds of drugs. She was convinced that there were little bugs in her face. Absolutely convinced. She'd pick at her face day and night. Picked her face skin off bit by bit until the sight was horrific. She got clean for a little while, came to her senses, and stopped picking. But the damage was done, her entire face was scarred. u/ShiraCheshire

4. Anorexia Nervosa

I don’t have it, but my psychiatrist referred to Anorexia Nervosa as the “7-year” disease because, 7 years from diagnosis, you're either in recovery or dead. u/TooManyMeds. This. I’m an alcoholic coming up on three years sober. I tell people eating disorders are like telling me, “You can only have three shots of vodka a day. But you have to have three.” And then expecting a good outcome. I do not know how any person manages to survive anorexia and I respect the hell out of those who do. u/ernurse748. I have had an ED for most of my life and have no idea how to 'recover.' I have been inpatient and in therapy. But food is everywhere and at times when my life is stressful I eat. And when I get too big, I fast. It's not hard at all to go from obese to underweight in under a year. It is not hard to go from under to overweight in a year. It is damn hard to find a middle ground and not compensate without actually focusing on my eating. And as soon as I focus on my eating it's so easy to race myself to the bottom. u/ItsmeKristy

5. Body Integrity Disorder

Though not a medical professional, during my brief time working at an outpatient facility, I encountered a patient with Body Integrity Identity Disorder (BIID). Convinced that his arm wasn't his own, he consistently described it as feeling like a stranger's limb. His intense desire to have his arm removed led him into a deep depressive episode, culminating in a self-mutilation attempt that ultimately needed amputation. Post-surgery, he claimed to finally feel a sense of peace. However, I left the job so I don't know the lasting impact on his mental state from the surgery. BIID is still a relatively unknown identity disorder and doesn't have many treatment options so far. SSRIs are usually given to alleviate depressive symptoms but it doesn't always seem to help. Going through something like that just seems like an awful experience. Dealing with those obsessive thoughts non-stop? That's gotta mess with your head big time. u/BansheeBallad

6. Prosopagnosia and Capgras syndrome 

Prosopagnosia. I had a patient with this as a therapist. They reported to the ER because their "face fell off." The only thing therapy could accomplish was to teach the patient how to use other markers to identify people. Capgras syndrome. The idea that the people around you were replaced with imposters. This one is absolutely hell on everyone. And in neuropsych definitely primary progressive aphasia. Basically, you aggressively lose the ability to speak and understand language. I had a patient once that was late to their appointment and when they finally got there they were pissed because "none of the signs were in English." They failed all of their language tests but passed all the other markers to rule out dementia. This person was an avid runner, vegan, perfectly healthy and would likely go on to never be able to speak or understand anyone speaking to them within 5 years or so yet live a long life due to no other health concerns. u/mymommademewritethis

7. Drinking hand sanitizer 

Have a friend who works with seriously disturbed patients, and told me about a woman who habitually drank hand sanitizer; apparently, when you do that, your joints lock up and you have to be immediately rushed to the ER for treatment and what do they have in the ER, every ten feet or so? Yeah, more hand sanitizer. So this woman would have to be restrained, otherwise, they would find her in the hallway pumping it directly into her mouth all over again. u/Chimerain. I worked in rehab and COVID regulations were a trip bc we had clients drinking hand sanitizer. I did not see that coming lol. u/Few_Cup3452

8. Feeling like they were on fire 

I heard about a guy who thought he was on fire all the time he was awake. So he screamed until he passed out. Day after day. How can you even treat that? u/Apprehensive-Gas2072. Ooh!!! I know a similar story. There was an old guy who did that all the time, exactly as described. No medical professional could figure it out, and nothing helped at all. I’m not sure how they found out but eventually, they found medical records that had been hidden and no one (doctors, etc) could see it. It was hidden because it was a massive f*** up. It had occurred years before he started having a bad time. Turns out he went in for heart surgery and he woke up right as they started cutting into him. So he felt, saw and heard everything. It ended up being a repressed memory until years down the line he started screaming anytime he woke up and never stopped. There was a Mr Ballen video on it I think, if anyone wants the link to the video I can probably find it. u/Skg42

9. Paranoid schizophrenia 

Paranoid schizophrenia is no joke. I had a pt who was so convinced that aliens were watching his life through his eye, that he tore it out with his bare hand. And didn't even regret it. u/zenejinzorin. My mom suffered from paranoid schizophrenia throughout my whole childhood. She thought my dad was trying to kill her and was making a pact with the devil as well as other things. Sometimes she was on meds and was okay but she’d often stop them after a while. S*** was not fun to be around and I hope to god I never have to experience it myself. u/just_a_guy_at_aldi. That's one of the most intense things I've ever read. real horror movie s***. u/nothingidentifying_

10. Childhood disintegrative disorder

Childhood disintegrative disorder, nightmare fuel of the highest order. The child starts to regress in development language and speech start deteriorating losing acquired motor skills, losing ladder control progressing until they are vegetative and non-communicative. The person that the child was has disintegrated completely, we have no idea what causes it nor any treatments and no detection of it beforehand. But what turns it into pure nightmare fuel is that there actually is one preceding symptom, the child is utterly gripped by fear and intense feelings of something being very wrong with them, often complaining to the parents that something is terribly wrong with them. u/delayedcolleague