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Passive-aggressive behavior is a pattern of indirectly expressing negative feelings instead of openly addressing them. There’s a disconnect between what a passive-aggressive person says and what he or she does.

For example, a passive-aggressive person might appear to agree — perhaps even enthusiastically — with another person’s request. Rather than complying with the request, however, he or she might express anger or resentment by failing to follow through or missing deadlines.

Specific signs of passive-aggressive behavior include:
•Resentment and opposition to the demands of others
•Procrastination and intentional mistakes in response to others’ demands
•Cynical, sullen or hostile attitude
•Frequent complaints about feeling underappreciated or cheated

Although passive-aggressive behavior can be a feature of various mental health conditions, it isn’t considered a distinct mental illness. However, passive-aggressive behavior can interfere with relationships and cause difficulties on the job. If you’re struggling with passive-aggressive behavior — or you think a loved one is — consider consulting a therapist.

What’s the difference between mental health and mental illness? Sometimes the answer is clear, but often the distinction between mental health and mental illness isn’t so obvious. For example, if you’re afraid of giving a speech in public, does it mean you have a mental health condition or a run-of-the-mill case of nerves? Or, when does shyness become a case of social phobia?

Here’s help understanding how mental health conditions are identified.

Why is it so tough to tell what’s normal?

It’s often difficult to distinguish normal mental health from mental illness because there’s no easy test to show if something’s wrong. Also, primary mental health conditions can be mimicked by physical disorders. Mental health conditions are judged not to be due to a physical disorder and are diagnosed and treated based on signs and symptoms, as well as on how much the condition affects your daily life. Signs and symptoms can affect your:
•Behavior. Obsessive hand-washing or drinking too much alcohol might be signs of a mental health condition.
•Feelings. Sometimes a mental health condition is characterized by a deep or ongoing sadness, euphoria or anger.
•Thinking. Delusions — fixed beliefs that are not changeable in light of conflicting evidence — or thoughts of suicide might be symptoms of a mental health condition.

What is the Diagnostic and Statistical Manual of Mental Disorders (DSM)?

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a guide published by the American Psychiatric Association that explains the signs and symptoms of several hundred mental health conditions.

Mental health providers use the DSM to diagnose everything from anorexia to voyeurism and, if necessary, determine appropriate treatment. Health insurance companies also use the DSM to determine coverage and benefits and to reimburse mental health providers.

It can be challenging to help a loved one struggling with alcoholism, drug problems, an eating disorder or other destructive behavior. Sometimes a direct, heart-to-heart conversation can start the road to recovery. But when it comes to addiction, a more focused approach is often needed. You may need to join forces with others and take action through a formal intervention.

People who struggle with addictive behaviors are often in denial about their situation or are unwilling to seek treatment. Often they don’t recognize the negative effects their behavior has on themselves and others. An intervention presents your loved one a structured opportunity to make changes before things get even worse.

What is an intervention?

An intervention is a carefully planned process involving family and friends and sometimes colleagues, clergy members or others who care about a person struggling with addiction. During the intervention, these people gather together to confront the person about the consequences of addiction and ask him or her to accept treatment. The intervention:
•Provides specific examples of destructive behaviors and their impact on the addicted person and loved ones
•Offers a prearranged treatment plan with clear steps, goals and guidelines
•Spells out what each person will do if a loved one refuses to accept treatment

Who might benefit from an intervention?

An intervention can help people who struggle with addictive behaviors but who are in denial about their situation or who have been unwilling to accept treatment. Some examples of behaviors that may warrant an intervention include:
•Alcoholism
•Prescription drug abuse
•Abuse of street drugs
•Eating disorders
•Compulsive gambling

People with addiction often don’t see the negative effects their behavior has on them and others. It’s important not to wait until they “want help.” Instead, think of an intervention as giving your loved one a clear opportunity to make changes before things get really bad.

How does a typical intervention work?

An intervention usually includes the following steps:
1.Planning. A family member or friend proposes an intervention and forms a planning group. It’s best if you consult with an intervention professional (interventionist), a qualified professional counselor or a social worker when planning an intervention. An intervention is a highly charged situation and has the potential to cause anger, resentment or a sense of betrayal. If you have any concerns that the intervention may trigger anger or violent behavior, consult an intervention professional before taking any action.
2.Gathering information. The group members find out about the extent of the loved one’s problem and research the condition and treatment programs. The group may make arrangements to enroll the loved one in a specific treatment program.
3.Forming the intervention team. The planning group forms a team that will personally participate in the intervention. Team members set a date and location and work together to present a consistent, rehearsed message and a structured treatment plan. Do not let your loved one know what you are doing until the day of the intervention.
4.Deciding on specific consequences. If your loved one doesn’t accept treatment, each person on the team needs to decide what action he or she will take. Examples include asking your loved one to move out or taking away contact with children.
5.Writing down what to say. Each member of the intervention team should detail specific incidents where the addiction has resulted in problems, such as emotional or financial issues. Discuss the toll of your loved one’s behavior while still expressing care and the expectation that your loved one can change.
6.The intervention meeting. Without revealing the reason, the loved one is asked to the intervention site. Members of the core team then take turns expressing their concerns and feelings. The loved one is presented with a treatment option and asked to accept that option on the spot. Each team member will say what specific changes they will make if the addicted person doesn’t accept the plan.
7.Follow-up. Involving a spouse, family members or others is critical in helping someone with an addiction stay in treatment and avoid relapsing. This can include changing patterns of everyday living to make it easier to avoid destructive behavior, offering to participate in counseling with your loved one, seeking your own therapist and recovery support, and knowing what to do if relapse occurs.

A successful intervention must be planned carefully to work as intended. A poorly planned intervention can worsen the situation — your loved one may feel attacked and become isolated or more resistant to treatment.

Should you consult a professional for an intervention?

Consulting an intervention professional (interventionist), an addiction specialist, psychologist or mental health counselor can help you organize an effective intervention. It may be a good idea to have the intervention professional attend the actual intervention to help keep things on track.

It’s a good idea to get professional help if your loved one:
•Has a history of serious mental illness
•Has a history of violence
•Has had suicidal behavior or recently talked about suicide
•May be taking several mood-altering substances
•Is in denial, likely to become angry or tends to minimize his or her situation

It’s especially important to consult an intervention professional if you suspect your loved one may react violently or self-destructively.

If you’ve never seen a mental health provider before, you may not know how to find one who suits your specific needs. Here are some points to keep in mind as you search for a mental health provider.

What type of mental health provider do you need?

Mental health providers are professionals who diagnose mental health conditions and provide treatment. Most have either a master’s degree or more advanced education and training. Be sure that the mental health provider you choose is licensed to provide mental health services. Services offered depend on the provider’s training and specialty area.

Below you’ll find some of the most common types of mental health providers. Some may specialize in certain areas, such as depression, substance misuse or family therapy. They may work in different settings, such as private practice, hospitals, community agencies or other facilities.

Psychiatrist

A psychiatrist is a physician — doctor of medicine (M.D.) or doctor of osteopathic medicine (D.O.) — who specializes in mental health. This type of doctor may further specialize in areas such as child and adolescent, geriatric, or addiction psychiatry. A psychiatrist can:
•Diagnose and treat mental health disorders
•Provide psychological counseling, also called psychotherapy
•Prescribe medication

Psychologist

A psychologist is trained in psychology — a science that deals with thoughts, emotions and behaviors. Typically, a psychologist holds a doctoral degree (Ph.D., Psy.D., Ed.D.). A psychologist:
•Can diagnose and treat a number of mental health disorders, providing psychological counseling, in one-on-one or group settings
•Cannot prescribe medication unless he or she is licensed to do so
•May work with another provider who can prescribe medication if needed

Psychiatric-mental health nurse

A psychiatric-mental health nurse (P.M.H.N.) is a registered nurse with training in mental health issues. A psychiatric-mental health advanced practice registered nurse (P.M.H.-A.P.R.N.) has at least a master’s degree in psychiatric-mental health nursing. Other types of advanced practice nurses able to provide mental health services include a clinical nurse specialist (C.N.S.), a certified nurse practitioner (C.N.P) or a doctorate of nursing practice (D.N.P.). Mental health nurses:
•Vary in the services they can offer, depending on their education, level of training, experience and state law
•Can assess, diagnose and treat mental illnesses, depending on their education, training and experience
•Can — if state law allows — prescribe medication if they’re an advanced practice nurse

Physician assistant

A certified physician assistant (P.A.-C.) practices medicine under the supervision of a physician. Physician assistants can specialize in psychiatry. These physician assistants can:
•Diagnose and treat mental health disorders
•Provide psychological counseling, also called psychotherapy
•Prescribe medication

Licensed clinical social worker

If you prefer a social worker, look for a licensed clinical social worker (L.C.S.W.) with training and experience specifically in mental health. A licensed clinical social worker must have a master’s degree in social work (M.S.W.), a Master of Science in social work (M.S.S.W.) or a doctorate in social work (D.S.W. or Ph.D.). These social workers:
•Provide assessment, psychological counseling and a range of other services, depending on their licensing and training
•Are not licensed to prescribe medication
•May work with another provider who can prescribe medication if needed

Licensed professional counselor

Training required for a licensed professional counselor (L.P.C.) may vary by state, but most have at least a master’s degree with clinical experience. These counselors:
•Provide diagnosis and psychological counseling (psychotherapy) for a range of concerns
•Are not licensed to prescribe medication
•May work with another provider who can prescribe medication if needed

What factors should you consider?

Consider these factors when choosing among the various types of mental health providers:
•Your concern or condition. Most mental health providers treat a range of conditions, but one with a specialized focus may be more suited to your needs. For example, if you have an eating disorder, you may need to see a psychologist who specializes in that area. If you’re having marital problems, you may want to consult a licensed marriage and family therapist. In general, the more severe your symptoms or complex your diagnosis, the more expertise and training you need to look for in a mental health provider.
•Whether you need medications, counseling or both. Some mental health providers are not licensed to prescribe medications. So your choice may depend, in part, on your concern and the severity of your symptoms. You may need to see more than one mental health provider. For example, you may need to see a psychiatrist to manage your medications and a psychologist or another mental health provider for counseling.
•Your health insurance coverage. Your insurance policy may have a list of specific mental health providers that are covered or only cover certain types of mental health providers. Check ahead of time with your insurance company, Medicare or Medicaid to find out what types of mental health services are covered and what your benefit limits are.

Stigma is when someone judges you based on a personal trait. Unfortunately, this is a common experience for people who have a mental health condition. Stigma may be obvious and direct, such as someone making a negative remark about your mental illness or your treatment. Or it may be subtle, such as someone assuming you could be unstable, violent or dangerous because you have a mental health condition. You may even judge yourself. Some of the harmful effects of stigma can include:
•Lack of understanding by family, friends, colleagues or others you know
•Discrimination at work or school
•Difficulty finding housing
•Bullying, physical violence or harassment
•Health insurance that doesn’t adequately cover your mental illness
•The belief that you will never be able to succeed at certain challenges or that you can’t improve your situation

Steps to cope with stigma

Here are some ways you can deal with stigma:
•Get treatment. You may be reluctant to admit you have a condition that needs treatment. Don’t let the fear of being “labeled” with a mental illness prevent you from seeking help. Treatment can provide relief by identifying what’s wrong in concrete terms and reducing symptoms that interfere with your work and personal life.
•Don’t let stigma create self-doubt and shame. Stigma doesn’t just come from others. You may have the mistaken belief that your condition is a sign of personal weakness, or that you should be able to control it without help. Seeking psychological counseling, educating yourself about your condition and connecting with others with mental illness can help you gain self-esteem and overcome destructive self-judgment.
•Don’t isolate yourself. If you have a mental illness, you may be reluctant to tell anyone about it. Have the courage to confide in your spouse, family members, friends, clergy or other members of your community. Reach out to people you trust for the compassion, support and understanding you need.
•Don’t equate yourself with your illness. You are not an illness. So instead of saying “I’m bipolar,” say “I have bipolar disorder.” Instead of calling yourself “a schizophrenic,” call yourself “a person with schizophrenia.” Don’t say you “are depressed.” Say you “have clinical depression.”
•Join a support group. Some local and national groups, such as the National Alliance on Mental Illness (NAMI) offer local programs and Internet resources that help reduce stigma by educating people with mental illness, their family members and the general public. A number of state and federal agencies and programs also offer support for people who have mental health conditions. Examples include agencies such as Vocational Rehabilitation and Veterans Affairs (VA).
•Get help at school. If you or your child has a mental illness that affects learning, find out what plans and programs might help. Discrimination against students because of a mental health condition is against the law, and educators at primary, secondary and college levels are required to accommodate students as best they can. Talk to teachers, professors or administrators about the best approach and available resources. If a teacher doesn’t know about a student’s disability, it can lead to discrimination, barriers to learning and poor grades.
•Speak out against stigma. Express your opinions at events, in letters to the editor or on the Internet. It can help instill courage in others facing similar challenges and educate the public about mental illness.

Others’ judgments almost always stem from a lack of understanding rather than information based on the facts. Learning to accept your condition and recognize what you need to do to treat it, seeking support, and helping educate others can make a big difference.