1 / 69

Disorders of Mood

Disorders of Mood. Chapter 8. Slides & Handouts by Karen Clay Rhines, Ph.D. American Public University System. Disorders of Mood. Two key emotions : Depression Low, sad state in which life seems dark and its challenges overwhelming Mania State of breathless euphoria or frenzied energy.

teresathomas
Download Presentation

Disorders of Mood

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Disorders of Mood Chapter 8 Slides & Handouts by Karen Clay Rhines, Ph.D. American Public University System

  2. Disorders of Mood • Two key emotions : • Depression • Low, sad state in which life seems dark and its challenges overwhelming • Mania • State of breathless euphoria or frenzied energy Comer, Abnormal Psychology, 8e DSM-5 Update

  3. Disorders of Mood • People with depressive disorders suffer only from depression • This pattern is called unipolar depression • Person has no history of mania • Mood returns to normal when depression lifts • Others experience periods of mania that alternate with periods of depression • This pattern is called bipolar disorder • One might logically expect a third pattern – unipolar mania, in which people suffer from mania only – but this pattern is uncommon Comer, Abnormal Psychology, 8e DSM-5 Update

  4. Disorders of Mood • Mood problems have always captured people’s interest • Millions of people have mood problems • Economic costs of mood problems amount to many billions of dollars each year • The human suffering is beyond calculation Comer, Abnormal Psychology, 8e DSM-5 Update

  5. Unipolar Depression • The term “depression” is often used to describe general sadness or unhappiness • This loose use of the term confuses a normal mood swing with a clinical syndrome • Depressive disorders can bring severe and long-lasting psychological pain that may intensify as time goes by Comer, Abnormal Psychology, 8e DSM-5 Update

  6. How Common Is Unipolar Depression? • Around 8% of adults in the U.S. suffer from severe unipolar depression in any given year • As many as 5% suffer from mild forms • Around 19% of all adults experience unipolar depression at some time in their lives • The prevalence is similar in Canada, England, France, and many other countries • The rate of depression is higher among poor people than wealthier people Comer, Abnormal Psychology, 8e DSM-5 Update

  7. How Common Is Unipolar Depression? • People of any age may suffer from unipolar depression • Women are at least twice as likely as men to experience severe unipolar depression • Lifetime prevalence: 26% of women vs. 12% of men • Among children, the prevalence is similar among boys and girls • Approximately 85% of people with unipolar depression recover, some without treatment • Around 40% will experience another episode later in their lives Comer, Abnormal Psychology, 8e DSM-5 Update

  8. What Are the Symptoms of Unipolar Depression? • Symptoms may vary from person to person • Five main areas of functioning may be affected: • Emotional symptoms • Feeling “miserable,” “empty,” “humiliated” • Experiencing little pleasure • Motivational symptoms • Lacking drive, initiative, spontaneity • Between 6% and 15% of those with severe depression die by suicide Comer, Abnormal Psychology, 8e DSM-5 Update

  9. What Are the Symptoms of Unipolar Depression? • Five main areas of functioning may be affected: • Behavioral symptoms • Less active, less productive • Cognitive symptoms • Hold negative views of themselves • Blame themselves for unfortunate events • Pessimistic • Physical symptoms • Headaches, dizzy spells, general pain Comer, Abnormal Psychology, 8e DSM-5 Update

  10. Diagnosing Unipolar Depression • A major depressive episode is a period of two or more weeks marked by five or more symptoms of depression • In extreme cases, symptoms are psychotic, including • Hallucinations • Delusions Comer, Abnormal Psychology, 8e DSM-5 Update

  11. Diagnosing Unipolar Depression • DSM-5 lists several types of depressive disorders: • Major depressive disorder • People who experience a major depressive episode with no history of mania • Dysthymic disorder • Individuals who experience a longer-lasting (at least two years) but less disabling pattern of depression Comer, Abnormal Psychology, 8e DSM-5 Update

  12. Diagnosing Unipolar Depression • DSM-5 lists several types of depressive disorders: • Premenstrual dysphoric disorder • A diagnosis given to women who repeatedly experience clinically significant depressive symptoms during the week before menstruation • Disruptive mood regulation disorder • Characterized by a combination of persistent depressive symptoms and recurrent outbursts of severe temper Comer, Abnormal Psychology, 8e DSM-5 Update

  13. What Causes Unipolar Depression? • Stress may be a trigger for depression • People with depression experience a greater number of stressful life events during the month just before the onset of their symptoms • Some clinicians distinguish reactive (exogenous) depression from endogenous depression, which seems to be a response to internal factors Comer, Abnormal Psychology, 8e DSM-5 Update

  14. What Causes Unipolar Depression? • Today’s clinicians usually concentrate on recognizing both the situational and the internal aspects of any given case • The current explanations of unipolar depression point to biological, psychological, and sociocultural factors Comer, Abnormal Psychology, 8e DSM-5 Update

  15. What Causes Unipolar Depression?The Biological View • Genetic factors • Family pedigree, twin, adoption, and molecular biology gene studies suggest that some people inherit a biological predisposition • Researchers have found that as many as 20% of relatives of those with depression are themselves depressed, compared with fewer than 10% of the general population Comer, Abnormal Psychology, 8e DSM-5 Update

  16. What Causes Unipolar Depression?The Biological View • Genetic factors • Twin studies demonstrate a strong genetic component: • Concordance rates for identical (MZ) twins = 46% • Concordance rates for fraternal (DZ) twins = 20% • Adoption studies also have implicated a genetic factor in cases of severe unipolar depression • Using techniques from the field of molecular biology, researchers have found evidence that unipolar depression may be tied to specific genes Comer, Abnormal Psychology, 8e DSM-5 Update

  17. What Causes Unipolar Depression?The Biological View • Biochemical factors • NTs: serotonin and norepinephrine • In the 1950s, medications for high blood pressure were found to cause depression • Some lowered serotonin, others lowered norepinephrine • The discovery of truly effective antidepressant medications, which relieved depression by increasing either serotonin or norepinephrine, confirmed the NT role • Depression likely involves not just serotonin nor norepinephrine… a complicated interaction is at work, and other NTs may be involved Comer, Abnormal Psychology, 8e DSM-5 Update

  18. What Causes Unipolar Depression?The Biological View • Biochemical factors • Endocrine system / hormone release • People with depression have been found to have abnormal levels of cortisol • Released by the adrenal glands during times of stress • People with depression have been found to have abnormal melatonin secretion • “Dracula hormone” • Other researchers are investigating deficiencies of important proteins within neurons as tied to depression Comer, Abnormal Psychology, 8e DSM-5 Update

  19. What Causes Unipolar Depression?The Biological View • Biochemical factors • Model has produced much enthusiasm but has certain limitations: • Relies on analogue studies: depression-like symptoms created in lab animals • Do these symptoms correlate with human emotions? • Measuring brain activity has been difficult and indirect • Current studies using newer technology are attempting to address this issue Comer, Abnormal Psychology, 8e DSM-5 Update

  20. What Causes Unipolar Depression?The Biological View • Brain anatomy and brain circuits • Biological researchers have determined that emotional reactions of various kinds are tied to brain circuits • These are networks of brain structures that work together, triggering each other into action and producing a particular kind of emotional reaction • It appears that one circuit is tied to GAD, another to panic disorder, and yet another to OCD • Although research is far from complete, a circuit responsible for unipolar depression has begun to emerge • Likely brain areas in the circuit include the prefrontal cortex, hippocampus, amygdala, and Brodmann Area 25 Comer, Abnormal Psychology, 8e DSM-5 Update

  21. What Causes Unipolar Depression?The Biological View • Immune System • This system is the body’s network of activities and cells that fight off bacteria and other foreign invaders • When stressed, the immune system may become dysregulated, which some believe may help produce depression • Support for this explanation is circumstantial but compelling Comer, Abnormal Psychology, 8e DSM-5 Update

  22. What Causes Unipolar Depression?The Psychological Views • Three main models: • Psychodynamic model • No strong research support • Behavioral model • Modest research support • Cognitive views • Considerable research support Comer, Abnormal Psychology, 8e DSM-5 Update

  23. What Causes Unipolar Depression?The Psychological Views • Psychodynamic view • Link between depression and grief • When a loved one dies, an unconscious process begins and the mourner regresses to the oral stage and experiences introjection – a directing of feelings for the loved one onto oneself • For most people, introjection is temporary • For some, grief worsens over time; if grief is severe and long-lasting, depression results • Those with oral stage issues (unmet or excessively met needs) are at greater risk for developing depression • Instead of actual loss, some people experience “symbolic” (or imagined) loss instead • Newer psychoanalysts (object relations theorists) propose that depression results when people’s relationships leave them feeling unsafe and insecure Comer, Abnormal Psychology, 8e DSM-5 Update

  24. What Causes Unipolar Depression?The Psychological Views • Psychodynamic view • Strengths: • Studies have offered general support for the psychodynamic idea that depression may be triggered by a major loss (e.g., anaclitic depression) • Research supports the theory that early losses set the stage for later depression • Research also suggests that people whose childhood needs were improperly met are more likely to become depressed after experiencing a loss Comer, Abnormal Psychology, 8e DSM-5 Update

  25. What Causes Unipolar Depression?The Psychological Views • Psychodynamic view • Limitations: • Early losses and inadequate parenting sometimes lead to depression but may not be typically responsible for development of the disorder • Many research findings are inconsistent • Certain features of the model are nearly impossible to test Comer, Abnormal Psychology, 8e DSM-5 Update

  26. What Causes Unipolar Depression?The Psychological Views • Behavioral view • Depression results from changes in rewards and punishments people receive in their lives • Lewinsohn suggests that the positive rewards in life dwindle for some people, leading them to perform fewer and fewer constructive behaviors, and they spiral toward depression • Research supports the relationship between the number of rewards received and the presence or absence of depression • Social rewards are especially important Comer, Abnormal Psychology, 8e DSM-5 Update

  27. What Causes Unipolar Depression?The Psychological Views • Behavioral view • Strengths: • Researchers have compiled significant data to support this theory • Limitations: • Research has relied heavily on the self-reports of depressed subjects • Behavioral studies are largely correlational and do not establish that decreases in rewards are the initial cause of depression Comer, Abnormal Psychology, 8e DSM-5 Update

  28. What Causes Unipolar Depression?The Psychological Views • Cognitive views • Two main theories: • Negative thinking • Learned helplessness Comer, Abnormal Psychology, 8e DSM-5 Update

  29. What Causes Unipolar Depression?The Psychological Views • Cognitive views • Negative thinking • Beck theorizes four interrelated cognitive components combine to produce unipolar depression: • Maladaptive attitudes • Self-defeating attitudes are developed during childhood • Beck suggests that upsetting situations later in life can trigger an extended round of negative thinking Comer, Abnormal Psychology, 8e DSM-5 Update

  30. What Causes Unipolar Depression?The Psychological Views • Cognitive views • This negative thinking typically takes three forms, called the cognitive triad: • Individuals repeatedly interpret (1) their experiences, (2) themselves, and (3) their futures in negative ways, leading to depression Comer, Abnormal Psychology, 8e DSM-5 Update

  31. What Causes Unipolar Depression?The Psychological Views • Cognitive views • Negative thinking • Depressed people also make errors in their thinking, including: • Arbitrary inferences • Minimization of the positive and magnification of the negative • Depressed people also experience automatic thoughts • A steady train of unpleasant thoughts that suggest inadequacy and hopelessness Comer, Abnormal Psychology, 8e DSM-5 Update

  32. What Causes Unipolar Depression?The Psychological Views • Cognitive views • Strengths: • Many studies have produced evidence in support ofBeck’s explanation: • High correlation between the level of depression and the number of maladaptive attitudes held • Both the cognitive triad and errors in logic are seen in people with depression • Automatic thinking has been linked to depression • Limitations: • Research fails to show that such cognitive patterns are the cause and core of unipolar depression Comer, Abnormal Psychology, 8e DSM-5 Update

  33. What Causes Unipolar Depression?The Psychological Views • Cognitive views • Learned helplessness • This theory asserts that people become depressed when they think that: • They no longer have control over the reinforcements (rewards and punishments) in their lives • They themselves are responsible for this helpless state Comer, Abnormal Psychology, 8e DSM-5 Update

  34. What Causes Unipolar Depression?The Psychological Views • Cognitive views • Learned helplessness • Theory is based on Seligman’s work with laboratory dogs • Dogs subjected to uncontrollable shock were later placed in a shuttle box • Even when presented with an opportunity to escape, dogs that had experienced uncontrollable shocks made no attempt to do so • Seligman theorized that the dogs had “learned” to be “helpless” to do anything to change negative situations, and drew parallels to human depression Comer, Abnormal Psychology, 8e DSM-5 Update

  35. What Causes Unipolar Depression?The Psychological Views • Cognitive views • Learned helplessness • There has been significant research support for this model • Human subjects who undergo helplessness training score higher on depression scales and demonstrate passivity in laboratory trials • Animal subjects lose interest in sex and social activities • In rats, uncontrollable negative events result in lower serotonin and norepinephrine levels in the brain Comer, Abnormal Psychology, 8e DSM-5 Update

  36. What Causes Unipolar Depression?The Psychological Views • Cognitive views • Learned helplessness • Recent versions of the theory focus on attributions • Internal attributions that are global and stable lead to greater feelings of helplessness and possibly depression • Example: “It’s all my fault” [internal]. “I ruin everything I touch” [global] “and I always will” [stable]. • If people make other kinds of attributions, this reaction is unlikely • Example: “She had a role in this also” [external], “the way I’ve behaved the past couple weeks blew this relationship” [specific]. “I don’t know what got into me – I don’t usually act like that” [unstable]. Comer, Abnormal Psychology, 8e DSM-5 Update

  37. What Causes Unipolar Depression?The Psychological Views • Cognitive views • Learned helplessness • Some theorists have refined the helplessness model yet again in recent years; they suggest that attributions are likely to cause depression only when they further produce a sense of hopelessness in an individual Comer, Abnormal Psychology, 8e DSM-5 Update

  38. What Causes Unipolar Depression?The Psychological Views • Cognitive views • Learned helplessness • Strengths: • Hundreds of studies have supported the relationship between styles of attribution, helplessness, and depression • Limitations: • Laboratory helplessness does not parallel depression in every way • Much of the research relies on animal subjects • The attributional component of the theory raises particularly difficult questions in terms of animal models of depression Comer, Abnormal Psychology, 8e DSM-5 Update

  39. What Causes Unipolar Depression?Sociocultural Views • Sociocultural theorists propose that unipolar depression is greatly influenced by the social context that surrounds people • This belief is supported by the finding that depression is often triggered by outside stressors • There are two kinds of sociocultural views: • The family-social perspective • The multicultural perspective Comer, Abnormal Psychology, 8e DSM-5 Update

  40. What Causes Unipolar Depression?Sociocultural Views • The Family-Social Perspective • The connection between declining social rewards and depression (as discussed by the behaviorists) is a two-way street • Depressed people often display social deficits that make other people uncomfortable and may cause them to avoid the depressed individuals • This leads to decreased social contact and a further deterioration of social skills Comer, Abnormal Psychology, 8e DSM-5 Update

  41. What Causes Unipolar Depression?Sociocultural Views • The Family-Social Perspective • Consistent with these findings, depression has been tied repeatedly to the unavailability of social support such as that found in a happy marriage • People who are separated or divorced display three times the depression rate of married or widowed persons and double the rate of people who have never been married • There also is a high correlation between level of marital conflict and degree of sadness that is particularly strong among those who are clinically depressed • It also appears that people who are isolated and without intimacy are particularly likely to become depressed in times of stress Comer, Abnormal Psychology, 8e DSM-5 Update

  42. What Causes Unipolar Depression?Sociocultural Views • The Multicultural Perspective • Two kinds of relationships have captured the interest of multicultural theorists: • Gender and depression • A strong link exists between gender and depression • Women cross-culturally are twice as likely as men to receive a diagnosis of unipolar depression • Women also appear to be younger, have more frequent and longer-lasting bouts, and to respond less successfully to treatment Comer, Abnormal Psychology, 8e DSM-5 Update

  43. What Causes Unipolar Depression?Sociocultural Views • The Multicultural Perspective • A variety of theories has been offered: • The artifact theory holds that women and men are equally prone to depression, but that clinicians often fail to detect depression in men • The hormone explanation holds that hormone changes trigger depression in many women • The life stress theory suggests that women in our society experience more stress than men Comer, Abnormal Psychology, 8e DSM-5 Update

  44. What Causes Unipolar Depression?Sociocultural Views • The Multicultural Perspective • A variety of theories has been offered: • The body dissatisfaction theory state that females in Western society are taught, almost from birth, to seek a low body weight and slender body shape – goals that are unreasonable, unhealthy, and often unattainable • The lack-of-control theory picks up the learned helplessness research and argues that women may be more prone to depression because they feel less control than men over their lives Comer, Abnormal Psychology, 8e DSM-5 Update

  45. What Causes Unipolar Depression?Sociocultural Views • The Multicultural Perspective • A variety of theories has been offered: • The rumination theory holds that people who ruminate when sad – keep focusing on their feelings and repeatedly consider the causes and consequences of their depression – are more likely to become depressed and stay depressed longer Comer, Abnormal Psychology, 8e DSM-5 Update

  46. What Causes Unipolar Depression?Sociocultural Views • The Multicultural Perspective • Each explanation offers food for thought and has gathered just enough supporting evidence to make it interesting (and just enough contrary evidence to raise question about its usefulness) Comer, Abnormal Psychology, 8e DSM-5 Update

  47. What Causes Unipolar Depression?Sociocultural Views • The Multicultural Perspective • Two kinds of relationships have captured the interest of multicultural theorists: • Cultural background and depression • Depression is a worldwide phenomenon, and certain symptoms seem to be constant across all countries, including sadness, joylessness, anxiety, tension, lack of energy, loss of interest, and thoughts of suicide • Beyond such core symptoms, research suggests that the precise picture of depression varies from country to country Comer, Abnormal Psychology, 8e DSM-5 Update

  48. What Causes Unipolar Depression?Sociocultural Views • The Multicultural Perspective • Depressed people in non-Western countries are more likely to be troubled by physical symptoms of depression than by cognitive ones • As countries become more Westernized, depression seems to take on the more cognitive character it has in the West Comer, Abnormal Psychology, 8e DSM-5 Update

  49. What Causes Unipolar Depression?Sociocultural Views • The Multicultural Perspective • Within the United States, researchers have found few differences in depression symptoms among members of different ethnic or racial groups, however, often striking differences exist between racial/ethnic groups on the chronicity of depression • Hispanic Americans and African Americans are 50 percent more likely than white Americans to have recurrent episodes of depression - a finding possibly related to limited treatment opportunities Comer, Abnormal Psychology, 8e DSM-5 Update

  50. What Causes Unipolar Depression?Sociocultural Views • The Multicultural Perspective • In addition, although overall depression rates are similar, differences exist in specific populations living under oppressive circumstances • In a study of one Native American village, lifetime risk was 37% among women, 19% among men, and 28% overall • These findings are thought to be the result of economic and social pressures Comer, Abnormal Psychology, 8e DSM-5 Update

More Related