Caraga State University

Butuan City
2nd Sem., AY 2021-2022

Psych 110 - Abnormal Psychology

Facilitator: Ruth E. Sanchez

7.1 Mood Disorders and Suicide Part 1

Characteristics of Depressive Disorders

Characteristics of Bipolar Disorder
Theories of Depression
Theories of Bipolar Depression

CHARACTERISTICS OF DEPRESSIVE DISORDERS

SYMPTOMS OF DEPRESSION

A cardinal symptom of depression is depressed mood out of proportion to any cause. Many people diagnosed
with depression report that they have lost interest in everything in life, a symptom referred to as anhedonia.

 Behaviorally, many people with depression are slowed down, a condition known as psychomotor
retardation.
o They walk more slowly, gesture more slowly, and talk more slowly and quietly.
 The thoughts of people with depression may be filled with themes of worthlessness, guilt,
hopelessness, and even suicide.
 In some severe cases, people with depression lose touch with reality, experiencing delusions (beliefs
with no basis in reality) and hallucinations (seeing, hearing, or feeling things that are not real).

DIAGNOSING DEPRESSIVE DISORDERS

 A severe bout of depressive symptoms lasting two weeks or more can be diagnosed as a major
depressive disorder.
o The diagnosis of major depressive disorder requires that a person experience either depressed
mood or loss of interest in usual activities, plus at least four other symptoms of depression,
chronically for at least 2 weeks
o In addition, these symptoms must be severe enough to interfere with the person's ability to
function in everyday life.
o People who experience only one depressive episode receive a diagnosis of major depressive
disorder, single episode.
o Two or more episodes separated by at least 2 consecutive months without symptoms merit
the diagnosis of major depressive disorder, recurrent episode.
o The DSM-5 criteria include a note to clinicians that a "normal and expected" depressive
response to a negative event such as a loss should not be diagnosed as a major depressive
disorder unless other, more atypical symptoms are present, including worthlessness, suicidal
ideas, psychomotor retardation, and severe impairment.
 o In addition, research has shown that a syndrome labeled complicated grief is shown by 10 to
15 percent of bereaved people, characterized by strong yearning for the deceased person and
preoccupation with the loss, persistent regrets about one's own or others' behavior toward
the deceased, difficulty accepting the finality of the loss, and a sense that life is empty and
meaningless
 More chronic forms of depression have been reformulated in DSM-5.
o Persistent depressive disorder (formerly dysthymic disorder and chronic major depressive
disorder in DSM-IV) has as its essential feature depressed mood for most of the day, for more
days than not, for at least 2 years.
 In children and adolescents, persistent depressive disorder requires depressed or
irritable mood for at least 1 year duration.
 In addition, its diagnosis requires the presence of two or more of the following
symptoms: (a) poor appetite, (b) insomnia or hypersomnia, (c) low energy or fatigue,
(d) low self-esteem, (e) poor concentration, and/ or (f) hopelessness.
 During these 2 years (1 year in youth), the person must never have been without
symptoms of depression for longer than a 2-month period.
 When an individual meets diagnostic criteria for major depressive disorder for 2 years,
he or she is also given the diagnosis of persistent depressive disorder.

 The DSM-5 recognizes several subtypes of depression.

o The first subtype is depression with anxious distress.
 Anxiety is extremely common in depression, and people with this subtype have
prominent anxiety symptoms as well as depressive symptoms.
o The second subtype of depression is with mixed features.
  People with this subtype meet the criteria for a major depressive disorder and have at
least 3 symptoms of mania, but they do not meet the full criteria for a manic episode
o The third subtype is depression with melancholic features, in which the physiological
symptoms of depression are particularly prominent.
o The fourth subtype is depression with psychotic features, in which people experience
delusions and hallucinations.
o In the fifth subtype, depression with catatonic features, people show the strange behaviors
collectively known as catatonia, which can range from a complete lack of movement to excited
agitation.
o The sixth subtype is depression with atypical features-the criteria for this subtype are an odd
assortment of symptoms
o The seventh subtype of major depressive disorder is depression with seasonal pattern, also
referred to as seasonal affective disorder, or SAD.
 People with SAD have a history of at least 2 years of experiencing and fully recovering
from major depressive episodes.
 Some people with this disorder actually develop mild forms of mania or have full
manic episodes during the summer months and are diagnosed with bipolar disorder
with seasonal pattern.
o Eighth is depression with peripartum onset.
 This diagnosis is given to women when the onset of a major depressive episode occurs
during pregnancy or in the 4 weeks following childbirth.
 Because 50 percent of "postpartum" major depressive episodes actually begin prior to
delivery, DSM-5 refers to these episodes collectively as peripartum episodes.
o The last depressive disorder is premenstrual dysphoric disorder.
 Some women regularly experience significant increases in distress during the
premenstrual phase of their menstrual cycle.

PREVALENCE AND COURSE OF DEPRESSIVE DISORDERS

 The rates of depression rise among people over age 85.

 It may be surprising that the rate of depression is so low among adults over age 65.
 Diagnosing depression in older adults is complicated
o First, older adults may be less willing than younger adults to report the symptoms of
depression because they grew up in a society less accepting of depression.
o Second, depressive symptoms in older adults often occur in the context of a serious medical
illness, which can interfere with making an appropriate diagnosis
 o Third, older people are more likely than younger people to have mild to severe cognitive
impairment, and it is often difficult to distinguish between a depressive disorder and the early
stages of a cognitive disorder
 Although these factors are important, other researchers suggest that the low rate is valid, and they
have offered several explanations for it
o The first is quite grim: Depression appears to interfere with physical health, and as a result
people with a history of depression may be more likely to die before they reach old age.
o The second explanation is more hopeful: As people age, they may develop more adaptive
coping skills and a psychologically healthier outlook on life
o We consider a third explanation, that there have been historical changes in people's
vulnerability to depression, later in this chapter
 Depression is less common among children than among adults.
 Children will often show irritability instead of sadness; also, rather than lose weight,
they may simply fail to gain the weight expected for their developmental period
 Women are about twice as likely as men to experience both mild depressive symptoms and severe
depressive disorders
 Depression is a costly disorder, both to the individual and to society.
o People who have a diagnosis of major depression lose an average of 27 days of work per year
because of their symptoms.
 The good news is that when people undergo treatment for their depression, they tend to recover
much more quickly than they would without treatment and to reduce their risk of relapse.
 The bad news is that many people with depression either never seek care or wait years after the onset
of symptoms before they seek care

CHARACTERISTICS OF BIPOLAR DISORDER

SYMPTOMS OF MANIA

 The mood of people who are manic can be elated, but that elation is often mixed with irritation and
agitation
 People with mania have unrealistically positive and grandiose (inflated) self-esteem.
 They experience racing thoughts and impulses.
 At times, these grandiose thoughts are delusional and may be accompanied by grandiose
hallucinations.
 In order to be diagnosed with a manic episode, an individual must show an elevated, expansive, or
irritable mood for at least 1 week, as well as at least three of the other symptoms
 These symptoms must impair the individual's functioning.
 People who experience manic episodes meeting these criteria are said to have bipolar I disorder.
o Some people diagnosed with bipolar I disorder have mixed episodes in which they experience
the full criteria for manic episodes and at least three key symptoms of major depressive
episodes in the same day, every day for at least 1 week.
 People with bipolar II disorder experience severe episodes of depression that meet the criteria for
major depression, but their episodes of mania are milder and are known as hypomania
o Hypomania involves the same symptoms as mania.
o The major difference is that in hypomania these symptoms are not severe enough to interfere
with daily functioning, do not involve hallucinations or delusions, and last at least 4
consecutive days.

 There is also a less severe but more chronic form of bipolar disorder, known as cyclothymic disorder.
o A person with distinct cyclothymic disorder alternates between periods of hypomanic
symptoms and periods of depressive symptoms, chronically over at least a 2-year period.
 o The hypomanic and depressive symptoms are of insufficient number, severity, or duration to
meet full criteria for hypomania or major depressive episode, respectively.
o People with cyclothymic disorder are at increased risk of developing bipolar disorder
 One area of great interest and controversy is bipolar disorder in youth.
o Increasingly, researchers and clinicians have become interested in identifying early signs of
bipolar disorder in children and young teenagers so interventions can be initiated and
researchers can investigate the causes and course of the disorder in youth
 Although some children show the alternating episodes of mania and depression interspersed with
periods of normal mood characteristic of bipolar disorder, others show chronic symptoms and rapid
mood switches.
 The authors of the DSM-5 decided to distinguish children with these temper tantrums from children
with more classic bipolar disorder by adding a new diagnosis for youth age 6 and older called
disruptive mood dysregulation disorder.
o To qualify for this diagnosis, a young person must show severe temper outbursts that are
grossly out of proportion in intensity and duration to a situation and inconsistent with
developmental level.
o To receive the diagnosis, a child must have at least three temper outbursts per week for at
least 12 months and in at least two settings (e.g., home and school).

PREVALENCE AND COURSE OF BIPOLAR DISORDER

 Bipolar disorder is less common than depressive disorders.

o Internationally, only 0.6 percent of people will experience bipolar I disorder and only 0.4
percent of people bipolar II disorder in their lifetimes

CREATIVITY AND THE MOOD DISORDERS

Some theorists have argued that the symptoms of mania-increased self-esteem, a rush of ideas and the
courage to pursue those ideas, high energy, little need for sleep, excessive optimism, and decisiveness-can
actually have benefits in certain settings.

 In turn, the melancholy of depression is often seen as inspirational for artists.

o Political leaders including Abraham Lincoln, Alexander Hamilton have been posthumously
diagnosed by psychiatric biographers as having had periods of mania, hypomania, or
depression
o Although during periods of depression these leaders often were incapacitated, during periods
of mania and hypomania they accomplished extraordinary feats.

THEORIES OF DEPRESSION

BIOLOGICAL THEORIES OF DEPRESSION

 Genetic Factors
o Family history studies find that the first-degree relatives of people with major depressive
disorder are two to three times more likely to also have depression than are the first-degree
relatives of people without the disorder
o Twin studies of major depression find higher concordance rates for monozygotic twins than for
dizygotic twins, implicating genetic processes in the disorder
 Neurotransmitter Theories
o The neurotransmitters that have been implicated most often in depression are the
monoamines, specifically, norepinephrine, serotonin, and, to a lesser extent, dopamine.
o These neurotransmitters are found in large concentrations in the limbic system, a part of the
brain associated with the regulation of sleep, appetite, and emotional processes.
o The early theory of the role of these neurotransmitters in mood disorders was that depression
is caused by a reduction in the amount of norepinephrine or serotonin in the synapses
between neurons
 Structural and Functional Brain Abnormalities
o Neuroimaging studies have found consistent abnormalities in at least four areas of the brain in
people with depression: the prefrontal cortex, anterior cingulate, hippocampus, and amygdala
o Critical functions of the prefrontal cortex include attention, working memory, planning, and
novel problem solving.
o The anterior cingulate, a subregion of the prefrontal cortex, plays an important role in the
body's response to stress, in emotional expression, and in social behavior
o The hippocampus is critical in memory and in fear-related learning.
 Neuroimaging studies show smaller volume and lower metabolic activity in the
hippocampus of people with major depression
 People with depression show chronically high levels of the hormone cortisol,
particularly in response to stress, indicating that their bodies overreact to stress and
their levels of cortisol do not return to normal as quickly as those of nondepressed
people.
o Abnormalities in the structure and functioning of the amygdala also are found in depression
 The amygdala helps direct attention to stimuli that are emotionally salient and have
major significance for the individual.
 Studies of people with mood disorders show an enlargement and increased activity in
this part of the brain, and activity in the amygdala has been observed to decrease to
normal levels in people successfully treated for depression
 Neuroendocrine Factors
o Hormones have long been thought to play a role in mood disorders, especially depression.
o Three key components of the neuroendocrine system - the hypothalamus, pituitary, and
adrenal cortex - work together in a biological feedback system richly interconnected with the
amygdala, hippocampus, and cerebral cortex. This system, often referred to as the
hypothalamic-pituitary adrenal axis, or HPA axis, is involved in the fight-or-flight response
o Normally, when we are confronted with a stressor, the hypothalamus releases
corticotropinreleasing hormone (CRH) onto receptors on the anterior pituitary
o People with depression tend to show elevated levels of cortisol and CRH, indicating chronic
hyperactivity in the HPA axis and difficulty in the HPA axis's returning to normal functioning
following a stressor
o Changes in the ovarian hormones, estrogen and progesterone, affect the serotonin and
norepinephrine neurotransmitter systems and thus theoretically could affect mood.
o Some women show increases in depressed mood when their levels of estrogen and
progesterone are in flux, such as during pregnancy and the postpartum period and
premenstrually
PSYCHOLOGICAL THEORIES OF DEPRESSION

 Behavioral Theories
o Depression often arises as a reaction to stressful negative events, such as the breakup of a
relationship, the death of a loved one, a job loss, or a serious medical illness
o Behavioral theories of depression suggest that life stress leads to depression because it
reduces the positive reinforcers in a person's life
 Behavioral theorists suggest that such a pattern is especially likely in people with poor
social skills, because they are more likely to experience rejection by others and also
more likely to withdraw in response to rejection than to find ways to overcome it
o Another behavioral theory - the learned helplessness theory - suggests that the type of
stressful event most likely to lead to depression is an uncontrollable negative event
 Such events, especially if they are frequent or chronic, can lead people to believe they
are helpless to control important outcomes in their environment.
 In turn, this belief in helplessness leads people to lose their motivation and to reduce
actions on their part that might control the environment as well as leaving them
unable to learn how to control situations that are controllable.
 Cognitive Theories
o Aaron Beck (1967) argued that people with depression look at the world through a negative
cognitive triad: They have negative views of themselves, the world, and the future.
 Beck's theory led to one of the most widely used and successful therapies for
depression----cognitive-behavioral therapy.
o Another cognitive theory of depression, the reformulated learned helplessness theory,
explains how cognitive factors might influence whether a person becomes helpless and
depressed following a negative event
 This theory focuses on people's causal attributions for events.
 A causal attribution is an explanation of why an event happened.
 According to this theory, people who habitually explain negative events by causes that
are internal, stable, and global tend to blame themselves for these negative events,
expect negative events to recur in the future, and expect to experience negative
events in many areas of their lives.
o Hopelessness depression develops when people make pessimistic attributions for the most
important events in their lives and perceive that they have no way to cope with the
consequences of these events
o Another cognitive theory, the ruminative response styles theory, focuses more on the process
of thinking than on the content of thinking as a contributor to depression
 They do not attempt to do anything about these causes, however, and instead
continue to engage in rumination about their depression.
 Several studies have shown that people with this more ruminative coping style are
more likely to develop major depression
o In addition, depressed people tend to show overgeneral memory
 When given a simple word cue such as "angry" and asked to describe a memory
prompted by that cue, depressed people are more likely than nondepressed people to
offer memories that are highly general (e.g., "People who are mean") instead of
concrete (e.g., "Jane being rude to me last Friday")
  Interpersonal Theories
o The interpersonal relationships of people with depression often are fraught with difficulty. The
interpersonal theories of depression focus on these relationships.
 Interpersonal difficulties and losses frequently precede depression and are the
stressors most commonly reported as triggering depression
 Some depressed people have a heightened need for approval and expressions of
support from others but at the same time easily perceive rejection by others, a
characteristic called rejection sensitivity
 They engage in excessive reassurance seeking, constantly looking for
assurances from others that they are accepted and loved
 Sociocultural Theories
o Sociocultural theorists have focused on how differences in the social conditions of
demographic groups lead to differences in vulnerability to depression.
o Historical changes may have put more recent generations at higher risk for depression than
previous generations, a phenomenon called a cohort effect
 That younger generations have unrealistically high expectations for themselves that
older generations did not have.
o We noted earlier that women are about twice as likely as men to suffer from depression.
Several explanations have been offered for this gender difference
 When faced with distress, men are more likely than women to turn to alcohol to cope
and to deny that they are distressed, while women are more likely than men to
ruminate about their feelings and problems

THEORIES OF BIPOLAR DISORDER

BIOLOGICAL THEORIES OF BIPOLAR DISORDER

 Genetic Factors
o Bipolar disorder is strongly and consistently linked to genetic factors, although the specific
genetic abnormalities that contribute to bipolar disorder are not yet known.
o First-degree relatives (parents, children, and siblings) of people with bipolar disorder have 5 to
10 times higher rates of both bipolar disorder and depressive disorders than relatives of
people without bipolar disorder
 Structural and Functional Brain Abnormalities
o Like the depressive disorders, bipolar disorder is associated with abnormalities in the structure
and functioning of the amygdala, which is involved in the processing of emotions and the
prefrontal cortex, which is involved in cognitive control of emotion, planning, and judgment
o An area of the brain called the striatum, part of a structure called the basal ganglia, is involved
in the processing of environmental cues of reward.
 This area of the brain is activated abnormally in people with bipolar disorder but not
consistently so in people with major depression, suggesting that people with bipolar
disorder may be hypersensitive to rewarding cues in the environment
 When they are in a manic phase, they inflexibly and excessively seek reward; when
they are in a depressive phase, they are highly insensitive to reward
  Neurotransmitter Factors
o The monoamine neurotransmitters have been implicated in bipolar disorder as well as in
major depressive disorder.
o High levels of dopamine are thought to be associated with high reward seeking, while low
levels are associated with insensitivity to reward.

PSYCHOSOCIAL CONTRIBUTORS TO BIPOLAR DISORDER

In line with biological evidence that dysregulation of reward systems plays a role in bipolar disorder,
psychologists have been examining relationships between bipolar disorder and behavioral indicators of
sensitivity to reward.

 In some of these studies, individuals play games on the computer, such as gambling games, that assess
their willingness to take risks in order to pursue possible rewards and their ability to detect what kinds
of behaviors will be rewarded.
o These studies confirm that people with bipolar disorder, even when they are asymptomatic,
show greater sensitivity to reward than do people without the disorder
 In contrast, individuals with high sensitivity to punishment relapsed into depressive episodes sooner
than did those with lower sensitivity to punishment.
 Another psychological factor that has been studied in people with bipolar disorder is stress.
o Experiencing stressful events and living in an unsupportive family may trigger new episodes of
bipolar disorder
o Even positive events can trigger new episodes of mania or hypomania, particularly if they
involve striving for goals seen as highly rewarding.
 Changes in bodily rhythms or usual routines also can trigger episodes in people with bipolar disorder

Thank you so much for our time together!