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Comer, Abnormal Psychology, 7e

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Title: Comer, Abnormal Psychology, 7e


1
Mood Disorders
  • Chapter 8

2
Mood Disorders
  • Two key emotions on a continuum
  • Depression
  • Low, sad state in which life seems dark and its
    challenges overwhelming
  • Mania
  • State of breathless euphoria or frenzied energy

3
Mood Disorders
  • Most people with a mood disorder experience only
    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

4
Mood Disorders
  • Mood disorders have always captured peoples
    interest
  • Millions of people have mood disorders
  • Economic costs of mood disorders amount to more
    than 80 billion each year
  • The human suffering is incalculable

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
  • Clinical depression can bring severe and
    long-lasting psychological pain that may
    intensify over time

6
How Common Is Unipolar Depression?
  • Almost 7 of adults in the U.S. suffer from
    severe unipolar depression in any given year
  • As many as 5 suffer from mild forms
  • The prevalence is similar in Canada, England,
    France, and many other countries
  • Approximately 17 of all adults experience
    unipolar depression at some time in their lives
  • The risk of experiencing this problem has
    increased steadily since 1915

7
How Common Is 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
  • These rates hold true across socioeconomic
    classes and ethnic groups
  • Approximately 50 recover within six weeks and
    90 within a year, some without treatment
  • Most will experience another episode at some point

8
What Are the Symptoms of 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 commit suicide

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
  • Pessimism
  • Physical symptoms
  • Headaches, dizzy spells, general pain

10
Diagnosing Unipolar Depression
  • Criteria 1 Major depressive episode
  • Marked by five or more symptoms lasting two or
    more weeks
  • In extreme cases, symptoms are psychotic,
    including
  • Hallucinations
  • Delusions
  • Criteria 2 No history of mania

11
Diagnosing Unipolar Depression
  • Two diagnoses to consider
  • Major depressive disorder
  • Criteria 1 and 2 are met
  • Dysthymic disorder
  • Symptoms are mild but chronic
  • Depression is longer lasting but less disabling
  • Consistent symptoms for at least two years
  • When dysthymic disorder leads to major depressive
    disorder, the sequence is called double
    depression

12
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
  • Todays clinicians usually concentrate on
    recognizing both the situational and the internal
    aspects of any given case

13
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
  • 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

14
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 complex interaction is at work,
    and other NTs may be involved

15
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 whether
    deficiencies of important proteins within neurons
    are tied to depression

16
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 an
    indirect
  • Current studies using modern technology are
    attempting to address this issue

17
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
    Brodmanns Area 25

18
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

19
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 merging of
    his/her own identity with that of the lost person
  • For most people, introjection is temporary
  • 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
  • Some people experience symbolic (or imagined)
    loss
  • Newer psychoanalysts (object relations theorists)
    propose that depression results when peoples
    relationships leave them feeling unsafe and
    insecure

20
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

21
What Causes Unipolar Depression?The
Psychological Views
  • Psychodynamic view
  • Limitations
  • Early losses and inadequate parenting dont
    inevitably lead to depression and may not be
    typically responsible for development of
    depression
  • Many research findings are inconsistent
  • Certain features of the model are nearly
    impossible to test

22
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

23
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

24
What Causes Unipolar Depression?The
Psychological Views
  • Cognitive views
  • Two main theories
  • Negative thinking
  • Learned helplessness

25
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

26
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

27
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 experience automatic thoughts
  • A steady train of unpleasant thoughts that
    suggest inadequacy and hopelessness

28
What Causes Unipolar Depression?The
Psychological Views
  • Cognitive views
  • Strengths
  • There is significant research support for Becks
    model
  • High correlation between the level of depression
    and the number of maladaptive attitudes
  • 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

29
What Causes Unipolar Depression?The
Psychological Views
  • Cognitive views
  • Learned helplessness
  • 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

30
What Causes Unipolar Depression?The
Psychological Views
  • Cognitive views
  • Learned helplessness
  • Theory is based on Seligmans 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

31
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

32
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 Its 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 Ive behaved the past couple
    weeks blew this relationship specific. I
    dont know what got into me I dont usually act
    like that unstable.

33
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

34
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

35
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

36
What Causes Unipolar Depression?The
Sociocultural View
  • 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

37
What Causes Unipolar Depression?The
Sociocultural View
  • 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

38
What Causes Unipolar Depression?The
Sociocultural View
  • 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

39
What Causes Unipolar Depression?The
Sociocultural View
  • The Multicultural Perspective
  • Various theories have 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

40
What Causes Unipolar Depression?The
Sociocultural View
  • The Multicultural Perspective
  • Various theories have 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

41
What Causes Unipolar Depression?The
Sociocultural View
  • The Multicultural Perspective
  • Various theories have been offered
  • The self-blame explanation holds that women are
    more likely than men to blame their failures on
    lack of ability and to attribute their successes
    to luck an attribution style that has been
    linked depression
  • 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

42
What Causes Unipolar Depression?The
Sociocultural View
  • 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)

43
What Causes Unipolar Depression?The
Sociocultural View
  • 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

44
What Causes Unipolar Depression?The
Sociocultural View
  • 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

45
What Causes Unipolar Depression?The
Sociocultural View
  • The Multicultural Perspective
  • Within the United States, researchers have found
    few differences in depression symptoms among
    members of different ethnic or racial groups,
    however, sometimes striking differences exist in
    specific populations living under special
    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

46
Bipolar Disorders
  • People with a bipolar disorder experience both
    the lows of depression and the highs of mania
  • Many describe their lives as an emotional roller
    coaster

47
What Are the Symptoms of Mania?
  • Unlike those experiencing depression, people in a
    state of mania typically experience dramatic and
    inappropriate rises in mood
  • Five main areas of functioning may be affected
  • Emotional symptoms
  • Active, powerful emotions in search of outlet
  • Motivational symptoms
  • Need for constant excitement, involvement,
    companionship

48
What Are the Symptoms of Mania?
  • Five main areas of functioning may be affected
  • 3. Behavioral symptoms
  • Very active move quickly talk loudly or
    rapidly
  • Flamboyance is not uncommon
  • 4. Cognitive symptoms
  • Show poor judgment or planning
  • Especially prone to poor (or no) planning
  • 5. Physical symptoms
  • High energy level often in the presence of
    little or no rest

49
Diagnosing Bipolar Disorders
  • Criteria 1 Manic episode
  • Three or more symptoms of mania lasting one week
    or more
  • In extreme cases, symptoms are psychotic
  • Criteria 2 History of mania
  • If currently experiencing hypomania or depression

50
Diagnosing Bipolar Disorders
  • DSM-IV-TR distinguishes between two kinds of
    bipolar disorder
  • Bipolar I disorder
  • Full manic and major depressive episodes
  • Most sufferers experience an alternation of
    episodes
  • Some experience mixed episodes
  • Bipolar II disorder
  • Hypomanic episodes and major depressive episodes

51
Diagnosing Bipolar Disorders
  • Without treatment, the mood episodes tend to
    recur for people with either type of bipolar
    disorder
  • If people experience four or more episodes within
    a one-year period, their disorder is further
    classified as rapid cycling
  • If their episodes vary with the seasons, their
    disorder is further classified as seasonal

52
Diagnosing Bipolar Disorders
  • Regardless of particular pattern, individuals
    with bipolar disorder tend to experience
    depression more than mania over the years
  • In most cases, depressive episodes occur three
    times as often as manic ones, and last longer

53
Diagnosing Bipolar Disorders
  • Between 1 and 2.6 of all adults in the world
    suffer from a bipolar disorder at any given time,
    and as many as 4 over the course of their lives
  • The disorders are equally common in women and men
    and among all socioeconomic classes and ethnic
    groups
  • Women may experience more depressive episodes and
    fewer manic episodes than men and rapid cycling
    is more common in women

54
Diagnosing Bipolar Disorders
  • Onset usually occurs between 15 and 44 years of
    age
  • In most cases, the manic and depressive episodes
    eventually subside, only to recur at a later time
  • Generally, when episodes recur, the intervening
    periods of normality grow shorter and shorter

55
Diagnosing Bipolar Disorders
  • A final diagnostic option
  • If a person experiences numerous episodes of
    hypomania and mild depressive symptoms, a
    diagnosis of cyclothymic disorder is appropriate
  • Mild symptoms for two or more years, interrupted
    by periods of normal mood
  • Affects at least 0.4 of the population
  • May eventually blossom into bipolar I or II
    disorder

56
What Causes Bipolar Disorders?
  • Throughout the first half of the 20th century,
    the search for the cause of bipolar disorders
    made little progress
  • More recently, biological research has produced
    some promising clues
  • These insights have come from research into NT
    activity, ion activity, brain structure, and
    genetic factors

57
What Causes Bipolar Disorders?
  • Neurotransmitters
  • After finding a relationship between low
    norepinephrine and unipolar depression, early
    researchers expected to find a link between high
    norepinephrine levels and mania
  • This theory is supported by some research
    studies bipolar disorders may be related to
    overactivity of norepinephrine

58
What Causes Bipolar Disorders?
  • Neurotransmitters
  • Because serotonin activity often parallels
    norepinephrine activity in unipolar depression,
    theorists expected that mania would also be
    related to high serotonin activity
  • Although no relationship with HIGH serotonin has
    been found, bipolar disorder may be linked to LOW
    serotonin activity, which seems contradictory

59
What Causes Bipolar Disorders?
  • Neurotransmitters
  • This apparent contradiction is addressed by the
    permissive theory about mood disorders
  • Low serotonin may open the door to a mood
    disorder and permit norepinephrine activity to
    define the particular form the disorder will
    take
  • Low serotonin Low norepinephrine Depression
  • Low serotonin High norepinephrine Mania

60
What Causes Bipolar Disorders?
  • Ion activity
  • Ions, which are needed to send incoming messages
    to nerve endings, may be improperly transported
    through the cells of individuals with bipolar
    disorder
  • Some theorists believe that irregularities in the
    transport of these ions may cause neurons to fire
    too easily (mania) or to stubbornly resist firing
    (depression)
  • There is some research support for this theory

61
What Causes Bipolar Disorders?
  • Brain structure
  • Brain imaging and postmortem studies have
    identified a number of abnormal brain structures
    in people with bipolar disorder in particular,
    the basal ganglia and cerebellum among others
  • It is not clear what role such structural
    abnormalities play

62
What Causes Bipolar Disorders?
  • Genetic factors
  • Many experts believe that people inherit a
    biological predisposition to develop bipolar
    disorders
  • Family pedigree studies support this theory when
    one twin or sibling has bipolar disorder, the
    likelihood for the other twin or sibling
    increases
  • Identical (MZ) twins 40 likelihood
  • Fraternal (DZ) twins and siblings 5 to 10
    likelihood
  • General population 1 to 2.6 likelihood

63
What Causes Bipolar Disorders?
  • Genetic factors
  • Recently, genetic linkage studies have examined
    the possibility of faulty genes
  • Other researchers are using techniques from
    molecular biology to further examine genetic
    patterns
  • Such wide-ranging findings suggest that a number
    of genetic abnormalities probably combine to help
    bring about bipolar disorders
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