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