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B E Mood Disorders H • Mood disorders - Psychological disorders A characterized by disturbances of mood. V I • Major forms of mood disorder: O • depressive disorders and R • bipolar disorders (mood swing disorders).
D • Two major types of depressive disorders that vary in I severity: S • major depressive disorder and O • dysthymic disorder R D • Similarly, bipolar or mood swing disorders vary in E severity R S
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B E A Mood Thermometer H A V I O R
D I S O R D Mood states can be conceptualized as varying E along a spectrum or continuum. R S
B E Major Depressive Disorder H A Major depressive disorder - A severe mood V disorder characterized by major depressive I episodes. O R Mania - A state of unusual elation, energy, and
D activity. I S Hypomania - A relatively mild state of mania. O R D E R S
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B E The Case of Helen H A V I O R
D I S O R D E R S Depression
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D I S O R D E R Major depressive episodes affect about twice as S many women as men.
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B E Major Depressive Disorder H A Major depression impairs people’s ability to V meet the ordinary responsibility of everyday life. I O People with major depression may lose interest R in most of their usual activities and pursuits, have difficulty concentrating and making D I decisions, have pressing thoughts of death, and S attempt suicide. O R They even show impaired driving skills in driving D simulation tests (Bulmash et al., 2006). E R S
B Risk Factors in E H Major Depression A Factors that place people at increased risk of V developing major depression include: I O R Age (initial onset is most common among young adults) D I Socioeconomic status (people lower down the S socioeconomic ladder are at greater risk than O those who are better off) R D Marital status (people who are separated or E R divorced have higher rates than married or S never-married people).
B E Seasonal Affective Disorder H A Many people report that their moods do vary V with the weather. I O For some people, the changing of the seasons R from summer into fall and winter leads to a type of major depression called seasonal affective D I (mood) disorder (SAD). S O SAD is not a diagnostic category in its own right R in the DSM-IV but is a specifier or subcategory of D a mood disorder involving major depression. E R S
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B E Postpartum Depression H Postpartum derives from the Latin roots post, A V meaning “after,” and papere, meaning “to bring I forth.” O R Postpartum depression (PPD) - Persistent and severe mood changes that occur after D childbirth. I S O R PPD is often accompanied by disturbances in D appetite and sleep, low self-esteem, and E difficulties in maintaining concentration or R attention. S
B E Dysthymic Disorder H A Dysthymia derives from Greek roots dys-, V meaning “bad” or “hard” and thymos, meaning I “spirit.” O R Dysthymic disorder - A mild but chronic type of depressive disorder. D I S Dysthymia affects about 4% of the general O population at some point in their lifetimes (APA, R 2000; Conway et al., 2006). D E R S
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D I S O R D E Like major depression, dysthymic disorder R occurs in about twice as many women as men. S
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B E Double Depression H Some people are affected by both dysthymic A V disorder and major depression at the same I time. O R The term double depression applies to those who have a major depressive episode D superimposed on a longer-standing dysthymic I S disorder. O R People suffering from double depression D generally have more severe depressive episodes E than do people with major depression alone R (Klein, Schwartz et al., 2000). S
B E Bipolar Disorder H Bipolar disorder - A psychological disorder A characterized by mood swings between states of V extreme elation and depression. I O R People with bipolar disorder ride an emotional roller coaster, swinging from the heights of D elation to the depths of depression without I external cause. S O The first episode may be either manic or R depressive. Manic episodes, typically lasting from D E a few weeks to several months, are generally R shorter in duration and end more abruptly than S major depressive episodes.
B E The Case of Craig H A V I O R
D I S O R D E R Bipolar Disorder S
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B E Manic Episode H • Manic episode - A period of unrealistically A heightened euphoria, extreme restlessness, and V excessive activity characterized by disorganized I O behavior and impaired judgment. R • During a manic episode, the person experiences a sudden elevation or expansion of mood and D feels unusually cheerful, euphoric, or optimistic. I • The person seems to have boundless energy and S is extremely sociable, although perhaps to the O R point of becoming overly demanding and D overbearing toward others. E • Other people recognize the sudden shift in R mood to be excessive in the light of the person’s S circumstances.
B E Cyclothymic Disorder H Cyclothymia is derived from the Greek kyklos, which A means “circle,” and thymos, meaning “spirit.” V I Cyclothymic disorder - A mood disorder characterized O by a chronic pattern of less-severe mood swings than are R found in bipolar disorder.
D The periods of elevated mood are called hypomanic I episodes (from the Greek prefix hypo-, meaning “under” S or “less than”). O R They are less severe than manic episodes and are not D accompanied by the severe social or occupational E problems associated with full-blown manic episodes. R S
B E Stress and Depression H Stress plays an important role in determining A vulnerability in bipolar disorder and even more strongly V in major depression. I O Sources of stress may include: R The loss of a loved one D The breakup of a romantic relationship I Prolonged unemployment S Physical illness O Marital or relationship problems R Economic hardship D Pressure at work E Exposure to racism and discrimination R Living in an unsafe S Distressed neighborhood
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B E Psychodynamic Theories H The classic psychodynamic theory of depression of Freud A (1917/1957) and his followers (e.g., Abraham, V 1916/1948) holds that depression represents anger I directed inward rather than against significant others. O R Freud believed that mourning, or normal bereavement, is a healthy process by which one eventually comes to D separate oneself psychologically from a person who is I lost through death, separation, divorce, or other reason. S O From the psychodynamic viewpoint, bipolar disorder R represents shifting dominance of the individual’s D personality between the ego and superego. E R S
B E Research Evidence H Psychodynamic theorists focus on the role of loss in A depression. V I Research does show that loss of significant others O (through death or divorce, for example) is often R associated with the development of depression.
D Evidence supports the view that a self-focusing style—an I inward or self-absorbed focus of attention—is associated S with depression, especially in women. O R D E R S
B E Humanistic Theories H From the humanistic framework, people become A depressed when they cannot imbue their existence with V meaning and make authentic choices that lead to self- I fulfillment. O R Like psychodynamic theorists, humanistic theorists focus on the loss of self-esteem that can arise when D people lose friends or family members or suffer I occupational setbacks. S O We tend to connect our personal identity and sense of R self-worth with our social roles as parents, spouses, D students, or workers. E R S
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B E Learning Theories H Whereas the psychodynamic perspectives focus on A inner, often unconscious, causes, learning theorists V emphasize situational factors, such as the loss of I positive reinforcement. O R We perform best when levels of reinforcement are commensurate with our efforts. D I Changes in the frequency or effectiveness of S reinforcement can shift the balance so that life becomes O unrewarding. R D E R S
B E The Role of Reinforcement H Learning theorist Peter Lewinsohn (1974) proposed that A depression results from an imbalance between behavior V and reinforcement. I O A lack of reinforcement for one’s efforts can sap R motivation and induce feelings of depression.
D Inactivity and social withdrawal reduce opportunities I for reinforcement; lack of reinforcement exacerbates S withdrawal. O R D E R S
B E Interactional Theory H Difficulties in social interactions may help explain the A lack of positive reinforcement. V I Interactional theory, developed by psychologist O James Coyne (1976), proposes that the adjustment to R living with a depressed person can become so stressful that the partner or family member becomes D progressively less reinforcing. I S Interactional theory is based on the concept of O reciprocal interaction. R D E R S
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B E Cognitive Theories H Cognitive theorists relate the origin and maintenance of A depression to the ways in which people see themselves V and the world around them. I O One of the most influential cognitive theorists, R psychiatrist Aaron Beck (Beck, 1976; Beck et al., 1979), relates the development of depression to the adoption D early in life of a negatively biased or distorted way of I thinking—the cognitive triad of depression. S O Cognitive triad of depression - The view that R depression derives from adopting negative views of D oneself, the environment or world at large, and the E future. R S
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B E Cognitive Theories H Psychiatrist David Burns (1980) enumerated a A number of the cognitive distortions associated with V depression: I O 1. All-or-nothing thinking. R 2. Overgeneralization. 3. Mental filter. D 4. Disqualifying the positive. I 5. Jumping to conclusions. S 6. Magnification and minimization. O 7. Emotional reasoning. R 8. “Should” statements. D 9. Labeling and mislabeling. E 10. Personalization. R S
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B E Research Evidence on Cognitions H and Depression A Evidence that depressed people show higher levels of V distorted or dysfunctional thinking than nondepressed I controls supports Beck’s model. O R Yet more recent evidence links cognitive errors and depression among African American, Caucasian, and D Hispanic adolescents (Kennard et al., 2006). I S We also find that dysfunctional attitudes (above a certain O threshold) increase vulnerability to depression in the face R of negative life events. D E R S
B Learned Helplessness E H (Attributional) Theory A Learned helplessness - A behavior pattern V characterized by passivity and perceptions of lack of I control. O R The originator of the learned helplessness concept, Martin Seligman (1973, 1975), suggests that people D learn to perceive themselves as helpless because of their I experiences. S O The learned helplessness model therefore straddles the R behavioral and the cognitive: Situational factors D foster attitudes that lead to depression. E R S
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B Learned Helplessness E H (Attributional) Theory A The reformulated helplessness theory holds that people V who explain the causes of negative events (such as failure I in work, school, or romantic relationships) according to O the following three types of attributions are most R vulnerable to depression: 1. Internal factors, or beliefs that failures reflect their D personal inadequacies, rather than external factors, or I beliefs that failures are caused by environmental factors. S 2. Global factors, or beliefs that failures reflect sweeping O flaws in personality rather than specific factors, or beliefs R that failures reflect limited areas of functioning. D 3. Stable factors, or beliefs that failures reflect fixed E personality factors rather than unstable factors, or beliefs R that the factors leading to failures are changeable. S
B E Genetic Factors H Genetic factors play a significant role in determining A proneness to mood disorders, including major V depression and bipolar disorder. I O Not only does major depression tend to run in families, R but the closer the genetic relationship people share, the more likely they are to share a depressive disorder. D I An emerging model in the field focuses on interactions S of genetic and environmental factors in the development O of major depression and other mood disorders. R D E R S
B Biochemical Factors and Brain E H Abnormalities A Early research more than 50 years ago showed that V drugs we now call antidepressants, which increase I levels in the brain of the neurotransmitters O norepinephrine and serotonin, often helped relieve R depression.
D Brain-imaging studies show lower metabolic activity in I the prefrontal cortex of clinically depressed people as S compared to healthy controls. O R Other research reveals brain abnormalities in people D with mood disorders (major depression and bipolar E disorder) in parts of the brain involved in governing R emotions. S
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B E Causal Factors In Bipolar H Disorders A In a large population based study in Finland, V investigators found the concordance rate to be seven I times greater among MZ twins than DZ twins (43% O versus 6%, respectively). R
If bipolar disorder were caused entirely by heredity, then D an identical twin of someone having the disorder would I always develop the disorder, but this isn’t the case. S O Consistent with the diathesis–stress model, stressful life R factors and other biological influences may interact with D a genetic predisposition to increase vulnerability to the E disorder. R S
B E Treating Depression H Depressive disorders are typically treated with A psychotherapy, such as in the form of psychodynamic V therapy, behavior therapy, or cognitive therapy, or with I biomedical approaches, such as antidepressant O medication or electroconvulsive therapy (ECT). R Sometimes a combination of treatment approaches is D used. I S O R D E R S
B E Psychodynamic Approaches H Just as different theoretical perspectives point to many A factors that may be involved in the development of mood V disorders, these models have spawned different I approaches to treatment. O R Depressive disorders are typically treated with psychotherapy, such as in the form of psychodynamic D therapy, behavior therapy, or cognitive therapy, or with I biomedical approaches, such as antidepressant S medication or electroconvulsive therapy (ECT). O R Sometimes a combination of treatment approaches is D used. E R S
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B E Psychodynamic Approaches H • Traditional psychoanalysis aims to help people who A become depressed understand their ambivalent feelings V toward important people (objects) in their lives they have I lost or whose loss was threatened. O • By working through feelings of anger toward these lost R objects, people can turn anger outward— through verbal expression of feelings, for example—rather than leave it D to fester and turn inward. I • Traditional psychoanalysis can take years to uncover S and deal with unconscious conflicts. O • Modern psychoanalytic approaches also focus on R unconscious conflicts, but they are more direct, relatively D brief, and focus on present as well as past conflicted E relationships. R S
B E Behavioral Approaches H Behavior therapists generally focus on helping depressed A patients develop more effective social or interpersonal V skills and increasing their participation in pleasurable or I rewarding activities. O R Evidence shows that behavioral techniques can produce substantial benefits in treating depression in both adults D and adolescents. I S In fact, this model of therapy, generally called behavioral O activation, produced higher rates of remission in treating R severely depressed patients in one recent study than did D alternative forms of treatment. E R S
B E Cognitive Therapy H Cognitive therapists believe that distorted thinking A (cognitive distortions) play a key role in the development V of depression. I O Depressed people typically focus on how they are feeling R rather than on the thoughts that may underlie their feeling states. D I That is, they usually pay more attention to how bad they S feel than to the thoughts that may trigger or maintain O their depressed moods. R D E R S
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B E Cognitive Therapy H A V I O R
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B E Antidepressant Drugs H Today, we have three major classes of antidepressants A that increase the availability of key neurotransmitters in V the brain: I O (1) Tricyclic antidepressants (TCAs) R (2) Monoamine oxidase (MAO) inhibitors D I (3) Selective serotonin-reuptake inhibitors (SSRIs) S O R D E R S
B E The actions of various types of H antidepressants at the synapse. A V I O R
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B E Electroconvulsive Therapy H Electroconvulsive therapy (ECT), more commonly A called shock therapy, continues to evoke controversy. V I The idea of passing an electric current through O someone’s brain may seem barbaric. R Yet ECT is a generally safe and effective treatment for D severe depression, and it can help relieve major I depression in many cases in which alternative S treatments have failed. O R D E R S
B E Clinical Practice Guidelines for H Depression A A government-sponsored expert panel set up to develop V guidelines for treating depression found the following I treatments to be effective (Depression Guideline Panel, O 1993b): R • Antidepressant medication (tricyclics or selective serotonin-reuptake inhibitors) D • Three specific forms of psychotherapy: cognitive I therapy, behavioral therapy, and interpersonal S psychotherapy. O • A combination of one of the recommended forms of R psychotherapy and antidepressant medicatíon. D • Other specified forms of treatment, including ECT and E phototherapy for seasonal depression. R S
B E Lithium and Other Mood H Stabilizers A V It could be said that the ancient Greeks and Romans I were among the first to use lithium as a form of O chemotherapy. R They prescribed mineral water that contained lithium for D people with turbulent mood swings. I S Today, the drug lithium carbonate, a powdered form of O the metallic element lithium, is widely used in treating R bipolar disorder. D E R S
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B E Psychological Approaches H Large-scale investigations of the effects of psychological A treatments for bipolar disorder are underway. V I Early studies suggest that psychosocial treatments, such O as cognitive-behavioral therapy, interpersonal therapy, R and family therapy, may be helpful adjunctive therapies when used along with drug therapy in the treatment of D bipolar disorder. I S We also have evidence that psychological treatment can O improve the level of functioning and adherence to a R medication regimen in bipolar patients. D E R S
B E Suicide H A nationally representative survey found that 13% of U.S. A adults reported having experienced suicidal thoughts, V and 4.6% reported making a suicide attempt (Kessler, I Borges, & Walters, 1999). O R It is fortunate that most people who have suicidal thoughts do not act on them. D I Still, each year in the United States some 500,000 S people are treated in hospital emergency rooms for O attempted suicide, and more than 30,000 “succeed” in R taking their lives. D E R S
B E Suicide H A V I O R
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B E Suicide rates according to age. H A V I O R
D I S O R D E Although adolescent suicides may be more R highly publicized, adults, especially older S adults, have higher suicide rates.
B E Suicide in Older Adults H Despite life-extending advances in medical care, some A older adults find the quality of their lives less than V satisfactory. I O Older people are more susceptible to diseases such as R cancer and Alzheimer’s, which can leave them with feelings of helplessness and hopelessness that, in turn, D can give rise to depression and suicidal thinking. I S Many older adults also suffer a mounting accumulation O of losses of friends and loved ones, leading to social R isolation. D E R S
B E Gender and Ethnic/Racial H Differences A V More women attempt suicide, but more men “succeed”. I O For every female suicide, there are four male suicides. R More males “succeed” in large part because they tend to
D choose quicker-acting and more lethal means, such as I handguns. S O Suicides are more common among (non-Hispanic) White R Americans and Native Americans than African D Americans, Asian Americans, or Hispanic Americans. E R S
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B E Ethnicity and suicide rates. H A V I O R
D I S O R D E Suicide rates are higher among males than females, and higher R among White (European) Americans and Native Americans than other ethnicities. S
B E Predicting Suicide H Evidence points to the pivotal role of hopelessness A about the future in predicting suicidal thinking and V suicide attempts. I O People who commit suicide tend to signal their R intentions, often quite explicitly, such as by telling others about their suicidal thoughts. D I In fact, most people who commit suicide make contact S beforehand with a health-care provider O R D E R S
B E H A V I O R QUESTIONS? D I S O R D E R S
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