CHAPTER 8: MOOD DISORDERS
Overview of Mood Disorders:
Mood disorders run the spectrum from severe depression to extreme mania and involve
extreme, persistent, or poorly regulated emotional states
DSM-IV-TR divides mood disorders into two general categories:
Depressive disorders: irritability and angry in depressed children, behavioral
disorders. Easiest emotion to feel is anger-effortless, eventually become sad.
Bipolar disorder: mood swings, cycling through being depressed to a low to a
high mood. Unipolar depression- low side-one side of curve. Bipolar: both sides
high and low experience.
Apervasive unhappy mood disorder-longevity, more severe than mood swings. Generally
people regularly feel mood swings in the population, is normal.
Children who are depressed can’t shake their sadness; it interferes with their daily
routines, social relationships, school performance, and overall functioning ie/trouble
going to school, in social relation groups, eating a meal with family. Biggest problem is
that it goes unrecognized, bad picking up young children but not for teens.
Over 800,000 teens in U.S. suffer from depression yearly. Often have anxiety. Over half
of them are suicidal- half a million attempting suicide. Every two minutes.
History of depression in children: didn’t exist, not in DSM, no research in children until
recently. Depression has no age barrier to have a true depression even infants. When
children do have depression often coexists with other disorders. High risk for bipolar
As many as 5% of children and 10-20% of adolescents experience significant depression
at some time. Recurrent episodes. People having relapses is common.
Concerns: suicide among teens, depression in young people. Higher risk for bipolar, risk
of suicide, substance abuse, poorer medical health issues.
90% show significant impairment in daily functions
Depression and Development
Experience and expression of depression change with age: effects all ages
Infants: mutually deprived environment, often times primary caregiver is depressed,
orphanages. 3 months of a baby being sad, expressionless. No interest to eye contact,
stare onto distance, disconnected, sleeping and feeding problems. Very irritable. Difficult
to soothe. Disinterested in social interactions. Separate baby from mother would do
Preschoolers- lack enthusiasm, lack energy, low self-esteem,
School-aged children: lots of self-blame. Have lots of social inhibition-isolated.
Anatomy of Depression
Depression as a symptom: feeling sad or miserable
Depression as a disorder:
Major depressive disorder (MDD): occur for two weeks, loss of interest of social
interaction, significant daily functioning.
Dysthymic disorder: more long lasting, more severe, low level of depression for at
least a year. Can be described as a personality.
Major Depressive Disorder (MDD) Key features: short length 4-5 days, criteria the same with one difference. Often
misdiagnose as a behavior. Need 9 symptoms. Feeling sad and loss of interest. Other:
eating habits, insomnia, psychomotor agitation, guilt.
Symptoms must represent change from previous functioning
Diagnosis requires the presence of a major depressive episode, the exclusion of other
conditions, and ruling out physical factors, normal bereavement, or underlying thought
Diagnosis in children
Prevalence- ages 4 to 18. Under 4 have no data. Rare. Lifetime prevalence is 10-14% will
continue to have it through adulthood. Individuals start to self reflect and don’t have
interest to be with friends.
Comorbidity- 90% of adolescence will also have another condition at some point. 50%
will have two or more conditions.Alot of funding from government given attention to
Onset- come suddenly or gradually. Most common age is around 13 for depression.
Average depressive episode lasts 8 months. No gender differences until puberty so more
girls diagnosed b.c of hormones, social circles. Things become more complex more of
environmental issue not genetic.
Dysthymic Disorder (DD)
Dysthymic disorder (DD), or dysthymia, is characterized by symptoms of depressed
mood that occur on most days, and persist for at least one year
Less severe symptoms
Characterized by poor emotion regulation:
Chronic depressive disorder has been proposed to describe both MDD and DD in DSM-
V: double depression
Prevalence- not as common. Comorbidity is still high: 50% have some other diagnosis.
Mood, anxiety or ADHD
Onset:12. Children with DD have higher chances of going into double depression. Onset
in childhood is more persistent and chronic as adult, worse prognosis b.c pathways have
longer to practice and longer it stays, didn’t have a chance to experience health emotion
regulation, cope with current state, stronger genetic component if at 5 is rare but evidence
that a lot of genes associated so presenting easier.
Associated Characteristics of Depressive Disorders: as a way of investigating the individual.
Different from diagnostic characteristics b.c these features below have other diagnoses as well,
Intellectual and academic functioning: have a hard time concentrating. Speaking to
teachers. Children losing interest when have a mood disorder. Thinking is slow, low
grades. Poor ratings. Processing speed is low in various of tasks, but production and
quality can still be there.
Cognitive biases and disturbances: thinking style. Distortions are analyzed here. They
have a selective attention bias. Selective what they pay attention to. Mostly on the
negative event. Lots of negative beliefs and negative attitudes. Evaluating negative
thoughts and their self critical statements they make.And is this generalized in their
thinking when they make a faulty belief. Negative self-esteem: low s-e with unstable self esteem. Different on days. Both equally
as damaging. Body image-mood and eating disorder closely linked. Is body image
Social and peer problems: fewer close relationships with people who have mood disorder.
Are they seeking social and peer interactions these people will not but have high level of
loneliness. So are misunderstood that these mood children do not want social
relationships but they cant follow through with it with their disorder at the time.
Ineffective coping style with their social isolation. High risk factor for mood disorders b.c
two are closely correlated especially with kids who are bullied.
Family problems: family becomes less supportive and more conflict arises in both parent-
child relationship and sibling parent relationship. Withdrawl and lonely feeling in
families b.c the stress dealing with a child who has a mood disorder causes this and will
not do anything. So young adolescence are not in clinics. Education is the answer
Depression and suicide: common technique is drug overdose, cutting is second one.
Cutting multiplies quickly to cope with their problems without the intension of suicide.
Form of coping mechanism is the idea that when emotions build up so is a panic attack so
blood flow is releasing emotions. No long lasting effect so cut again. Over time cuts
become deeper and visible. People are doing it in groups as a support group to cut
together. More powerful with group mentality. Dangerous is learning from others, very
hard to treat. Suicide: boys 13
Causes of Depression: genes huge factor. Twin studies-if one twin has depression, 30% for other
twin to have depression. Whereas bipolar has a stronger correlation. Children who have
depressed parents, are three times as likely to have a mood disorder. Evidence from genetics but
mostly environment the child is growing up is created by parents. Genetics for depression-really
inheriting a vulnerability for depression and to turn it on requires an environmental stressor
which can be a depressed parent. All stressors are not equal to everyone, depends on individual
and how they procc