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Chapter 13 Emotions and Mental Health in Adulthood
Psychiatric Disorders: Symptoms and Prevalence
Emotional disorder: when states reach levels at which person can no longer do ordinary things such as go to work or look after
Depression: affective disorder. It’s intense sadness. It’s despair that can be painfully persecuting and drains all meaning from life
o Davidson identifies diminution of pleasurable goal achievement as principal emotion component of depression
o Depression is most frequently diagnosed in relation to criteria set out in APA DSM-IV-TR
o Major depressive episode is diagnosed when for at least 2 weeks sufferer is unbearably sad or depressed or has lost
pleasure in all activities along with being unable to sleep, slowed down in actions, lack of energy and inability to
concentrate, feelings of worthlessness and thoughts of suicide
Anxiety: come in several forms. Overwhelming fears together with more protracted moods of disabling anxiety, avoidance of what
is especially feared, and loss of personal confidence
o When someone has nervous breakdown, suffers major depressive episode with or without accompanying anxiety
o In an emotional disorder, aspects of one’s emotions tend to become difficult to understand than normal
Psychiatric Epidemiology
Psychiatric epidemiology: statistical study of how frequently disorders occur
Epidemiologist :detective who finds out why some people suffer disorders, while others don’t
Some think modern medicine owes success to discovery of drugs like antibiotics, and from advances like surgery without germs
but with anesthetics history shows infectious diseases were receding before innovations
o Advances most important in improving health were epidemiological discoveries of how people caught infectious disease
and reduction of infection by providing clean water
Psychiatric epidemiology was slow to take place alongside epidemiology of physical medicine because it was first difficult to agree
on criteria for diagnosis of disorders, and because reliable psychological assessment
o Kessler used research interview to make diagnoses according to DSM-III-R and determine risks in 48 states
Robins and Regier found that depression and anxiety states were twice as common in women as in men
Depression recognized by WHO as single most important chronic condition in middle years of life in terms of economic impact and
impairment of relationships
o For Kessler, women more likely (30.5%) than men (19%) to have had 1 of 5 kinds of anxiety disorder diagnosed in study
Prevalence: percentage of people suffering from diagnosed disorder
o Kessler with higher prevalence for women of depression and anxiety, found that 35% of men, but only half that
percentage of women, had disorder of alcohol or drug abuse
o Men also higher prevalence (6%) of antisocial personality disorder compared to women (1%)
Gender differences: occur in normal emotions. They’re small in comparison to gender differences in prevalence of disorders,
which continue trends seen in childhood, where boys more likely than girls to show externalizing disorders, and girls somewhat
more likely than boys to have internalizing disorders
o No gender difference in prevalence of depression in childhood, in adolescence, difference becomes large and stays so
Robins and Reiger conducted the Epidemiologic Catchment Area study and showed patterns that were similar to those found by
Kessler, with some differences that depended on interviews
Cultural factors play important part in emotional disorders
o Tsai and Chentsova-Dutton reviewed number of studies and found that prevalence of depression in West countries is
higher than East
o Patel found that in India, Zimbabwe, Chile and Brazil, being female, poor and having little education were associated with
depression, just like West industrialized societies
Some differences in prevalence may reflect roles and resources open to people in different societies, but other kinds of difference
occur too
o WHO studied depression in Switzerland, Canada, Japan, and Iran core cluster of symptoms occurred in countries
sadness, joylessness, anxiety and lack of energy
o In Iran 57% of patients reported symptoms where 27% in Canada did
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o Weissman compared results from 10 countries and found that insomnia, loss of energy, difficulty concentrating and
thoughts of suicide occurred in West and Asian countries, but other symptoms like poor appetite and feelings of guilt
weren’t common
Difference in prevalence are clues epidemiological detective starts with and some differences are larger than most of those that
psychologists consider but evidence is correlational
o Epidemiological evidence doesn’t tell us whether poverty makes depression more likely, or being depressed makes it
harder to hold a job
Different Kinds of Depression and Anxiety
Most usual form of depression is depressive episode major depressive disorder
o Characterized by symptom of at least 2 weeks of either depressed mood or lack of pleasure in activities, plus 4+ other
o Minor depression classified as having 2-4 symptoms in all
o Kessler found that numbers of people who suffered during lifetime from minor depression where 10% of adult
population, major depression with 5-6 symptoms altogether were 8.3% and more severe major depression with 7-9
symptoms were 7.5%
o Proposed that these conditions are progressively more severe forms of same underlying condition
Bi-polar disorder: manic-depressive disorder, in which depression has been preceded or followed by at least one period of mania
o Mania is disorder of happiness, exhilaration, and pride.
o Bi-polar disorder is rare, with prevalence of 1% and no gender difference
o Genetic risk for bi-polar disorder, measured by heritability of some 80%, higher than for major depressive episodes
Anxiety disorder takes 7 forms and include unexpected panic attacks with sudden terror or dread, often with bodily symptoms like
racing heart, dizziness and shortness of breath
o Panic attack example of emotion difficult to understand
o Anxiety includes phobias irresistible urges to avoid certain places, things or activities. Most disabling is agoraphobia
fear and avoidance of being away from home
o Lifetime prevalence of condition without panics is 5.5% and with panics is higher
o Often starts with life in precarious state then person has attack and rushes home where they feel calmer
o People with agoraphobia find that safe area on own becomes reduced
o Can be treated successfully by CBT accomplishment is usually to better able to tolerate anxiety
o Generalized anxiety disorder defined in terms of at least 6 months of disabling and persistent anxiety of worry, and
condition has lifetime prevalence
Obsessions and compulsions
o Obsessions: intrusive anxious thoughts. Thoughts occur repeatedly and person can’t stop them even though they might
know them to be irrational
o Obsessions repeated actions or rituals as washing hands constantly or checking and rechecking
o Lifetime prevalence of OCD has been 2-3%
PTSD intense anxiety, disturbed sleep, flashbacks in which traumatic event is remembered and repeatedly re-experienced,
together with avoidance of anything that might remind one of it
o Traumas that can provoke disorder happen in war when people have been in danger of losing their lives
o Vietnam War brought it to attention as repercussions included increased antisocial behaviour, but can also occur from
rape, environmental hazards, assaults
o Brewin, Dalgleish and Joseph define trauma as anything radically violating basic assumptions and conclude that chaotic
nature of post traumatic flashbacks and intense phobic anxiety can best explained by 2 kinds of memory systems
One is veral and subject to making of meaningful sense of experience
Automatically triggered by aspects of situations, external or internal
o Traumas represented in memory in both ways, which are activated, but don’t correspond to each other
Stress and Diathesis in Causation of Disorders
Probably most widespread general understanding of emotional disorders and other psychiatric conditions is in terms of stress-
diathesis hypothesis
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Hypothesis is that disorder most typically caused by stress, adversity in immediate environment , in presence of one or more
predisposing factors, called diatheses, which are inherent in person
For most part, at least for first occurrence of emotional disorder initiating stress is severe
Stresses: Life Events and Difficulties
Brown and Harris interviewed 458 women in London and found that in previous year, 37 of them (8%) suffered onset of
depression at level that was disabling, equivalent to MDD
o Another 9% of women had disabling psychiatric problem at case level for more than year
o 89% of women with onset of depression had severe life event or difficulty before breakdown
o Of women who didn’t have disorder, 30% had life event or difficulty in year before
o Developed new method that gave stronger predictions that had been possible and was a semi-structure interview, the
Life Events and Difficulties Schedule, which replaced checklists
o Using schedule people asked about 40 areas of life and interviews are recorded and stressful events are written up with
date so temporal relation to any onset of depression can be found
People become depressed when extreme adversities occur
Shrout found that clinic patients suffering from depression were 3x more likely than people in non-depressed community sample
to have suffered negative and uncontrollable event
o Depression involves sadness and hopelessness, brought on by events that have serious implications for our lives
Event that can cause depression most typically a loss of role highly valued
Hammen, using life event interviews found that people who valued relationships became depressed when social loss or social
disruption occurred
o Those whom autonomy and work were most important were likely to become depressed when failure in achievement
Kinds of events that cause depressive and anxiety breakdowns events that cause strong negative emotions sad emotions of
loss, painful emotions of humiliation, desperate emotions of not being able to escape from intolerable situations, anxious
emotions of danger
Kenlder produced categories of events that produce emotional disorders
o Loss events like death of loved ones, losses of means of livelihood
o Humiliation events such as separations in which there has been infidelity or delinquency of kid, rape and public
humiliation by loved ones or authority that threaten core roles
o Entrapment person stuck in adverse situation with no way out
o Danger likelihood of future loss, or of even that yet to realize full potential
Appearance of humiliation indicates that depression may be related to social motivation of assertion in pursuit of status
Episodes of anxiety can be caused by negative evens as severe negative events associated with 3x increase of anxiety disorder in
men and women
o Lesser events associated with 8x increase of generalized anxiety disorder in men, but not women
Anxiety and depression caused by same kinds of events?
o Finlay-Jones and some events were future directed involving danger. Anxiety disorders precipitated by danger events.
By contrast, depressive disorders precipitated by events that were losses
Clear that most episodes of major depression and some types of anxiety occur when things go severely wrong in life and have long
term consequences
Relation Between Emotions and Emotional Disorders
Way severe life events licit depression and anxiety is similar to how lesser events elicit negative emotions but there is difference
o Short term negative emotions and moods are caused by events that are setbacks to our projects and concerns we
experience emotion and deal with implications
How are clinical depression and anxiety states related to normal sadness and fear?
o Although depression isn’t just sadness, emotion is involved.
o As to anxiety, no question that anxiety disorders are kinds of fear main questions are why fears can be entirely out of
proportion to what person seems to be frightened of and can be elicited by neutral or ambiguous stimuli
Ohman and Mineka - Approach to understanding anxiety that reaches clinical levels because fear is elected by appraisals carried
out by dedicated neural networks that involve amygdala
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