Chapter 8: Mood Disorders
General Characteristics of Mood Disorders
Mood disorders involve disabling disturbances and emotion, from the
sadness of depression to deletion and irritability of mania.
Mood disorders are often associated with other psychological problems such
as panic attacks, substance abuse, sexual dysfunction, and personality
Depression: Signs and Symptoms
Depression is an emotional state marked by great sadness and feelings of
worthlessness and guilt. Additional symptoms include withdrawal from
others and loss of sleep, appetite, sexual desire, and interest and pleasure in
Paying attention is exhausting for depressed people. Conversation is also a
chore; depressed individuals may speak slowly, after long pauses, using few
words and the low, monotonous voice.
Depressed people may make somatic complaints with no apparent physical
Depression in children often results in somatic complaints. In older adults,
depression is often characterized by distractibility and complaints of
People from non-Western cultures emphasize somatic symptoms of
depression while people from Western cultures emphasize emotional
Only 15% of depressed primary care patients in Canada are psychologizers
(people emphasized the psychological aspect of depression).
Mania: Signs and Symptoms
Mania is an emotional state or mood of intense but unfounded elation
accompanied by irritability, hyperactivity, talkativeness, and flight of ideas,
distractibility, and impractical grandiose plans.
People who experience episodic periods of depression may at times suddenly
Formal Diagnostic Listings of Mood Disorders
Two major mood disorders are listed in DSM-IV-TR; major depression also
referred to as unipolar depression, and bipolar disorder.
Diagnosis of Depression
The formal DSM-IV-TR diagnosis of a major depressive disorder requires the
presence of five of the following symptoms for at least two weeks. (See page
239 for the list).
MDD is a very prevalent. Lifetime prevalence rates range from 5.2% to 17.1%
and three large-scale American studies.
The large discrepancy possibly reflects differences between studies in
diagnostic criteria used, and the amount of training of the interviewers, and
in the use of interviewers for collecting symptom information. Major depressive disorder is about two times more common in women than
in men. The gender gap emerges at age 14 and is maintained across the
The world health organization identified major depression as one of the
leading causes of disability adjusted life years.
Participants with major depressive disorder with certain coexisting
personality disorder had significantly longer time to remission of symptoms
than did MDD participants without any personality disorder.
The first episode typically has a stronger link with major life event stress
than do subsequent bouts of depression.
The kindling hypothesis – the notion that once the depression has already
been experienced, it takes relatively less stress to induce a recurrence.
The autonomy hypothesis: that parent reduced role of life event stress and
subsequent depression is because depression has become autonomous and
no longer requires stress.
Depression in Females Vs. Males: Why is there a Gender Difference?
Females are more likely than males to engage in ruminative coping, while
males are more likely to engage in distracting activities such as watching a
hockey game. Ruminators focus their attention on their depressive
A more maladaptive rumination component is referred to as brooding. They
concluded that the relationship between gender and depression could be
due to the brooding component. Brooding it may be a nonspecific on ability
for different forms of emotional distress.
An interpersonal form of rumination called co-rumination, in which friends
typically female, discuss and brood over each other's problems as part of
their friendship, has been linked with depression and adolecent girls but, on
a positive note, it also fosters stronger friendship.
Females are more likely than males to engage in silencing the self – a passive
style of keeping upsets and concerns to oneself in order to maintain
Another explanation is objectification theory, Mason the premise that the
tendency to be viewed as an object, scrutinized and appraised by others,
including appraisal of physical appearance, has a greater negative influence
on the self-esteem of girls than boys.
Diagnosis of Bipolar Disorder
The DSM defines bipolar one disorder as involving episodes of mania or
mixed episodes that include symptoms of both mania and depression. Most
people with bipolar one disorder also experiences episodes of depression.
A formal diagnosis of a manic episode requires the presence of elevated or
irritable mood this three additional symptoms. Irritable mood and even
depressive features are more common.
The symptoms must sufficiently be severe to impair social and occupational
functioning. See list on page 242 for symptoms. Bipolar disorder occurs less often than major depressive disorder. Average
age of onset is in the 20s and occurs equally often in men and women.
People with bipolar disorder often lose insight into their condition and this
can result in treatment resistance, financial and legal difficulties, substance
abuse, and marital and occupational failure.
Anxiety comorbidity is prevalent among bipolar individuals and has a great
impact on quality of life. Comorbidity with personal disorders also predicts a
Heterogeneity Within the Categories
A problem in the classification of mood disorders is their great heterogeneity.
People with the same diagnosis can vary greatly from one another.
A mixed episode of bipolar disorder involves experiencing the full range of
symptoms of both mania and depression almost every day.
Bipolar 2 disorder individuals have episodes of major depression
accompanied by hypomania, a change in behavior and mood that is less
extreme than a full-blown mania.
The presence of delusions appeared to be a useful distinction among people
with unipolar depression; depressed people with delusions to not generally
responded well to the usual drug therapies for depression, but they do
respond favorably to these drugs when they are combined with the drugs
commonly used to treat other psychotic disorders.
Some people with depression may have melancholic features. Melancholic
refers to the specific pattern of depressive symptoms. People with
melancholic features find no pleasure in an activity (anhedonia) and are
unable to feel better even temporarily when something good happens.
People with melancholic features had more comorbidity, more frequent
episodes, and more impairment, suggesting it may be a more severe type of
Manic and depressive episodes may be characterized as having catatonic
features, such as motor inability or excessive, purposeless activity.
Both bipolar and unipolar disorders can be summed diagnosed seasonal and
if there is a regular relationship between an episode and a particular time of
Reduced light does cause decreases in the activity of serotonin neurons in the
hypothalamus and these neurons regulate some behaviors, such as sleep,
that are part of the syndrome of SAD.
(Read Canadian Perspective 8.2 page246)
Chronic Mood Disorders
in cyclothymic disorder, the person has frequent periods of depressed mood
and hypomania, which may be mixed with, may alternate with, or maybe
separated by periods of normal mood lasting as last two months.
During hypomania, their self-esteem is inflated.
A person with a dysthymic disorder is chronically depressed – more than half
the time for at least two years. The person experiences several other signs of depression such as insomnia
or sleeping too much; feeling of inadequacy; and effectiveness and lack of
energy; pessimism; an inability to concentrate and to think clearly and a
desire to avoid the company of others
Women are more likely than men to be diagnosed with dysthymia.
Many people with dysthymia have episodes of major depression as well as a
condition known as double depression.
Mixed anxiety depression is a proposed new mood disorder. To receive the
diagnosis, it was proposed that the client have three or four symptoms of
major depression accompanied by two or more symptoms of anxious distress
that have lasted at least two weeks.
Premenstrual dysphoric disorder is a controversial disorder that occurs a
week or so before menstruation and is marked by depression, anxiety, anger,
mood sinks and decrease interest in activities usually engage in pleasure and
the symptoms are severe enough to interfere with social or occupational
Psychological Theories of Mood Disorders
Psychoanalytic View of Depression
Freud theorized that the potential for depression is graded in early
childhood. During the oral period, a child needs may be insufficiently or over
sufficiently gratified, causing the person to become fixated in this stage and
dependent on the instinctual gratification particular to it. The person may
develop a tendency to be excessively dependent on other people for the
maintenance of self-esteem.
After the loss of a loved one, most commonly for child, through separation or
withdrawal of affection, the more non-first interjects or incorporates the lost
person; he or she identifies with the lost one, perhaps in a fruitless attempt
to undo the last. We unconsciously harbor negative feelings toward those we
love, the learner then becomes the object of his or her own hate and anger.
The mourner resents being deserted and feels guilt for real or imagined sins
against the lost person.
Cognitive Theories of Depression
Cognitive processes play a decisive role in emotional behavior.
Beck’s Theory of Depression
Depressed individuals feel as they do because their thinking is negatively
biased toward negative interpretation.
In childhood and adolescence, depressed individuals acquire a negative
schema-a tendency to see the world negatively- through loss of a parent, an
unrelenting succession of tragedies.
The negative schemata acqui