Mood disorders: involve disabling disturbances in emotion, from sadness of depression to elation and
irritability of mania. Panic attacks, substance abuse, sexual dysfunction, personality disorders.
Depression: emotional state marked by great sadness and feelings of worthlessness and guilt. Withdrawl
from others, loss of sleep, appetite, sexual desire, and interest in usual activities.
– Paying attention is exhausting; cannot converse, speak slowly, monotonous, prefer loneliness,
some agitated and cannot sit still, neglect hygiene, anixious, apprehensive
– In children: somatic complaints ie. Headaches
– In adults: distractibility
– Cross-cultural differences due to standards of acceptable behaviour (less prevalent in China,
cannot show emotion)
Psychologizers (Kirmayer): people who emphasize psychological aspect of depressed rather than the
physical somatic aspect.
Mania: emotional state of intense but unfounded elation accompanied by irritability, hyperactivity,
talkativeness, flight of ideas, distractibility, and impractical, grandiose plans. (side effect of depression)
– Manic episodes, incoherent shift of topic to topic, overly sociable and intrustive, oblivious to
pitfalls of their behaviour.
– Attempt to curb this behaviour can elicit rage
2 major mood disorders in DSM-5: major depressive and dipolar disorder (now has separate chapters for
it) – Bipolar disorder is a bridge between two diagnostic classes of schizophrenia spectrum disorders
and depressive disorders in terms of symptomatology, family history and genetics.
Diagnosis of depression: requires presence of five of following symptoms for at least two weeks.
– Depressed mood/loss of interest and pleasure must be one
– Sad, depressed mood most of day nearly every day
– Difficulty sleeping
– Shift inactivity level (lethargic or agitated). Psychomotor agitation of retardation.
– Poor appetite, weight loss or vise versa
– Loss of energy and fatigue every day
– Negative self concept, self blame, feelings of worthlessness and blame
– Difficulty concentrating, slowed thinking, indecisiveness
– Thoughts of death/suicide
Controversial: whether person with five symptoms and two week duration is different from one who has
three symptoms for 10 days.
– Using twin studies: less than five symptoms and duration less than two weeks, more likely to be
diagnosed with depression and have recurrences.
– Depression exists on continuum of severity, DSM classified those with MDD at severe end
– Question of whether diagnosis should be by category or by continuum.
– Broad spectrum of severity: not all individuals require intensive treatment
Persistent depressive disorder: chronic depression and dysthymia.
Predictors: comorbid diagnosis. Younger age of onset, history of more frequent episode of depression.
– MDD two times more common women than men; gender gap emerges at age 14.
– WHO identified MDD as one leading cause of disability-adjusted life years. First in disease
burden in high income countries by year 2030.
Diagnosis of Bipolar disorder
– Defined as: episodes of mania or mixed episodes that include mania and depression.
– Formal diagnosis of manic episode requires presence of elevated or irritable mood and
abnormally goal-directed activity(new to DSM5) /energy PLUS three additional symptoms.
– Symptoms severe enough to impair social and occupational functioning:
o Increase in goal-directed activity
o More talkative
o Flight of idea, racing thoughts
o Less than normal sleep needed
o Inflated self-esteem, belief of special talents, powers, abilities
o Distractibility
o Excessive involvement in pleasurable activities that are likely to have undesirable
consequences, ie. Reckless spending
Reasons for gender gap
– Women more predisposed at adolescence already
– More likely to engage in ruminative coping; men more likely to distract.
– Brooding: moody pondering, may be factor of gender gap
– Corumination – female friends brood over problems together
– Females more likely to be targets for abuse
– Best understood from complex biopsychosocial perspective (hormones, social interactions and
psychology)
Biopolar disorders occur less often than MDD; average age of onset: 20s
In women: episodes of depression more common, mania less common than in men
People with disorder often lose insight into their condition, result in treatment resistance, financial and
legal difficulties, substance abuse, martial and occupational failure.
Anxiety comorbidity prevalent.
Problem with classification: heterogeneity (people with same diagnosis can vary from one another)
– Bipolar II disorder: episodes of MD accompanied by hypomania
– Hypomania: less intense mania
– Depressed people with delusions do not respond well to drug therapies for depression; respond
better to these drugs with in combination with drug used to treat psychotic disorders, ie.
Schizophrenia.
– Melancholic features: people with depression who find no pleasure inactivity (anhedonia), unable
to feel better even temporarily when something good happens.
– Postpartum onset: manic and depressive disorder occurring within four weeks of childbirth.
Predicted by depression in pregnancy and lack of warmth from own parents growing up.
– Seasonal affective disorder: subdiagnosis of mood disorder when episodes occur at particular
time. Common during winter due to decrease in daylight hours, reduced exposure to sunlight.
o Icelanders have adapted to reduced amounts of sunlight so SAD is less prevalent in their
population
o Reduced light causes decrease of activity of serotonin neurons in hypothalamus
– Cyclothymic disorder: frequent periods of depressed mood and hypomania, mixed with normal
mood lasting as long as two months. Experience symptoms of MDD and hypoamania; may also
have full-blown episodes
Psychological theories of mood disorders
Psychoanalytic – depression:
– According to Freud, potential for depression created early in childhood. In oral period, needs may
be under or over gratified, causing person to become fixated on this stage and dependent on
gratifications particular to it.
– Arrest in psychosexual development
– Dependent on other peple for maintenance of self-esteem
– Analysis of bereavement: loss of loved one or withdrawl of affection, mourner incorporates the
lost person to undo the loss
– Since we unconsciously harbour negative feelings towards those we love; mourner becomes
object of his or her own hate.
– Mourner resents being deserted, feels guilt, followed by mourning
– Mourning can go astray; become self-abusive, self-blame and depression. Mourner’s anger
towards loved one continues to be directed inwards.
Personality orientations in depression
Aaron beck – cognitive approach: depression associated with sociotropy (concerned with pleasing others,
avoiding disapproval, avoiding separation) and autonomy, achievement-related (self-critical goal striving,
desire for solitude, freedom of control). Autonomy predicts recurrence of depression.
Sydney Blatt – psychoanalytic: introjective (self-criticism) and anaclitic (dependency on others)
personality styles are associated with vulnerability to depression. DEQ questionnaire (dependency and
self criticism) showed association with self-criticism and depression, weaker with dependency.
– Measures maladaptive dependency ie. Neediness more associated with depression
– Maladaptive dependency and self criticism.
– Perfectionism linked to self-criticism; self oriented and socially prescribed. Also closely linked to
unipolar and bipolar depression.
Research approaches: congruency hypothesis
– Diathesis-stress approach; stressful life events in depression
– Congruency hypothesis: if non-depressed person with personality style that makes him or her
vulnerable to depression also experiences a negative life event that is congruent with vulnerability
in some way, this person will become depressed. Highlights link between interpersonal and
achievement-based. Ie. Perfectionist fails a test.
– Self-criticism predicts poor response to cognitive therapy. Measure if self-critical person becomes
less self-critical over time.
– Self-critical perfectionism scale (SCPS): measures self-criticism, autonomy, perfectionism. Only
significant unique positive predictor of depressive symptoms and comorbidity.
– MDD and anxiety disorder groups together highest levels of self-critical perfectionism.
– Self-critical perfectionism scale (SCPS) shows need to target self-critical perfectionism in
psychological interventions for depression
Cognitive theories of depression:
Beck’s theory of depression: thought processes as causative factors in depression.
– Depressed individuals feels as they do because their thinking is biased toward negative
interpretations
– In childhood and adolescence, acquired a negative schema – a tendency to see the world
negatively through loss of parent, social rejection of peers, critisicm of teachers, etc.
– Negative schemata reactivated when faced with situations similar to conditions in which the
schemata was learned.
– Negative triad (pessimistic views) → negative schemas triggered by negative life events →
cognitive biases → depression
– Negative triad: negative views of self, world and future; activated after negative life experienced
– Dysfunctional attitudes that bias interpretation of events.
– DAS – dysfunctional attitudes scale test dysfunctional beliefs reflectingneed for approval and
dysfunctional beliefs reflecting need for achievement and perfection
– When schemas are activated by an event they skew the information processing system, which
directs attentional resources to negative stimuli and translates specific experience into a distorted
negative interpretation
o Arbitrary inference: conclusion drawn in absence of sufficient evidence or any evidence
at all.
o Selective abstraction: conclusion drawn on basis of only one of many elements in a
situation. Ie. Worker feels worthless when product fails to function even though there
were other workers involved
o Overgeneralization: overall sweeping conclusion drawn on the basis of a single ad trivial
event. Ie. Student feels stupid due to her poor performance in class one day.
o Magnification (car is ruined because there is one scratch) and minimalization (woman
feels worthless despite succession of praiseworthy achievements): exaggerations in
evaluationg performance.
– Depressed individuals choose more negative words to self-describe, and have greater recall of
adjectives with depressive content.
Stroop task: provided with series of words in different colours, asked to identify colour of each word and
ignore word itself. Assesses the latency or length of time it takes to respond.
– Depressed students took longer to colour name the depression-oriented words, suggesting that
these themes were more cognitively accessible for them.; have reduced accessibility to positive
information that is specific to themselves.
McCabe: non-depressed individuals have a protective bias that involved diverting their attention away
from negative stimuli and focusing on positive stimuli.
Dozois and Dobson: depressed individuals have an interconnected negative self-representational system
and lack a well-organized positive template of self.
2 issues with Beck’s theory: whether depressed people actually think in the ways enumerated by Beck
(confirmed in clinical observations); and whether it could be that negative beliefs of depressed people do
not follow the depression, but cause the depressed mood.
– Do negative thoughts cause depression, or does depression cause negative thoughts?
Helplessness theories:
Learned helplessness: individual’s passivity and sense of being unable to act and control his/her own life
is acquired through unpleasant experiences and traumas that the individual tried to unsuccessfully control.
– Dogs that were shocked and later given the option to avoid the shock, did not avoid is as
efficiently as those that did not receive inescapable shock. As if they accepted the shock; impairs
their performance in stressful situations
– Appear passive in face of stress; do not initiate actions to allow them to cope
Attribution and learned helplessness
– Studied humans similarily to animals
– Indivated helplessness inductions sometimes lead to subsequent improvement of performance;
many depressed people hold themselves responsible for their failures
– Depressive paradox: feeling helpless, but blaming oneself
– Attribution: explanation a person has for his or her behaviour. Ie. Attribute their failure to some
cause
o Global attributions (I never do anything right) increase generalty of offects of failure
o Attribution to stable factors (I never test well) make them long term
o Attributions to internal characteristics (I am stupid) more likely to diminish self-esteem if
personal fault is global and persistent
o Attributional style lies in childhood experiences
Hopelessness theory
Depression is caused by a state of hopelessness, Metalsky and colleagues.
– Examined how students differing in attributional style responded to success vs failure on a class
test. Attributing poor grades to global and stable factors led to more persistent depressed mood.
– Advantage of this theory: can deal directly with comorbidity of depression and anxiety disorders.
– Hopelessness depression develops when perceived probability of future occurrence of negative
events becomes certain (depressive predictive certainty)
Interpersonal theory of depression
– Depressed people have sparse social networks
– Reduced social support may lessen an individuals’ ability to handle negative life
– Depressed people elicit negative reactions from others; tend to reject their partners and display
relatively few positive social behaviors (evident in high autonomy)
– Depression and marital discord co-occur
– Depressed people have poor interpersonal skills ie. Problem-solving
– Constant reassurance seeking as a result of being reared in rejecting environment
– Only temporarily satisfied with reassurance; doubt truth of feedback
– Social deficits may be cause and conseuqnece of depression
Psychological theories of bipolar disorder
