Psychology Chapter 15

Depression manifests itself differently in different people, but only rarely is it only about feeling blue.

Although sadness is the emotion most associated with depression, many find the lack of interest in or ability to feel anything (positive or negative) to be the most disabling aspect of living with depression.

The DSM-5 distinguishes between two kinds of bipolar disorder, depending on the severity of the mania

Bipolar I is more severe because it involves meeting the criteria for mania (at least 7 days), whereas bipolar II is less severe because it involves meeting the criteria for hypomania (at least 4 days). Recall that hypo means "below," so hypomania is not as severe as mania. Thus, the degree of depression is the same in bipolar I and II, but the mania is less severe in bipolar II than in I.

A useful mnemonic for remembering the symptoms of mania is D-I-G-F-A-S-T

D = Distractibility I = Indiscretion (occurs when a person says things that are somewhat inappropriate or gets involved in promiscuous sexual relationships) G = Grandiosity F = Flight of ideas A = Activity increased S = Sleep (decreased need for) T = Talkativeness

Nature and Nurture Explanations of Depression

Depression is sometimes caused by a stressful or traumatic life event, such as physical or sexual abuse, but not always. For some people, depression just comes on, like using a switch to turn on a light. In humans, stressful events, especially social rejection, start a host of biological reactions, including activating the hypothalamic-pituitary-adrenal (HPA) system, which increases the likelihood of developing depression Indeed, recent evidence suggests that stress is associated with accelerated aging of cells, which in turn is associated with depression Medications that make more serotonin available in the brain stimulate neural growth, which lessens the symptoms of depression Also, the personality traits of anxiety, neuroticism, and negative emotionality, for instance, are most associated with vulnerability to depression.

Mental disorder

Following a long-standing tradition, the DSM-5 defines a mental disorder as a syndrome

Anxiety disorders

For some, however, fear and anxiety can get out of hand, occurring repeatedly in response to imagined threat and sometimes persisting for days. For about 26% of the U.S. population, though, anxious states can interfere with everyday functioning (Kessler et al., 2012).

How common are mental disorders?

In a given year, 26% of the U.S. population suffers from a diagnosable disorder. Even though these are non-normative patterns of behavior, they are not rare. Over the course of an entire lifetime, almost half (46%) of the adults in the United States will suffer from at least one psychological disorder.

Cyclothymia

In an even milder but longer-lasting form of bipolar disorder both the manic and the depressive episodes are less severe than they are in bipolar II disorder—that is, the hypomanic and depressive symptoms never reach the criteria for hypomania and major depression.

Comorbidity

In the United States, more than half of those 46% will suffer from two or more disorders (Kessler et al., 2005). The existence of two or more disorders at the same time is called

Specific phobias

In the United States, up to 9% of the population has a specific phobia for a particular object or situation, such as spiders (arachnophobia), heights, flying, enclosed spaces (claustrophobia), doctors and dentists, or snakes (APA, 2013). Specific phobias are marked by an intense and immediate fear, even panic, when confronted with very particular situations or objects; even thinking about those situations or objects may set off the fear reaction. People with specific phobias are not generally anxious people, but they will do almost anything to avoid coming in contact with the feared object or experiencing the feared event or object.

Psychological disorder

Less common ways of behaving might be revealed through exceptional talent or might not be well suited for the environment. We might consider these less common behaviors disordered, because they do not function well in the world.

Persistent depressive disorder (PDD

Other forms of depressive disorder have milder symptoms but last longer. One of these milder forms is Most of the symptoms are the same as in a major depressive disorder, but they are less intense in ___, though the depressive mood lasts most of the day and most of the time for at least 2 years.

Depression demographics

Overall, approximately 7% of the American population has major depressive disorder, but the occurrence varies depending on age and sex. The disorder is three times more likely in 18- to 29-year-olds than in 60+-year-olds. Females experience depression up to three times more often than males

Disturbance

Psychological disorders are distinguished by their clinically significant disturbance of psychological processes of thought, emotion, and behavior. Mental disorders are distinguished from physical disorders that affect physiological and bodily structures and processes.

The classification and diagnosis of psychological disorders is fraught with ambiguity and disagreement.

The first attempt to do so in the United States began with the government census of 1840 and simply had one category: "idiocy/insanity" (S. Greenberg, Shuman, & Meyer 2004). The first official attempt at diagnosing mental disorders in the United States came in 1952 with the publication of the Diagnostic and Statistical Manual (DSM). It was not until the third edition in 1980 that diagnoses became grounded in scientific evidence and clinical observations rather than theory. Currently in its fifth edition, the DSM-5 has continued the tradition of defining disorders based on a combination of scientific evidence and clinical observations

Causes of Obsessive-Compulsive Disorder

The overactive ACC creates a perpetual feeling that something is wrong, which the limbic system structures translate into anxiety. In turn, anxiety stimulates more intrusive thoughts, which sometimes become compulsive actions. These actions occur as behavioral responses aimed at reducing the tensions or anxiety generated by the situation The cycle goes on endlessly, due to the hyperactivity of the brain circuit—which is stuck in the "on" position.

Nature and Nurture Explanations of Anxiety Disorders

Three biological factors that make people vulnerable to anxiety disorders are deficiencies in the neurotransmitter GABA, their genetic heritage, and their personalities. Deficiencies in GABA lead to excessive activation in certain brain regions, especially the limbic structures associated with fear. As for personality, people who are high in neuroticism—prone to worry, anxiety, and nervousness—are more likely to develop anxiety disorders

Panic attack diagnosis

To receive a diagnosis of panic disorder, a panic attack must be followed by at least a month of persistent worry over future attacks, along with the development of potentially maladaptive behaviors to avoid attacks Although about 10% of the U.S. population has experienced a panic attack in the past 12 months

Causes of Bipolar Disorder

Twin studies also point to a role for genetics in bipolar disorder. If one identical twin develops bipolar disorder, there is a 40%-70% chance that the other twin will also develop the disorder Abnormalities in the brains of people who suffer from bipolar disorder may be a cause or a result of the biochemical, genetic, and environmental elements that contribute to the disorder. The prefrontal cortex, amygdala, hippocampus, and basal ganglia all may play a role

Major depressive disorder

What most people refer to as "depression" a chronic condition characterized by enduring changes in mood, motivation, and sense of self-worth. According to DSM-5, to be diagnosed with major depressive disorder, one must have at least five of nine symptoms associated with major depression, which must continue for at least 2 consecutive weeks : 1. Depressed (sad, listless) mood that stays low all day for several days 2. Reduced interest or pleasure in doing anything 3. Significant change in body weight (indicating dieting or overeating) 4. Sleep disturbances 5. Sluggishness or restlessness 6. Daily fatigue or loss of energy 7. Daily feelings of worthlessness, self-reproach, or excessive guilt 8. Lack of ability to concentrate or think clearly 9. Recurrent thoughts of death or suicidal ideation

Dysfunction

___behavior interferes with everyday functioning, such as participating in everyday social relationships, holding a regular job, or being productive, and occasionally it can be a risk to oneself or others.

Distress

___behavior leads to discomfort, pain, or anguish, either in the person directly or in others, especially family members. The ___ element is one reason we say a person is "suffering" from a disorder.

Bipolar disorder

a mood disorder characterized by substantial mood fluctuations, cycling between very low (depressive) and very high (manic) moods.

Syndrome

a set of related conditions—of clinically significant disturbances of thoughts, feelings, or behaviors. More specifically, they argue for the "4 Ds" of determining whether something is a mental disorder: disturbance dysfunction distress or disability deviant

Hypomanic episodes

are nearly the same symptoms but shorter in duration—they last at least 4 days

Behaviors that possess only one or even two of these "4 Ds"

are not typically classified as disordered. Finally, if a behavior is culturally accepted it cannot be a disorder, such as hallucinations of shamans in some preliterate cultures.

Recent evidence from more than 60,000 people worldwide suggests that five major psychiatric disorders

autism spectrum disorder, attention deficit hyperactivity disorder(ADHD), bipolar disorder, depression, and schizophrenia actually have a common genetic cause

The DSM-5

derives from an American perspective of psychological illness. More than previous editions, the DSM-5 tries to expand beyond the U.S. perspective by aiming to be consistent with international standards for disorder classification and discussing the prevalence rates of certain disorders in different countries. Some disorders are found only in certain cultures. Additionally, some disorders spread from culture to culture

Panic attacks

involve sudden changes in body and mind, characterized by an overwhelming sense of impending doom, heart palpitations, trembling, sweating, shortness of breath, dizziness, intense dread, nausea, and even a fear of dying. Such attacks are associated with perceptions of threat and can occur for a number of reasons: fear of danger, an inability to escape, fear of embarrassment, or fear of a specific category of objects. Panic attacks usually last about 10 minutes but sometimes come and go over a period of an hour or more. Due to their physiological effects, people undergoing a panic attack may believe they are having a heart attack or are "going crazy."

Psychiatry

is a branch of medicine, so it is not a coincidence that terms such as illness, diagnosis, and therapy or treatment are used in the context of psychological disorders.

Generalized anxiety disorder (GAD)

is a common anxiety disorder, characterized by a pervasive, excessive, hard-to-control state of anxiety or worry that lasts at least 6 months (APA, 2013). People with GAD may also have trouble with sleep, body restlessness or agitation, difficulty concentrating, or muscle tension. Adults must exhibit at least three of the preceding symptoms to receive a diagnosis of GAD (APA, 2013). GAD affects between 3% and 9% of the U.S. population, although females are twice as likely as males to have GAD

Obsessive-compulsive disorder (OCD)

is a disorder that is manifested in both thought and behavior. In short, obsessions are thought disturbances, whereas compulsions are repetitive behaviors People who suffer from OCD often know that their thoughts are irrational, or at least that their compulsive behaviors are excessive, but they cannot stop themselves. In some cases, compulsive behaviors stem from superstitions.

Phobia

is a persistent and unreasonable fear of a particular object, situation, or activity (APA, 2013).

Compulsion

is a repetitive behavior performed in response to uncontrollable urges or according to a ritualistic set of rules.

An obsession

is an unwanted thought, word, phrase, or image that persistently and repeatedly comes into a person's mind and causes distress. People with OCD have thoughts that they cannot dismiss, especially negative thoughts that most people can disregard

Panic disorder

is defined by frequent panic attacks and pervasive and persistent fear, worry, embarrassment, and concern about having future panic attacks (APA, 2013). The preoccupation with and anxiety over having another attack create an anxious mood, which then increases the likelihood of more worrisome thoughts and, ironically, another attack. Thus, panic disorder creates a positive feedback cycle, wherein anxiety about future attacks hijacks the body's emergency response system and catapults it out of control.

Social phobia, or social anxiety disorder

is marked by a pronounced fear of humiliation or embarrassment in the presence of others or severe self-consciousness about one's appearance, behavior, or both.

Post-traumatic stress disorder (PTSD)

is one of the trauma- and stressor-related disorders and involves a set of intrusive and persistent cognitive, emotional, and physiological symptoms triggered by exposure to a catastrophic or horrifying event—such as experiences of war, attempted murder, rape, natural disasters, the sudden death of a loved one, or physical or sexual abuse

Agoraphobia

is the most severe of all phobias is intense anxiety, fear, and panic about being in places from which escape might be difficult or in which help might not be available, should a panic attack occur, such as in open spaces, in a public market, in line somewhere, outside of the home alone, or in enclosed spaces This fear of being unable to escape keeps people at home, where they feel safe. Panic attacks are associated with agoraphobia in about one-third of all cases.

Deviant

literally means "different from the norm," or different from what most people do. It is important to point out, as the DSM-5 does, that deviant behavior can be classified as disordered only if it is also dysfunctional. Albert Einstein was deviant in his intelligence and creativity, but he was not suffering from a psychological disorder.

Post-traumatic stress disorder (PTSD) diagnosis

one must have directly experienced a traumatic event or witnessed such an event occurring to others, learned of a violent or accidental extreme trauma (e.g., death or sexual violence) occurring to a loved one, and/or repeatedly been exposed to or reminded of the details of such an event People suffering from __ experience a number of intrusive symptoms that last for at least 1 month. These may include recurring intrusive thoughts, feelings, or memories of the traumatic event, either while awake or dreaming, as well as flashbacks, vivid reactions in which the person feels as if he or she were experiencing the traumatic event all over again.

Depressive disorder

the highest order category of the ___ and subsumes all forms of depression, including major depressive disorder and persistent depressive disorder.

If schizophrenia and other psychotic disorders are expressions of thought and perceptual disturbances,

then bipolar disorder and depression are expressions of disturbance in mood and emotion. The depressive disorders, bipolar disorders, and anxiety disorder are marked especially by disturbances in emotional behavior that prevent people from functioning effectively in everyday life.

Manic episodes

typically involve increased energy, sleeplessness, euphoria, irritability, delusions of grandeur, increased sex drive, and "racing" thoughts that last at least 1 week.