chapter 7 abnormal psychology
multicultural perspective (sociocultural)
ties depression to factors like gender, race, and economic status 1-links between gender and depression (strong relationship, unclear explanation) New zealand and us are 2x as liekly as men to receive a diagnosis of unipolar depression women are younger when depression happens, has more frequent and lasting bouts, and responds less successfully to treatment than men -artifact theory- women and men are equally prone to depression but that clinicians often fail to detect depression in men (masculine symptoms, socially acceptable?), failed to receive consistent research , women are no more willing or able than men to identify their depressive symptoms and to seek treatment -hormone explanation-that hormone changes trigger depression in many women, puberty for women and depression rates happen at same time (hormone changes alone are not responsible), could be important social and life events (sexist explanation?) -life stress theory- women in our society are subject to more stress than men, face more poverty, menial jobs, worse housing, and more discrimination-all factors have been linked to depression and more housework -body dissatisfaction explanation- females in western society are taught almost from birth to seek a low body weight and slender body shape, goals that are unreasonable, unhealthy, and unattainable, gender differences in depression first appear during adolescenes when lots of pressure on women and ppl w eating disorders often have high levels of depression/ however unclear if eating and weight concerns actually cause depression, may be result -lack of control theory- learned helplessness research and proposes that women may be more prone to depression bc they feel less control than men over their lives. (women are more prone than men to develop learned helplessness in the lab), any victimization (robbery, rape) can produce helplessness , and women in our society are more likley than men to be victims, particularly of sexual assault and child abuse rumination theory- (tendency to keep focusing on one's feeling when depressed and to consider repeatedly the causes and consequences of that depression), ppl who ruminate when they are sad stay sad longer, women are more likely to ruminate than men when their mood darkens each has evidence and raises questions, most talked about and least understood phenomena 2-links between cultural and ethnic background and depression (maybe?) study-canada swiz, iran, japan, depressed ppl reported sadness, joylessness, anxiety, tension, lack of energy, loss of interest, loss of abilit;y to conventrate, ideas of insufficiency, thoughts of suicide -study- non westerniszed countries like china and nigeria are more likely to be troubled by physical symptoms such as fatigue, weakness, sleep disturbances, and weight loss, less often marked by cognitive symptoms of self blame, low self esteem and guilt ... as countries become more westernized depression takes on more cognitive character in the west depression varies from country to country -in us, few differences in symptoms of depression among members of different ethic or racial groups , nor sig differences in the overall rates of depression between such miniority groups / but major differences in chronicity (how likely it is that a person will have recurrent episodes of a disorder) hispanic and african americans are 50% more likely than white americans to have recurrent episodes 54% of whites get treatment (medication and or psychotherapy) vs 34% of hispanics and 40% of blacks, more limited treatment when they are depressed -similar among minority groups but specific ethnic populations living under unusually oppressive circumstances sometimes do have strikingly high rates of depression ex: indians in us risk 37% for women, 19% for men, 28% overall, much higher than general us population, hugh economic and social pressure to live on reserves ex: hispanic and blacks residing in public housing said half had depression likelihood of being depressed rises w individual's degree of poverty, family size, and number of health problems depression is distributed unevenly within some minority groups, more common in hispanic and blacks born in us than hispanic and black immigrants puerto ricans have a higher rate of depression than do mexican or cuban whereas african americans whose families came by way of the caribbean islands have similar rates of depression
cause of bipolar
- only a few studies support relationship between loss early or later in life and the onset of manic episodes neurotransmitter activity, ion activity, brain structure, and genetic factors
texting
18-24 yr old averages 4000 texts a month communicating primarily through text messages does affect relationships negatively/not making important emotional connections leads to misunderstandings/ ongoing text convos interupt real in person convos so hurts those relationships as well /participants who averaged the most daily texts were most likely than other participants to report more stress, unhappiness, anxiety, and sleeping problems - lead to broader unhappiness and stress exclusive and excessive use of it is the problem, not just texting in general /important convos need to be in person
women are at least 2x as likely as men to have episodes of severe unipolar depression
26% of women have an episode at some time in their lives, compared to 12% of men for children, the same rate for boys and girls
85% of ppl w unipolar depression recover, some w/o treatment
40% of them have at least one other episode of depression later in their lives
9% suffer from a severe unipolar pattern of depression in a year in the US
5% suffer from mild forms
more than 350 mil ppl suffer from depression worldwide
50% of stroke victims experience clinical depression 30% of cancer patients 20% of heart attack victims 18% of ppl w diabetes
disruptive mood dysregulation disorder
combo of persistent depressive symptoms and recurrent outbursts of severe temper emerges during mid childhood or adolescence
bipolar
focus on biological factors
persistent depressive disorder
a chronic form of unipolar depression marked by ongoing and repeated symptoms of either major or mild depression can have repeated major depressive episodes, called persistent depressive disorder with major depressive episodes, can have less severe, less disabling symptoms called persistent depressive disorder w dysthymic syndrome
bipolar disorder
a disorder marked by alternating or intermixed periods of mania and depression
premenstrual dysphoric disorder
a disorder marked by repeated episodes of significant depression and related symptoms during the week before menstruation DSM 5 controversial
Major depressive episode
a period of 2 or more weeks marked by at least 5 symptoms of depression including sad mood and/or loss of pleasure extreme cases involve psychotic symptoms, w loss of contact w reality such as delusions (bizarre ideas w/o foundation) or hallucinations (perceptions of things that are not actually present) DSM 5 READ IN BOOK
major depressive disorder
a severe pattern of depression that is disabling and is not caused by such factors as drugs or a general medical condition go through major depressive episode w/o history of mania seasonal (changes w seasons) catatonic ( either immobility or excessive activity) peripartum (during pregnancy or within four weeks of giving birth melancholic ( totally unaffected by pleasurable events can be a depressive episode within a larger pattern of bipolar disorder, in which manic episodes have not appeared yet, when they appear it is called bipolar
mania
a state or episode of euphoria or frenzied activity in which people may have exaggerated belief that the world is theirs for the taking
clinical oversight
around 70% of ppl w bipolar disorder are misdiagnosed at least once
brain structure
basal ganglia and cerebellum of bipolar ppl are smaller, they have lower gray matter in the brain, and their dorsal raphe nucleus, striatum,amygdala hippocampus,and prefrontal cortex have some structual abnormalities (not clear what role this gives bipolar ppl) -may help produce neurotransmitter and ion abnormalitites (dorsal raphe nucleus is a brain site where serotonin is produced -may be result of neurotransmiter or ion abnormalities or of the medications that many patients w bipolar disorders take now
theory of negative thinking (cognitive)
beck- maladaptive attitudes, a cognitive triad, errors in thinking and automatic thoughts combine to produce depression maladaptive attitudes-"worth is tied to tasks I perform", result from own experiences, afmily relationships and judgements from ppl around them depressed ppl hold maladaptive attitudes and that the more of these attitudes they hold the more depressed they are cognitive triad-three forms of negative thinking that aaron beck theorizes lead ppl to feel depressed, individuals repeatedly interpret negative views of one's experiences, oneself, and the future upsetting situations later in life may trigger this extended round of thinking (1/3 of ppl who felt unhappy as children continue to feel unhappy as adults) depressed ppl seem to recall unpleasant experiences more readily than positive ones, rate their performances on lab tasks lower than nondepressed ppl and select pessimistic statements in storytelling tests errors in thinking- arbitrary inferences (negative conclusions based on little evidence/ minimize significance of positive experiences or magnify negative ones study to read and interpret paragraphs about women in difficult situations, depressed ppl made more errors in logic (inferences) automatic thoughts- a steady train of unpleasant thoughts that help to cuase or maintain depression, anxiety, or other forms of psychological dysfunction/ suggest that they are inadequate or that their situation is hopeless/thoughts just happen/ have hundreds of horrible thoughts in a couple of hours 1- being tricked into reading negative automatic thought like statements about themselves and became increasingly depressed 2- ppl who make ruminative responses during depressed moods (repeatedly dwell mentally on their mood without acting to change it) feel dejection longer and are more likely to get depression later in life negative thinking is linked to depression but fails to show that patterns of thought are the cause and core
immune system
bodys network of activities and body cells that fight off bacteria, viruses, and other foreign invaders intense stress for awhile causes immune system to get dysregulated and has lower functioning of important white blood cells (lymphocytes) and increased production of (C-reactive protein or CRP- protein that spreads throughout body and causes inflammation and various illnesses dysregulation may cause depression circumstancial but compelling -stress triggers depression, leads to poor immune functioning - depressed ppl have lower lymphocyte activities and increased CRP production and body inflammation -depressed ppl have higher incidence than other ppl of migraines, irritable bowel syndrome, chronic fatigue syndrome, rheumatoid arthritis, and other illnesses caused by CRP production and inflammation -antidepressants combat CRP related inflammation unclear relationship between immune system dysregulation and depression but there is a relationship
hypergraphia
compulsive need to write. during severe episodes, ppl w this rare problem write constantly, not only filling up notebooks or computer screens but also feverishly finding unusual writing surfaces including their own skin. the problem has been linked to several disorders, including bipolar, temporal lobe epilepsy, and schiz. there is speculation that some famous wrtiers and artists worked under the sway of hypergraphia such as author fyodor dostoyevski and painter vincent van gogh, who produced an endless stream of paintings and letters
abnormality and creativity
creative genuises=psychologically disturbed study- artists and writers more likely to suffer from certain mental disorders particularly bipolar disorders normally struggle before, art just brings attention to it and most have family history of psych probs, many have experienced intense psych trauma during childhood -creative endeavors create emotional turmoil that is overwhelming (murder book changed him) -creative professions offer a welcome climate for those types of psych disturbances - emotional expression, unusual thinking, personal turmoil are all valued as sources of inspiration and success 1-psych disturbance is hardly a requirement for creativity, most creative geniuses are stable and happy 2- mild psych disubances relate to creative achievement much more strongly than severe disturbances do (27 works one yr, next nothing when severe) 3- successful treatment for severe psych disorders more often than not improves the creative process (has little redeeming value anywhere if severe)
unipolar depression
depression without a history of mania, normal or nearly normal mood when depression lifts
symptoms of mania
dramatic and inappropriate rises in moods, span same areas of functioning as depression (emotional, motivational, behavioral, cognitive, physical) , but affects in opposite ways active powerful emotions in search of an outlet/ euphoric joy and wellbeing is out of proportion to the actual happenings in the person's life/feel no restrictions/not afraid of anything or anyone some become angry and irritable esp when others get in way of exaggerated ambitions want constant excitement, involvement, and compainionship, seek new and old friends, new and old interests, litle awareness that their social style is overwhelmming, domineering and excessive usually very active, move quickly, talk loudly and rapidly w jokes and efforts to be clever, or w complaints and verbal outbursts, flamboyance is not uncommon, flashy clothes, giving alot of money to strangers, getting involved in dangerous activities poor judgment and planning filled w optimism, can't slow them down or tell them to spend money bette inflated opinion of themselves, self esteem is near grandiosity if severe, some have trouble remaining coherent or in touch w reality remarkably energetic, get little sleep, even if miss two nights of sleep have high energy levels
crying
easier for crying man to be taken seriously than crying women, depends on matter, man-sensitive, women-lack of control study-a moist eye was viewed much more positively than open crying, and males got the most positive responses damned if you do damned if you dont when men express anger they gain status, when women express anger, they lose status male crying has gain acceptance again in past 30-40 yrs (ab lincoln)
anatomical factors
emotional reactions of various kinds are tied to brain circuits (networks of brain structures that work together, triggering each other into action and producing a particular kind of emotional reaction) members of unipolar circuit (filled w serotonin or 5HTT's, proteins that help serotonin carry messages from one neuron to another): -prefrontal cortex (frontal cortex in brain)-recieves info from many other brain areas, deals w mood/attention/ immune functioning found lower activity and blood flow in depressed ppl / other studies find increased activities during depression in some parts of prefrontal cortex prefrontal cortex activity of depressed ppl increases after successful treatment by some antidepressants, but decreases after successful treatment by other kinds of antidepressants knows it plays a critical role but not clearly defined yet -hippocampus strong neural connections w prefrontal cortex, produces new neurons throughout adulthood (neurogenesis) neurogenesis decreases dramatically when a person becomes depressed when depressed ppl are successfully treated by antidepressants neurogenesis in hippo returns back to normal reduction in size of hippo among depressed ppl controls brains and bodys reactions to stress and plays role in formation and recall of emotional memories role in depression is not surprising -amygdala expression of negative emotions and memories tied to generalized anxiety disorder, panic disorder, posttraumatic stress disorder and depression PET and fMRI scans say 50% more activity and blood flow in amygdala when depressed as a patients depression gets worse, amygdala increases in activity proportionally nondepressed- increases in activity when see sad faces depressed- increases when recall sad moments in their life -brodmann area 25 (located under cingulate cortex in brain) smaller in depressed ppl more active among depressed brain scans say that when depression subsides, activity decreases significantly activation of area 25 comes and goes w episodes of depression, theorists think its a depression switch, a junction box whose malfuntion might be necessary and sufficient for depression to occur
depression has many symptoms
emotional, motivational, behavioral, cognitive, and physical
bipolar disorder
experience lows of depression and highs of mania, rollercoaster of extreme moods, usually become suicidal, impact on friends and fam
cognitive symptoms
extremely negative views of themselves/ inadequate, undesirable, inferior, evil/ blame themselves for every unfortunate event, dont credit themselves for positive achievements/ pessimism (nothing will ever improve, helpless to change aspects of their life) expect the worse so they procrastinate/hopelessness and helplessness more vulnerable to suicidal thinking complain their intellectual ability is poor/ confused/unable to remember things/easily distracted/ unable to solve small problems/ perform more poorly than nondepressed ppl on some tasks of memory, attention, and reasoning (may reflect motivation vs cognitive problems)
genetic
family pedigree supports this identical twins of those w bipolar disorder have 40% likelihood of developing the same disorder, and fraternal twins, siblings, and other close relatives of such ppl have a 5-10% likelihood, compared to 1-2.6 in general pop genetic linkage- pick large families who have had high rates of disorders over several generations, observe the pattern of distribution of the disorder among fmaily members, and determine wheter it closely follows the distribution pattern of a known genetically transmitted family trait (called genetic marker) such as color blindness red hair or a medical syndrome israeli, belgian, italian, and finnish families had high rates of bipolar and found genes on x chromosome used molecular biology to examine genetic patterns of large families and found chromosomes 1,4,6,10,11,12,13,15,18,20,21,22 suggest a number of genetic abnormalities probably combine to help bring about bipolar disorders
statistic
family physicians, internists, and pediatricians fail to detect depression in at least 50% of their depressed patients
genetic
four researches- family pedigree, twin, adoption, and molecular biology gene studies- suggest that ppl inherit a predisposition to unipolar depression family pedigree studies: select ppl w unipolar depression as probands(person who is focus of a genetic study), examine relatives, and see whether depression also afflicts other members of the family 30% of relatives are depressed , compared to 10% general population twin studies: 200 pairs of twins when monozygotic (identical) twin had unipolar depression, there was 46% chance the other twin would too dizygotic (fraternal) twin- then 20% chance of developing disorder adoption studies: study looked at families of adopted persons who had been hospitalized for disorder in denmark biological parents of disordered adoptees turned out to have higher incidence of severe depression (but not mild depression) than biological parents of control group of nondepressed adoptees thinks that severe depression is more likely than mild to be caused by genetic factors biology gene studies: look at genes on certain chromosomes abnormality on 5-HTT gene (chromosome 17) which is responsible for brain's production of serotonin transporters or 5HTT's, proteins that help the neurotransmitter serotonin carry messages from one neuron to another low serotonin is related to depression ppl w this abnormality of serotonin transporter gene are more likely than others to display low serotonin activity in the brain and be more prone to depression
diagnosing bipolar
full manic episode when for at least one week that display an abnormally high or irritable mood, increased activity or energ, and at least three other symptoms of mania, episode may have psychotic features like delusions or hallucinations. hypomanic episode ( when symptoms of mania are less severe or cause little impairment) two kinds: bipolar 1 and bipolar 2 bipolar 1- a type of bipolar disorder marked by full manic and major depressive episodes alternation of the episodes (weeks of mania, wellness, then depression) or mixed features (with manic and depression in same episode) bipolar 2- a type of bipolar disorder marked by mildly manic (hypomanic) episodes and major depressive episodes alternate episodes , some ppl accomplish huge amounts of work during their mild manic periods w/o treatment the mood episodes tend to recur for ppl w either type of disorder rapid cycling- if a person has 4 or more episodes in 1 yr experience depression more (3x more) than manic episodes, and depressive episodes last longer 1-2.6% of adults worldwide suffer from bipolar disorder /4% experience bipolar disorder at some time in their life, bipolar 1 is more common than 2, equally common in men and women, women may have more depressive episodes and more rapid cycling than men, more common among ppl w low incomes onset is between 15-44 yrs old normally in most untreated cases, manic and depressive episodes eventually subside only to recur at a later time, over time ppl w bipolar develop more medical ailments than the rest of the population cyclothymic disorder in DSM5- a disorder marked by numerous periods of hypomanic symptoms and mild depressive symptoms/ symptoms for 2 or more yrs, interrupted sometimes by normal moods that may last for days or weeks/ usually begins in adolescence like 1 and 2 and is equally common among men and women, .4% of population has this/sometimes milder symptoms go into 1 and 2 PG 241 FOR DSM LIST
biological view
genetic, biochemical, anatomical, immune system
physical symptoms
headaches/indigestion/constipation/dizzy spells/ general pain misdiagnosed as medical problems at first disturbances in appetite and sleep/eat less/sleep more/
stat
it has been estimated that 400,000 infants are born each year to depressed mothers
behavioral symptoms
less active/less productive/ more alone time/more time in bed/ move and speak more slowly
motivational symptoms
lose desire to pursue usual activities/ lack drive, initiative, spontaneity/ force themselves to go to work, eat, talk w friends, have sex-paralysis of will 6-15% w severe depression commit suicide/ultimate escape to life challenges
biochemical factors
low levels of norepinephrine and serotonin have been strongly linked to unipolar depression norepinephrine-a neurotransmitter whose abnormal activity is linked to depression and panic disorder serotonin- a neurotransmitter whose abnormal activity is linked to depression, obsessive compulsive disorder, and eating disorders evidence: -reserpine and other medications for high blood pressure caused depression (some lowered nore, others sero) -first truly effective antidepressant discovered by accident increased nore, or sero interactions between serotonin and norepinephrine activity, or between these and other kinds of neruotransmitters in the brain, rather than operation of one neurotransmitter alone may account for unipolar depression -studies hint that depressed ppl have overall imbalance of serotonin, nopinephrine, dopamine, and acetylcholine -some believe serotonin is a neruomodulator ( chemical whose primary function is to increase or decrease the activities of other key neurotransmitters) -body's endocrine system for unipolar- endocrine glands release hormones throughout the body, ppl w depression have abnormally high levels of cortisol, one of the hormones released during stress, makes sense bc stressful events trigger depression -melatonin tied to depression (dracula hormone, released in the dark) -some think what happens inside neurons is more important than the chemical that carrys messages between neurons, activity by key neurotransmitter sor hormones lead to deficiencies in certain proteins and chemicals within neurons, particularly deficiencies in brain-derived neurotrophic factor (BDNF) (chemical that promotes the growth and survival of neurons) , deficiencies impair neuron health and then depression limitations to studies: - analogue studies- depressionlike symptoms in laboratory animals, may not reflect human disorder, -limited technology and studies of human depression had to measure brain biochemical activity indirectly - never certain of biochemical events taking place in the brain (now use PET and MRI scans)
depression
low sad state marked by significant levels of sadness, lack of energy, low self-worth, guilt, or related symptoms
ppl in their 40's are more likely than any other age group to have unipolar depression in most countries
median age to get it is now 26 in us has increased steadily since 1915 keeps dropping for each generation
ppl w bipolar disorder are more likely than other ppl to engage in criminal behaviors particularly during manic episodes
mostly see gray when sad black in describing depression LOOK AT PG 249 AND READ
ion activity
neurotransmitters-communication between neurons ions- communications within a neuron sodium ions (NA+) are positively charges and sit on both sides of a neuron's cell membrane, when neuron is at rest, more sodium ions sit outside the membrane when receive a message sodium ions go to inside of pores and increase positive charge inside the neuron, results are neurons firing then potassium ions (K+) flow from the inside of a neuron across cell membrane to the outside to help return the neuron to its original resting state irregularities in the transport of these ions may cause neurons to fire too easily (thus mania) or stubbornly resisting firing (depression) - have found abnormal functioning in proteins that help transport ions across a neuron's membrane and have found membrane defects in neurons from bipolar ppl
depressive disorders have
no redeeming characteristics, they bring severe and long lasting psychological pain that may intensify as time goes by. lose their will to carry out simpliest of life's activities and even lose their will to live
neurotransmitters bipolar
norepinephrine overactivity? - one study found norepinephrine activity of pplw mania to be higher, another study ppl w bipolar were given reserpine, the blood pressure dug known to reduce norepinephrine activity in the brain and some manic symptoms decreased no relationship to be found w high serotonin instead may be linked to low serotonin like depression serotonin acting as a neuromodulator will open the door for a mood disorder and permits the activity of norepinephrine to define the particular form of disorder? may be linked to abnormal activity of GABA
cognitive views
persistently view events in negative ways that such perceptions lead to their disorder theory of negative thinking, theory of learned helplessness
according to a study of 2500 retined NFL players, those who suffer three concussions during their careers are three times more likely later to develop a depressive disorder than those who had no concussions
players who experience one or two concussions are 1.5 times more likely than other players to develop a depressive disorder around 26% of all former professional football players have suffered 3 or more concussions
negative thinking,self dissatisfaction and life stress were found to predict depression
poor social relationships and reductions in positive rewards did not (helps to maintain it) biological and cognitive were leading explanations
10-30% of women get peripartum or postpartum depression begins within four weeks after childbirth, many begin during pregnancy, dif from baby blues baby blues, 80% of women, normal, crying spells, fatigue, anxiety, insomnia, and sadness
postpartum may last up to a year or more , extreme sadness, dispair, tearfulness, insomnia, anxiety, intrusive thoughts, compulsions, panic attacks, feelings of inability to cope, suicidal thoughts if have postpartum episode- 25-50% chance of developing it with another birth could be from hormones (drop 50X below normal level after spiking) or genetic , at high risk if family of mood disorders sleep and relaxation decrease, more stress from job, psychological and social changes, stress increases risk for depression, sick or difficult children have more stress treatment is a big help, self help support groups, antidepressants, cog therapy, interpersonal psychotherapy, or combo of these , many do not seek help bc its supposed to be most joyful part of life
in previous dsm's
ppl who lose a loved one were excluded from receiving a diagnosis of major depressive diosrder during the first 2 months of their grieving however according to dsm 5, newly grieved ppl can quality for this diagnosis if their depressive symptoms are severe enough, critics fear that many ppl undergoing a normal grief reaction may now receive an incorrect diagnosis of major depressive disorder
psychological views on unipolar
psychodynamic (not strongly supported), behavioral (modest support), and cognitive ( considerable support and has large following)
18% of all adults experience an episode of severe unipolar depression at some point in their lives
rate is higher among poor than the wealthy similar rates in canada, england, france, other countries
"depressed" the word
responding to sad events, fatigue, or unhappy thoughts, do not influence daily functioning or persist long, can be good for inner selves
behavioral view
results from significant changes in the number of rewards and punishments ppl recieve in their lives Lewinsohn- positive rewards in life dwindle for some ppl, leading them to perform less and less constructive behaviors, leads to depression ex college life, basketball player found that number of rewards ppl receive in life is related to the presence or absence of depression/ depressed ppl report fewer positive rewards than non depressed but when their rewards begin to increase their mood does too/ strong relationship between positive life events and feelings of life satisfaction and happiness social rewards are particularly important in the downward spiral of depression / depressed ppl receive fewer social rewards tan nondepressed and when their mood improves, their social rewards increase / victims of social circumstances but also dark mood and flat behaviors make decline in social rewards limitations 1-relied heavily on self reports of depressed ppl (can be biased and inaccurate, influenced by gloomy mood and negative outlook) 2-studies are largely correlational and do not establish that decrease in rewarding events are the initial cause of depression (depressed mood in itself may lead to neg behaviors and decreases in activities so fewer rewards)
family social perspective (sociocultural)
role played by interpersonal factors in the development of depression connection between declining social rewards and depression (like behaviorists) display weak social skills and communicate poorly(ppl might feel uncomfortable around them now and avoid them) so social rewards and contacts of depressed ppl decrease over time depressed ppl (esp with repeated episodes of depression) lower their expectations of what they can get from social relationships and scale back their social ambitions tied to unavailability of social support such as found in happy marriages ppl who are separated or divorced display at least 3x the depression rate of married or widowed ppl and double the rate of those who have never been married spouses depression may contribute to marital disocrd, a separation, or divorce but often the interpersonal conflicts and low social support found in troubled relationships seem to lead to depression high correlation of marital conflict and degree of sadness- .37 for men and .42 for women - if depressed correlation rises to .66 ppl who are in unsatisfying relationships were 3x more likely to have a major depressive episode (1/3 of cases could be prevented if marital stress was eliminated) ppl who are isolated and without intimacy are particularly likely to become depressed at times of stress study- women that had 3 or more young children, no close confidante, and no outside employment were more likely to be depressed after a stressful event study- ppl that lack social support remain depressed longer than those w supportive spouse or warm friendships
emotional symptoms
sad/dejected/miserable/empty/humiliated lose humor, little pleasure from anything anhedonia-inability to experience any pleasure at all anxiety/anger/agitation/crying spells
theory of learned helplessness (cognitive)
seligman- the perception, based on past experiences that one has no control over one's reinforcements (or life) or they think that they themselves are responsible for this helpless state ppl become depressed after developing a general belief that they have no control over reinforecements in their life hammock w shocks no matter what they did, next day shuttle box, jump over shocks and could be controlled but most found it helpless and took the shocks 1-when ppl are exposed to uncontrollable negative events they later score higher than other individuals on the 2-depressive mood scale 2-animals lose interest in sexual and social activities, same as humans 3- uncontrollable negative events result in lower norepinephrine and serotonin activity in rats new versions: 1-attribution helplessness theory- ppl view events as beyond their control they ask themselves why this is so / if they attribute their present lack of control to some internal cause that is both global and stable( i am inadequate at everything and I always will be) / less depression if specific unstable and external ex college girlfriend dumps him, study- at end of therapy less internal/global/stable pattern of attribution and depression improved 2- suggest that attributions are likely to cause depression only when they further produce a sense of hopelessness in a person, predict depression better limitations: 1- lab helplessness does not parallel depression in every respect (ex uncontrollable shocks w produce anxiety w helplessness, and humans dont always have anxiety during depression) 2- much of helplessness research relies on animals (reflect depression in humans?) 3- attributional feature of the theory raises difficult questions (what about the dogs and rats who learn helplessness? can animals make attributions even implicitly?) READ table 7-4 on 234
psychodynamic view
similarity between depression and grief in ppl losing loved ones-weeping, loss of appetite, difficulty sleeping, loss of pleasure in life, and general withdrawal unconscious processes when death happens oral stage- period of total dependency when infants cannot distinguish themselves from their parents (merge identities to that of the person they lost, to symbollically regain the lost person) introjection- direct all their feelings for he loved one, sadness and anger, toward themselves/ temporary/could get worse/feel empty, avoid social relationships, sense of loss increases depressed in the face of loss: those who parents failed to nurture them and meet their needs during th oral stage and those whose parents gratified those needs excessively symbolic or imagined loss-according to freudian theory, the loss of a valued object, for example loss of employment, that is unconsciously interpreted as the loss of a loved one object relations theorists say depression reslts whne ppl's relationships leave them feeling unsafe and insecure / excessive dependence or excessive self reliance more likely to be depressed when later lose important rlationships anaclitic depression- a pattern of depressed behavior found among very young children that is caused by separation from one's mother support that psychodymanic idea of depression may be triggered by a major loss and that losses suffered early in life may set the stage for later depression and ppl whose childhood needs were improperly met are more likely to be depressed after a loss limitations to this view: 1- losses and inadequate parenting sometimes relate to depression but not factors that are typically responsibe for disorder (less tan 10% of all ppl who have major losses in life actually become depressed) 2- findings are inconsistent, some connections and some have none 3- certain features of this explanation are nearly impossible to test (unconscious level)
sociocultural views
social context that surrounds ppl / triggered by outside stressors family social perspective and multicultural perspective
unipolar mania
suffer only from mania uncommon
DSM4-5 premenstrual dysphoric disorder
suggestion to formally list as new depressive disorder, when woman was regularly impaired by at least 5 of 11 symptmos during the week before menstruation-depressed or hopeless feelings, tense or anxious feelings, marked mood changes, frequent irritability or anger and increased interpersonal conflicts, decreased interest in her usual activities, poor concentration lack of energy, changes in appetite, insomnia or sleepiness, a sense f being overwhelmed or out of control, physical symptoms such as swollen breasts, heaches muscle pain a bloated sensation or weight gain though it would treat PMS as something that was unhealthy so contreversy compromise, not listed as formal category but in dsm5 appendix as something to be studied more thoroughly 20 yrs later, listed as somthing to be considered for new dsm5 w more uproar PMDD is now official category in dsm 5
depressive disorders
the group of disorders marked by unipolar depression
in the us new immigrants from all cultures and races display a lower ate of depression than do us natives
the rate of depression is equally high for adult natives and for adult immigrants who came to the us by the age of 12 george frideric handel wrote his messiah in less than a month during a manic episode
unipolar depression causes
triggered by stressful events depressed ppl have a larger number of stressful life events during the month just before the onset of their disorder than do normal ppl during same period of time reactive (exogenous) depression- follows clear cut stressful events endogenous depression- seems to be response to internal factors can have stressful events and not be reactive concentrate on recognizing both situational and internal aspects of each unipolar case biological, psychological, sociocultural factors