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Understanding Unipolar and Bipolar Disorders: Symptoms, Diagnosis, and Prevalence, Exercises of Abnormal Psychology

Dayalbagh Educational InstituteAbnormal Psychology

An overview of unipolar and bipolar disorders, including major depressive disorder, dysthymia, bipolar ii disorder, cyclothymia, melancholia, and seasonal affective disorder. It discusses the symptoms, diagnosis, and prevalence of these disorders, as well as the role of episode specifiers and course specifiers in diagnosis. The document also touches upon the gender difference in depression prevalence and cross-cultural differences.

Typology: Exercises

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Abnormal Psychology – PSY404 VU
©Copyright Virtual University of Pakistan
122
LESSON 27
MOOD DISORDERS II
DIAGNOSIS
Unipolar Disorders
• The unipolar disorders include two specific types: major depressive disorder and dysthymia.
• In order to meet the criteria for major depressive disorder, a person must experience at least one
major depressive episode in the absence of any history of manic episodes.
• Dysthymia differs from major depression in terms of both severity and duration.
• Dysthymia represents a chronic mild depressive condition that has been present for many years.
• In order to fulfill DSM-IV-TR criteria for this disorder, the person must, over a period of at least 2
years, exhibit a depressed mood for most of the day on more days than not.
• Two or more of the following symptoms must also be present for a diagnosis of dysthymia:
1. Poor appetite or overeating
2. Insomnia or hypersomnia
3. Low energy or fatigue
4. Low self-esteem
5. Poor concentration or difficulty making decisions
6. Feelings of hopelessness
• These symptoms must not be absent for more than 2 months at a time during the 2-year period.
• If at any time during the initial 2 years the person met criteria for a major depressive episode, the
diagnosis would be major depression rather than dysthymia.
• As in the case of major depressive disorder, the presence of a manic episode would rule out a
diagnosis of dysthymia.
• The distinction between major depressive disorder and dysthymia is somewhat artificial because
both sets of symptoms are frequently seen in the same person.
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LESSON 27

MOOD DISORDERS II

DIAGNOSIS

Unipolar Disorders

  • The unipolar disorders include two specific types: major depressive disorder and dysthymia.
  • In order to meet the criteria for major depressive disorder, a person must experience at least one major depressive episode in the absence of any history of manic episodes.
  • Dysthymia differs from major depression in terms of both severity and duration.
  • Dysthymia represents a chronic mild depressive condition that has been present for many years.
  • In order to fulfill DSM-IV-TR criteria for this disorder, the person must, over a period of at least 2 years, exhibit a depressed mood for most of the day on more days than not.
  • Two or more of the following symptoms must also be present for a diagnosis of dysthymia: 1. Poor appetite or overeating 2. Insomnia or hypersomnia 3. Low energy or fatigue 4. Low self-esteem 5. Poor concentration or difficulty making decisions 6. Feelings of hopelessness
  • These symptoms must not be absent for more than 2 months at a time during the 2-year period.
  • If at any time during the initial 2 years the person met criteria for a major depressive episode, the diagnosis would be major depression rather than dysthymia.
  • As in the case of major depressive disorder, the presence of a manic episode would rule out a diagnosis of dysthymia.
  • The distinction between major depressive disorder and dysthymia is somewhat artificial because both sets of symptoms are frequently seen in the same person.
  • In such cases, rather than thinking of them as separate disorders, it is more appropriate to consider them as two aspects of the same disorder, which waxes and wanes over time.

Bipolar Disorders

  • All three types of bipolar disorders involve manic or hypomanic episodes.
  • The mood disturbance must be severe enough to interfere with occupational or social functioning.
  • A person who has experienced at least one manic episode would be assigned a diagnosis of bipolar I disorder.
  • Hypomania refers to episodes of increased energy that are not sufficiently severe to qualify as full- blown mania.
  • A person who has experienced at least one major depressive episode, at least one hypomanic episode, and no full-blown manic episodes would be assigned a diagnosis of bipolar II disorder.
  • The differences between manic and hypomanic episodes involve duration and severity.
  • The symptoms need to be present for a minimum of only 4 days to meet the threshold for a hypomanic episode (as opposed to 1 week for a manic episode).
  • The mood change in a hypomanic episode must be noticeable to others, but the disturbance must not be severe enough to impair social or occupational functioning or to require hospitalization.
  • Cyclothymia is considered by DSM-IV-TR to be a chronic but less severe form of bipolar disorder.
  • In order to meet criteria for cyclothymia, the person must experience numerous hypomanic episodes and numerous periods of depression (or loss of interest or pleasure) during a period of 2 years.
  • There must be no history of major depressive episodes and no clear evidence of a manic episode during the first 2 years of the disturbance.

Bipolar Disorders

  • Onset of bipolar mood disorders usually occurs between the ages of 28 and 33 years, which is younger than the average age of onset for unipolar disorders.
  • The first episode is just as likely to be manic as depressive.
  • The average duration of a manic episode runs between 2 and 3 months.
  • The long-term course of bipolar disorders is most often episodic, and the prognosis is mixed.
  • Most patients have more than one episode, and bipolar patients tend to have more episodes than unipolar patients.
  • Several studies that have followed bipolar patients over periods of up to 10 years have found that 40 to 50 percent of patients are able to achieve a sustained recovery from the disorder.

Incidence and Prevalence

  • Unipolar depression is one of the most common forms of psychopathology.
  • Among people who were interviewed for the ECA study, approximately 6 percent were suffering from a diagnosable mood disorder during a period of 6 months.
  • The ratio of unipolar to bipolar disorders is at least 5:1.
  • Lifetime risk for major depressive disorder was approximately 5 percent, averaged across sites in the ECA program.
  • The lifetime risk for dysthymia was approximately 3 percent and the lifetime risk for bipolar I disorder was close to 1 percent.
  • Almost half the people who met diagnostic criteria for dysthymia had also experienced an episode of major depression at some point in their lives.
  • The National Comorbidity Survey produced even higher figures for the lifetime prevalence of mood disorders; therefore the prevalence estimates for mood disorders in the ECA study are probably conservative.
  • Slightly more than 30 percent of those people in the ECA study who met diagnostic criteria for a mood disorder made contact with a mental health professional during the 6 months prior to their interview.

Gender Differences

  • Women are two or three times more vulnerable to depression than men are.
  • The increased prevalence of depression among women is apparently limited to unipolar disorders.
  • Possible explanations for this gender difference have focused on a variety of factors, including sex hormones, stressful life events, and childhood adversity as well as response styles that are associated with gender roles.

Cross-Cultural Differences

  • Comparisons of emotional expression and emotional disorder across cultural boundaries encounter a number of methodological problems.
  • One problem involves vocabulary.
  • Cross-cultural differences have been confirmed by a number of research projects that have examined cultural variations in symptoms among depressed patients in different countries.
  • These studies report comparable overall frequencies of mood disorders in various parts of the world, but the specific type of symptom expressed by the patients varies from one culture to the next.
  • In Chinese patients, depression is more likely to be described in terms of somatic symptoms, such as sleeping problems, headaches, and loss of energy.
  • Depressed patients in Europe and North America are more likely to express feelings of guilt and suicidal ideas.
  • These cross-cultural comparisons suggest that, at its most basic level, clinical depression is a universal phenomenon that is not limited to Western or urban societies.
  • They also indicate that a person’s cultural experiences, including linguistic, educational, and social factors, may play an important role in shaping the manner in which he or she expresses and copes with the anguish of depression.

Risk for Mood Disorders Across the Life Span

  • Data from the ECA project suggest that mood disorders are most frequent among young and middle-aged adults.
  • Prevalence rates for major depressive disorder and dysthymia were significantly lower for people over the age of 65.
  • The frequency of bipolar disorders was also low in the oldest age groups.
  • The frequency of depression is much higher among certain subgroups of elderly people.
  • The prevalence of depression is particularly high among those who are about to enter residential care facilities.
  • Elderly people in nursing homes are more likely to be depressed in comparison to a random sample of elderly people living in the community.
  • People born after World War II seem to be more likely to develop mood disorders than were people from previous generations.
  • The average age of onset for clinical depression also seems to be lower in people who were born more recently; a pattern sometimes called a birth cohort trend.
  • At low levels and over brief periods of time, depressed mood may help us refocus our motivations and it may help us to conserve and redirect our energy in response to experiences of loss and defeat.
  • A disorder that is as common as depression must have many causes rather than one.
  • The principle of equifinality, which holds that there are many ways to reach the same outcome, clearly applies in the case of mood disorders.

Social Factors

  • The experience of stressful life events is associated with an increased probability that a person will become depressed.
  • Prospective studies have found that stressful life events are useful in predicting the subsequent onset of unipolar depression.
  • Although many kinds of negative events are associated with depression, a special class of circumstances—those involving major losses of important people or roles—seem to play a crucial role in precipitating unipolar depression.
  • Brown and his colleagues believe that depression is more likely to occur when severe life events are associated with feelings of humiliation, entrapment, and defeat.
  • Variations in the overall prevalence of depression are driven in large part by social factors that influence the frequency of stress in the community.

Social Factors and Bipolar Disorders

  • Some studies have found that the weeks preceding the onset of a manic episode are marked by an increased frequency of stressful life events.
  • The kinds of events that precede the onset of mania tend to be different from those that lead to depression.
  • While the latter include primarily negative experiences involving loss and low self-esteem, the former include schedule-disrupting events (such as loss of sleep) as well as goal attainment events.
  • Some patients experience an increase in manic symptoms after they have achieved a significant goal

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