1. Chapter 7 Mood Disorders and Suicide
ABNORMAL PSYCHOLOGY, SIXTEENTH EDITION James N. Butcher/ Jill M. Hooley/ Susan Mineka
Chapter 7
Mood Disorders and Suicide
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

2. What Are Mood Disorders?
Mood disorders (affective disorders)
Defining feature = abnormal mood
Emotional extremes
Intense, persistent, and maladaptive disturbances
Other symptoms or co-occurring disorders
Mood disorders are also known as affective disorders
Extremes of emotion—or affect—are common to all mood disorders
Deep depression or soaring elation
Other symptoms or co-occurring disorders may also be present, but abnormal mood is the defining feature
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

3. What Are Mood Disorders?
Two key moods
Mania
Depression
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

4. What Are Mood Disorders?
Unipolar depressive disorders
Only depressive episodes
Bipolar depressive disorders
Manic and depressive episodes
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

5. The Prevalence of Mood Disorders
Lifetime prevalence for bipolar disorder is near 1%
About twice as common in women than men
12-month prevalence rates are nearly 7%
Lifetime prevalence of unipolar depression is nearly 17%
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

6. Unipolar Mood Disorders
Mild, brief depression
Can be normal and adaptive
Sadness, hopelessness, and pessimism are common human experiences
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

7. Depressions That Are Not Mood Disorders
When depression is not mood disorder
Loss and grieving process
Postpartum “blues”
Two fairly common causes of depression that are generally not considered mood disorders are:
‒ Loss and the grieving process
‒ Postpartum “blues”
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

8. Persistent Depressive Disorder (Dysthymic Disorder )
Mild to moderate version of depression
Lasts a long time
Intermittent normal moods occur briefly
Lifetime prevalence of 2.5 to 6%
For diagnosis, symptoms must persist for at least 2 years (1 year in children)
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

9. Major Depressive Disorder
Diagnostic criteria for major depressive disorder
Person exhibits more symptoms than are required for dysthymia
Symptoms are more persistent
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

10. Major Depressive Disorder
Specifiers
Major depressive episode with melancholic features
Severe major depressive episode with psychotic features
Major depressive episode with atypical features
Major depressive episode with catatonic features
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

11. Major Depressive Disorder
Persistent major depressive disorder
Major depression does not remit for more than two years
Seasonal affective disorder
Recurrent depressive episodes with a pattern
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

12. Causal Factors in Unipolar Mood Disorders
Biological causal factors
Psychological causal factors
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

13. Biological Causal Factors
Biological factors
Heredity
Altered neuro-transmitter activity
Hormones
Family studies and twin studies suggest a moderate genetic contribution
Altered neurotransmitter activity in several systems is clearly associated with major depression
The hormone cortisol also plays a role
Depression may be linked to low activity in the left anterior or prefrontal cortex
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

14. Figure 7. 1: Number of Stressful Life Events vs
Figure 7.1: Number of Stressful Life Events vs. Probability of Major Depressive Episode
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

15. Biological Causal Factors
Genes
Serotonin-transporter gene
Three combinations
Gene-environment interaction research
A specific gene that might be implicated in major depressive disorder is the serotonin-transporter gene
This gene occurs in one of three combinations:
Two short alleles (ss)
Two long alleles (ll)
One of each (sl)
In 2003, Caspi and colleagues published a study in which they tested for a gene-environment interaction involving this gene
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

16. Biological Causal Factors
Disruptions
Sleep
Circadian rhythms
Exposure to sunlight (seasonal)
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

17. Psychological Causal Factors
Depression
Stressful life events
Risk-related vulnerability factors
Neuroticism or negative affectivity
Early adversity or parental loss
Stressful life events are linked to depression
Diathesis-stress models propose that some people have vulnerability factors that may increase the risk for depression
Neuroticism or negative affectivity can predispose people to depression
Early adversity or parental loss can be a diathesis
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

18. Psychological Causal Factors
Theorists
Freud
Behaviorists
Cognitive model
Freud believed that depression was anger turned inward
Behaviorists used conditioning to explain depression
Beck proposed a cognitive model of depression
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

19. Figure 7.3: Beck’s Cognitive Model of Depression
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

20. Figure 7.4: Negative Cognitive Triad
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

21. Psychological Causal Factors
Theories
Reformulated helplessness theory
Hopelessness theory
Excessive rumination
The reformulated helplessness theory proposes that a pessimistic attributional style is a diathesis for depression
The hopelessness theory proposes that a pessimistic attributional style and one or more negative life events will not produce depression unless one first experiences a state of hopelessness
Excessive rumination can be a diathesis
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

22. Psychological Causal Factors
Interpersonal effects
Lack of social support or social skills
Hostility and rejection from others
Marital dissatisfaction
Depression has significant interpersonal correlates:
Lack of social support or social skills can contribute to depression
Depression can elicit sympathy and care, but it can also elicit hostility and rejection from others
Depression and marital dissatisfaction correlate highly
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

23. Bipolar Disorders
Bipolar disorders
Distinguished from unipolar disorders by presence of manic or hypomanic symptoms
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

24. Cyclothymic Disorder Cyclical mood swings
Less severe than those of bipolar disorder
Symptoms present for at least 2 years
Lacking severe symptoms and psychotic features of bipolar disorder
Some people are subject to cyclical mood swings less severe than those of bipolar disorder; these are symptoms of cyclothymic disorder
Symptoms must be present for at least 2-year duration
Lacking some of the severe symptoms and psychotic features of bipolar disorder
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

25. Bipolar Disorders (I and II)
Bipolar I disorder
Includes at least one manic or mixed episode
Bipolar II disorder
Includes hypomanic episodes but not full-blown manic or mixed episodes
“Bipolar” replaces the term “manic-depressive”
Bipolar I disorder includes at least one manic or mixed episode
Mixed episode includes both depressive and manic symptoms
Bipolar II disorder does not include full-blown manic or mixed episodes, but does include hypomanic episodes
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

26. Bipolar Disorders (I and II)
About three times as many days are depressed as manic/hypomanic
Average age of onset is 18 to 22 years
Usually start in adolescence or young adulthood
Occur equally in males and females
Characteristics
Bipolar disorders occur equally in males and females
Usually start in adolescence or young adulthood
Average age of onset is 22 years
About three times as many days are depressed as manic/hypomanic
Some people experience rapid cycling of episodes of mania or depression
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

27. Figure 7.6: The Manic-Depressive Spectrum
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

28. Causal Factors in Bipolar Disorder
Biological causal factors
Psychological causal factors
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

29. Biological Causal Factors
Heredity
Norepinephrine, serotonin, and dopamine
Abnormalities in transportation of ions across neural membrane
There is a greater genetic contribution to bipolar disorder than to unipolar disorder
Norepinephrine, serotonin, and dopamine all appear to be involved in regulating our mood states
Bipolar patients may have abnormalities in the way ions are transported across the neural membranes
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

30. Biological Causal Factors
Other biological influences
Cortisol levels
Shifting patterns of blood flow to prefrontal cortex
Disturbances in biological rhythms
Shifting patterns of blood flow to the left and right prefrontal cortex
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

31. Psychological Causal Factors
Stressful life events
Personality variables
Low social support
Pessimistic attributional style
Stressful life events
Personality variables (such as neuroticism and high levels of achievement striving)
Low social support
Pessimistic attributional style
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

32. Sociocultural Factors Affecting Unipolar and Bipolar Disorders
Symptoms of mood disorders
Can differ widely across cultures and demographic groups
Prevalence of mood disorders
Also differs across cultures
Differences across demographic groups within the U.S.
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

33. Cross-Cultural Differences in Depressive Symptoms
Examples
China and Japan
Other Asian beliefs
In China and Japan, somatic and vegetative symptoms replace psychological symptoms such as guilt and suicidal ideation
May stem from Asian beliefs of the unity of body and mind, or stigma attached to mental illness
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

34. Cross-Cultural Differences in Prevalence
Rates of depression vary more than rates of bipolar disorder
Lifetime prevalence of depression is 17-19% in the U.S., but only 1.5% in Taiwan
Reasons for different rates of depression are not yet clear
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

35. Figure 7.7: Prevalence Rates for Depression across Several Nations
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

36. Demographic Differences in the United States
Native Americans have relatively high rates of depression
African-Americans have relatively low rates
U.S. rates of unipolar depression inversely related to socioeconomic status
Recent studies have found Native Americans to have relatively high rates of depression
African-Americans were found to have relatively low rates
In the U.S., rates of unipolar depression are inversely related to socioeconomic status
Mood disorders appear relatively common in artists
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

37. Figure 7.8: Rates of Mood Disorders in Writers and Artists
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

38. Treatments and Outcomes
Pharmacotherapy
Alternative biological treatments
Psychotherapy
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

39. Lithium common mood stabilizer for bipolar
Pharmacotherapy
Antidepressants, mood-stabilizing, antipsychotic drugs used to treat mood disorders
Lithium common mood stabilizer for bipolar
Antidepressants, mood-stabilizing, antipsychotic drugs are used to treat mood disorders
SSRI’s are most recent generation of antidepressants
Drugs often require weeks to take effect
Lithium is common mood stabilizer for bipolar
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

40. Alternative Biological Treatments
Electroconvulsive therapy
Transcranial magnetic stimulation
Deep brain stimulation
Bright light therapy
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

41. Psychotherapy Forms of effective psychotherapy
Cognitive-behavioral therapy
Behavioral activation treatment
Interpersonal therapy
Family and marital therapy
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

42. Suicide risk significant factor in all types of depression
Suicide ranks among the top ten leading causes of death
Suicide ranks among the top ten leading causes of death in most Western countries
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

43. The Clinical Picture and the Causal Pattern
Who Attempts and Who Commits Suicide?
Suicide in Children
Suicide in Adolescents and Young Adults
Other Psychosocial Factors Associated with Suicide
Biological Causal Factors
Sociocultural Factors
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

44. Who Attempts and Who Commits Suicide?
Suicide attempts and age
Completed suicides and age
Gender differences
Suicide attempts are most common in people between 18 and 25 years old
Completed suicides are most common in the elderly (65 and older)
Women are more likely to attempt suicide, but men are more likely to complete suicide
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

45. Suicide in Children Rates very low but increasing
Suicide in children age has increased by 70% since 1981
Multiple risk factors
Rates of suicide among children are very low but seem to be increasing
Suicide in children age has increased by 70% since 1981
Risk factors include loss of parent, abuse, depression, antisocial behavior, and high impulsivity
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

46. Suicide in Adolescents and Young Adults
Rates tripled between the mid-1950s and mid-1980s
Multiple risk factors
Rates of suicides for people tripled between the mid-1950s and mid-1980s
Risk factors for adolescent suicide include mood disorders, conduct disorder, and substance abuse
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

47. Other Psychosocial Factors Associated with Suicide
Impulsivity
Aggression
Pessimism
Family psychopathology or instability
Genetics
Sociocultural factors
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

48. Biological Causal Factors
Genetics
Reduced serotonergic activity
Genetic factors may play a role in risk for suicide
Reduced serotonergic activity appears to be associated with increased risk
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

49. Sociocultural Factors
Ethnicity
Whites have higher rates of suicide than African Americans
Rates of suicide
Vary across cultures and religions
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

50. Figure 7.10: U.S. Suicide Rates by Age, Gender, and Racial Group
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

51. Suicidal Ambivalence
Some people do not wish to die but instead want to communicate
Methods are nonlethal
Actions arranged so that intervention by others is likely
Some people do not really wish to die but instead want to communicate a dramatic message concerning their distress
Methods are nonlethal and may include minimal drug ingestion or minor wrist slashing
Often, they arrange their action so that intervention by others is likely
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

52. Communication of Suicidal Intent
True or false?
Research has clearly proved that those who threaten to take their lives seldom do so.
False
Interviews with family and friends indicate that 40% of people who committed suicide specifically indicated suicidal intent
Another 30% had talked about death or dying in preceding weeks or months
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

53. Suicide Notes Only 15-25% of completed suicides leave notes
Some notes include statement of love and concern
Others include very hostile content
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

54. Suicide Prevention and Intervention
Current preventive efforts
Treatment of person’s current mental disorder(s)
Crisis intervention
Working with high-risk groups
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

55. Treatment of Mental Disorders
Prevention of suicide can take the form of treatment of the underlying mental disorder(s)
Antidepressant medication or lithium
Benzodiazepines
Cognitive-behavioral therapy
Prevention of suicide can take the form of treatment of the underlying mental disorder(s)
For depression, antidepressant medication or lithium can be helpful
For anxiety, benzodiazepines can be helpful
Cognitive-behavioral therapy can be helpful in reducing suicide attempts among those who had previously made an attempt
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

56. Crisis Intervention Intervention Primary objective Examples Hotlines
Hotline efficacy
Suicide hotlines have expanded since 1960s
Good information about the effects of these hotlines is not available
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

57. Unresolved Issues Is there a right to die?
Not all societies agree that others should interfere with suicide
Challenging ethical and legal questions remain
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.