Abnormal Psychology Jill M. Hooley | James N.

Butcher
Seventeenth Edition, Global Edition Matthew K. Nock | Susan Mineka

Chapter 7
Mood Disorders and
Suicide

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 Mood Disorders: An Overview

Mood disorders
• Defining feature = extremes
of emotion (affect)
• Other symptoms or co-
occurring disorders
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 Mood Disorders: An Overview

Two key moods

• Depression
• feelings of extraordinary sadness
and dejection
• Mania
• intense and unrealistic feelings of
excitement and euphoria
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 Types of Mood Disorders

Unipolar
Bipolar depressive
depressive
disorders
disorders
• Only depressive • Manic and
episodes depressive
episodes

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 Unipolar Depressive Disorders

• A major depressive episode

without having manic, hypomanic,
Major or mixed episodes
Depressive • Relapse and recurrence
Disorder • May begin at any point in lifespan,
(MDD) incidence rises during adolescence
• May include additional symptoms
(specifiers)

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 Table 7.1 Specifiers of Major Depressive Episodes

Specifier Characteristic Symptoms

Three of the following: early morning awakening, depression worse in the morning, marked
With Melancholic Features psychomotor agitation or retardation, loss of appetite or weight, excessive guilt, qualitatively
different depressed mood
Delusions or hallucinations (usually mood congruent); feelings of guilt and worthlessness
With Psychotic Features
common
Mood reactivity—brightens to positive events; two of the four following symptoms: weight gain
With Atypical Features or increase in appetite, hypersomnia, leaden paralysis (arms and legs feel as heavy as lead),
being acutely sensitive to interpersonal rejection
A range of psychomotor symptoms from motoric immobility to extensive psychomotor activity,
With Catatonic Features
as well as mutism and rigidity
At least two or more episodes in past 2 years that have occurred at the same time (usually fall
With Seasonal Pattern or winter), and full remission at the same time (usually spring). No other nonseasonal
episodes in the same 2-year period

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 Martha: Major Depressive Disorder
(MDD)

Click to see video with closed captioning

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 Persistent Depressive Disorder

Mild to moderate version of depression

• Persistently depressed mood most of
the day for at least 2 years
• Intermittent normal moods occur
briefly
• Lifetime prevalence of 2.5 to 6%
• Average duration is 4-5 years

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 Other Forms of Depression

Bereavement-
triggered depression

Postpartum
depression

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 Causal Factors in Unipolar
Mood Disorders

Causal
Factors

Biological Psychological
causal factors causal factors

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 Biological Causal Factors

Hormone &
Altered neuro-
Genetic immune system
transmitter
influences regulation
activity
abnormalities

Neuro-physical
Sleep and
& neuro-
biological Sex differences
anatomical
rhythms
influences

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 Psychological Causal Factors

Stressful Independent Vulnerability

vs. in response
life events dependent to stress

Risk-related Personality
Early
vulnerability and cognitive
adversity
factors diatheses

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 Psychological Causal Factors

Freud
Theorists

Behaviorists

Cognitive model

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 Figure 7.4 Beck’s Cognitive Model of Depression
According to Beck’s cognitive model of depression, certain kinds of early experiences can lead to the
formation of dysfunctional assumptions that leave a person vulnerable to depression later in life if
certain critical incidents (stressors) activate those assumptions. Once activated, these dysfunctional
assumptions trigger automatic thoughts that in turn produce depressive symptoms, which further fuel
the depressive automatic thoughts.
(Adapted from Fennell, 1989.)

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 Figure 7.5 Negative Cognitive Triad
Beck’s cognitive model of depression describes a pattern of negative automatic thoughts. These
pessimistic predictions center on three themes: the self, the world, and the future.

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 Psychological Causal Factors

Reformulated
helplessness theory
Theories

Hopelessness theory

Excessive rumination

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 Psychological Causal Factors

Lack of social support or social skills

Interpersonal
effects

Hostility and rejection from others

Marital dissatisfaction

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 Bipolar and Related Disorders

Bipolar disorders
• Distinguished from unipolar
disorders by presence of
manic or hypomanic
episodes
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 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

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 Bipolar Disorders (I and II)

Bipolar II
Bipolar I disorder
disorder
• Includes at • Includes
least one manic hypomanic
or mixed episodes but
episode not full-blown
manic or mixed
episodes
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 Bipolar Disorders (I and II)

Occur equally in males and females

Usually start in adolescence or young adulthood

Average age of onset is 18 to 22 years

About three times as many days are depressed as

manic/hypomanic

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 Ann: Bipolar Disorder

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 Figure 7.7 The Manic-Depressive Spectrum
There is a spectrum of bipolarity in moods. All of us have our ups and downs, which are indicated here
as normal mood variation. People with a cyclothymic personality have more marked and regular mood
swings, and people with cyclothymic disorder go through periods when they meet the criteria for
dysthymia (except for the 2-year duration) and other periods when they meet the criteria for hypomania.
People with bipolar II disorder have periods of major depression and periods of hypomania. Unipolar
mania is an extremely rare condition. Finally, people with bipolar I disorder have periods of major
depression and periods of mania.
(Adapted from Frederick K. Goodwin and Kay R. Jamison. (2009). Manic Depressive Illness. Copyright
© 1990. Oxford University Press, Inc.)

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 Causal Factors in Bipolar Disorders

Causal
factors

Biological Psychological

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 Biological Causal Factors

Abnormalities in
transportation of
Norepinephrine, ions across
serotonin, and neural
Heredity dopamine membrane

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 Biological Causal Factors

Disturbances
in biological
Shifting rhythms
patterns of
Cortisol blood flow to
levels prefrontal
cortex

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 Psychological Causal Factors

Stressful life events

causal factors
Psychological

Personality variables

Low social support

Pessimistic
attributional style

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 Sociocultural Factors Affecting Unipolar
and Bipolar Disorders

Symptoms of Prevalence of
mood disorders mood disorders
• Can differ • Also differs
widely across across
cultures and cultures
demographic
groups

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 Feliziano: Living with Bipolar Disorder

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 Cross-Cultural Differences
in Depressive Symptoms

• Western:
Form of psychological
depression symptoms
varies • Non-Western:
physical
across symptoms
cultures

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 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

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 Treatments and Outcomes

Pharmacotherap
y

Alternative
biological
treatments

Psychotherapy

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 Pharmacotherapy

Antidepressants, mood-
stabilizing, antipsychotic
drugs used to treat
mood disorders

Lithium common mood

stabilizer for bipolar

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 Depression

Click to see video with closed captioning

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 Alternative Biological Treatments

Electroconvulsive
therapy

Transcranial magnetic
stimulation

Deep brain stimulation

Bright light therapy

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 Research close-up: Brain Stimulation

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 Psychotherapy

Forms of effective
psychotherapy
• Cognitive-behavioral
therapy
• Behavioral activation
treatment
• Interpersonal therapy
• Family and marital
therapy

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 Suicide: The Clinical Picture and the
Causal Pattern

Suicide risk Suicide is the

significant factor 15th leading
in all types of cause of death
depression in the world

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 Figure 7.11 Suicide Around the World
The rate of suicide varies dramatically in different parts of the world, as shown in this figure using data
from the World Health Organization. More people die each year by suicide than by all other forms of
violence combined.
(Adapted from World Health Organization, http://www.who.int/mental_health/suicide-prevention/en.)

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 Suicide: The Clinical Picture and the
Causal Pattern
Distinguish
between:

Suicidal
self-injury

Nonsuicidal
self-injury
(NSSI)

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 The Clinical Picture and
the Causal Pattern
Who Attempts and Dies by Suicide?

Psychological Disorders

Other Psychosocial Factors Associated with

Suicide

Biological Causal Factors

Theoretical Models of Suicidal Behavior

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 Who Attempts and
Dies by Suicide?

Suicide
attempts Gender
and age differences

Completed
suicides
and age

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 Psychological Disorders

• Posttraumatic stress
disorder
Increase • Bipolar disorder
risk of • Conduct disorder
suicide
• Intermittent explosive
disorder

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 Other Psychosocial Factors Associated
with Suicide
Impulsivity

Aggression

Pessimism
Psychosocial
factors
Family psychopathology or instability

Hopelessness

Negative affectivity

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 Biological Factors

Reduced
serotonergic
Genetics activity

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 Sociocultural Factors

Rates of
Ethnicity
suicide
• Whites have • Vary across
higher rates cultures and
of suicide religions
than African
Americans
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 Theoretical Models of Suicidal
Behavior

Joiner’s
Diathesis–stress interpersonal-
models psychological
model of suicide

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 Treatment of Mental Disorders

Antidepressant
medication or lithium
Prevention of
suicide can take
the form of
Benzodiazepines
treatment of the
underlying mental
disorder(s)
Cognitive-behavioral
therapy

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 Crisis Intervention

Help show
that distress
is impairing
judgment
Maintain Help show
supportive distress in
contact not endless

Cope with
immediate
crisis

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 Focus on High-Risk Groups
and Other Measures

Provide treatment aimed

Use cognitive-behavioral
directly at decreasing
therapy for suicide
suicidal thoughts and
prevention for use with
behaviors among those
adolescents who have
already experiencing these
attempted suicide
outcomes

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 Unresolved Issues

Is there a right to die?

Not all societies agree that others

should interfere with suicide

Challenging ethical and legal questions

remain

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