ABNORMAL PSYCHOLOGY IN A CHANGING

WORLD 10TH EDITION NEVID

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CHAPTER 7

MOOD DISORDERS AND SUICIDE

Learning Objectives

7.1 Describe the key features of major depressive disorder and evaluate factors that may account
for the higher rate of depression among women.
7.2 Describe the key features of persistent depressive disorder (dysthymia).
7.3 Describe the key features of premenstrual dysphoric disorder.
7.4 Describe the key features of bipolar disorder.
7.5 Describe the key features of cyclothymic disorder.
7.6 Evaluate the role of stress in depression.
7.7 Describe psychodynamic models of depression.
7.8 Describe the humanistic model of depression.
7.9 Describe learning theory models of depression.
7.10 Describe Beck’s cognitive model and the learned helplessness model of depression.
7.11 Identify biological factors in depression.
7.12 Identify causal factors in bipolar disorders.
7.13 Describe psychological methods used to treat depression.
Copyright © 2018, 2014, 2011 by Pearson Education, Inc. All rights reserved.
79
 7.14 Describe biomedical approaches to treating depression.
7.15 Identify risk factors in suicide.
7.16 Identify the major theoretical perspectives on suicide.
7.17 Apply your knowledge of factors in suicide to steps you can take if someone you know
experiences suicidal thoughts.

Key Terms
mood disorders, p. 248
major depressive disorder, p. 250
mania, p. 250
hypomania, p. 250
postpartum depression (PPD), p. 255
persistent depressive disorder, p. 257
double depression, p. 259
premenstrual dysphoric disorder (PMDD), p. 260
bipolar disorder, p. 260
manic episode, p. 262
cyclothymic disorder, p. 264
cognitive triad of depression, p. 269
cognitive-specificity hypothesis, p. 271
learned helplessness, p. 272

Chapter Outline

I. Types of Mood Disorders

A. Major Depressive Disorder
B. Persistent Depressive Disorder (Dysthymia)
C. Premenstrual Dysphoric Disorder
D. Bipolar Disorder
E. Cyclothymic Disorder

II. Causal Factors in Mood Disorders

A. Stress and Depression
B. Psychodynamic Theories
C. Humanistic Theories
D. Learning Theories
E. Cognitive Theories
F. Biological Factors
G. Causal Factors in Bipolar Disorders

III. Treatment of Mood Disorders

A. Psychological Treatment
B. Biomedical Treatments

Copyright © 2018, 2014, 2011 by Pearson Education, Inc. All rights reserved.
80
IV. Suicide
A. Risk Factors in Suicide
B. Theoretical Perspectives on Suicide
C. Predicting Suicide

V. Summing Up

Chapter Overview

Types of Mood Disorders

Mood disorders are disturbances in mood that are serious enough to impair daily functioning. The DSM-5
does not include a general category of mood disorders. Rather, mood disorders are now classified in separate
categories called “Depressive Disorders” and “Bipolar and Related Disorders.” Major mood disorders
discussed include major depressive disorder, persistent depressive disorder, and premenstrual dysphoric
disorder. Two major types of bipolar disorders described are bipolar disorder and cyclothymic disorder
(also called cyclothymia).

People with major depressive disorder experience profound changes in mood that impair their ability to
function. There are many associated features of major depression, including depressed mood; changes in
appetite; difficulty sleeping; reduced sense of pleasure in formerly enjoyable activities; feelings of fatigue
or loss of energy; sense of worthlessness; excessive or misplaced guilt; difficulties concentrating, thinking
clearly, or making decisions; repeated thoughts of death or suicide; attempts at suicide; or even psychotic
behaviors (hallucinations and delusions). About twice as many women as men seem to be affected by major
depression, but the reasons for this gender difference remain unclear. Depression can begin or recur at any
age, but the risk of initial onset of depression is age related. Major depression has been increasing
worldwide. A type of depression that some individuals experience with the change of seasons from summer
to fall and winter is called seasonal affective (mood) disorder (SAD). The causes of this disorder are
uncertain; it is speculated that seasonal changes in light may alter the body’s underlying biological rhythms
that regulate processes such as body temperature and sleep–wake cycles. Another type of depression that
some women experience is postpartum depression. Women with postpartum depression experience a major
depressive episode within four weeks of delivery. Women with a prior history of depression are more at
risk for developing postpartum depression.

Persistent depressive disorder is a form of chronic depression lasting at least two years that is milder than
major depression but may, nevertheless, be associated with impaired functioning in social and occupational
roles. This affects about 4 percent of the general population at some point in their life. Those who have a
major depressive episode superimposed on a long-standing dysthymic disorder are said to suffer from
“double depression.”

Premenstrual dysphoric disorder (PMDD) is a new addition to the DSM and is a more severe form of
premenstrual syndrome (PMS). The diagnosis of PMDD is intended to apply to women who experience a
range of significant psychological symptoms in the week before menses. The diagnosis of PMDD remains
controversial. Critics fear it will pathologize the woman’s natural menstrual cycle and may stigmatize
women who have serious premenstrual complaints by labeling them with a psychiatric diagnosis.

There are two general types of bipolar disorders: bipolar I disorder and bipolar II disorder. Bipolar I disorder
is identified by the occurrence of one or more manic episodes, which generally, but not necessarily, occur
Copyright © 2018, 2014, 2011 by Pearson Education, Inc. All rights reserved.
81
in persons who have experienced major depressive episodes. In bipolar II disorder, depressive episodes
occur along with hypomanic episodes, but without the occurrence of full-blown manic episodes. Manic
episodes are characterized by sudden elevation or expansion of mood and sense of self-importance, feelings
of almost boundless energy, hyperactivity, and extreme sociability, which often takes a demanding and
overbearing form. People in manic episodes tend to exhibit pressured or rapid speech, rapid “flight of
ideas,” and decreased need for sleep.

Cyclothymic disorder is a type of bipolar disorder characterized by a chronic pattern of mild mood swings
and sometimes progresses to bipolar disorder.

Causal Factors in Mood Disorders

Stressful life events increase vulnerability for both major depression and bipolar disorder. Examples of
sources of significant stress include the loss of a loved one, interpersonal struggles, physical illness, and
economic hardship. Social support from family and friends may buffer the effects of stress and reduce the
risk of depression.

In classic psychodynamic theory, depression is viewed in terms of inward-directed anger. People who hold
strongly ambivalent feelings toward people they have lost, or whose loss is threatened, may direct
unresolved anger toward the inward representations of these people they have incorporated or introjected
within themselves, producing self-loathing and depression. Bipolar disorder is understood within
psychodynamic theory in terms of the shifting balances between the ego and superego. More recent
psychodynamic models, such as the self-focusing model, incorporate both psychodynamic and cognitive
aspects in explaining depression in terms of the continued pursuit of lost love objects or goals that would
be more adaptive to surrender.

In the humanistic framework, feelings of depression reflect the lack of meaning and authenticity in the
person’s life. For some, the focus is on the loss of self-esteem that can arise when there is loss or personal
setback.

Learning theories focus on situational factors in explaining depression, such as changes in the level of
reinforcement. When reinforcement is reduced, the person may feel unmotivated and depressed, which can
lead to inactivity and further reduction in opportunities for reinforcement. Coyne’s interactional theory
focuses on the negative family interactions that can lead family members of depressed people to become
less reinforcing to them.

Beck’s cognitive theory focuses on the role of negative or distorted thinking in depression. Depression-
prone people hold negative beliefs toward themselves, the environment, and the future. This cognitive triad
of depression leads to specific errors in thinking, or cognitive distortions, in response to negative events,
that in turn lead to depression. The learned helplessness model is based on the belief that people may
become depressed when they come to view themselves as helpless to control the reinforcements in the
environment or to change their lives for the better. A reformulated version of the theory held that the ways
in which people explain events—their attributions—determine their proneness toward depression in the
face of negative events. The combination of internal, global, and stable attributions for negative events
renders one most vulnerable to depression.

Genetics appears to play a role in mood disorders, especially in explaining major depressive disorder and
bipolar disorder. Imbalances in the neurotransmitter activity in the brain appear to be involved in depression
and mania. Brain abnormalities may contribute to mood disorders as reduced volume and lower metabolic
Copyright © 2018, 2014, 2011 by Pearson Education, Inc. All rights reserved.
82
activity in the areas of the brain involved in regulating thinking processes, mood, and memory has been
observed. The diathesis-stress model is used as an explanatory framework to illustrate how biological or
psychological diatheses may interact with stress in the development of depression.

Treatment of Mood Disorders

Psychodynamic treatment of depression has traditionally focused on helping the depressed person uncover
and work through ambivalent feelings toward the lost object, thereby lessening the anger directed inward.
Modern psychodynamic approaches tend to be more direct and briefer and focus on developing more
adaptive means of achieving self-worth and resolving interpersonal conflicts.

Behavioral approaches have focused on helping people with depression increase the frequency of
reinforcement in their lives through such means as increasing the rates of pleasant activities in which they
participate and assisting them in developing more effective social skills to increase their ability to obtain
social reinforcements from others.

Cognitive therapists focus on helping depressed people identify and correct distorted or dysfunctional
thoughts and learn more adaptive behaviors. Cognitive-behavioral therapies have been very successful in
treating major depression.

Biological approaches have focused on the use of antidepressant drugs and other biological treatments, such
as electroconvulsive therapy (ECT). Antidepressant drugs appear to increase the levels of neurotransmitters
in the brain. Bipolar disorder is commonly treated with lithium. Transcranial magnetic stimulation (TMS)
shows promise as a new form of treatment for moderate depression.

Suicide

Mood disorders are often linked to suicide. Although women are more likely to attempt suicide, more men
actually succeed, probably because they select more lethal means. The elderly, not the young, are more
likely to commit suicide, and the rate of suicide among the elderly appears to be increasing. People who
attempt suicide are often depressed, but they are generally in touch with reality.

From the psychodynamic perspective, suicide is inward-directed anger. Sociocultural theorists attribute
suicide to alienation and social isolation. According to learning theorists, people who attempt suicide lack
problem-solving skills for handling significant stressors. Social-cognitive theory focuses on personal
expectancies and modeling (such as social contagion). Biological approaches focus on genetic factors and
neurotransmitter imbalances.

People who commit suicide tend to signal their intentions, often quite explicitly, such as by telling others
about their suicidal thoughts. Research indicates that about 90 percent of people who commit suicide
leave clear clues.

Lecture and Discussion Suggestions

1. Interpersonal aspects of depression. Our interactions with others may be an important factor in the
onset and management of depression. Especially helpful here is James Coyne’s interactional theory,
described in this chapter (p. 268). According to this view, people who are depressed affect and are affected
by their interactions with loved ones. Basically, Coyne holds that living with a depressed person can become
so stressful that this person’s partner or family becomes less supportive over time toward the depressed
Copyright © 2018, 2014, 2011 by Pearson Education, Inc. All rights reserved.
83
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Lime will lose its value as a whitewash after long exposure to the
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After the glass has been painted white, and still is wet, gently
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To clean, a paste made from whiting and a solution of potash is

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When cover white is too short or stiff to be workable, add a

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