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Depressive Disorders

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Depressive Disorders
in review
474
Chapter 12 Psychological Disorders
ANXIET Y, SOMATOFORM, AND DISSOCIATIVE DISORDERS
Disorder
Subtypes
Major Symptoms
Anxiety disorders
Phobias
Intense, irrational fear of objectively nondangerous
situations or things, leading to disruptions of behavior.
Excessive anxiety not focused on a specific situation or
object; free-floating anxiety.
Repeated attacks of intense fear involving physical
symptoms such as faintness, dizziness, and nausea.
Persistent ideas or worries accompanied by ritualistic
behaviors performed to neutralize the anxiety-driven
thoughts.
Generalized anxiety disorder
Panic disorder
Obsessive-compulsive disorder
Somatoform
disorders
Conversion disorder
Hypochondriasis
Somatization disorder
Pain disorder
Dissociative
disorders
Dissociative amnesia/fugue
Dissociative identity disorder
(multiple personality disorder)
?
A loss of physical ability (e.g., sight, hearing) that is related
to psychological factors.
Preoccupation with, or belief that one has, serious illness in
the absence of any physical evidence.
Wide variety of somatic complaints that occur over several
years and are not the result of a known physical disorder.
Preoccupation with pain in the absence of physical
reasons for the pain.
Sudden, unexpected loss of memory, which may result in
relocation and the assumption of a new identity.
Appearance within the same person for two or more distinct
identities, each with a unique way of thinking and behaving.
1. Concern that it may be triggered by media stories or therapists’ suggestions has made
dissociative disorders.
2. A person who sleepwalks but is not able to walk when awake is showing signs of
3. Panic disorder sometimes leads to another anxiety disorder called
.
the most controversial of the
.
Depressive Disorders
major depressive disorder A condition in which a person feels sad and
hopeless for weeks or months, often
losing interest in all activities and taking pleasure in nothing.
delusions False beliefs, such as those
experienced by people suffering from
schizophrenia or severe depression.
Depression can range from occasional, normal “down” periods to episodes severe
enough to require hospitalization. A person suffering major depressive disorder
feels sad and overwhelmed for weeks or months, typically losing interest in activities
and relationships and taking pleasure in nothing (Coryell et al., 1993; Rapaport et al.,
2005; Sloan, Strauss, & Wisner, 2001). Exaggerated feelings of inadequacy, worthlessness, hopelessness, or guilt are common. Despite the person’s best efforts, anything
from conversation to bathing can become an unbearable, exhausting task (Solomon,
1998). Changes in eating habits resulting in weight loss or weight gain often accompany major depressive disorder. So does disturbed sleeping or, sometimes, excessive
sleeping. Problems in working, concentrating, making decisions, and thinking clearly
are also common, as are symptoms of an accompanying anxiety disorder (Zimmerman,
McDermut, & Mattia, 2000). In extreme cases, depressed people may express false
beliefs, or delusions—worrying, for example, that government agents are planning to
punish them. Major depressive disorder may come on suddenly or gradually. It may
consist of a single episode or, more commonly, repeated depressive periods. Here is a
case example:
Mr. J. was a fifty-one-year-old industrial engineer …. Since the death of his wife five
years earlier, he had been suffering from continuing episodes of depression marked by
extreme social withdrawal and occasional thoughts of suicide …. He drank, and when
Mood Disorders
475
thoroughly intoxicated would plead to his deceased wife for forgiveness. He lost all
capacity for joy. … Once a gourmet, he now had no interest in food and good wine …
and could barely manage to engage in small talk. As might be expected, his work record
deteriorated markedly. Appointments were missed and projects haphazardly started and
left unfinished. (Davison & Neale, 1990, p. 221)
Depression is not always so extreme. In a less severe pattern of depression, called
dysthymic disorder, the person shows the sad mood, lack of interest, and loss of pleas-
ure associated with major depression but less intensely and for a longer period. (The
duration must be at least two years to qualify as dysthymic disorder.) Mental and behavioral disruptions are also less severe. People exhibiting dysthymic disorder rarely require
hospitalization.
Major depressive disorder occurs sometime in the lives of about 13 to 17 percent of
people in North America and Europe (Hasin et al., 2005; Kessler et al., 1994, 2003; U.S.
Surgeon General, 1999). The incidence of the disorder varies considerably across cultures and subcultures, however. For example, it occurs at much higher rates in urban
Ireland than in urban Spain (Judd et al., 2002). There are gender differences in some
cultures, too. North American and European women are two to three times more likely
than men to experience major depressive disorder (American Psychiatric Association,
2000; Weissman et al., 1993), but this difference does not appear in the less economically developed countries of the Middle East, Africa, and Asia (Ayuso-Mateos et al.,
2001; Culbertson, 1997). Depression can occur at any age, but it frequently first appears
in late adolescence or young adulthood. Increased rates of depression are also found
among the elderly (Cross-National Collaborative Group, 2002; Fassler & Dumas, 1997;
Sowdon, 2001).
dysthymic disorder
A pattern of depression in which the person shows the
sad mood, lack of interest, and loss of
pleasure associated with major depressive disorder but to a lesser degree and
for a longer period.
Suicide and Depression Suicide is associated with a variety of psychological disorders, but it is most closely tied to depression. Some form of depression has been
implicated in 40 to 60 percent of all suicides (Angst, Angst, & Stassen, 1999; Oquendo
& Mann, 2001; Rihmer, 2001). In fact, thinking about suicide is a symptom of depressive disorders. Hopelessness about the future—another depressive symptom—and a
desire to seek instant escape from problems are also related to suicide attempts (Beck
et al., 1990; Brown et al., 2000).
About 31,000 people in the United States commit suicide each year, and 10 to 20
times that many people attempt it (Centers for Disease Control and Prevention, 2004).
This puts the U.S. suicide rate at about 11 per 100,000 individuals, making suicide the
eleventh leading cause of death. Worldwide, the suicide rate is as high as 25 per 100,000
in some northern European countries, China, and Japan and as low as 6 per 100,000
in countries with stronger religious prohibitions against suicide, such as Greece, Italy,
Ireland, and the nations of the Middle East (Lamar, 2000; Phillips, Li, & Zhang, 2002).
Suicide rates differ considerably depending on sociocultural factors such as age, gender, and ethnicity (Centers for Disease Control and Prevention, 2002b; Oquendo et al.,
2001). In the United States, suicide is most common among people sixty-five and older,
especially males (Centers for Disease Control and Prevention, 2004). However, since
1950, suicide among adolescents has tripled, making it the third leading cause of death,
after accidents and homicides, among fifteen- to twenty-four-year-olds (Centers for
Disease Control and Prevention, 2002a). Suicide is the second leading cause of death
among college students; about 10,000 try to kill themselves each year, and about 1,000
succeed. These figures are much higher than for young people in general, but much
lower than for the elderly. Women attempt suicide three times as often as men, but men
are four times as likely to actually kill themselves (Centers for Disease Control and Prevention, 2002b). Suicide rates also differ across ethnic groups (see Figure 12.4). Among
males in the United States, for example, the overall rate for American Indians is 19.1
per 100,000, compared with 19.4 for European Americans, 9.7 for Asian Americans,
10.7 for Hispanic Americans, and 10.4 for African Americans. The same pattern of ethnic differences appears among women, though the actual rates are much lower (Centers
for Disease Control and Prevention, 2002a).
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