Reflection

PSY 2301, Abnormal Psychology 1

Course Learning Outcomes for Unit III Upon completion of this unit, students should be able to:

5. Describe current treatments for mental illness. 5.1 Discuss at least two current treatment protocols for mood disorders and for anxiety disorders.

6. Examine various psychopathological disorders.

6.1 Discuss what constitutes a specific diagnosis within the mood disorder category and one within the anxiety disorder category.

Course/Unit Learning Outcomes

Learning Activity

5.1

Unit Lesson Chapter 5 Chapter 6 Unit III Reflection Paper

6.1

Unit Lesson Chapter 5 Chapter 6 Unit III Reflection Paper

Required Unit Resources Chapter 5: Mood Disorders Chapter 6: Anxiety Disorders

Unit Lesson

Introduction The chart below represents the point that anxiety and mood disorders are separate from one another. Mood disorder is a term that covers depressive and bipolar conditions only. Anxiety disorder is separate. When the term mood disorders is used within psychology, it goes beyond a bad mood and actually encompasses certain diagnosable psychological conditions. Though bipolar and depressive disorders are listed in two separate chapters of Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the term mood disorders itself should bring to mind a sort of family of conditions. In fact, you can compare the idea of unipolar (meaning one) to bipolar (meaning two). In unipolar depressive conditions, the symptoms include a depressed and low state; with bipolar depressive conditions there is a low state and a high (manic) state, occurring at different times. Since bipolar symptomology includes both mania and depression, there is a natural connection to the next category of depressive disorders. Anxiety disorders, comorbid though they may sometimes be, are organized in a separate category from mood disorders (American Psychiatric Association, 2013).

UNIT III STUDY GUIDE

Mood Disorders and Anxiety Disorders

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(Adapted from Sylverarts, n.d.)

Unipolar Depression

Depression itself is certainly a term that has been absorbed into the public vernacular and used to describe a multitude of situations from grief over a loss to having a bad day at work. However, for people who suffer from major depressive disorder (MDD), the term depression has a different meaning. For purposes in the world of psychology, the term depression relates to certain diagnoses, including some mixture of suicidality, feelings of excessive worthlessness or guilt, minimal energy, changes in sleep or weight, low self-esteem, an inability to feel pleasure, and other related symptoms (Kring & Johnson, 2018).

Sufferers of depression may focus on negative aspects of life and situations, experience exhaustion, and encounter a decrease in sexual functioning, as well as a host of other disturbances, prior to developing symptoms. Symptoms may include difficulty with concentration or thoughts about death and suicide. These symptoms are not new. The Ancient Greeks wrote about people who could not derive pleasure from life. Sigmund Freud viewed depression as aggression turned inward on the self. Cognitive theorists have pointed to negative thought processes, which seem to be automatic in depression sufferers. DSM-5 has eight specific diagnoses, which fall under the depressive disorders category, but the symptomology discussed above should paint a picture of the overall idea (American Psychiatric Association, 2013). Important, too, in selecting the correct diagnosis for depression, is the length of time one has been experiencing symptoms and the severity of the symptoms. Individual diagnoses are discussed in relation to prevalence, gender, cultural implications, identified risk factors, and instances of comorbidity in DSM-5.

Depressive Disorders Depressive disorders are a prevalent psychological diagnosis in the United States (Kring & Johnson, 2018). The specific diagnoses of focus are highlighted below (American Psychiatric Association, 2013). It is interesting to note that depression occurs twice as often among women as men. In addition, depression rates change based on socioeconomic status (SES) and countries of origin. According to the American Psychiatric Association (2013) and Kring and Johnson (2018), there are four types of depressive disorders.

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• Major depressive disorder (MDD) is five or more pervasive symptoms of depression for 2 weeks or more (quite possibly much longer).

• Persistent depressive disorder is low mood at least half the time for at least 2 years.

• Premenstrual dysphoric disorder (PMDD) is five or more symptoms leading up to menses, including irritability, anger, and sleep disturbance.

• Disruptive mood dysregulation disorder is severe temper responses, which do not match the situation or age/development level for at least one year in addition to negative affect.

Bipolar Disorders The other large category of mood disorders deals with bipolar disorders. Bipolar disorders, known as manic depression in earlier years of psychological diagnosis, include symptoms of mania, defined as “…a state of intense elation or irritability, along with activation and other symptoms …” (Kring & Johnson, 2018, p. 127– 128). According to Kring and Johnson (2018), there are three main diagnoses of bipolar disorder as outlined below. Bipolar I Disorder Bipolar I disorder is diagnosed by a weeklong episode of mania at any point in one’s lifetime, though it may certainly recur or ebb and flow with major depressive episodes. While these depressive episodes are not required for bipolar I diagnosis, three of the following symptoms must be present:

• increased goal-directed activity or psychomotor agitation,

• rapid speech,

• racing thoughts,

• decreased need for sleep,

• increased self-esteem,

• lack of attention, and

• increase in risky activities (Kring & Johnson, 2018). Sufferers who have an episode of four days (rather than a full week) can be labeled hypomanic—less extreme mania. Bipolar II Disorder Bipolar II disorder is perhaps more easily recognizable by name because it has two extremes: an episode of depression and an episode of hypomania. Hypo is translated as low/lower, so this is not as extreme as full- blown mania like in bipolar I disorder. It is this relationship of polar opposites, some depression and some hypomania, which originally led to depressive and bipolar disorders to be grouped together under the label of mood disorders in DSM-5. Cyclothymic Disorder Cyclothymic disorder is a chronic form of bipolar II disorder (just as dysthymia is a chronic form of depression). The criteria for a cyclothymic diagnosis include numerous hypomanic episodes as well as numerous periods of depressive symptoms.

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Bipolar disorders are less prevalent than major depression, and they are more prevalent in the United States than in other countries (Kring & Johnson, 2018). The course of bipolar disorders can be extremely challenging. Many people are unable to work or to retain their employment long-term after manic episodes. Suicidal attempts occur more often in bipolar sufferers than sufferers from the majority of illnesses in the DSM-5.

Etiology of Mood Disorders What causes such severe disorders as major depression and bipolar II? The question of etiology, or again, causation, is a chief concern of the psychological community. Your textbook describes several factors and theories that may contribute to the development of mood disorders (Kring & Johnson, 2018). Genetic factors have been studied between family members and twins, which indicate a hereditary component in some instances of depressions and manias. Research is ongoing to determine which genes are specifically involved, and work has been done to understand the impact of neurotransmitter functions in the brain with mood disorders. We do know that classes of drugs thought to target specific neurotransmitters can provide relief to some depression sufferers. Dopamine is a neurotransmitter involved with the brain’s reward system; one can see that too much or not enough dopamine might be a part of manic or depressive symptoms. Additionally, there is evidence that the amygdala, a primitive part of the brain that handles stress response, appears to be overly taxed in depression sufferers. Life events certainly have an impact on patients suffering from mood disorders, and neurological evidence suggests that some people are wired to handle stressors better than others are. Such events that elicit a great amount of stress can include an illness, a cross-country move, a failing grade, etc. It appears that some persons are more vulnerable to psychosocial stressors. Consider, then, a vulnerability within the brain coupled with the stresses of life. A hormone called cortisol is sometimes called the stress hormone and is linked to sexual desire, issues with appetite and weight management, and quality sleep (Kring & Johnson, 2018). See how complex it is to answer the big question of, “Why do people get depressed?” Clinical psychology (as opposed to the neurological considerations above) poses additional theories to further understand the etiology of mood disorders. According to Jorm et al. (2000, as cited in Kring & Johnson, 2018), “neuroticism, a personality trait that involves the tendency to experience frequent and intense negative affect” (p. 139), has been linked to people who experience greater instances of depressive mood disorders and may also have a correlating genetic component. Then again, we know that Sigmund Freud viewed depression as aggression turned inward. What do you think of this concept? Cognitive theorists point to the negative thoughts and pessimistic belief symptoms, as well as the hopelessness theory, which addresses pessimism and feelings that sufferers have no control in life (Kring & Johnson, 2018). Ruminating, or thinking over something (negative) repeatedly, has also been linked to depression. The triggers for mania are not as well researched, but sleep deprivation and reward sensitivity are thought to play a role. Reward sensitivity deals with how much pleasure someone derives from reaching a goal, which can spiral into an increased confidence and feelings of euphoria.

Treatment of Mood Disorders So what do we do about these very serious diagnoses? Treatments for mood disorders often include psychotherapy working from a variety of theoretical orientations. Interpersonal psychotherapy addresses issues of life transition and their exploration. Cognitive therapy works to undo the automatic thoughts and beliefs that lead to repeated negative thought processes. Behavioral therapy involves working with positive reinforcement and activities in which the sufferer will attain this esteem-building feedback. Analytic

Amygdala location in the brain (Adapted from Normaals, n.d.)

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psychology works to unearth the internal struggles that can torment mood disorder sufferers and to make these unconscious phenomena known. Psychoeducation is often beneficial so that patients have a greater understanding of their own illness. Different medications are often prescribed to alleviate symptoms, though clinical psychologists sometimes argue that this is treating the symptom, not the disease.

The Threat of Suicide Suicide is an increased risk factor for persons suffering from mood disorders. Suicidal ideation (thoughts/plans for suicide) and actual suicide attempts must be taken very seriously. As with the causes of depression and bipolar disorders, many factors contribute to suicide, and each school of thought has views and recommendations to prevent it (Kring & Johnson, 2018). Psychological disorders like the ones described in this unit can put a person at risk. So, too, can low levels of serotonin, a neurotransmitter that can promote feelings of happiness. Some suicide attempts are a cry for help, and this is certainly influenced by the internal mind and the outside environment. Thankfully, there are trained professionals available to facilitate matter-of- fact discussions, treatment for underlying psychological disorders, therapeutic interventions (including hospitalization), and prevention hotlines.

Anxiety Disorders Now, let us turn our attention to anxiety disorders, which are closely linked in some ways to the depressive disorders discussed above. Anxiety is defined as increased focus over an anticipated problem (Kring & Johnson, 2018). Of course, we have all most likely felt anxious before, though the concept of an anticipated problem means that the minds of anxiety sufferers can create problems where none actually exists. Imagine being in a constant state of a threat response, even if you know the threat may never come. As you are discovering with many, if not all, of the disorders discussed in this course, a normal occurrence like being anxious becomes a psychological disorder when it manifests so often that it interferes with daily life. The individual disorders discussed in this part of the lesson are specific phobias, social anxiety disorder, panic disorder, agoraphobia, and generalized anxiety disorder, though DSM-5 does provide criteria for twelve anxiety disorders in total (American Psychiatric Association, 2013). Take time to learn the differences between the disorders below; social anxiety is what it sounds like, whereas the anxiety associated with agoraphobia can lead to isolation in one’s house or room. At this point, it is important to recognize that anxiety disorders are the most common category of disorders (Kring & Johnson, 2018). As such, it is likely that you or someone close to you has had experience with a specific anxiety disorder at some point during life. According to Kring and Johnson (2018), anxiety disorders include the following.

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All of these disorders have specific criteria for diagnosis as a mental illness; it is known that many people suffer anxiety-related issues whether or not they carry a psychological diagnosis. These are called subthreshold symptoms; they are present and problematic, but perhaps the person meets two rather than three required criteria. It is also known that anxiety disorder sufferers who qualify for one diagnosis are likely to qualify for another anxiety disorder diagnosis during their life (Kring & Johnson, 2018).

Etiology and Treatment of Anxiety Disorders Just as with mood disorders, it is hard to pin down etiology conclusively for anxiety disorders, and the best answer may be to consider a variety of causes. Conditioning can certainly affect our responses to stimuli (Kring & Johnson, 2018). Consider the example of a childhood dog bite that develops into a specific phobia of dogs later in life. Here, again, the trepidation of a growling animal is not called into question, but when one’s life is adversely impacted, we could consider a professional diagnosis and professional help to deal with such symptomology. Neurobiologically, the amygdala, which was discussed regarding depression, also impacts anxiety symptoms. In what is sometimes identified as the fear circuit, research has observed that for anxiety sufferers the

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amygdala is activated to cause a feeling of fear but the off switch (also known as the medial prefrontal cortex) is unable to stop that reaction to danger (Kring & Johnson, 2018). Patterns of cognition and irrational negative belief systems can produce anxiety symptoms (Kring & Johnson, 2018). In a prior discussion of cognitive therapy, we discussed confronting these patterns of thinking, but for many sufferers, this is not as easy as it sounds. Perhaps someone with social anxiety disorder recognizes that his or her behavior is irrational and abnormal but is still unable to engage in social settings. You may have heard of exposure therapy, a type of cognitive-behavioral treatment that exposes sufferers to the very thing that brings them fear. Psychoanalytic theory regards anxiety as agitated depression. Here, again, the answer to an analytical therapist is to uncover the buried reason deep within the unconscious mind, and this kind of work takes time. Consider again the complex question of nature and nurture. If one’s condition stems from a repressed childhood episode, is a psychoactive medication really going to solve the problem? Conversely, if the problem is a lack of feel-good neurotransmitters in the brain, will psychotherapy help? Once more, we may need to rely on the expertise of several professionals to find a lasting relief from suffering. If medication is chosen, several classes of drugs are available to treat anxiety symptoms. Benzodiazepines like Xanax and Valium work on the neurotransmitter gamma-aminobutyric acid (GABA), which is associated with relaxing the central and peripheral nervous systems, while serotonin-specific reuptake inhibitors (SSRIs) and serotonin– norepinephrine reuptake inhibitors (SNRIs) encourage a more free-flow of serotonin and norepinephrine in the synaptic clefts, respectively (Kring & Johnson, 2018). Gender and culture also play a part in the prevalence of anxiety disorders. Women are twice as likely as men to carry a diagnosis (Kring & Johnson, 2018). Some scholars feel this is because women in our society are more willing to seek treatment for mental illness than men. Some cultures place a high value on pleasing others, which is linked with anxiety disorders. Consider traditional Japanese culture, for example. Reflecting on taijin kyofusho from Unit II, the fear of insult by too much eye contact, one can draw the conclusion that worry about proper conduct plays a significant role in this culture.

Summary This unit covers two broad categories of disorders that are among the most prevalent in society. Keep developing your understanding, not only of what constitutes each diagnosis but also of the complex etiology and treatment protocols used to explain and help those suffering from one or more psychological diagnoses.

References Alexaldo. (n.d.). Speed of heart beating (ID 87273629) [Illustration]. Dreamstime.

https://www.dreamstime.com/stock-illustration-speed-heart-beating-medicine-illustration-pulsating- fast-normal-slow-image87273629

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

American Psychiatric Publishing. Kring, A. M., & Johnson, S. L. (2018). Abnormal psychology: The science and treatment of psychological

disorders (14th ed.). Wiley. Normaals. (n.d.). Amygdala medical labeled vector illustration and scheme with response to threat (ID

125279049) [Illustration]. Dreamstime. https://www.dreamstime.com/amygdala-medical-labeled- vector-illustration-scheme-response-to-threat-amygdala-medical-labeled-vector-illustration- image125279049

Sylverarts. (n.d.). Psychology, brain and mental health vector conceptual icons or I (ID 110284436)

[Illustration]. Dreamstime. https://www.dreamstime.com/psychology-brain-mental-health-vector- conceptual-icons-logos-set-relationship-gender-psychology-problems-conflicts-image110284436

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Suggested Unit Resources To reinforce the concepts from this unit, review the Chapter 5 Presentation or review the Chapter 5 Presentation in PDF form. To reinforce the concepts from this unit, review the Chapter 6 Presentation or review the Chapter 6 Presentation in PDF form.

Learning Activities (Nongraded) Nongraded Learning Activities are provided to aid students in their course of study. You do not have to submit them. If you have questions, contact your instructor for further guidance and information. Please review and complete this interactive presentation on key terminology from Chapter 5 and Chapter 6.