The “increasing activities and elevating mood” phase of beck's treatment for depression:

Somatoform and Dissociative Disorders : 1 91

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1. What are the symptoms of each of the hysterical somatoform disorders? How do practitioners distinguish hysterical disorders from "genuine" medical problems? pp. 164-167

2. How does a somatoform disorder differ from a factitious disorder? pp. 167- 169

3. List the central features of each of the preoccupation somatoform disorders. pp. 169-170

..,,,..

4. What are the leading explanations and treatments for the somatoform disorders? How well does research support them? pp. 170- 176

5. List and describe the different dis- sociative disorders. pp. 176-184

6. What are four kinds of dissociative amnesia? pp. 177-780

7. What are the different kinds of rela- tionships that the subpersonalities may have in dissociative identity disorder? pp. 182-183

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8. Describe the psychodynamic, behavioral, state-dependent learn- ing, and self-hypnosis explanations of dissociative disorders. How well is each supported by research? pp. 184- 187

9. What approaches have been used to treat dissociative amnesia and dissociative fugue? pp. 187- 188

10. What are the key features of treatment for dissociative identity disorder? Is treatment successful? pp. 188-189

Search the Fundamentals of Abnormal Psychology Video Tool Kit www.worthpublishers.com/apvtk

A Chapter 6 Video Cases Beyond Perfection: Body Dysmorphic Disorder Repressed Memories or False Memories? Three Faces of Eve: The Real Patient

A Video case discussions, study guides, and questions

Log on to the Corner Web Page www.worthpublishers.com/comer

A Chapter 6 outline, learning objectives, research exercises, study tools, and practice test questions

A Additional Chapter 6 case studies, Web links, and FAQs

Somatoform and Dissociative Disorders : 1 91

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1. What are the symptoms of each of the hysterical somatoform disorders? How do practitioners distinguish hysterical disorders from "genuine" medical problems? pp. 164-167

2. How does a somatoform disorder differ from a factitious disorder? pp. 167- 169

3. List the central features of each of the preoccupation somatoform disorders. pp. 169-170

..,,,..

4. What are the leading explanations and treatments for the somatoform disorders? How well does research support them? pp. 170- 176

5. List and describe the different dis- sociative disorders. pp. 176-184

6. What are four kinds of dissociative amnesia? pp. 177-780

7. What are the different kinds of rela- tionships that the subpersonalities may have in dissociative identity disorder? pp. 182-183

• #!,,A 8' 0'1.5, 4, 4, {",$'47.

8. Describe the psychodynamic, behavioral, state-dependent learn- ing, and self-hypnosis explanations of dissociative disorders. How well is each supported by research? pp. 184- 187

9. What approaches have been used to treat dissociative amnesia and dissociative fugue? pp. 187- 188

10. What are the key features of treatment for dissociative identity disorder? Is treatment successful? pp. 188-189

Search the Fundamentals of Abnormal Psychology Video Tool Kit www.worthpublishers.com/apvtk

A Chapter 6 Video Cases Beyond Perfection: Body Dysmorphic Disorder Repressed Memories or False Memories? Three Faces of Eve: The Real Patient

A Video case discussions, study guides, and questions

Log on to the Corner Web Page www.worthpublishers.com/comer

A Chapter 6 outline, learning objectives, research exercises, study tools, and practice test questions

A Additional Chapter 6 case studies, Web links, and FAQs

MOOD DISORDERS

or ... a six-month period, her irritability bordered on the irrational. She screamed in anger or sobbed in despair at every dirty dish left on the coffee table or on the bedroom floor. Each day the need to plan the dinner menu provoked agonizing indecision. How

L: could all the virtues or, more likely, vices of hamburgers be accurately compared to those of spaghetti? . . . She hod her whole family walking on eggs. She thought they would be better off if she were dead.

Beatrice could not cope with her job. As a branch manager of a large chain store, she had many decisions to make. Unable to make them herself, she would ask employees who were much less competent for advice, but then she could not decide whose advice to take. Each morning before going to work, she complained of nausea. . . .

Beatrice's husband loved her, but he did not understand what was wrong. He thought that she would improve if he made her life easier by taking over more housework, cooking, and child care. His attempt to help only made Beatrice feel more guilty and worthless. She wanted to make a contribution to her family. She wanted to do the chores "like normal people" did but broke down crying at the smallest impediment to a perfect job. . . . Months passed, and Bea- trice's problem became more serious. Some days she was too upset to go to work. She stopped seeing her friends. She spent most of her time at home either yelling or crying. Finally, Beatrice's husband called the psychiatrist and insisted that something was seriously wrong.

Lickey & Gordon, 1991, p. 181

Most people's moods come and go. Their feelings of elation or sadness are under- standable reactions to daily events and do not affect their lives greatly.The moods of people with mood disorders, in contrast, tend to last a long time.As in Beatrice's case, the mood colors all of their interactions with the world and interferes with normal functioning.

Depression and mania are the key emotions in mood disorders. Depression is a low, sad state in which life seems dark and its challenges overwhelming. Mania, the opposite of depression, is a state of breathless euphoria, or at least frenzied energy, in which people may have an exaggerated belief that the world is theirs for the taking. Most people with a mood disorder suffer only from depression, a pattern called unipolar depression. They have no history of mania and return to a normal or nearly normal mood when their depression lifts. Others experi- ence periods of mania that alternate with periods of depression, a pattern called bipolar disorder.

Mood disorders have always captured people's interest, in part because so many famous people have suffered from them.The Bible speaks of the severe depressions of Nebuchadnezzar, Saul, and Moses. Queen Victoria of England and Abraham Lincoln seem to have experienced recurring depressions. Mood disorders also have plagued such writers as Ernest Hemingway, Eugene O'Neill,Virginia Woolf, and Sylvia Plath. Their severe mood problems have been shared by millions.

TOPIC OVERVIEW Unipolar Depression

How Common Is Unipolar Depression?

What Are the Symptoms of Depression?

Diagnosing Unipolar Depression

Stress and Unipolar Depression

The Biological Model of Unipolar Depression

Psychological Models of Unipolar Depression

The Sociocultural Model of Unipolar Depression

Bipolar Disorders What Are the Symptoms of Mania?

Diagnosing Bipolar Disorders

What Causes Bipolar Disorders?

What Are the Treatments for Bipolar Disorders?

Putting It Together: Making Sense of All That Is Known

MOOD DISORDERS

or ... a six-month period, her irritability bordered on the irrational. She screamed in anger or sobbed in despair at every dirty dish left on the coffee table or on the bedroom floor. Each day the need to plan the dinner menu provoked agonizing indecision. How

L: could all the virtues or, more likely, vices of hamburgers be accurately compared to those of spaghetti? . . . She hod her whole family walking on eggs. She thought they would be better off if she were dead.

Beatrice could not cope with her job. As a branch manager of a large chain store, she had many decisions to make. Unable to make them herself, she would ask employees who were much less competent for advice, but then she could not decide whose advice to take. Each morning before going to work, she complained of nausea. . . .

Beatrice's husband loved her, but he did not understand what was wrong. He thought that she would improve if he made her life easier by taking over more housework, cooking, and child care. His attempt to help only made Beatrice feel more guilty and worthless. She wanted to make a contribution to her family. She wanted to do the chores "like normal people" did but broke down crying at the smallest impediment to a perfect job. . . . Months passed, and Bea- trice's problem became more serious. Some days she was too upset to go to work. She stopped seeing her friends. She spent most of her time at home either yelling or crying. Finally, Beatrice's husband called the psychiatrist and insisted that something was seriously wrong.

Lickey & Gordon, 1991, p. 181

Most people's moods come and go. Their feelings of elation or sadness are under- standable reactions to daily events and do not affect their lives greatly.The moods of people with mood disorders, in contrast, tend to last a long time.As in Beatrice's case, the mood colors all of their interactions with the world and interferes with normal functioning.

Depression and mania are the key emotions in mood disorders. Depression is a low, sad state in which life seems dark and its challenges overwhelming. Mania, the opposite of depression, is a state of breathless euphoria, or at least frenzied energy, in which people may have an exaggerated belief that the world is theirs for the taking. Most people with a mood disorder suffer only from depression, a pattern called unipolar depression. They have no history of mania and return to a normal or nearly normal mood when their depression lifts. Others experi- ence periods of mania that alternate with periods of depression, a pattern called bipolar disorder.

Mood disorders have always captured people's interest, in part because so many famous people have suffered from them.The Bible speaks of the severe depressions of Nebuchadnezzar, Saul, and Moses. Queen Victoria of England and Abraham Lincoln seem to have experienced recurring depressions. Mood disorders also have plagued such writers as Ernest Hemingway, Eugene O'Neill,Virginia Woolf, and Sylvia Plath. Their severe mood problems have been shared by millions.

TOPIC OVERVIEW Unipolar Depression

How Common Is Unipolar Depression?

What Are the Symptoms of Depression?

Diagnosing Unipolar Depression

Stress and Unipolar Depression

The Biological Model of Unipolar Depression

Psychological Models of Unipolar Depression

The Sociocultural Model of Unipolar Depression

Bipolar Disorders What Are the Symptoms of Mania?

Diagnosing Bipolar Disorders

What Causes Bipolar Disorders?

What Are the Treatments for Bipolar Disorders?

Putting It Together: Making Sense of All That Is Known

1 94 ://CHAPTER 7

,,Unipogar Depression Whenever we feel particularly unhappy, we are likely to describe ourselves as "depressed." In all likelihood, we are merely responding to sad events, fatigue, or unhappy thoughts.This loose use of the term confuses a perfectly normal mood swing with a clinical syndrome. All of us experience dejection from time to time, but only some experience unipolar depression. Clinical depression brings severe and long-lasting psychological pain that may intensify as time goes by. Those who suffer from it may lose their will to carry out the simplest of life's activities; some even lose their will to live.

1,1i1-'-fyfil r,!Iltoi.j.6-t-C-jim,°•HI-','[-",'-'-°-4-'1b!-',--°}- 1N,

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edepressioneA low, sad state marked by lack of energy, low self-worth, guilt, or related symptoms.

emaniacA state or episode of euphoria or frenzied activity in which people may have an exaggerated belief that the world is theirs for the taking.

ounipolar depression*Depression without a history of mania.

ebipolar disorder°A disorder marked by alternating or intermixed periods of mania and depression.

How Common Is Unipolar Depression? Almost 7 percent of adults in the United States suffer from a severe unipolar pat- tern of depression in any given year, while as many as 5 percent suffer from mild forms (Kessler & Wang, 2009; Taube-Schiff & Lau, 2008). Around 17 percent of all adults experience an episode of severe unipolar depression at some point in their lives. These prevalence rates are similar in Canada, England, France, and many other countries (Vasiliadis et al., 2007; WHO, 2004).

In almost all countries, women are at least twice as likely as men to experi- ence episodes of severe unipolar depression (Taube-Schiff & Lau, 2008). As many as 26 percent of women may have an episode at some time in their lives, compared with 12 percent of men. Among children the prevalence is similar for girls and boys (Avenevoli et al., 2008). All of these rates hold steady across the various socioeconomic classes and ethnic groups.

Approximately half of the people with unipolar depression recover within six weeks and 90 percent recover within a year, some without treatment

(Kessler, 2002; Kendler et al., 1997). However, most of them have at least one other episode of depression later in their lives (Taube-Schiff & Lau, 2008).

What Are the Symptoms of Depression? The picture of depression may vary from person to person. Earlier you saw how Beatrice's indecisiveness, uncontrollable sobbing, and feelings of despair, anger, and worthlessness brought her job and social life to a standstill. Other depressed people have symptoms that are less severe. They manage to function, although their depression typically robs them of much effectiveness or pleasure, as you can see in the case of Derek:

Derek has probably suffered from depression all of his adult life but was unaware of it for many years. Derek called himself a night person, claiming that he could not think clearly until after noon even though he was often awake by 4:00 A.M. He tried to schedule his work as editorial writer for a small town newspaper so that it was compatible with his de- pressed mood at the beginning of the day. Therefore, he scheduled meetings for the morn- ings; talking with people got him moving. He saved writing and decision making for later in the day.

.. Derek's private thoughts were rarely cheerful and self-confident. He felt that his marriage was a mere business partnership. He provided the money, and she provided a home and children. Derek and his wife rarely expressed affection for each other. Occasion- ally, he had images of his own violent death in a bicycle crash, in a plane crash, or in a murder by an unidentified assailant.

Derek felt that he was constantly on the edge of job failure. He was disappointed that his editorials had not attracted the attention of larger papers. He was certain that several of the younger people on the paper had better ideas and wrote more skillfully than he did. He scolded himself fora bad editorial that he had written ten years earlier. Although that particular piece had not been up to his usual standards, everyone else on the paper

1 94 ://CHAPTER 7

,,Unipogar Depression Whenever we feel particularly unhappy, we are likely to describe ourselves as "depressed." In all likelihood, we are merely responding to sad events, fatigue, or unhappy thoughts.This loose use of the term confuses a perfectly normal mood swing with a clinical syndrome. All of us experience dejection from time to time, but only some experience unipolar depression. Clinical depression brings severe and long-lasting psychological pain that may intensify as time goes by. Those who suffer from it may lose their will to carry out the simplest of life's activities; some even lose their will to live.

1,1i1-'-fyfil r,!Iltoi.j.6-t-C-jim,°•HI-','[-",'-'-°-4-'1b!-',--°}- 1N,

fir \''4+ ?il

edepressioneA low, sad state marked by lack of energy, low self-worth, guilt, or related symptoms.

emaniacA state or episode of euphoria or frenzied activity in which people may have an exaggerated belief that the world is theirs for the taking.

ounipolar depression*Depression without a history of mania.

ebipolar disorder°A disorder marked by alternating or intermixed periods of mania and depression.

How Common Is Unipolar Depression? Almost 7 percent of adults in the United States suffer from a severe unipolar pat- tern of depression in any given year, while as many as 5 percent suffer from mild forms (Kessler & Wang, 2009; Taube-Schiff & Lau, 2008). Around 17 percent of all adults experience an episode of severe unipolar depression at some point in their lives. These prevalence rates are similar in Canada, England, France, and many other countries (Vasiliadis et al., 2007; WHO, 2004).

In almost all countries, women are at least twice as likely as men to experi- ence episodes of severe unipolar depression (Taube-Schiff & Lau, 2008). As many as 26 percent of women may have an episode at some time in their lives, compared with 12 percent of men. Among children the prevalence is similar for girls and boys (Avenevoli et al., 2008). All of these rates hold steady across the various socioeconomic classes and ethnic groups.

Approximately half of the people with unipolar depression recover within six weeks and 90 percent recover within a year, some without treatment

(Kessler, 2002; Kendler et al., 1997). However, most of them have at least one other episode of depression later in their lives (Taube-Schiff & Lau, 2008).

What Are the Symptoms of Depression? The picture of depression may vary from person to person. Earlier you saw how Beatrice's indecisiveness, uncontrollable sobbing, and feelings of despair, anger, and worthlessness brought her job and social life to a standstill. Other depressed people have symptoms that are less severe. They manage to function, although their depression typically robs them of much effectiveness or pleasure, as you can see in the case of Derek:

Derek has probably suffered from depression all of his adult life but was unaware of it for many years. Derek called himself a night person, claiming that he could not think clearly until after noon even though he was often awake by 4:00 A.M. He tried to schedule his work as editorial writer for a small town newspaper so that it was compatible with his de- pressed mood at the beginning of the day. Therefore, he scheduled meetings for the morn- ings; talking with people got him moving. He saved writing and decision making for later in the day.

.. Derek's private thoughts were rarely cheerful and self-confident. He felt that his marriage was a mere business partnership. He provided the money, and she provided a home and children. Derek and his wife rarely expressed affection for each other. Occasion- ally, he had images of his own violent death in a bicycle crash, in a plane crash, or in a murder by an unidentified assailant.

Derek felt that he was constantly on the edge of job failure. He was disappointed that his editorials had not attracted the attention of larger papers. He was certain that several of the younger people on the paper had better ideas and wrote more skillfully than he did. He scolded himself fora bad editorial that he had written ten years earlier. Although that particular piece had not been up to his usual standards, everyone else on the paper

he Color of Depression

1.'

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LOW SELF-ESTEEM

Mood Disorders :11 195

had forgotten it a week after it appeared. But ten years later, Derek was still ruminating over that one editorial. . . .

Derek brushed off his morning confusion as a lack of quick intelligence. He had no way to know that it was a symptom of depression. He never realized that his death images might be suicidal thinking. People do not talk about such things. For all Derek knew, everyone had similar thoughts.

(Lithe) , & Gordon, 1991, pp. 183-185)

MP.

As the cases of Beatrice and Derek indicate, depression has many symptoms other than sadness. The symptoms, which often feed upon one another, span five areas of functioning: emotional, motivational, behavioral, cognitive, and physical.

Emotion El Symptoms Most people who are depressed feel sad and dejected.They describe themselves as feeling "miserable," "empty," and "humiliated." They tend to lose their sense o I humor, report getting little pleasure from anything, and in some cases dis- play anlredonia, an inability to experience any pleasure at all. A number also experience anxiety; ange r, or agitation.This sea of misery may lead to crying spells.

MOtiVatiOnal Symptoms Depressed people typically lose the desire to pursue their usual activities. Almost all report a lack of drive, initiative, and spontaneity. They may have to force themselves to go to work, talk with friends, eat meals, or have sex. Terrie Williams, author of Black Pain, a book about depression in African Americans, describes her social withdrawal during a depressive episode:

I woke up one morning with a knot of fear in my stomach so crippling that I couldn't face light, much less day, and so intense that I stayed in bed for three days with the shades drawn and the lights out.

Three days. Three days not answering the phone. Three days not checking my e-mail. I was disconnected completely from the outside world, and I didn't care. Then on the morn- ing of the fourth day there was a knock on my door. Since I hadn't ordered food I ignored it. The knocking kept up and I kept ignoring it. 1 heard the sound of keys rattling in my front door. Slowly the bedroom door opened and in the painful light from the doorway I saw the figures of two old friends. "Terrie, are you in there?"

(Williams, 2008, p. xxiv)

Suicide represents the ultimate escape from life's challenges.As you will see in Chapter 8, many depressed people become uninterested in life or wish to die; others wish they could kill themselves, and some actually do. It has been estimated that between 6 and 15 percent of people who suffer from severe depression commit suicide (Taube-Schiff & Lau, 2008; Stolberg et al., 2002).

Behavioral Symptoms Depressed people are usually less active and less productive.They spend more time alone and may stay in bed for long periods. One man recalls, "I'd awaken early, but I'd just lie there—what was the use of getting up to a miserable day?" (Kraines & Thetford, 1972, p. 21). Depressed people may also move and even speak more slowly ( Joiner, 2002).

COgnitiVe Symptoms Depressed people hold extremely negative views of themselves.They consider themselves inadequate, undesirable, inferior, per- haps evil.They also blame themselves for nearly every unfortunate event, even things that have nothing to do with them, and they rarely credit themselves for positive achievements.

he Color of Depression

1.'

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"....) I ., ^::, . . -PI; 11:::cIi.:

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LOW SELF-ESTEEM

Mood Disorders :11 195

had forgotten it a week after it appeared. But ten years later, Derek was still ruminating over that one editorial. . . .

Derek brushed off his morning confusion as a lack of quick intelligence. He had no way to know that it was a symptom of depression. He never realized that his death images might be suicidal thinking. People do not talk about such things. For all Derek knew, everyone had similar thoughts.

(Lithe) , & Gordon, 1991, pp. 183-185)

MP.

As the cases of Beatrice and Derek indicate, depression has many symptoms other than sadness. The symptoms, which often feed upon one another, span five areas of functioning: emotional, motivational, behavioral, cognitive, and physical.

Emotion El Symptoms Most people who are depressed feel sad and dejected.They describe themselves as feeling "miserable," "empty," and "humiliated." They tend to lose their sense o I humor, report getting little pleasure from anything, and in some cases dis- play anlredonia, an inability to experience any pleasure at all. A number also experience anxiety; ange r, or agitation.This sea of misery may lead to crying spells.

MOtiVatiOnal Symptoms Depressed people typically lose the desire to pursue their usual activities. Almost all report a lack of drive, initiative, and spontaneity. They may have to force themselves to go to work, talk with friends, eat meals, or have sex. Terrie Williams, author of Black Pain, a book about depression in African Americans, describes her social withdrawal during a depressive episode:

I woke up one morning with a knot of fear in my stomach so crippling that I couldn't face light, much less day, and so intense that I stayed in bed for three days with the shades drawn and the lights out.

Three days. Three days not answering the phone. Three days not checking my e-mail. I was disconnected completely from the outside world, and I didn't care. Then on the morn- ing of the fourth day there was a knock on my door. Since I hadn't ordered food I ignored it. The knocking kept up and I kept ignoring it. 1 heard the sound of keys rattling in my front door. Slowly the bedroom door opened and in the painful light from the doorway I saw the figures of two old friends. "Terrie, are you in there?"

(Williams, 2008, p. xxiv)

Suicide represents the ultimate escape from life's challenges.As you will see in Chapter 8, many depressed people become uninterested in life or wish to die; others wish they could kill themselves, and some actually do. It has been estimated that between 6 and 15 percent of people who suffer from severe depression commit suicide (Taube-Schiff & Lau, 2008; Stolberg et al., 2002).

Behavioral Symptoms Depressed people are usually less active and less productive.They spend more time alone and may stay in bed for long periods. One man recalls, "I'd awaken early, but I'd just lie there—what was the use of getting up to a miserable day?" (Kraines & Thetford, 1972, p. 21). Depressed people may also move and even speak more slowly ( Joiner, 2002).

COgnitiVe Symptoms Depressed people hold extremely negative views of themselves.They consider themselves inadequate, undesirable, inferior, per- haps evil.They also blame themselves for nearly every unfortunate event, even things that have nothing to do with them, and they rarely credit themselves for positive achievements.