Unipolar Depression

All of us experience dejection from time to time, but only some experience unipolar depression. Normal dejection is seldom so severe as to influence daily functioning significantly or to persist very long. Such downturns in mood can even be beneficial. Periods spent in contemplation can lead us to explore our inner strength, our values, and our way of life, and we often emerge with a sense of greater strength, clarity, and resolve.

Clinical depression, on the other hand, has no redeeming characteristics. It brings severe and long lasting psychological pain that may intensity 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. There are two kinds of Unipolar Depression.

1. People with Major depressive disorder experience major depressive episode without having any history of mania in their diagnosis. The disorder may be additionally categorized as recurrent if it has been preceded by previous episodes; seasonal if it changes with the seasons; catatonic if it is marked by either immobility or excessive activity; postpartum if it occurs within four weeks of giving birth; or melancholic if the person is almost totally unaffected by pleasurable events.
2. People with Dysthymic disorder display longer-lasting ( at least 2 years) but less disabling pattern of unipolar depression. When dysthymic disorder leads to major depressive disorder, the sequence is called double depression.

Symptoms:

According to DSM-IV, a major depressive episode is a period marked by at least five symptoms of depression and lasting for two weeks or more. The picture of depression may vary from person to person so pin pointing a clear set of symptoms is difficult. The symptoms, which often exacerbate one another, span five areas of functioning: emotional, motivational, behavioral, cognitive, and physical.

• Emotoinal Symptoms: Most people who are depressed feel sad and dejected. They described themseleves as feeling "miserable", "empty", and "humiliated". They report getting little pleasure from anything, and they tend to lose their sense of humor. Some also experience anxiety, anger, or agitation.
• 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. This state has been described as a "paralysis of will". Suicide represents the ultimate escape from life's challenges. Many depressed people become uninterested in life or wish to die; others wish they could kill themseleves, and some actually try. It has been estimated that between 6% and 15% of people who suffer from severe depression commit suicide.
• Behavioral Symptoms: Depressed people are usually less active and less productive. They spend more time alone and may stay in bed for long periods. Depressed people may also move and even speak more slowly, with seeming reluctance and lack of energy.
• Cognitive Symptoms: Depressed people hold extremely negative views of themselves. They consider themselves inadequate, undesirable, inferior, perhaps 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. Another cognitive symptom of depression is pessimism. Sufferers are usually convinced that nothing will ever improve, and they feel helpless to change any aspect of their lives. Because they expect the worst, they are likely to procrasinate. They also frequently complain that their intellectual ability is poor. They feel confused, unable to remember things, easily distracted, and unable to solve even the smallest problems.
• Physical Symptoms: People who are depressed frequently have such physical ailments as headaches, indigestion, constipation, dizzy spells, and general pain. In fact, many depressions are misdiagnosed as medical problems at first. Disturbances in appetite and sleep are particularly common.

Causes of Unipolar Depression:

Episodes of unipolar depression often seem to be triggered by stressful events. The current explanations of unipolar depression point to biological, psychological, and sociocultural factors. Today, many therapists believe that the various explanations should be viewed collectively in order for unipolar depression to be fully understood.

to be continued...

Mood Disorders

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 the 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 is lifted.
Others experience periods of mania that alternate with periods of depression, a pattern called bipolar disorder. One might logically expect a third pattern of mood disorder, unipolar mania, in which people suffer from mania only, but this pattern is uncommon. Some experts even doubt its existence, except when it is brought on by a medical condition.
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 mood problems have been shared by millions , and today the economic costs amount to more than $40 billion each year.

Posttraumatic Stress Disorder ( PTSD)

Unlike the anxiety disorders, like phobia and OCD , which typically are triggered by objects or situations that most people would not find threatening, the situations that cause posttraumatic stress disorder like combat, rape, earthquake, airplane crash, would be traumatic for anyone. An example would be the attacks of September 11 which resulted in mass casualties and injuries, affecting not only the immidiate victims and survivors but the entire nation, as millions witnessed the resulting death and destruction on televisions. At this time people became prone to PTSD. More common examples may include, motor vehicle accidents and war veterans and rape victims.

Symptoms:
If the symptoms begin within four weeks of the traumatic event and last for less than a month, DSM-IV assigns a diagnosis of acute stress disorder. If the symptoms continue longer than a month, a diagnosis of posttraumatic stress disorder is assigned. The symptoms of PTSD may begin either shortly after the traumatic event or months or years afterward. Many cases of acture stress disorder develop into PTSD. Some common symptoms are listed below:

• Reexperiencing the traumatic event: People may be battered by recurring memories, dreams, or nightmares connected to the event. A few relive the event so vividly in their minds that they think it is actually happening again ( flashback).
• Avoidance: People will usually avoid activities that remind them of the traumatic event and will try to avoid related thoughts, feelings, or conversations.
• Reduced responsiveness: People feel detached or estranged from other people or lose interest in activities that once brought enjoyment. They may lose their ability to experience such intimate emotions as tenderness and sexuality.
• Increased arousal, anxiety, and guilt: People with these disorders may feel overly alert ( hyperalertness), be easily startled, develop sleep problems, and have trouble concentrating. They may feel extreme guilt because they survived the traumatic event while others did not.

Causes of PTSD:
In attempting to explain why some people develop PTSD and others do not, researchers have focused on biological factors, personality factors, childhood experiences, social support, and the severity of the traumatic event.

• Biological factors: Invesgators have gathered evidence that traumatic events trigger physical chances in the brain and body that may lead to severe stress reactions and, in some cases, to stress disorders. They have, for example, found abnormal activity of the hormone cortisol and the neurotransmitter/hormone norepinephrine in the urine and blood of combat soldiers, rape victims, and survivors of other severe stresses.
• Personality factors: Some studies suggest that people with certain personality profiles, attitudes, and coping styles are more likely to develop stress disorders. For example, people who are anxious and have some psychological problems before the stressful event are more likley to develop PTSD. Also, people who generally view life's negative events as beyond their control tend to develop more severe stress symptoms after stressful events.
• Childhood Experience: Some studies have found that certain childhood experiences seem to leave some people at risk for later acute and posttraumatic disorders. People whose childhood have been marked by poverty, psychological disorders of family members, assault, abuse or catastrophe at an early age appear more likely to develop these disorders in the face of later trauma.
• Social support: It has been found that people whose social support systems are weak are more likely to develop a stress disorder after a traumatic event.
• Severity of trauma: The severity and nature of traumatic events help determine whether an individual will develop a stress disorder. Some events can override even a nurturing childhood, positive attitude, and social support. Generally, the more severe the trauma and the more direct one's exposure to it, the greater the likelihood of developing a stress disorder.

Treatments:

Techniques used to treat the stress disorders include:

Drug Therapy: Antianxiety drugs help control the tension and exaggerated startle responses that many clients experience. In addition, antidepressants may reduce occurance of nightmares, panic attacks, flashbacks, and feelings of depression.

Behavioral Therapy: Behavioral exposure techniques have helped reduce specific symptoms and they have often led to improvements in overall adjustment.

Eye Movement Desensitization and Reprocessing ( EMDR): in which clients move their eyes in a saccadic, or rhytmic, manner from side to side while flooding their mind with images of the objects and situations they ordinarily try to avoid.

Obsessive- Compulsive Disorder ( OCD)

Obsessions are persistent thoughts, ideas, impulses, or images that seem to invade a person's consciousness. Compulsions are repetitive and rigid behaviors or mental acts that people feel they must perform in order to prevent or reduce anxiety. Minor obsessions and compulsions are familiar to almost everyone and can play a helpful role in life. Distracting tunes or little rituals often calms us during times of stress. Common themes in obsessions are contamination and violence.Compulsions commenly center on cleaning and checking. Other common compulsions involve touching, verbal rituals, or counting.

Symptoms:

According to DSM- IV, a diagnosis of obssesive-compulsive disorder may be called for when obsessions or compulsions feel excessive or unreasonable, cause great distress, consume considerable time, or interfere with daily functions. OCD is often classified as an anxiety disorder because the victim's obsessions cause intense anxiety, while their compulsions are aimed at preventing or reducing anxiety. In addition, their anxiety rises if they try to resist their obsessions or compulsions.

Prevalence of disorder:

As many as 2% of the people in the United States and other countries throughout the world suffer from OCD in any given year.

Age of disorder emergence:

The disorder may emerge at any age, but usually it first appears in childhood or adolescence.

Gender Differences in Diagnosis:

It is equally common in men and women to suffer from OCD.

Causes and Treatments:

Psychodynamic View:

According to the psychodynamic view, OCD arises out of a battle between id impulses, which appear as obsessive thoughts, and ego defense mechanisms, which take the form of counterthoughts or compulsive actions.

Behaviorist View:

Behaviorists believe that compulsive behaviors develop through chance associations. The leading behavioral treatement combines prolong exposure with response prevention.

Cognitive View:

Cognitive theorists believe that obsessive- compulsive disorder grows from a normal human tendency to have unwanted and unpleasant thoughts. The efforts of some people to understand, estimate, or avoid such thoughts actually lead to obsessions and compulsions. A promising cognitive- behavioral treatment is habituation training, during which therapists encourage clients to summon their obsessive thoughts to mind for a prolong period, expecting that such prolonged exposures will cause the thoughts to feel less threatening and to generate less anxiety.

Biological View:

Biological researchers have tied OCD to low serotonin activity and abnormal functioning in the orbital region of the frontal cortex and the caudate nuclei. Antidepressant drugs that raise serotonin activity are a useful form of treatment.

Phobias

A phobia ( from the Greek for "fear") is a persistent and unreasonable fear of a particular object, activity, or situation. People with a phobia become fearful if they even think about the object or situation they dread, but they usually remain comfortable as long as they avoid the object or thoughts about it. Most are well aware that their fear are excessive and unreasonable. Some have no idea how their fear started.
We all have are areas of special fear, and it is normal for some things to upset us more than other things. So how do these common fears differ from phobias?

Symptoms:
DSM- IV indicates that a phobia is more intense and persistent and the desire to avoid the object or situation is greater than in common fears. People with phobia feel such distress that their fear may interfere dramatically with their personal, social, or occupational lives.

Incidents of disorder:
Surveys suggest that 14% of adults in the United States develop a phobia at some point in their lives.

Age of disorder emergence:
The disorder may emerge at any age, but usually it first appears in childhood or adolescence.

Gender Differences in Diagnosis:
The disorder is more than twice as common in women as in men.


Although there are many kinds of phobias, most phobias fall under the category of specific phobias, social phibias and agoraphobia.
Specific Phobias:
DSM IV's lable for a marked and persistent fear of a specific object or situation.
Social Phobia:
A fear of social or performance situations in which embarassement may occure.
Agoraphobia:
A fear of venturing into public places, especially when one is alone. Agoraphobia is usually, perhaps always, experienced in conjunction with panic attacks ( unpredictable attacks of terror).

Causes of Phobia:

• Classical conditioning: A process of learning in which two events that repeatedly occure closely together in time become tied together in a person's mind and so produce the same response.
• Modeling: A process of learning in which a person observes and then imitates others.
• Stimulus generalization: A phenomenon in wich responses to one stimulus are also produced by similar stimuli

Treatment:
Biological View:
Biological theorists believe that abnormal norepinephrine activity in the brain's locus ceruleus is the key to panic disorders. These therapists use certain antidepressant drugs or powerful benzodiazpines to treat people with this disorder. Patients whose panic disorder is accompanied by agoraphobia may need a combination of drug therapy and behavioral exposure therapy.
Cognitve View:
These theorists suggest that panic- prone people become preoccupied with some of their bodily sensations, misinterpret them as signs of medical catastrophe, panic, and in some cases develop panic disorder. Cognitive therapists teach patients to interpret their physical sensations more accurately and to cope better with anxiety.
Behavioral View:
These theorists believe that the phobia is a result of a learned experienced and can be unlearned through exposure therapy and gradual systematic desensetization to the object or situation of dread.

Also see the list of all phobias.

Generalized Anxiety Disorder

Anxiety is the central nervous system's physiological and emotional response to a vague sense of threat or danger. People with generalized anxiety disorder experience excessive anxiety under most circumstances and worry about everything all the times. This problem is sometimes described as free-floating anxiety. These individuals usually have the following characteristics:

Symptoms:

• feel restless
• keyed up
• on edge
• tire easily
• have difficulty concentrating
• suffer from muscle tension
• have sleep problems

These symptoms must last for at least six months. Many individuals with this disorder experience depression as well. Nevertheless, most people with generalized anxiety disorder are able, with some difficulty, to carry on social relationships and job activities.

Age of disorder emergence:

The disorder may emerge at any age, but usually it first appears in childhood or adolescence.

Gender Differences in Diagnosis:

Women diagnosed with the disorder out number men 2to 1.

A variety of factors have been cited to explain the development of generalized anxiety disroder, such as, sociocultural, psychodynamic, humanistic, cognitive, and biological models.

Treatment:

Sociocultural View:

According to this view, increases in social dangers and pressures create a climate in which cases of generalized anxiety disorder are more likely to develop. Hence, avoiding or learning to deal with pressures such as low income, race and gender can decrease the insidents of this disorder.

Psychodynamic View:

Freud said that generalized anxiety disorder may develop when anxiety is excessive and defense mechanisms break down and function poorly. Psychodynamic therapists use free association, interpretation, and related psychodynamic techniques to help people overcome this problem.

Humanistic View:

Carl Rogers, the leading humanistic theorist, believed that people with generalized anxiety disorder fail to receive unconditional positive regard from significant others during their childhood and so become overly critical of themselves. He treated such individuals with client- centered therapy.

Cognitive View:

Cognitive theorists believe that generalized anxiety disorder is caused by maladaptive assumptions and beliefs that lead people to view most life situations as dangerous. Cognitive therapist help their clients change such thinking, and they teach them how to cope during stressful situations.

Biological View:

Biological theorists hold that generalized anxiety disorder results from low activity of the neurotransmitter GABA. The most common biological treatment is antianxiety drugs, particularly benzodiazpines. Relaxation training and biofeedback are also applied in many cases.