Emotion

Affect

Mood

Subjective states of feeling

ex. sadness, anger, disgust

Observable behavior that goes with emotion

ex. facial expression

Pervasive and sustained emotional response

ex. depression and elation

1. Pervasiveness
2. Absence of situational cues
3. Additional signs and symptoms
4. Subjective quality- doesn't feel like 'normal sadness'

• Involve discrete periods of time dominated by depressed and/or manic mood, which is reflected ina person's behavior
• Causes clinically significant distress, impairment, and/or possibility of harm to person

on one end of the spectrum: Depression and Dysthymia (Only Mania probably subs abuse)

on both poles person is experience (Mania, Hypo Mania and Depression): Bipolar 1, Bipolar 2, Cyclothymia

• Major Depressive Disorder
• Dysthymia

Bipolar I

Bipolar II

Cyclothymia

• Greater than 1 major depressive episodes (MDEs)
• Episode must last at least 2 weeks
• No manic or unequivocal hypomanic epidsodes

Depressed or dysphoric mood

Symptom Pattern of MDD

Depressed mood for at least 2 years, more days than not but:

• No MDE during first 2 years
• Never without these symptoms for longer than 2 months

Women are double likely to Develop MDD than Men

26% women vs 12% Male

In Kids prevalence is similar

Anxiety Disorder are most common (40%)

Also Subs Abuse (18%)

• Differences in cortisol, melatonin, and serotonin
• Life-Stress
• Body dissatisfaction
• Distraction vs. Rumination

Race/ Ethnicity

Education (Lower=more risk)

Income (Poverty=more risk)

Marital Status

Mixed Episode

Hypomanic Episode

More talkative and pressured speech

Increased goal-directed behavior

Excessive involvement in high-risk pleasurable activities

Elevated, expansive or irritable mood

* Can have greater than or equal to one MDEs too but not required

No manic episodes

Not during schizophrenia

Greater than or equal to:

hypomanic episodes

major depressive episodes

Mulitple hypomanic episodes and mild depressive symptoms

No manic episodes (During 1st two years)

No major depressive episodes

Psychotic features

Postpartum onset

Rapid Cycling

Seasonal Pattern

Epidemiology for Bipolar Disorders:

Gender Differences?

Epidemiology for Bipolar Disorders:

What are common comorbidities?

Subs abuse

Anxiety Disorders

Eating Disorders

Discrete episodes

Unipolar Depression: Biological Perspective:

Twin Studies

• Negative thoughts influence how we feel and act
• Depression is associated with errors in thinking or cognitive biases

Negative impact of stressful events higher in a sample of women at greater genetic risk for unipolar depression

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Decreased nonrepinephrine or serotnin in the limbic system 

Abnormal sensitivity or number of receptors

Dysregulation of the HPA axis leads to increased levels of cortisol

ex. crushings syndrome

Unipolar Biological Perspective:

Brain Imaging Studies

• Abnormal Patterns of activation of Prefrontal cortex
• Increased activity in limbic system, particularly the amygdala
• Overactivity of Brodmann's Area 25

• Seasonal Affective Disorder
• Mania

• Depression (REM starts sooner, is shorter, less deep sleep)

• Antidepressant Medications (ADM)
• Electroconvulsive Therapy (ECT)
• Light Therapy

• Monoamine Oxidase Inhhibitors (MAOIs)
• Tricyclic Antidepressants (Tricyclics)
• -Lithium as adjunctive treatment
• Selective Serotonin Reuptake Inhibitors (SSRIs)

Negative Life Events

• 3 times more likely to have experienced a negative LE in the year prior to onset of depressive episode 

• Behavioral activation
• Improve social skills

1. Beck's Cognitive Theory
2. Seligman's Learned Helplessness Theory
3. Nolen-Hoeksema's Response Style Theory

• Overgeneralization
• Arbitrary inferences
• Minimizing/Magnifying

Reformulated Learned Helplessness 

(Attribution-Helplessness Theory)

Permanence: Temporary vs. Permanent (Stable):

Event: You fail your abnormal Psychology Exam

Pervasiveness: Specific vs. Universal (Global)

Event: You fail your Abnormal Psychology Exam

Personalization:  External vs. Internal

Event: You fail your Abnormal Psychology exam 

Internal, Stable, Global

Inward Attention

(Longer, more severly depressed moods)

Diverted Attention

(Shorter, Less Depressed Moods)

• Collaborative Empiricism
• Thoughts Records
• Behavioral Experiments

• Social Support
• (strong social supports decrease the likelihood of depression)

Focused on Problems in Current Relationships

Focused on Challenges in Four areas

1. Interpersonal loss (grief)
2. Role Dispute
3. Role Transition
4. Interpersonal Deficits

• CT as efficaious as ADM for even more severly depressed outpatients
• CT has enduring effect (comparable to keeping patients on medications)
• MBCT and BA appear to be promising treatments
• Modest benefits of combination treatment

Continuation therapy for recovered patients

Significantly reduced risk for relapse in patients with 3 or more previous episodes of depression

Which is more common:

Completed Suicide or Attempts?

Attempts- Over 800,000 suicide attempts in 2005- parasuicide

vs.

Completed- 80 per day in the U.S. compared to 1900 per day from hear disease. 11th overall, but 3rd leading cause of death for young people aged 15-24 years old.

Varies by country,

Maybe due to religious beliefs,

In the U.S. <1% (12 per 100,000 people)

Women attempt more often than men

and

Men are more likely to complete suicide

Elderly at increased risk

Caucasians higher rates than most others except Native Americans

• Lack of connection to others
• Acute Major Stressors
• Long-term stress
• Changes in mood
• Hoplessness
• Dichotomous Thinking
• Alcohol Drug use- implicated in up to 70% of attempts
• Mental Disorders (e.g. Depression)
• Prior suicide attempts

Why do some people commit suicide and others do not?:

Joiner's Interpersonal Theory of Suicide

• Develops when self-injury and other dangerous experience become unthreatening/mundane.
• Accrues with repeated and escalating experiences involving painand provocation (e.g. past suicidal behavior, repeated witnessing or experiencing pain, violence or injury.
• The "taboo" and prohibited quality of suicidal behavior diminishes with habituation, and so may the fear and pain associated with self-harm.

Anecdotal Evidence- Kurt Cobain

Evidence from research- Longitudinal study of anorexic women

Thomas Joiner 

Those who are capable of suicide

• Perceived Burdensomesness (Essential Calculation: "My death is worth more than my life to my loved ones/family/society")
• Empirical Support: (Percceived burdensomeness has been found to be a predictor of suicidal ideation and suicide attempts)

A belief that the person does not have meaningful relationships with others

Empirical Support:

• Twins and women with more children have a lower risk for suicide.
• Higher national rankings of popular college football teams related to lower rates of suicide

Low serotonin- Asberg (1976) high vs. low serotonin depressed patients

Relation to impulsivity and aggression independent of depression.

Alcohol, Drug use- implicated in up to 70% of suicide attempts

Mental Disorders (e.g. depression, borderline personality disorder)

Prior suicide attempts

• Part of the implication of Joiner's model is that prevention of the acquired ability to commit suicide or reductions in perceived burdensomeness or feelings of thwarted belongingness will precent serious suicidality.
• Belongingness may be the most malleable and most powerful
• (Ad Council Campaign: "What a difference a friend makes")

• Impatient Hospitalization
• Drug Treatments
• Suicide Prevention Programs (e.g. hotlines)
• Cognitive Therapy 
• (Study: Cognitive Therapy for the Prevention of Suicide Attempts) 
• Less likely to reattempt suicide
• Decreased severity of self-reported depression 
• reduced hopelessness

• Hard to evaluate
• Rate of suicide in a community with a prevention program, mixed findings
• Rate of suicide among callers compared to other high risk groups suggest possible efficacy

• Look for warning signs: mood changes, talk of suicide, giving away prized possessions, hopeless about future, drug use
• Remember, just because they talk about suicidal feelings doesn't mean they wont do it.
• Help the person make a plan for what they will do when they are feeling sucidal
• Be supportive and try to get them help

• Remove access to harmful things
• Try to convince them to go to the hospital
• If they are unwilling to go, call the police

1. Genetics
2. Neurochemical
3. Brain Imaging

Biological Findings for Bipolar Disorder:

Genetics

Biological Findings for Bipolar Disorder:

Neurochemical

Biological Findings for Bipolar Disorder:

Brain Imaging

• Pharmacotherapy
• Electroconvulsive Therapy

Lithium Carbonate (helps in 60% of cases)

Anticonvulsants (for rapid Cycling) - Tegretol, Depakene

• Negative life events increase time to recovery from episodes (not due to medication noncompliance).
• Life events involving goal attainment or disruption of social rhythms increase manic symptoms.
• Social support exerts a stronger influence on symptoms of depression than symptoms of mania.

• Family-Focused Therapy
• Interpersonal Social Rhythm Therapy

Identify conflicts with the family

Reduce "expressed emotion" and improve communication

• Regualte sleep-wake cycles
• Resolve interpersonal Problems effectively

• 45% of women and 25% of men are on diets to contol their weight
• Americans spend over 30 billion per year to lose or control weight
• Over 70% of American girls have dieted by age 10
• About 1/3 of high school girls and 16% of boys show some signs of an eating disorder

• 65% of adults in the U.S are either overweight or obese
• Up to 1 in 3 children under age 18 are overweight or obese

• Refusal to maintain normal body weight (<85%)
• Sever voluntary restriction of food intake resulting from: Disturbances in body image and INtense fear of weight gain
• Amenorrhea — Comprehensive overview covers symptoms, causes and treatment of absent menstruation.
• Failure to meet growth marks

• Commonly diagnosed among white, young, upper class, competitive females
• Most are between the ages of 18-30
• Very high achievers
• Perfectionists

• Amenorrhea
• Cardiac problems and low blood pressure
• Lowered body temperature
• Metabolic and electrolyteBrittle hair, hair loss, lanugo (fine hair to make up for fat)
• Muscle loss and weakness
• reduced bone density

• Frequent binge eating episodes (binge= more food than a person normally would eat)
• Inappropriate compensatory behavior (e.g. vomiting, laxatives, excessive exercise)
• Self-evaluation extremely influenced by body shape
• Binge eating and compensatory behavior occurs at least twice per week for 3 months

• Still relies on some kind of compensatory behavior (e.g. fasting, excercise)
• Less restraint/impulse control
• Lasts longer, poorer recovery

What are differences between anoreixa and buliema?

In Weight

AN underweight

BN underweight to overweight

What are differences between anoreixa and buliema?

In Restricting?

AN- Successful

BN - Unsuccessful

What are differences between anoreixa and buliema?

Denial Differences?

AN - Denial of Hunger and disorder

BN- intense hunger, understands abnormality of behaviors

Prevalence

AN: 0.5-1%

BN: 1-3%

Alls: 4-10%

Different social pressures

different methods for weight loss

"muscle dysmorphobia"

Average age of onset: late teens

90-95% sufferers are female

AN: OCD, OCPD, Depression

BN: depression, anxiety, personality disorders, substance abuse

Genetic Factors: moderate heritabilty

Bulimia MZ 23% DZ 9%

Anorexia MZ 70% DZ 20%

Hypothalamus

theory is that the human body has a specific weight at which it is comfortable

Body has thermostat

=your body's ideal weight

When weight falls below biological mechanisms get the body back

Regulates Appetite

 Works to maintain set point

Restricting AN might shut down/ignore signals

Those who binge-purge may battle with the signals

Personality Characteristics

Dysfunctional Cognitive Styles

Neuroticism

Prefer Orderliness, predictability

Show conformity, deference

avoid risk

excessively perfectionistic

struggle for control / pverachieve

Dichotomous thinking

Obsession with importance of physical appearance

good girls

poor interoceptive awareness

Dysphoria

Negative Body Image

AN: enmeshed families

BN: Conflict and Rejection

Family or cognitive-behavioral therapy

-~80% show some improvement

True or False:

Medications are helpful treating anorexia

40% high response, 40% some response, 20% no response

CBT beats meds solo here but high relapse rate

1. Education about bulimia; orientation to CBT
2. Increased cognitive focus
3. Relapse prevention strategies

Characteristic style of relating with the world

(inborn, related to activity level, emotionality, sociability)

Evident during childhood

Foundation for later personality characteristics

Opennes to Experience

Conscientiousness

Extraversion

Agreeableness

Neuroticism

• Character disorder
• Maladaptive ways of relating to the world 
• few coping resources

-inflexibility

-distress

-Emotional instability

1. Are Axis I and II Disorder different? (Should they be separated?)
2. Difficulty in diagnosing
3. Etiology is poorly understood
4. Overlapping Categories
5. Poor Treatment Outcome

1. Maladaptive traits and behavior patterns in 2 or more of the following areas (Cognition, affect, interpersonal functioning, impulse control)
2. Enduring
3. Inflexible patterns across many situations
4. Deviates from expectations of culture
5. Impairments in social and Occupational functioning

Odd/Eccentric

-unusual behavior, social detachment

-similarity of symptoms to aspects of schizophrenia

Dramatic/Emotional/Erratic

-Dramatic Style, erratic & impulsive behavior

-difficulty sustaining relationiships

Anxious/Fearful

-Anxiety, fearfulness, Preoccupations with rules

Paranoid Personality Disorder

Schizoid Personality Disorder

Schizotypal Personality Disorder

Cluster A

Cluster B

Cluster C

– Pattern of distrust & suspiciousness

Suspect others are deceiving

On guard for perceived attacks by others

Doubt loyalty of friends/partners

Reluctant to confide in others

– Pattern of detachment from

relationships

– Restricted range of emotional

expression

 Lack close friends, sexual partner,

pleasure, affect

Chooses solitary activities

Not a precursor to schizophrenia

– Social/interpersonal deficits

– Cognitive/perceptual disturbances

– Oddities of speech/behavior

Suspicious beliefs

Magical thinking

Inappropriate affect

 Possible precursor to schizophrenia

Antisocial Personality Disorder

Borderline Personality Disorder

Histrionic Personality Disorder

Narcissitic Personality Disorder

– Pattern of disregard for, and violation of, the

rights of others

No remorse or guilt

 Impulsive, aggressive, illegal behavior

 Deceitfulness

Irresponsibility

Seem charming at first

More common in males

Genetic link is fairly strong

 Impulsivity

 Failure to learn from experiences

 Low arousal

– Pattern of instability in

interpersonal relationships,

self-image, and affect

– All or none thinking

– Marked impulsivity

– Self-injurious behaviors

– Depression/anger/anxiety

– Low tolerance for frustration

– Pattern of excessive emotionality

and attention-seeking

 Exhibitionism, sexual

inappropriateness

Shallow emotions

Exaggerated expression of emotion

better relationships

– Pattern of grandiosity, need for

admiration, lack of empathy

Exaggerated sense of own importance

Expecting to be treated with favor

Use others to achieve goals

Haughty attitudes

Is this actually fragile self-esteem?

Avoidant Personality Disorder

Dependent Personality Disorder

Obsessive-Compulsive Personality Disorder

– Pattern of social inhibition

– Feelings of inadequacy

– Hypersensitivity to negative evaluation

May overlap with social phobia

– Pattern of submissiveness and clinging

behavior

– Excessive need to be taken care of

– Fear of being separated

Often in abusive relationships

– Pattern of orderliness,

perfectionism, and control

Preoccupied with details/rules

 Interferes with task completion

 Excessively devoted to work

 Rigidity and stubbornness

 Difficulty with relationships

What is the sex ratio for personality disorders?

Varies

True or False:

Antisocial & OCPD more common in men

True or False:

Dependent and Borderline more common in men

high

– People with PDs usually have 2 or more

different ones

– with Axis I disorders as

well

Typically don't seek treatment

– Schizotypal: Antipsychotics/antidepressants

difficult to work with, tx

typically not effective

– BPD: pharmacotherapy, DBT

difficult to work with, tx

typically not effective

– BPD: pharmacotherapy, DBT

Linehan's Biosocial Theory of BDP's 

Two Components:

1. Emotional Dysregulation
2. Invalidating Environment

Helps patients adapt a realistic and positive

sense of self, regulate emotions, learn adaptive

skills for solving problems, and correct

dichotomous thinking.

• Decrease parasuicidal behavior
•  Decrease escapist behavior
• Increase behavioral skills

 -Social skills
       -Problem solving

True or False:

There are Negative Findings for DBT.

False.

• Fewer suicide attempts (23% vs. 46%)
• Fewer ER visits / inpatient care (43% vs. 58%)
• Less hospitalization for suicidal ideation (16% vs. 33%)

True or False:

We fully understand what causes personality disorders.