Emotion Dysfunction Flashcards
Classification types & prevalence of affective disorders
- affective disorder
- classification
- a mental disorder that is characterised by sudden changes or extremes of affect
- involves significant distress and impaired functioning
- can include episodes that are manic (ie elevated, expansive or irratable mood) and/ or depressive (ie. dejected, disinterested or agitated mood)
classification:
- classification systems use diagnostic symptoms usually derived by interview
- person has to meet the defined criteria for a defined period
- the 2 most widely used systems are;
1) International classification of diseases (ICD10-CM) = latest version)
(World Health Organisation, 2013)
2) Diagnostic and Statistical Manual of mental disorders (DSM5)
(APA, 2013)
- uses 5 axes to classify >290 disorders
- Axis 1 (mental and learning disorders) include depression, bipolar and anxiety
alternative?
- use continuum, rather than someone does/ doesn;t have a disorder
Depression (affective disorder)
symptoms
diagnosis
symptoms = unbearable sadness and loss of pleasure in activities for 2 weeks, plus:
- sleep problems
- slowing
- lack of energy
- can’t concentrate
- feeling worthless/ guilt
- suicidal thoughts
Major depression (unipolar) - can be based on a single or a recurrent episode
subtypes:
- depression (reactive)
- melancholinc (loss of pleasure)
- postpartum (after birth)
- seasonal affective disorder (winter depression)
requires 5 symptoms
Non-major depression includes:
- dysthymia (low daily mood for long period)
- brief recurrent episodes <2weeks
- requires 2-4 symptoms
Bipolar disorder (affective disorder) symptoms 3 types?
(formerly known as manic depression) manic symptoms include: - elevated, expansive or irritable mood - inflated self-esteem - decreased sleep need - speech pressure -racing thoughts - distractable - risk-taking (Mannell & Pedley, 2008)
Bipolar I = one or more manic episodes with or without major depressive episode
typical year = 32% weeks depressed, 9% weeks manic
Bipolar II = involves hypomanic and depressive episodes
- typical year 50% weeks depressed, 1% weeks hypomanic
Cyclothymia = involves hypomanic episodes and sub-depressive episodes
Anxiety disorder (affective disorder) symptoms
symptoms:
- overwhelming fears
- anxiety
- avoidance of fears
- loss of confidence
- generalised anxiety
- panic disorder (with bodily symptoms such as heart racing)
- phobias (urge to avoid specific social or other stimulus)
- obsessions (intrusive related thoughts) and compulsions (repeated actions that may provide temporary relief from anxiety)
- post traumatic stress disorder (event re-experienced with associated anxiety)
Childhood emotional disorders (affective disorders)
- 2 types
- externalising disorders - involve:
anger, hostility & aggression (Eg. oppositioanal defiant disorder; conduct disorder) - internalising disorder- involve:
depression, anxiety, withdrawal (eg. depression; anxiety disorder)
Psychiatric epidmiology: prevalence
children
adults
children:
-externalising disorders more common in younger children
boys show externalising more at all ages compared to girls
- anxiety disorders shows a 9-fold increase from age 3-8, and is fairly constant.
more common in girls
often co-occurs with depression
- depression rate increases with age.
equally likely in girls and boys until late adolescence, and then higher in girls
Adults: (Kessler et al, 1994)
- depression: 21% of women & 13% men have major depression in lifetime. More likely in western countries
symptoms vary by country
70% recover within 1 year, but 7% unsolved after 10yrs
- anxiety disorder: 30% women and 19% men have anxiety disorder in lifetime
- bipolar disorder: prevalence of 1%; no gender difference
50% relapse within a year
Causes of affective disorders in children
Children;
1) Diathesis-stress hypothesis (Davidson & Neale, 2001)
- may require both diathesis and stress for disorder to occur
- diathesis = predisposition or vulnerability to the disorder (may be genetic)
- stress = negative environmental impact (Eg. loss of parent)
Stresses (risks)
- conflict between parents increases risks of externalising disorders (may copy parents aggression)
- parental psychiatric problem increases risk of same type of problem. May copy behaviour, may also learn about effects of emotion (eg. using sadness to prevent anger of others), and may make negative attributions about self from negative feedback
- quality of parent-child relationship. child may receive less warmth. Parental hostility to brothers/ sisters makes externalising problems more likely for all
- Poverty, may work via the above stressors, but can also block goal attainment
Rutter (1979) identified 6 risk factors:
- material disharmony
- parental depression
- poverty
- large family
- institutionalisation
- parental criminality
ALSO, protective factors:
- good relationship with another person (eg. grandparent, friends)
Diathesis:
- genetic component for depression/ anxiety may be 20-40% (Rutter et al, 1999)
- other diatheses include: alcohol/ smoking and malnutrition before birth, cognitive impairments, delayed language development
- Caspi et al (2002) found evidence for combined influence of diathesis (MAOA) and stress (child maltreatment)
–> 12% male cohort responsible for 44% violent crimes (in community study)
(sex-linked MAOA gene = enzyme responsible for breaking down neurotransmitters// low version = can’t break it down as effectively)
causes of affective disorders in adults
Stresses (life events)
- Brown & Harris (1978) studied women in a London community and showed that a severe life event had preceded depression >80% cases
- developed life events & difficulties schedule to help predict the likelihood of someone developing depression
- events often involve: loss of valued role (Eg. work or relationship), humiliation (Eg. rape), entrapment (eg. no escape), or danger
(Kendler et al, 2003)
- life events usually precede anxiety too. More likely to involve danger
– BUT not everyone who experiences adversity develops a disorder –> social support may protect against life events (Cohen & Wills, 1995). Relationships may provide person with an alternative source of meaning and acceptance
Diatheses:
- genetics - Twin studies show a moderate genetic risk for depression and anxiety. Genes may bias cognitive processes via seratonin
Genetic influence on personality may also influence likelihood of person encountering particular life events
- previous episodes of the disorder = ‘kindling hypothesis’ (segal et al, 1996) - proposes that people are sensitised by previous episodes so that less stressful events can activate subsequent episodes. Evidence of anatomical changes to brain regions
- early experience
Wainwright & Surtees (2002) examined 8 types of adversity before age 17 as potential predictors of adult depression, but only parental divorce, a frightening event and physical abuse predicted
Early loss of a parent has also been shown to increase risk of affective disorder: lack of parental care may increase risk-taking; and negative schema of self may become reinforced by life choices
Understanding affective disorders
normal emotions and affective disorders -correspondence between them?
correspondence between ‘normal’ emotions and affective disorders:
- relationship between minor events and depressed/ anxious mood are analagous to those between severe event and depression/ anxiety disorders
BUT, in disorders the affect lasts longer and is more disabling
(continuum, rather than too distinguishable)
- sadness and depression appear to activate similar distinctive brain regions. As do fear and generalised anxiety
What is disordered? What causes it?
- may be….
may be attnetional problem eg. noticing info consisent with fear, more likely to result in phobia
- may be an appraisal/ attribution bias eg. making stable, internal, global attributions for negative events (Alloy et al, 2000)
- may be due to one emotion system dominating eg, responses are biased towards a particular type of emotion. Biased recall of negative memories may prolong negative emotion
- may be due to dysregulation of emotions eg. lack of effortful control may cause impulsive behaviour, or a problematic regulatory style eg. rumination
- may be due to prolonged negative interpersonal interactions (Hammen, 1991) eg. living with a depressed roommate and poor marriage increases risk
Depression
- cognitive inhibition and emotion regulation in depression (Joorman, 2010)
- creativity in depression
deficits in cognitive inhibition of negative material. Material remains in working memory, increasing rumination, and preventing mood repair using mood- incongruent memories
Rumination and depression
- the repetitive dwelling of thoughts involved in rumination may prolong depression (Nolen-Hoeksema, 2000)
- women report higher levels of rumination which may explain the gender difference in depression (Nolen-Hoeksema, 2000)
- Treynor et al(2003) distinguished between the reflective pondering and brooding components of rumination. ONLY brooding was associated with subsequent depression, and only brooding accounted for gender difference in depression
Depression, rumination and creativity(Verhaegen et al, 2015)
- paradoxical relationship between depresssion and creativity
- reflective rumination may account for the apparent relationship between depression and creativity
- cited a study by Ludwig (1995) which found a 50% prevalence of depression in creative arts (77% poets) compared to just 20-30% in other fields (yet, depression involves loss of energy and interest?)
- rumination on the other hand requires a sensitivity to the self, and reduced inhibition of cognitive material may lead to creative thought
(rumination part of depression accounts for creativity)
- past depression = more likely to have current depression and be more ‘reflective’
SO
(more reflecive = more serious about creative activity = more time spent on it = elaborate) ALSO
(more reflective = more fluency = greater originality)
SO
it is the reflective component of rumination that allows for this creativity, not just the depression
Biploar disorder
- mood swings and bipolar
- integrative model of mood swings and bipolar disorder
(Kelly, Dodd & Manuell, 2017; Manuell, 2007)
Attempts at affect regulation are disturbed through multiple and conflicting meanings given to internal states
this prompts exaggerated control known as ascent behaviours (for manic episodes) and descent behaviours (for depressive episodes)
Studying affective disorders
- ecolgoical momentary assessment of affective disorders good because…?
much of the research has been based on interviews with clients.
Recall of the symptoms may be inaccurate and distorted by the disorder
- ecological momentary assessment of affective disorders (Ebner-Priemer & Trull, 2009):
- reduces recall
- captures affect dynamics
- integrates data types (eg. physiological & self-report)
- reveals contextual effects (eg. situational triggers)
- can provide feedback to clients
Affective dynamics during affective disorders
- dinural variation?
- bipolar prodrome symptoms?
(prodrome meaning?)
-often a dinural variation in mood during depression in which the person is more depressed in the morning. This may be due to the circadian rhythm influence that is unmasked when people are less responsive to external events
- bipolar prodrome symptoms include: sleep loss prior to manic episodes, and sleep extension prior to depressive episodes
(prodrome = symptoms that precede onset)
- mood rarely switches within a day in bipolar disorder, but does so in rapid cycling cyclothymia
- individuals with low self-esteem and depressiojn have higher emotional inertia (ie emotions slower to change) in negative and positive emotions (Kuppens et al, 2010).. This may be because the person is under-reactive and/ or unable to use regulation effectively to repair moods
Relevance of emotion to other disorders
emotions implicated in a variety of disorders
-substance-induced disorders eg. alcohol and drug addictions
-eating disorders (eg. using food to regualte emotion)
- non-suicidal self-injury (Muenlenkamp et al, 2009)
- physcial health disorders (eg. coronary heart disease)
acute stress (eg. exams) can decreases immune response (Eg. healing) – Glaser et al, 1998
emotion in psychopathology
- excess of emotion eg. mania and phobia
- excessive change in emotion eg. personality disorders
- mismatch between emotional experience and expression (eg. schizophrenia)
- social emotion deficit eg. autism
- problem in understanding & describing emotion eg. alexithymia
- -> need transdiagnostic approach that focuses on emotion processes eg. awareness, regulation
Implications for treatment:
- Layard’s (2006) depression report for the UK:
- 1in6 have depression or an anxiety disorder
- only 1 in 4 receive tretment
- therapy could cure half
- cost would be £750, so person only needs to work an extra month for it to pay for itself
- recommended training of 10000 more therapies
