Pathology Diagnosis and the DSM-5

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Pathology Diagnosis and the DSM-5

Pathology Diagnosis and the DSM-5

Prior to beginning work on this assignment, review Chapter 3 and Chapter 6 in the course text and view the videos Depression and Its Treatments (Links to an external site.)OCD: One Patient’s Story (Links to an external site.)Diagnostic and Statistical Manual of Mental Disorders (5th ed.) (Links to an external site.) and The DSM-5 (Links to an external site.) screencast on how to access and use this resource and how to cite and reference the DSM-5. Utilize the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) (Links to an external site.) to support your analysis. Note that, in keeping with the focus of this class, the emphasis of your paper should be on the pathological aspects of the disorder you select to analyze.

ORDER ORIGINAL, PLAGIARISM-FREE ESSAY PAPERS HERE

To successfully complete this writing assignment,

1. Select a psychological disorder for comprehensive analysis from the following list (Choose only one.):

·

· Major depressive disorder

· Bipolar disorder

· Anxiety

o Focus on only one of the anxiety disorders (e.g., generalized anxiety disorder or social anxiety disorder).

· Post-traumatic stress disorder

· Obsessive-compulsive disorder

· Substance use disorder (substance abuse and addiction)

o Provide both an overview of this topic plus a focus on a single drug of your choice.

§ Your selection of topic should be based on your personal or professional experience or your own academic or personal interest in the topic. Be sure to use current terminology from the Diagnostic and Statistical Manual (DSM-5).

2. Based on the following requirements, create an outline (Links to an external site.) for your paper. Use this outline to determine the appropriate APA headings to be applied to your paper. To see APA guidelines for headings, visit APA Style Elements (Links to an external site.) in the Ashford Writing Center. Include the following in your paper:

·

· Introduction of the diagnosis

· Explanation of at least one theory of etiology (causes) of the disorder

· Explanation of the associated factors in development of the disorder (genetic, environmental, familial, lifestyle)

· A summary of the diagnostic and research technologies employed in clinical diagnosis, clinical and behavioral healthcare, and clinical interventions

· Discussion of treatment options of the disorder

· An analysis of the predominance of the disorder in our current society

· Conclusion

3. Next, research your topic and obtain a minimum of two scholarly and/or peer-reviewed sources published within the last five years. These sources should provide evidence-based information regarding the psychological features of the disorder. Be sure to cite these sources accurately in your paper and include them on your references page. Consider the following for this step:

·

· You may utilize required or recommended course materials in your work, but these will not count toward the reference requirements; however, you may cite and reference the DSM-5 as one of your sources used for the grading credit. Pathology Diagnosis and the DSM-5

· For support formatting your paper in APA, visit the Ashford Writing Center’s APA: Citing Within Your Paper (Links to an external site.) and Formatting Your References List (Links to an external site.).

4. Write your assignment.

·

· Suggestion: Complete your paper by the weekend to also take advantage of running a Paper Review (Links to an external site.) in the Ashford Writing Center to support your success.

5. Access the rubric (Links to an external site.) to confirm all required components have been addressed.

The Pathology, Diagnosis, and the DSM-5 writing assignment

· Must be a minimum of four double-spaced pages in length (not including title and references pages) and formatted according to APA Style as outlined in the Ashford Writing Center’s APA Style (Links to an external site.)

· Must include a separate title page with the following:

o Title of paper

o Student’s name

o Course name and number

o Instructor’s name

o Date submitted

§ For further assistance with the formatting and the title page, refer to APA Formatting for Word 2013 (Links to an external site.).

· Must utilize academic voice. See the Academic Voice (Links to an external site.) resource for additional guidance.

· Must include an introduction and conclusion paragraph. Your introduction paragraph needs to end with a clear thesis statement that indicates the purpose of your paper.

o For assistance on writing Introductions & Conclusions (Links to an external site.) as well as Writing a Thesis Statement (Links to an external site.), refer to the Ashford Writing Center resources.

· Must include APA headings. For formatting support, visit APA Style Elements (Links to an external site.) in the Ashford Writing Center.

· Must use at least two scholarly or peer-reviewed sources published within the last five years in addition to the course text or other course materials. You may also use required and recommended materials from the course but these will not count toward the research component of your grade. Pathology Diagnosis and the DSM-5

o The Scholarly, Peer-Reviewed, and Other Credible Sources (Links to an external site.) table offers additional guidance on appropriate source types. If you have questions about whether a specific source is appropriate for this assignment, please contact your instructor. Your instructor has the final say about the appropriateness of a specific source for a particular assignment.

o To assist you in completing the research required for this assignment, view this Ashford University Library Quick ‘n’ Dirty (Links to an external site.) tutorial, which introduces the Ashford University Library and the research process, and provides some library search tips.

· Must document any information used from sources in APA Style as outlined in the Ashford Writing Center’s APA: Citing Within Your Paper (Links to an external site.)

· Must include a separate references page that is formatted according to APA Style as outlined in the Ashford Writing Center. See the APA: Formatting Your References List (Links to an external site.) resource in the Ashford Writing Center for specifications.

Required Resources

Text

Getzfeld, A. R. (2018). Abnormal psychology (2nd ed.). Retrieved from https://content.ashford.edu

· Chapter 3: Anxiety and Obsessive-Compulsive Disorders

· Chapter 6: Depressive Disorders and Bipolar and Related Disorders

Book

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.) (Links to an external site.). https://doi.org/10.1176/appi.books.9780890425596

· This manual will support your understanding of diagnosis and treatment for mental illness. Note you will only be reviewing one to three pages and it will be based on specific disorders you choose to evaluate this week. It will assist you in your Anxiety and Depression: A Case Study discussion forum and Pathology, Diagnosis, and the DSM-5 assignment this week.
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Multimedia

Ashford University. (2018, August 8). The DSM-5 (Links to an external site.) [Video file]. Retrieved from https://ashford.mediaspace.kaltura.com/media/The%2BDSM-5/0_wa13z8fy

· This web page provides information about how to access and use the DSM-5 and will assist you in your Anxiety and Depression: A Case Study discussion forum and Pathology, Diagnosis discussion forum and the DSM-5 assignment this week. This video has closed captioning.
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nature video. (2014, December 19). Depression and its treatments (Links to an external site.) [Video file]. Retrieved from https://youtu.be/Yy8e4sw70ow

· This video provides information about the neural circuits affected in depression, as well as the molecular and cellular changes becoming better understood for treatment. This video will assist you in your Anxiety and Depression: A Case Study discussion forum and Pathology, Diagnosis, and the DSM-5 assignment this week. This video has closed captioning and a transcript.
Accessibility Statement (Links to an external site.)
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Sunnybrook Hospital. (2012, October 4). OCD: One patient’s story (Links to an external site.) [Video file]. Retrieved from https://youtu.be/x2JAXAmXd2w

· This video features a patient who has been diagnosed with OCD, as well as Dr. Peggy Richter, and discusses the illness as well as potential treatments. This resource will support your Anxiety and Depression: A Case Study discussion forum and Pathology, Diagnosis, and the DSM-5 discussion forum assignment this week. This video has closed captioning and a transcript.
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Web Page

Society of Clinical Psychology: Division 12. (n.d.). Case studies search (Links to an external site.). Retrieved from https://www.div12.org/case-studies/

· This web page will be utilized to identify a case study to analyze associated with your Anxiety and Depression: A Case Study discussion forum this week.
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Supplemental Material

Rosser-Majors, M. (2019). Week 2 Study Guide. Retrieved from https://www.ashford.instructure.com

· This study guide will help you prepare for your Week 2 Terminology Quiz and Week 2 Content Review this week.

Recommended Resources

Book

Ledley, D. R., Pai, A., & Franklin, M. E. (2007). Treating comorbid presentations: Obsessive-compulsive disorder, anxiety disorders, and depression. In M. M. Anthony, C. Purdon, & L. J. Summerfeldt (Eds.), Psychological treatment of obsessive-compulsive disorder: Fundamentals and beyond. (pp. 281–293). https://doi.org/10.1037/11543-013

· The full-text version of this chapter is available through the EBSCOhost database in the Ashford University Library. The chapter researches individuals with obsessive compulsive disorder (OCD) and additional psychological disorders, including other anxiety disorders and depression. The study reviews guidelines to differentiate OCD from other anxiety disorders and depression. This resource may helpful in supporting you with your assignments this week.

Article

Finley, E. P., Garcia, H. A., Ramirez, V. A., Haro, E. K., Mignogna, J., DeBeer, B., & Wiltsey-Stirman, S. (2019). Treatment selection among post-traumatic stress disorder (PTSD) specialty care providers in the Veterans Health Administration: A thematic analysisPsychological Trauma: Theory, Research, Practice, and Policy. https://doi.org/10.1037/tra0000477

· The full-text version of this article is available through the EBSCOhost database in the Ashford University Library. This article researches several treatment options specific to veterans experiencing post-traumatic stress disorder (PTSD). Specific psychotherapies are assessed. This article may helpful in supporting you with your assignments this week.

Supplemental Material

Maryland Recovery. (n.d.). Holistic remedies to help with mental disorders and substance abuse cravings (Links to an external site.) [Educational brochure]. Retrieved from https://www.marylandrecovery.com/wp-content/uploads/2017/05/marylandRecovery_HolisticRemedies.pdf

· The brochure offers insight into holistic methods for addressing addiction and may support you in your assignments this week, as well as future writing assignments in this course.
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    06CH_Abnormal_Getzfeld.pdf

    6 Depressive Disorders and Bipolar and Related Disorders

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    Learning Objectives

    After reading this chapter, you should be able to:

    • Understand the difference between normal emotions and pathological emotions.

    • Explain what depressive disorders are.

    • Explain what bipolar and related disorders are.

    • Know and discuss what causes depressive, bipolar, and related disorders.

    • Explain and discuss how depressive, bipolar, and related disorders are treated.

    • Analyze the relationships among depressive, bipolar, and related disorders and suicide.

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    Depressive Disorders and Bipolar and Related Disorders

    It is mid-June in a city known for a temperate climate. You awaken to a blue sky with puffy clouds; the sun is bright but not too hot, with low humidity. After eating your favorite break- fast, you go for a walk before heading off to your summer job. All seems right with the world, yet you are not happy. The sky appears gray to you, the sun covered by clouds. Breakfast seemed bland, almost tasteless. You didn’t sleep well; in fact, you awakened, again, in the middle of the night and couldn’t fall back to sleep. You were hoping to be intimate with your partner last night, but the desire and the drive remain missing.

    Does this scenario sound familiar to you? Perhaps it sounds like an everyday experience for many people. Have you ever had days with some, if not all, of these experiences? Before we continue, consider the next scenario.

    You awaken to the same sunny day, although this time the sun seems exceptionally bright and energizing. After making yourself a gourmet breakfast and wolfing it down in about three minutes, you go for a power walk, completing your usual course in record time and engag- ing everyone you pass in conversation, though the conversations have no connection to each other. Returning home, you decide, after showering, to clean the entire house as well as clean the windows and mow the lawn. You then head to work, put in a 13-hour day with a 15-min- ute lunch break, during which you consume a PowerBar and some Red Bull. At home you pre- pare a four-course meal from scratch. You should be tired but you’re not, so you call your best friend and see if she wants to go out to a bar for a few drinks. She calls it a night at 11 p.m., but you are going strong. You meet an attractive person and go back to his or her apartment for a while. You return home at about 2 a.m. and go to sleep. . .until 4 a.m., when you awaken, ready to start the new day, repeating this pattern for at least seven days. Pathology Diagnosis and the DSM-5

    How does the second scenario sound to you? Does this sound like a normal day and night for some people? Let’s take a closer look at what these scenarios seem to describe.

    The first scenario could illustrate some of the classic signs of depression, including sadness, hopelessness, self-blame, anger, insomnia, and loss of appetite. Depression is one of several depressive, bipolar, and related disorders, abnormal conditions characterized by persistent extremes of mood. Depression represents one pole of a person’s mood (see Figure 6.1) and

    is typically characterized by extreme sadness, lack of energy and sex drive, low self-worth, guilt, and oftentimes thoughts of suicide.

    The second scenario might illustrate the other pole, which is known as mania. Mania is marked by extreme elation. People who are in the grip of mania have lots of energy, form grandiose plans (to make a fortune or cure cancer), display a cavalier attitude toward money, and usually have a strong sex drive. At first glance, this may not seem to be much of a problem; left unchecked, however, mania can cause just as many difficulties as depression.

    Happily, most of us spend the bulk of our time some- where in the middle of the mood spectrum, neither very high nor very low. A telephone conversation, a walk in the park, or a dinner with friends can lift

    EgudinKa/iStock/Thinkstock Typically, the majority of people are somewhere in the middle of the mood spectrum and experience a range of emotions that are neither very high nor very low.

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    Depressive Disorders and Bipolar and Related Disorders

    our mood. By contrast, a bad day at work, failing an exam, losing a tennis match, indeed any of life’s disappointments can bring on the “blues.” When our mood rises, we feel happy, ener- gized, confident, and optimistic. When we get the blues, we feel sad, tired, and pessimistic. When we are low, we may decide to drown our sorrows in a drink, or maybe just go to bed. Pathology Diagnosis and the DSM-5

    The main difference between the blues, an emotion we all experience, and a depressive disor- der is one of degree (Oyama & Piotrowski, 2017). The blues pass quickly. In a day or two, we pick ourselves up and start again. However, when a negative mood persists for a long period of time, affecting social and occupational functioning, clinicians begin to suspect the presence of a depressive disorder.

    This chapter is concerned with the diagnosis, etiology, treatment, and prevention of depres- sive, bipolar, and related disorders. It also includes a discussion of suicide, which is some- times (but not always) caused by one of these disorders. Pathology Diagnosis and the DSM-5

    Figure 6.1: The mood spectrum

    Most of the time, we find ourselves in the middle of the spectrum, not too high or too low. Notice that the two extremes, mania and depression, are closer to one another than they are to the normal mood state. In fact, some people cycle between depression and mania, and a few manage to be both depressed and manic at the same time.

    Source: Adapted from S. Schwartz, Abnormal Psychology: A Discovery Approach. Mountain View, CA: Mayfield Publishing Company, 2000, Figure 8.1, p. 319.

    Normal mood

    Joy

    Depression Mania

    The “blues”

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    Section 6.1 Emotions: Normal and Pathological

    Before we continue, let’s examine the case of Bernard Louis, a man whose manic episodes severely affected his life.

    The Case of Bernard Louis: Part 1

    Note Dictated by Psychiatrist, Dr. Kahn, When Admitting Bernard Louis to the Hospital UNIVERSITY HOSPITAL

    Intake Note

    CONFIDENTIAL

    Admitting Psychiatrist: Dr. Sally Kahn

    Bernard Louis was brought involuntarily to the admitting ward by county police who were acting on a court order to have him committed for 24 hours of psychiatric observation.

    Mr. Louis is a large man, well over 6 feet tall. He weighs more than 200 pounds. When he appeared at the hospital, his face was very red, and his hair and clothing were disheveled. Otherwise, he seemed normal. According to his wife, who accompanied him to the hospital, Mr. Louis had been working alone, 18 hours a day, building a “golf course” in their suburban backyard. His plan was to turn their half-acre lot into a private country club with a clubhouse. He hoped to sell memberships at $5,000 a year. The clubhouse would offer catering facilities as well as a bar and pro shop. He planned to build sand and water traps and to invest in a fleet of motorized golf carts. When his wife suggested that he might be getting a little carried away, Mr. Louis lost his temper, shouted in rage, and threatened to leave her for another woman. He claimed to have four girlfriends whom he regularly “satisfied” ten times a night. Two days earlier, when his wife had left the house, Mr. Louis had taken all her jewelry to a pawnshop. He had used the money to invite strangers off the street to an all-night party that finally had to be stopped by the police. Mr. Louis had not slept at all for three days before his wife obtained the court order that brought him to the hospital.

    Mr. Louis was difficult to interview because he talked nonstop. He complained that he was being persecuted and that his wife was just jealous of the many women who were after him because of his sexual prowess. There was nothing wrong with him. In fact, he claimed, “I’ve never felt better in my life.” When asked if he was happy, Mr. Louis responded, “Am I happy? Why, if I felt any happier, you could sell tickets. I’m so happy, it should be illegal.” Pathology Diagnosis and the DSM-5

    See appendix for full case study.

    6.1 Emotions: Normal and Pathological Admirers of the original (and often-replicated) Star Trek television series and films will recall the Starship Enterprise’s Vulcan officer, Mr. Spock. Spock differed from earthlings in two ways: He had odd, pointy ears, and he was rarely emotional. Unlike Captain Kirk, Spock was never tempted by the seductive outer-space sirens who regularly tried to lure the space mariners to destruction. Even when the murderous Romulans seemed certain to destroy the Enterprise, Spock never panicked. As he coldly evaluated the ship’s predicament, the other

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    Section 6.1 Emotions: Normal and Pathological

    crew members would accuse Spock of being “inhuman.” To them, the essential charac- teristic of a human being is the ability to feel emotions—and most psychologists agree.

    Emotions are so much a part of life, we never stop to ask ourselves why they exist in the first place. What is the biological func- tion of negative emotions, such as fear and sorrow? Why did they evolve? Would we not be better off being unemotional like Spock?

    As is the case with many questions sur- rounding evolution, the first place to look for answers is in the works of Charles Dar- win (1809–1882). In his book The Expres- sion of Emotions in Man and Animals (1872), Darwin hypothesized that emotions evolved because they have survival value. Fear helps us to survive because, when we are afraid of something, we flee and avoid possible harm. Sorrow also has survival value. Parent-child bonds are cemented by the feelings of sadness parents and their children experience when they are separated. To avoid sadness, parents stay close to their children, thereby increas- ing their offspring’s chances of survival. Of course, it is possible to have too much of a good thing. Unrelenting fear or sorrow can be so debilitating that, instead of increasing a person’s chances of survival, they can actually decrease those chances.

    Grieving The loss of a loved one or a friend usually sets off a grieving process. The first reaction is usu- ally emotional numbness and disbelief punctuated with acute bouts of distress. Social sup- port is an important determinant of how quickly, and how well, people cope with the grieving process (Prest, 2017).

    Within a week or so after a loss, disbelief is replaced with a period of pining for the lost per- son. The survivors dwell on their loss, have trouble sleeping, neglect other aspects of life, and display anger at their fate (“Why me?”). This stage may last months or years, but most people eventually acknowledge the permanency of their loss (“I am now a widow”). In the final stage of grieving, people gradually regain their interest in life, and their sadness abates. The whole process may take a year or more and may involve significant periods of psychological distress. Still, the process is perfectly normal (see the accompanying Highlight). In fact, not grieving over the death of a loved one would be viewed by most psychologists as abnormal. Because grieving is normal, treatment is not indicated unless people become dangerous to themselves or are unable to function (Prest, 2017). In such cases, clinicians would probably consider the individual to be suffering from one of the depressive, bipolar, or related disorders described in the DSM–5. Pathology Diagnosis and the DSM-5

    Kimberley French/© Paramount Pictures/ Courtesy Everett Collection

    As Star Trek fans know, Mr. Spock differs from humans because he, as a half Vulcan, does not express emotions. Sometimes his cold ratio- nality is an advantage, but at other times his lack of emotion cuts him off from intuition and social connection.

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    Section 6.1 Emotions: Normal and Pathological

    DSM–5 Depressive, Bipolar, and Related Disorders By definition, a mood disorder is an abnormal condition characterized by persistent extremes of mood. The DSM–IV–TR categorized depressive and bipolar disorders in a single chapter titled “Mood Disorders.” The DSM–5 has divided the categories into two separate chapters: “Depressive Disorders” and “Bipolar and Related Disorders.” According to the DSM– 5, there are two general types of mood disorder: unipolar mood disorder and bipolar mood disorder. The “poles” referred to by these diagnostic labels are the extremes of the mood spectrum—depression and mania. Unipolar mood disorders are characterized by depres- sion, whereas bipolar disorders combine depression with manic periods. Both unipolar and

    Highlight: Removal of the Bereavement Exclusion Criterion From Depressive Disorders

    How do you handle the loss of a loved one? Most likely you go into a period of mourning, handling the situation in a way that is unique to you. This is called bereavement, a normal part of the grieving process. In the DSM–IV–TR (American Psychiatric Association [APA], 2000), psychologists, psychiatrists, and psychiatric social workers were advised (by the authors of the DSM–IV–TR) not to diagnose major depression in individuals within the first two months following the death of a loved one. This was called the “bereavement exclusion.” The inclusion of this criterion in the DSM–IV–TR meant that grieving a recent loss prevented a person from being diagnosed with major depression. Pathology Diagnosis and the DSM-5

    The bereavement exclusion was removed from the DSM–5 (APA, 2013) in order to ensure that unipolar depression (major depressive disorder) was not overlooked and that appropriate treatment could be implemented quickly before trouble ensued. The rationale behind this is simple enough: Normal grieving and unipolar depression, while sharing some common facets like withdrawal from everyday activities and intense overwhelming sadness, also differ in some very important ways.

    For example, during grieving, the painful feelings come in waves of grief when they occur; positive memories of the deceased individual also occur. However, in major depressive disorder (MDD), the mood and feelings and ideas are almost always negative and unpleasant. Second, while you are grieving, self-esteem (positive feelings about yourself) is usually maintained, whereas in MDD, feelings of worthlessness and self-loathing are common. Normal grieving can lead to MDD, but clinicians are cautioned not to confuse a normal process with a mental disorder.

    There is another perspective. The DSM–5 characterizes bereavement as a severe psychological stressor that can incite a major depressive episode even shortly after the loss of a loved one. Some critics say the risk is that of pathologizing grief, a normal human process. Individuals may be diagnosed with depression even in the absence of severe depressive symptoms (such as suicidal ideation) and even though their symptoms may be transient. Pathology Diagnosis and the DSM-5

    A person who meets the diagnostic criteria for MDD will no longer be excluded from that diagnosis solely because the person recently lost a loved one and is in the process of normal grieving or bereavement. The death of a loved one may or may not be the main, underlying cause of the person’s unipolar depression.

    What are your views on the bereavement exclusion?

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    Section 6.2 Depressive (Unipolar) Disorders

    bipolar disorders are divided into subtypes. The unipolar subtypes include a relatively mild condition known as persistent depressive disorder (dysthymia) and a more serious one called major depressive disorder. Bipolar disorders are divided into bipolar I disorder, which includes both depression and mania; bipolar II disorder (depression and hypomanic episodes, or episodes that do not cause as much impairment as manic episodes); and cyclo- thymic disorder (cycling between hypomanic periods and mildly depressed periods without ever fulfilling criteria for episodes of mania, hypomania, or major depression; APA, 2013). For adults to be diagnosed with cyclothymic disorder, the symptoms must be present for at least two years; for children, they must be present for at least one year (APA, 2013). Hypomanic episodes, unlike mania, do not require hospitalization (APA, 2013).

    6.2 Depressive (Unipolar) Disorders Depression is as old as recorded history. The Hippocratic Oath contains numerous refer- ences to depression, or as it was known during Hippocrates’s time (approximately 2,400 years ago in Greece), “melancholia.” Melancholia is derived from the Greek word melanchole, which means “black bile.” According to Hippocrates, the human body is filled with four basic substances, or bodily “humors,” which are in balance when a person is healthy. Ancient healers believed that depression, a “black” mood, resulted from an excess of black bile. Even though modern medicine has proved this to be incorrect, the idea that depression is caused by a chem- ical imbalance in the body remains popular today and will be discussed later in the chapter.

    Clearly, depression takes an enormous toll not only on the individual but also on society—particularly on the economy. Each year, the costs of major depressive dis- order for the U.S. workplace average about $43 billion (Greenberg, Fournier, Sisitsky, Pike, & Kessler, 2014). The overall costs of treating depression are estimated to be $210.5 billion per year (Greenberg, Fournier, Sis- itsky, Pike, & Kessler, 2014). Pathology Diagnosis and the DSM-5

    The signs of depression are common. We all experience periods of sadness and self-doubt, although these are not usually severe enough to qualify for a psychological diagnosis (Oyama & Piotrowski, 2017). Typically, these feelings begin with a reaction to some stressful life cir- cumstance (losing one’s job, for example). If these feel- ings dissipate within six months after the stressor or its consequences end, the DSM–5 labels them an adjust- ment disorder with depressed mood—a transient reaction to a stressful circumstance. A major depres- sive episode may appear superficially similar to an adjustment disorder, but it is more extreme.

    gameover2012/iStock/Thinkstock In approximately the 5th century BCE, Hippocrates inscribed what is now known as the “Hippocratic Oath.” The oath includes references to “melancholia,” or depression, and this ancient idea posited that depression resulted from an excess of black bile in the body. Although this antiquated conclusion was proved incorrect by modern medi- cine, it contributed to the possibil- ity that depression is caused by a chemical imbalance.

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    Section 6.2 Depressive (Unipolar) Disorders

    Major Depressive Episodes Major depressive episodes are part of the diagnostic criteria for bipolar I disorder. Although we can expect to see them in bipolar I disorder, they are not required to make a bipolar I disorder diagnosis (APA, 2013). The hallmark of a major depressive episode is a sad mood. Depressed people feel down and apathetic. They may go through the motions of daily exis- tence—get up, go to class, go to the library—but there is no enjoyment in it. Life seems dull and gray, and formerly pleasurable activities no longer bring any enjoyment. (This inability to feel pleasure is known as anhedonia.) Starting a new activity seems impossibly difficult. Suf- ferers describe themselves as constantly tired and just barely dragging themselves through life. Depressed people may talk and think slowly; some may be unable to get out of bed in the morning. Although slowness is more typical, some depressed people become agitated. Instead of lying around in bed, they are unable to sit still. They pace the floor, shaking their heads and restlessly wringing their hands. Pathology Diagnosis and the DSM-5

    A major depressive episode may affect the way people sleep; they may wake in the night or early morning and be unable to return to sleep. (However, some depressed people sleep most hours of the day.) Changes in appetite (usually eating less but sometimes eating more) and loss of interest in sex are also associated with a major depressive episode. Some writers believe that the presence of these so-called vegetative symptoms (appetite change, sleep dis- turbance, loss of sex drive, fatigue) is what distinguishes a major depressive episode from less severe forms of depression (Jaffe & Holle, 2017).

    Although a down mood and vegetative symptoms are the most obvious signs of a major depressive episode, cognition and memory are often affected as well (Jaffe & Holle, 2017). Depressed people have difficulty concentrating on cognitive tasks (Jaffe & Holle, 2017). They tend to see the downside of everything, dwelling on their failures and ignoring their suc- cesses. Because of their pessimism, they lose motivation. Depressed people judge themselves to be less liked and less capable than other people rate them (Ledrich & Gana, 2012). In chil- dren and adolescents, a depressive episode may look different. Children are more likely to be irritable than sad, for example, and they may show different symptoms at different develop- mental stages (Jaffe & Holle, 2017).

    It is difficult for depressed people to change because depression has a tendency to feed on itself. The vicious cycle begins with depressed people becoming irritable and short-tempered. They snap at their partners and their children. Regretting their behavior, they then feel guilty about mistreating their loved ones. These feelings of guilt, in turn, make them even more depressed (Roepke & Seligman, 2016). (See Table 6.1 for a summary of the diagnostic criteria for major depressive disorder.)

    Depression and physical symptoms often go together; for instance, headaches, dizzy spells, and general pain have been associated with depression (Trivedi, 2004). In addition to comor- bid physical conditions, there is considerable psychological comorbidity. Depressed children frequently display other problems, especially unruly misbehavior and conduct disorder (Rig- lin et al., 2016). In adults, depression is often accompanied by substance abuse. In addition, depression and anxiety are often related and show some clinical similarities in most adults (Jaffe & Holle, 2017).

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    Section 6.2 Depressive (Unipolar) Disorders

    Persistent Depressive Disorder (Dysthymia) Persistent depressive disorder (dysthymia) is a chronic, relatively mild, depressive disor- der that lasts at least two years but may last for decades (Oyama & Piotrowski, 2017). In children or adolescents, the diagnosis requires that the symptoms last at least one year. The person may experience occasional symptom-free days, but symptoms never disappear com- pletely for more than two months at a time. In addition to a depressed mood (or irritability in children and adolescents), the DSM–5 diagnostic criteria for persistent depressive disorder ( dysthymia) require the presence of at least two specific depressive symptoms. Pathology Diagnosis and the DSM-5

    Table 6.1: DSM–5 diagnostic criteria for a major depressive disorder

    A. Five (or more) of the following symptoms have been present during the same 2-week period and repre- sent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. Note: Do not include symptoms that are clearly attributable to another medical condition. 1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels

    sad) or observation made by others (e.g., appears fearful). (Note: In children and adolescents, can be irritable mood.)

    2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.

    3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)

    4. Insomnia or hypersomnia nearly every day. 5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective

    feelings of restlessness or being slowed down). 6. Fatigue or loss of energy nearly every day. 7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every

    day (not merely self-reproach or guilt about being sick). 8. Diminished ability to think or concentrate, or indecisiveness, nearly every day. 9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan,

    or a suicide attempt or a specific plan for committing suicide. B. The symptoms cause clinically significant distress or impairment in social, occupational, or other impor-

    tant areas of functioning. C. The episode is not attributable to the physiological effects of a substance or to another medical condition. Note: Criteria A–C represent a major depressive episode Note: Responses to a significant loss (e.g., bereavement, financial ruin, losses from a natural disaster, a

    serious medical illness or disability) may include the feelings of intense sadness, rumination about the loss, insomnia, poor appetite, and weight loss noted in Criterion A, which may resemble a depressive episode. Although such symptoms may be understandable or considered appropriate to the loss, the presence of a major depressive episode in addition to the normal response to a significant loss should also be carefully considered. This decision inevitably requires the exercise of clinical judgment based on the individual’s history and the cultural norms for the expression of distress in the context of loss.

    D. The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizo- phrenia spectrum and other psychotic disorders.

    E. There has never been a manic episode or a hypomanic episode. Note: This exclusion does not apply if all of the manic-like or hypomanic-like episodes are substance-

    induced or are attributable to the physiological effects of another medical condition.

    Source: Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (Copyright ©2013), p.160-161. American Psychiatric Association. All Rights Reserved.

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    Section 6.2 Depressive (Unipolar) Disorders

    Prevalence and Course of Depressive Disorders Clinical depression is the “common cold” of psychological disorders (Lorenzo-Luaces, 2015). About 300 million people worldwide suffer from depression, and the number of cases seems to be rising in most countries, putting considerable pressure on health expenditures (World Health Organization [WHO], 2017). The widespread use of psychoactive substances, mass international migrations, the breakdown of the traditional family, crime, unemployment, and poverty all make some contribution to the rising incidence of depressive disorders.

    A person’s first major depressive episode is now more likely to occur before age 19 than after (Gotlib & Hammen, 2009; Kessler, Berglund, Borges, Nock, & Wang, 2005). Most major depressive episodes begin gradually, usually with a prolonged period of anxiety or mild depression. Although they can last for years, most episodes improve within nine months to one year (Hasin, Goodwin, Stinson, & Grant, 2005; Kessler, 2002).

    Sex, Ethnic, and Cultural Differences In general, women are about twice as likely as men to be diagnosed as depressed (Oyama & Piotrowski, 2017). Why women should be more prone to depression than men has been the subject of substantial debate. Some researchers say women are more likely to seek assistance for psychological problems than men, so they turn up more often in the statistics (Rutter et al., 2016). Depressed men presumably cope in other ways such as hiding behind anger, but these theories have not received much support (Ramirez & Badger, 2014).

    If women seek psychological help more often than men, we would expect to find more women than men in all of the DSM–5 diagnostic groups. Because we do not, alter- native explanations have been offered that specifically target depression. For example, critics of the DSM–IV–TR and the DSM–5 allege that the diagnostic criteria for mood disorders are subtly biased to include more women than men. Still another explanation for the sex difference is that women blame themselves for being depressed and rumi- nate on this more than men, who tend to ignore their feelings (Ramirez & Badger, 2014). Instead of being diagnosed as depressed, men are diagnosed as substance abusers or as suf- fering from an antisocial personality disorder (discussed, respectively, in Chapters 4 and 9).

    In the Pennsylvania Amish (where all women work), depression is equally common in both sexes (Parker & Brotchie, 2010). The prevalence of depression varies across ethnic groups. For example, Native Americans are reputed to have higher rates of depression than the rest of the population (Roh et al., 2015). In addition, Latinos have higher rates of depression than African Americans, with Asians having the lowest rate of those ethnic groups sampled in one rather dated study (Algeria et al., 2008). Pathology Diagnosis and the DSM-5

    natalie_board/iStock/Thinkstock Commonly, women are more likely than men to be diagnosed with depression. There are several explanations for this statistic, yet all possibilities are still under debate.

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    Section 6.3 Bipolar and Related Disorders

    Otake (2008) looked at how unipolar depression is viewed in Japan. According to the Japa- nese Health, Labor and Welfare Ministry, 1 in 15 people in Japan suffer clinical depression at some point in their lives. Depression is considered one of the leading causes of suicide; in the industrialized world, Japan has the highest rate (Otake, 2008). Out of 100,000 people, 12.8 females and 35.6 males will kill themselves. This has translated into more than 30,000 suicides annually in recent years. Although these statistics are somewhat dated, they speak to the fact that untreated unipolar depression is a serious mental health concern in Japan. One reason the numbers appear as high as they are is that treatment options are limited. Most people in Japan use antidepressants and other drugs. More important, according to Otake (2008), few have access to, or seek out, psychotherapy. Japan’s national health insurance system discourages doctors from spending a lot of time with patients, and there is a short- age of professionals trained in verbal forms of therapy (Otake, 2008). One thing to ponder is whether increasing awareness of the seriousness of unipolar depression, or increasing the number of trained clinicians, would help to reduce the numbers of suicides. Pathology Diagnosis and the DSM-5

    6.3 Bipolar and Related Disorders Although it is possible to experience manic episodes without any periods of depression, clini- cians dating back to ancient Greece have noted that this is exceedingly rare. In the vast major-

    ity of people, manic episodes are either preceded or followed by depression (although there may be intervening periods of relative calm). By the 19th century, it was taken for granted that depression and mania go together. This is why Kraepelin coined the term manic-depressive to describe people with wide mood swings. The DSM–5 term bipolar con- veys a similar picture: episodes of elevated mood (one pole) alternating with periods of depression (the other pole). (See Part 2 of Bernard Louis’s case in the appendix.)

    Manic, Hypomanic, and Mixed Episodes The hallmark of a manic episode is an overly ele- vated mood. Manic people feel high and excited, although, like Bernard Louis, they are also easily irritated. In addition to an expansive mood, manic episodes are marked by grandiosity. In the grip of mania, people believe that they have unusual abili- ties and that they can accomplish anything. Con- vinced of their great wealth, manic people have been known to hand out money to strangers they meet on the street or to make enormous wagers at racecourses or casinos. Pathology Diagnosis and the DSM-5

    STUDIOGRANDQUEST/iStock/Thinkstock Bipolar disorders are characterized by feelings of extreme elation followed by depression. Individuals suffering from bipolar disorders usually experience symptoms starting at around age 18.

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