Understanding Mood Disorders: Symptoms and Classifications
Emotional Health Psychology
Emotion: Sudden and acute affections triggered by a perception (internal or external) or representation, with significant somatic correlation (reaction).
Humor or Mood: A type of affection with progressive onset, slower than emotions. It relates to the psychopathological concept of phase, lasting from hours to weeks or months. Its somatic component doesn’t follow a growing pattern but alters functions like sleep, nutrition, and hormone secretions.
Psychopathology of Feelings of State
Experienced as bodily sensations:
- Anxiety: Feelings of fearful expectation during prolonged stress, with physiological changes like tachycardia, hyperventilation, tremor, sweating, vasomotor disturbances, tiredness, and other somatic complaints. Related to anguish.
- Tension: Physical restlessness with high excitability, creating a sense of potential unexpected reaction.
- Vital Sadness: Embodied sadness affecting the person physically, conveying grief to the observer. In extreme cases, sadness is felt in a specific body part.
- Vital Joy: Similar to sadness, it spreads and affects the embodiment, with a picaresque look, elation, and over-optimization that transmits to the environment.
Experienced as less close to the body:
- Euphoria: Exaggerated state of well-being, inappropriate to the situation.
- Hebephrenic Affect: Playful attitude, lack of seriousness, perceived as banal superficiality and inadequacy.
- Childish Affect: Similar to hebephrenic, but highlights naivety, foolishness, and recklessness, causing discomfort or surprise.
- Blunted or Flat Affect: Decreased emotional responsiveness, lacking empathy and affect modulation, leading to indifference, indolence, apathy, and aloofness.
- Parathymia: Emotional response inconsistent with the lived experience, indicating ideo-affective dissociation or disagreement.
- Apathy: Almost complete lack of emotional response to oneself and the world, with global affective communication and empathy impairment.
- Discouragement: Inability to get excited about starting something, leading to indecisiveness in depression.
- Anhedonia: Inability to experience pleasure.
- Affective Coldness: Generic term for affective disorder, including flattening, apathy, and anhedonia.
- Sadness: Affective state of grief, bitterness, hopelessness, helplessness, pessimism, and depression, usually caused by significant loss.
- Depression: Quantitative reduction of mind with variable expression, assessed by the Hamilton Depression Scale. Symptoms include sadness, loneliness, despair, pessimism, guilt, and worthlessness.
- Dysphoria: Feeling of displeasure, dissatisfaction, irritability, anxiety, and sadness, with a changing mood.
- Dysthymia: Extreme mood swings with behavioral significance.
- Ambivalence: Simultaneous presence of two opposite feelings.
- Irritability: Excessive sensitivity or excitability, leading to impatience, tension, and aggression.
- Internal Restlessness: Psychic restlessness related to anxiety, where the person feels unable to quiet their thoughts and feelings. Also called psychic compulsion.
- Fear: Emotional reaction to flee or face with all energies, with physiological changes similar to anxiety but with an identifiable cause. Extreme fear is dread.
- Panic: Episodic affective state with intense, acute anxiety, disrupting cognitive and behavioral affects. It’s a contagious emotional state caused by life-threatening situations.
- Perplexity: Emotional reactions of fear, surprise, astonishment, and embarrassment to events perceived as unknown, new, curious, or strange, leading to confusion and defamiliarization.
Depressive Disorders
Symptoms
Varied in time course, from episodic to continuous. Severity ranges from mild to severe with suicidal ideation or attempts. The depressive syndrome can be reduced to five main areas:
- Sadness: The hallmark symptom, sometimes masked by irritability, emptiness, or nervousness. In severe cases, sadness may be denied.
- Inhibition: Experienced as anhedonia, apathy, and indifference, leading to psychomotor retardation in severe cases, or even depressive stupor, mutism, and near-total motor paralysis.
- Cognitive Alteration: Memory, attention, and concentration are affected. Negative self-assessment, autodepreciation, self-blame, and loss of self-esteem are common.
- Physical Symptoms: Sleep disorders, fatigue, appetite changes, decreased sexual desire, and various bodily discomforts.
- Interpersonal Relationship Deterioration: Depressed individuals often experience a decline in interpersonal relationships.
DSM-IV Classification
Depressive Disorder
Five or more symptoms for at least two weeks, representing a change from previous functioning, including either depressed mood or loss of interest/pleasure:
- Depressed mood most of the day, nearly every day.
- Diminished interest or pleasure in activities.
- Significant weight loss or gain, or appetite changes.
- Insomnia or hypersomnia.
- Psychomotor agitation or retardation.
- Fatigue or loss of energy.
- Feelings of worthlessness or excessive guilt.
- Diminished ability to think or concentrate.
- Recurrent thoughts of death or suicidal ideation.
Symptoms should not be due to a mixed episode, substance use, medical condition, or bereavement.
Depressive Disorder, Single Episode
Presence of a single major depressive episode, not better explained by other disorders, and no history of manic or hypomanic episodes.
Major Depressive Disorder, Recurrent
Presence of two or more major depressive episodes, separated by at least two months without meeting criteria for a major depressive episode.
Dysthymia
Chronically depressed mood for at least two years (one year in children and adolescents), with at least two additional symptoms like appetite changes, sleep disturbances, concentration difficulties, fatigue, hopelessness, or low self-esteem.
Depressive Disorder NOS
Depressive symptoms not meeting criteria for other specific depressive disorders, including premenstrual dysphoric disorder, minor depressive disorder, recurrent brief depressive disorder, psychotic depression, and others.
Bipolar Disorder
DSM-IV Classification
Episodes
Manic Episode
Distinct period of abnormally elevated, expansive, or irritable mood lasting at least one week, with three or more symptoms like inflated self-esteem, decreased need for sleep, increased talkativeness, flight of ideas, distractibility, increased goal-directed activity, and excessive involvement in pleasurable activities with high potential for negative consequences.
Mixed Episode
Criteria met for both manic and major depressive episodes nearly every day for at least one week.
Hypomanic Episode
Distinct period of elevated, expansive, or irritable mood lasting at least four days, with three or more symptoms similar to a manic episode but less severe, not causing significant impairment or requiring hospitalization.
Types
Bipolar I Disorder
One or more manic or mixed episodes and one or more major depressive episodes.
Bipolar II Disorder
One or more major depressive episodes and at least one hypomanic episode.
Cyclothymia
Numerous periods of hypomanic symptoms and depressive symptoms for at least two years, with persistent symptoms in the past two months.