Abnormal Psychology

Mood Disorders and Suicide 217

Bipolar Disorders

After receiving her Ph.D. in psychology and joining the faculty of the Department of

Psychiatry at UCLA, Kay Jamison went to a garden party for faculty. The man who

would later become her psychiatrist was there, and years later they discussed the party:

My memories of the garden party were that I had a fabulous, bubbly, seductive, assured

time. My psychiatrist, however, in talking with me about it much later, recollected it

very differently. I was, he said, dressed in a remarkably provocative way, totally unlike

the conservative manner in which he had seen me dressed over the preceding year.

I had on much more makeup than usual and seemed, to him, to be frenetic and far too

talkative. He says he remembers having thought to himself, Kay looks manic. I, on the

other hand, had thought I was splendid.

(Jamison, 1995, p. 71)

The other set of mood disorders is bipolar disorders—in which a person’s mood

is often persistently and abnormally upbeat or shifts inappropriately from upbeat to

markedly down. (Bipolar disorders were previously referred to as manic-depressive

illness or simply manic-depression.) Jamison’s behavior at the garden party indi-

cates the opposite of depression—mania.

Building Blocks for Bipolar Disorders

Diagnoses of bipolar disorders are based on four building blocks, which are types of

mood episodes. These four building blocks are major depressive episode (the build-

ing block of MDD), manic episode, mixed episode, andhypomanic episode. The

confi guration of an individual’s particular mood episodes determines not only

the diagnosis, but also the treatment and prognosis.

Manic Episode

The hallmark of a manic episode, such as the one Jamison apparently had when

at the garden party, is a discrete period of at least 1 week of abnormally euphoric

feelings, intense irritability, or an expansive mood. During an expansive mood, the

person exhibits unceasing, indiscriminate enthusiasm for interpersonal or sexual

interactions or for projects. The expansive mood and related behaviors contrast

with the individual’s usual state. For instance, a normally shy individual may, dur-

ing a manic episode, have extensive, intimate conversations with strangers in public

places. For some, though, the predominant mood during a manic episode may be

irritability. Alternatively, during a manic episode, a person’s mood can shift between

abnormal and persistent euphoria and irritability, as it did for Jamison:

There is a particular kind of pain, elation, loneliness, and terror involved in this kind

of madness. When you’re high, it’s tremendous. The ideas and feelings are fast and

frequent like shooting stars, and you follow them until you fi nd better and brighter

ones. Shyness goes, the right words and gestures are suddenly there, the power to

Making a Diagnosis

• Reread Case 6.1 about William Styron, and determine whether
  or not his symptoms meet the criteria for an MDE. Specifi cally,
  list which criteria apply and which do not. If you would like more
  information to determine his diagnosis, what information—
  specifically—would you want, and in what ways would the
  information infl uence your decision?


• Reread Case 6.2 about Marie Osmond, and determine
  whether or not her symptoms meet the criteria for MDD, post-
  partum onset. Specifi cally, list which criteria apply and which

do not. If you would like more information to determine her

diagnosis, what information—specifi cally—would you want,

and in what ways would the information influence your

decision?

• Reread Case 6.3 about Mr. A, and determine whether or not his
  symptoms meet the criteria for dysthymic disorder. Specifi cally,
  list which criteria apply and which do not. If you would like
  more information to determine his diagnosis, what informa-
  tion—specifi cally—would you want, and in what ways would
  the information infl uence your decision?

Bipolar disorders

Mood disorders in which a person’s mood

is often persistently and abnormally upbeat

or shifts inappropriately from upbeat to

markedly down.

Manic episode

A period of at least 1 week characterized

by abnormal and persistent euphoria or

expansive mood or irritability.

Expansive mood

A mood that involves unceasing,

indiscriminate enthusiasm for interpersonal

or sexual interactions or for projects.