192 CHAPTER 6
DSM-IV-TR distinguishes between two categories of mood disorders: depres-
sive disorders and bipolar disorders. Depressive disorders are mood disorders
in which someone’s mood is consistently low; in contrast, bipolar disorders are
mood disorders in which a person’s mood is sometimes decidedly upbeat, perhaps
to the point of being manic, and sometimes may be low. Note that the mood dis-
turbances that are part of depressive disorders and bipolar disorders are not the
normal ups and downs that we all experience; they are more intense and longer
lasting than just feeling “blue” or “happy.”
If such mood patterns are caused by substance abuse or a medical condition,
a mental health clinician would not diagnose a mood disorder as the primary prob-
lem. Similarly, as with all clinical disorders, in order to be classifi ed as a disorder,
the symptoms of the mood disorder must cause signifi cant distress, impair daily life,
or put a person at risk of harm. The signifi cant distress and suffering, along with
a pervasive hopelessness that can arise with depression, sometimes lead people to
contemplate or attempt suicide.
Using the DSM system to categorize mood disorders, a clinician must “build”
a diagnosis based on a person’s current and past history of disturbed moods. In
DSM-IV-TR, each type of episodeof a mood disorder is a “building block,” with a
diagnosis based on the presence or absence of different types of blocks. DSM-IV-TR
defi nes four types of episodes: major depressive episode, manic episode, hypomanic
episode, and mixed episode (see Table 6.1). Should a patient experience additional
types of mood episodes over time, his or her diagnosis may change.
Let’s fi rst examine depressive disorders—what they are and their causes and
treatments—and then consider bipolar disorders. Once we know more about mood
disorders, we’ll examine what is known about suicide and its prevention.Depressive Disorders
Most people who read Jamison’s description of her senior year in high school would
think that she was depressed during that time. But what, exactly, does it mean to
say someone is depressed? The diagnoses of depressive disorders are based on the
building block referred to as a major depressive episode; people whose symptoms
have met the criteria for a major depressive episode (see Table 6.2) are diagnosed
withmajor depressive disorder.The Building Block of Depressive Disorders: Major
Depressive Episode
A clinician who uses the DSM-IV-TR system to categorize mood disorders builds
a diagnosis based on a person’s current and past history of episodes of disturbed
moods. For depressive disorders, there is only one building block: major depressive
episode (MDE), which is characterized by severe depression that lasts for at least
2 weeks. MDE is not itself a diagnosis, but a building block toward a diagnosis (as
we shall see later in this chapter, the diagnosis for other disorders typically requires
several building blocks). Mood (which is a type of affect) is not the only symptom of
a major depressive episode. Behavior and cognition are also affected by depression.
These three spheres of functioning are sometimes referred to as the ABCs—affect,
behavior, and cognition (but should not be confused with the ABCs of behavior
therapy—antecedent, behavior, consequence).Affect, the Mood Symptoms of Depression
During a major depressive episode, a person can feel unremitting sadness, hopelessness,
or numbness. Some people also suffer from a loss of pleasure, referred to asanhedonia,
a state in which activities and intellectual pursuits that were once enjoyable no longer
are, or at least are not nearly as enjoyable as they had been. Someone who liked to goMajor depressive episode (MDE)
A mood episode characterized by severe
depression that lasts for at least 2 weeks.Anhedonia
A diffi culty or inability to experience pleasure.- A major depressive episode involves
symptoms of depression. - A manic episode involves elated, irri-
table, or euphoric mood (mood that is
extremely positive and may not neces-
sarily be appropriate to the situation). - A hypomanic episode involves elated,
irritable, or euphoric mood that is less
distressing or severe than mania and
is different than the individual’s non-
depressed state. That is, how a person
behaves during a hypomanic episode
is different from his or her usual state. - A mixed episode involves symptoms of
both a major depressive episode and a
manic episode.
Table 6.1 • Four Types of Mood
Disorder EpisodesPsychologist Kay Redfi eld Jamison described being
depressed: “My mind would... be drenched in awful
sounds and images of decay and dying: dead bodies
on the beach, charred remains of animals, toe-tagged
corpses in morgues. During these agitated periods
I became exceedingly restless, angry, and irritable,
and the only way I could dilute the agitation was to
run along the beach or pace back and forth across my
room like a polar bear at the zoo” (1995, p. 45).Robert Sherbow/Time Life Pictures/Getty Images