Mood Disorders

Dissociative identity disorder involves having at least two separate personalities that are distinct from one another. It used to be called multiple personality disorder. There can be gaps in memory, the hearing of voices, and lack of control of one s actions. While the disorder can be controversial, it does exist and is highly distressing to the individual having it. It is linked to high levels of intelligence and to recurrent childhood trauma.

MOOD DISORDERS

Mood disorders are disturbances in emotions and include depression and bipolar disorder. Most people have some type of inciting event but also have the preexisting disposition toward the disorders. The two main categories include depressive disorders and bipolar disorders.

People with major depressive disorder have psychological symptoms of depressed mood, hopelessness, emptiness, and sadness, along with a lack of enjoyment in life and physical symptoms. There can many possible symptoms, of which five must be seen for a minimum of two weeks. Physical symptoms include sleep disturbances, weight changes, fatigue, agitation, concentration difficulties, and suicidal ideation. The symptoms are episodic but recurrent over one s lifetime.

The disorder is seen in 17 percent of people in their lifetime. It is more common in women and more common in certain parts of the world. Other risk factors include being unemployed, low socio economic status, having poor social contacts and living in an urban environment. Comorbid diseases include substance abuse and anxiety.

Depressive disorders come in several types. These are considered subtypes of major depression. Those with a seasonal pattern have depression mostly in the wintertime when light levels are low. Those with peripartum depression have what s called postpartum depression, with themes related to their baby and the birth of their baby. Persistent depressive disorder is also called dysthymia. It involves about six months or more of depressive symptoms that tend not to be as severe as major depression.

Bipolar disorder is a different disorder from major depression. It must include at least one episode of mania, which is a period of persistent elevated or irritable mood, lasting at least one week in duration. Patients with mania get less sleep, talk more, and have

difficulty with spending or other risky behaviors. Flight of ideas is common, which is abruptly switching from one topic to another. Some will alternate with depressive periods of time, while others will have a combination of normal and elevated mood states.

Bipolar disorder is not as common as major depressive disorder and has a younger age at onset. Anxiety and substance abuse are often comorbid conditions. There is a higher risk of suicidality in those with bipolar disorder versus those with depression and half the patients do not require treatment.

Mood disorders in general have a biological basis, with bipolar disorder having the highest risk of being inherited. Patients will have some type of neuro chemical imbalance in serotonin or norepinephrine neurotransmitter systems. This explains why drugs designed to balance these two neurotransmitters are helpful in regulating particularly the depressive symptoms. Lithium is often used for mania because it blocks norepinephrine activity in the nerve synapses.

Stress and upbringing also are risk factors for depression. Patients with depression have higher than normal cortisol levels, particularly if they have traumatic events early in childhood. No one knows if the increased cortisol loves are the cause or effect of having depression. Stressful life events can also easily predict the onset of depression. Thus, the current model of depression is that depression has both genetic and environmental causes.

There are cognitive theories of depression that indicate the probability of negative thinking being related to the development of depression. Some believe that having a sense of hopelessness will also trigger depression. Depressed people have an increased risk of rumination, in which they chronically focus on distress and low mood states.

Depression and bipolar disorder can lead to extremes in emotional pain and the onset of suicidal behaviors. There are biological and psychological predispositions toward suicidality; a person also needs to have the means to commit suicide. Lack of social support, decreased problem-solving skills, and poor coping also contribute to suicide. Mood disorders in general increase the risk of suicide more than other disorders.