Course: Abnormal Psychology (Psy-01503) Course: Instructor: Mr.

Ahmed Ikram
Chapter: # Mood Disorders ADP-1st-1M (2023-2025 Fall)

Overview
Life’s ups and downs can impact your mood and make it fluctuate from time to time. When you experience a
challenge, you may feel down. If you get good news, your mood could take a positive turn. Emotional
responses to the world around you are natural and valid. But some of them might cause you great distress.
When those emotional states persistently affect the way you function in the world, it may be a sign of a mood
disorder.
The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), is a reference guide used
by healthcare and mental health professionals to more accurately identify and diagnose mental health
conditions.
The American Psychiatric Association (APA) created the tool to be the go-to guide for mental health
conditions in the United States.

Mood Disorder
A mood disorder is a condition that severely impacts mood and its related functions. Mood disorder is a
broad term that refers to the different types of depressive and bipolar disorders, all of which affect mood. If
you have symptoms of a mood disorder, your moods may range from extremely low depressed to extremely
high or irritable manic.

Mood problems of these kinds are at the center of two groups of disorders depressive disorders and bipolar
disorders (APA, 2013).

People with depressive disorders suffer only from depression, a pattern called unipolar depression. They
have no history of mania and return to a normal or nearly normal mood when their depression lifts. In
contrast, those with bipolar disorders have periods of mania that alternate with periods of depression.

Symptoms of Mood Disorders

Mood disorders can lead to difficulty in keeping up with the daily tasks and demands of life. Some people,
especially children, may have physical symptoms of depression, like unexplained headaches or
stomachaches.

Because there are various types of mood disorders, they can have very different effects on quality of life. In
general, symptoms may include:
  Loss of interest in activities one once enjoyed
 Eating more or less than usual
 Difficulty sleeping or sleeping more than usual
 Fatigue
 Crying
 Anxiety
 Feeling "flat," having no energy to care
 Feeling isolated, sad, hopeless, and worthless
 Difficulty concentrating
 Problems making decisions
 Feelings of guilt
 Irritability
 Thoughts of dying and/or suicide

With mood disorders, these symptoms are ongoing and eventually start to affect daily life negatively.

What Causes Mood Disorders?

No one knows the exact cause of mood disorders. A variety of factors seem to contribute to them, and they
tend to run in families.

There is no single factor that alone causes mood disorders. Instead, a number of factors are believed to play a
role, and certain things can increase a person's risk of developing a mood disorder.

Some factors that can play a role include:

 Genetics
 A family history of mood disorders
 Having other mental health conditions
 Chronic health conditions
 Taking certain medications

Stressful life events like death, divorce, or trauma can also trigger depression, especially if someone has
already had it before or there's a genetic component.
Mood disorders include:

Depression and its subtypes

Bipolar disorder and its subtypes

Disruptive mood dysregulation disorder

Premenstrual dysphoric disorder

With the update of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013, mood
disorders were separated into two groups: bipolar and related disorders and depressive disorders.

Depression is one of the most common mental health disorders. In fact, it's estimated that 1 in 5 adults in the
United States have received a depression diagnosis in their lifetime.

Depression is often described as being mild, moderate, or severe. When a person’s symptoms have reached
the chronic end of the spectrum and require professional treatment, it's typically referred to as clinical
depression.

Depression can take on many forms and may be categorized in several different ways; there are two primary
types of clinical depression as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM 5):
major depressive disorder (unipolar depression) and the depressive phase of bipolar disorder.

Major Depression

Also known as major depressive disorder or unipolar depression, this form is what most people think of
when they hear “depression.” Major depression is typically characterized by the following symptoms:

 Sadness, feelings of emptiness

 Loss of enjoyment of hobbies, work, other activities
 Appetite changes, weight loss or gain
 Trouble sleeping (too much or too little)
 Feeling "slowed down" or being excessively agitated
 Tiredness, fatigue, lack of energy
 Physical symptoms and pain (such as body aches, stomach upset, headaches)
 Feelings of worthlessness or guilt
 Problems with concentration or focus
 Inability to make decisions or poor decision-making
 Thinking about death or dying; planning or attempting suicide
Some Common Causes of Depression

The causes of depression are not completely understood, but it’s believed that there are several key factors,
including genetics and environment, that make a person more likely to become depressed.

Researchers have particularly been interested in investigating whether depression is an inherited condition. A
major theory is that certain genetic changes make neurotransmitters (mood-regulating chemicals in the brain)
ineffective or scarce.
The other major component is environmental triggers which may make a person who is genetically
predisposed to depression more likely to develop it. Certain factors that make it more likely a person will
experience clinical depression include:

 A family history of depression (especially a parent or sibling)

 Experiencing a traumatic event or major life change (such as loss of a job, death or serious illness of
a spouse, divorce)
 Financial troubles (such as debt and worries about paying for big expenses)
 Being very ill or injured (such as from cancer or a car accident), needing to have surgery or undergo
medical treatment, or having to manage a chronic and/or progressive health condition (such as
multiple sclerosis)
 Caring for a loved one (spouse, child, parent) who has a major illness, injury, or disability
 Taking certain medications that can cause symptoms associated with depression (including
medications used to treat depression)
 Using illegal drugs and/or misusing alcohol

There are several different types of depression, including:

Postpartum depression (peripartum depression)

This type of depression occurs during pregnancy or after the end of a pregnancy in women and people assigned
female at birth (AFAB). Women and people AFAB experience hormonal, physical, emotional, financial and
social changes after having a baby. These changes can cause symptoms of postpartum depression.
Symptoms can include:
 Low mood, feelings of sadness
 Severe mood swings
 Social withdrawal
 Trouble bonding with your baby
 Appetite changes
 Feeling helpless and hopeless
 Loss of interest in things you used to enjoy
 Anxiety and panic attacks
 Thoughts of hurting yourself or your baby
 Thoughts of suicide
Persistent depressive disorder

This is a chronic form of depression that must last for at least two years. Symptoms may occasionally lessen in
severity during this time. It’s less severe than major depressive disorder, but it’s ongoing.
Symptoms include:
 Feelings of sadness
 Loss of interest and pleasure
 Anger and irritability
 Feelings of guilt
 Low self-esteem
 Difficulty falling or staying asleep
 Sleeping too much
 Feelings of hopelessness
 Fatigue and lack of energy
 Changes in appetite
 Trouble concentrating

Seasonal affective disorder (SAD)

This type of depression occurs during certain seasons of the year. It typically starts in the late autumn or early
winter and lasts until spring or summer. Less commonly, SAD episodes may also begin during the late spring or
summer. Symptoms of winter seasonal affective disorder may resemble those of major depression. They tend to
disappear or lessen during spring and summer.
Symptoms can include:
 Fatigue
 Social withdrawal
 Increased sleep
 Increased appetite and carbohydrate cravings
 Weight gain
 Irritability
 Interpersonal difficulties (especially rejection sensitivity)
 A heavy, leaden feeling in the arms or legs

Depression with psychosis

This is a type of severe depression combined with psychotic episodes, such as hallucinations (seeing or hearing
things that others don’t) or delusions (having fixed but false beliefs). People who experience depression with
psychosis have an increased risk of thinking about suicide.

Bipolar disorder

Bipolar disorder is a mental health condition defined by periods (or episodes) of extreme mood disturbances that
affect mood, thoughts, and behavior.
There are two main types of bipolar disorders. Bipolar I disorder involves episodes of severe mania and often
depression. Bipolar II disorder involves a less severe form of mania called hypomania. There is also a third type
known as cyclothymic disorder.

Estimates suggest that around 4.4% of U.S. adults will have bipolar disorder at some point in their
lives. Genetics are thought to play a significant role, although brain abnormalities and environmental factors also
contribute as causes of bipolar disorder.

Bipolar I Disorder
This type of bipolar disorder involves the presence of at least one manic episode. Manic episodes may last seven
days or longer or be severe enough that a person requires acute care. People usually experience depressive
episodes as well, but they may also have mixed episodes where they experience depression and mania at the same
time
A manic episode is characterized by a sustained period of abnormally elevated or irritable mood, intense
energy, racing thoughts, and other extreme and exaggerated behaviors. People can also
experience psychosis during manic episodes, including hallucinations and delusions, which indicate a
separation from reality
Symptoms of mania can last for a week or more. Manic episodes may be interspersed with periods
of depression, with symptoms of fatigue, sadness, and hopelessness. While manic episodes are most
common in people with bipolar disorder, there are also other causes for these extreme changes in behavior
and mood.
Signs of Manic Episodes
Manic episode symptoms can be a medical emergency, much like shortness of breath, chest pain, and
bleeding are all symptoms of a serious physical health condition.

Below are some of the common behaviors associated with a manic episode.
Delusions or Hallucinations
Decreased Need for Sleep
Being Engaged in Many Activities at Once
Talking a Lot or Speaking Loudly
Easily Distracted
Increased Desire for Sex
Increase in Risky Behaviors
Rapid Thinking
Flight of Ideas
Hostility or Increased Irritability
Thoughts of Suicide
Excessive Religious Dedication
Bright Clothing
Diagnosis of Manic Episodes

For manic episodes to be diagnosed in bipolar disorder, a person must have a sustained and abnormally
elevated, expansive, or irritable mood for at least one week; the mania must be severe enough to cause
marked impairment in functioning or require hospitalization; and have at least three of the following
symptoms:
 Easily distracted
 Engaging in multiple tasks at one time (more than can be realistically accomplished in one day)
 Engaging in risky behavior, like gambling or unprotected sex
 Feeling pressured to speak, talking loudly and rapidly
 Grandiosity or an inflated sense of self
 Little need for sleep
 Racing thoughts

To diagnose bipolar I, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)
states that a person must have at least one manic episode that is not "better explained" by schizoaffective
disorder or occurring in someone with schizophrenia, schizophreniform disorder, delusional disorder, or
other specified or unspecified schizophrenia spectrum and other psychotic disorder

Causes of Manic Episodes

Manic episodes are common in people with bipolar I disorder. But they can also be caused by other factors
and health conditions, including:

 Brain injuries
 Brain tumors
 Dementia
 Encephalitis
 Lupus
 Medications (their side effects)
 Recreational drug or alcohol misuse
 Schizoaffective disorder
 Strokes
Bipolar II disorder

This disorder causes cycles of depression similar to those of bipolar I. A person with this illness also
experiences hypomania, which is a less severe form of mania. Hypomanic periods aren’t as intense or
disruptive as manic episodes. Someone with bipolar II disorder is usually able to handle daily
responsibilities.

Hypomania is characterized by overactive energy, mood, behavior, and activity levels significantly different
from your normal state of mind. These mood episodes are usually shorter in duration and less severe than
mania. Hypomania is a potential symptom of bipolar disorder, particularly bipolar II disorder.

A hypomanic episode commonly manifests with unusual gaiety, excitement, flamboyance, or irritation, along
with other characteristics such as inflated self-esteem, extreme talkativeness, increased distractibility,
reduced need for sleep, and racing thoughts.

Symptoms of Hypomania

The specific symptoms experienced during hypomania can vary from one person to another, and they can
also change over time. Examples of hypomanic behaviors and characteristics include:

 Behaving inappropriately, such as making crude remarks at a dinner party

 Dressing and/or behaving flamboyantly
 Hypersexuality, which may involve making unusual demands on your partner, inappropriate sexual
advances, engaging in an affair, or spending a lot of money on phone sex, pornography, or sex
workers
 Jumping from one subject to another unrelated topic when speaking
 Reduced need for sleep
 Spending recklessly, like buying a car you cannot afford
 Taking chances you normally wouldn't take because you "feel lucky"
 Talking so fast that it's difficult for others to follow what's being said
 Unusual irritability, excitement, hostility, or aggression

Diagnosis of Hypomania

To be diagnosed with bipolar II, a person must have had at least one episode of current or past hypomania (a
less severe form of mania), and at least one episode of current or past major depression but no history of any
manic episodes.
The mood, activity, and behaviors that are present with hypomania are clearly different from a person's
normal, everyday state and readily noticeable to those around them. A lack of mood fluctuation and
persistence of the mood state helps distinguish a hypomanic episode from normal mood variation.

Causes of Hypomania

While hypomania can be a symptom of bipolar disorder, this state can occur for other reasons as well. Some
of the potential causes of hypomania include the following.

Alcohol or Drug Use

Changes in Sleep Patterns
Depression
Genetics
High Levels of Stress
Medication

Cyclothymia, or cyclothymic disorder, is a condition that involves moods cycling

between hypomania and depression. Though milder than bipolar disorder, cyclothymia is sometimes a
precursor for bipolar I or II disorder.

How Cyclothymic Disorder Is Diagnosed

Criterion A from the Diagnostic and Statistical Handbook of Mental Disorders, Fifth Edition (DSM-5)
defines cyclomania as: “For at least two years (at least one year in children and adolescents) there have been
numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode and
numerous periods with depressive symptoms that do not meet criteria for a major depressive episode."

Additional criteria for cyclothymic disorder in the DSM-5 are:

 B. During the above two-year period (one year in children and adolescents), the hypomanic and
depressive periods have been present for at least half the time and the individual has not been without
the symptoms for more than two months at a time.
 C. Criteria for a major depressive, manic, or hypomanic episode have never been met. [If such
episodes appear later, the diagnosis would be changed to bipolar I or bipolar II disorder, as
appropriate.]
 D. The symptoms aren’t better explained by another mental disorder.
 E. The symptoms aren’t caused by a substance (i.e., medication or drug of abuse) or another medical
condition.
 F. The symptoms cause clinically significant distress or impairment in social, occupational, or other
important areas of functioning.
Other Mood Disorders
Disruptive mood dysregulation disorder (DMDD) is a childhood condition that is characterized by
severe anger, irritability, and frequent temper outbursts. While temper tantrums tend to be quite common in
kids, DMDD is more than just normal childhood moodiness. The angry outbursts that kids experience with
DMDD are extreme, intense, and can lead to significant disruption in many areas of a child's life.

This condition is a fairly new diagnosis, first appearing in the fifth edition of the Diagnostic and Statistical
Manual (DSM-5), which was published in 2013. This condition was added to the DSM-5 to help address
concerns about possible over-diagnosis and treatment of bipolar disorder in children.

In order to be diagnosed with disruptive mood dysregulation disorder, a child must be between the ages of
six and 18.

The symptoms include:

 Severe, recurrent temper tantrums: Such outbursts can involve yelling, pushing, hitting, or
destruction of property.

 Outbursts occurring three or more times a week: A child may still be diagnosed with DMDD if
they don’t always have this many outbursts a week. Kids may have more tantrums one week, and
fewer the next. On average, tantrums three or more times a week are required for the diagnosis.

 Tantrums that are out of proportion to the situation: For example, you might expect a child to get
angry when they don’t get a toy they want, but a child with DMDD might act out with
physical aggression and verbal outbursts that are excessive and intense.

 Tantrums that are inappropriate for the child's age level: For example, while you might not be
surprised if a very young child has a tantrum that involves falling to the floor crying and screaming, it
is not something you would expect from a 12-year-old.

 Irritable and angry moods between tantrums: In between bouts of intense emotional outbursts,
kids with DMDD have moods that are consistently angry and extremely irritable. Such moods are
present most of the time and are noticed by others.

 Symptoms happen in multiple settings: This means that temper outbursts don’t just occur in a
single setting, such as at school. DMDD is characterized by having tantrums in at least two settings
such as at school, at home, or with peers.

In addition to the above criteria, these symptoms must be present for at least 12 months with no more than
three consecutive months where the diagnostic criteria are not met. In addition to meeting these criteria,
psychiatrists will also rule out other causes such as substance use and developmental disability.
Causes
The exact causes of DMDD are not clear, although there are a number of factors that are believed to play a
role. Such factors may include genetics, temperament, co-occurring mental conditions, and childhood
experiences.

The disorder appears to be more common during early childhood and is likely to co-occur with other
psychiatric conditions, most commonly depressive disorders and oppositional defiant disorder.

A child's temperament may be a risk factor for developing DMDD. Some traits that are more commonly seen
in kids with this condition include:
 Moodiness
 Anxiousness
 Irritability
 Difficult behavior
Other risk factors associated with DMDD include:
 Low parental support
 Parental hostility and substance use
 Family conflicts
 Disciplinary problems at school

Diagnosis

If your child is experiencing symptoms of DMDD, start by making an appointment with a pediatrician. The doctor will
evaluate your child and make a diagnosis or refer you to a psychiatrist for further evaluation and treatment.

The first step of diagnosis involves assessing a child's health, ruling out other health conditions, and then evaluating
the child's symptoms. A doctor or psychiatrist may also interview the child, parents, other caregivers, and teachers to
get a clearer view of a child's behaviors.
Premenstrual dysphoric disorder (PMDD) is a mood disorder that occurs during the premenstrual phase of the
menstrual cycle. While similar to that of premenstrual syndrome (PMS), the symptoms of PMDD are much more
severe and can lead to extreme mood changes that can disrupt daily life and functioning.

The cause of PMDD is complex. According to research published in 2022, individuals with this condition
appear to have a genetic sensitivity to the sex hormone allopregnanolone combined with the neurotransmitter
serotonin being less available, and ovarian reproductive steroids may play a role as well.

Other evidence supports the role of reproductive steroids in PMDD. More specifically, a different study
noted that PMDD may be related to alterations in the cellular responses involved in the metabolism of the
reproductive steroids estrogen and progesterone.

One's environment can also have an impact on how PMDD appears. For example, research has shown that
experiencing high levels of stress can increase the severity of this condition.

Symptoms of Premenstrual Dysphoric Disorder

Premenstrual dysphoric disorder symptoms begin during the luteal phase, or after ovulation, and end shortly
after menstruation starts. They include:

 Feelings of sadness, hopelessness, or depressed mood

 Increased anxiety
 Having a sense of overwhelm or loss of control
 Food cravings and overeating
 Irritability or anger that is directed toward others
 Lack of interest in activities
 Lack of energy and fatigue
 Physical symptoms, including breast tenderness, bloating, and joint or muscle pain
 Severe mood swings
 Sleep disturbances
 Trouble concentrating or thinking

Studies also indicate that women with PMDD have a four times greater risk of suicidal ideation and a seven
times higher risk of attempting suicide. If suicidal thoughts or behaviors are present, seek immediate medical
attention

Diagnosis of Premenstrual Dysphoric Disorder

While PMS can have an impact on a woman's life and functioning, it is not a classified disorder. Conversely,
premenstrual dysphoric disorder is classified as a mental disorder by the Diagnostic and Statistical Manual
of Mental Disorders, 5th Edition (DSM-5).

 Experience at least five symptoms across two domains, one involving mood and the other being
physical symptoms
 Experience these symptoms during the premenstrual phase, with the symptoms mostly absent within
the week following menses

These symptoms must also interfere with functioning in work, school, relationships, and other important life
areas and not be related to an existing condition or caused by substance use. PMDD is generally confirmed
by having patients track their symptoms over at least two menstrual cycles.