Concept Creep

Heterodox Academy: The Most Dangerous Creep On Campus

Victims, Victims Everywhere: Trigger Warnings, Safe Spaces, and Academic Freedoms

Bret Weinstein and Heather Heying makes some intriguing points:

@16:11
(Bret) yeah can I synthesize several things that have come up that are really at least are the same thing? So we have all experienced the kind of, what seems like an insane deafness to transparently obvious realities and it's very bewildering to hear people denying things that are just simply factual and could be tested in this room if we wanted to bother. But this also reflects the failure of, as Heather was pointing out, the lack of outdoor play for example. The thing about play outdoor is it teaches you when you're confused. If you're confused then you fall rather than make the leap that you think you're going to make and so you end up with pain which then gets pondered and you realize that there's something in error in your thought process.
And so by eliminating this kind of outdoor play what we do is we decide that all reality is abstract and that all reality being abstract it's very easy to go down some road where, wouldn't it be nice if we could say males and females are the same, therefore anything that turns out uneven as the result of some broken process that we should then seek to fix. The problem is that doesn't map to reality and the, I think what is actually taking place and it is surprisingly postmodern, is that there is this sort of abandonment of obligation to reality itself almost as if the people who are engaged in it don't believe that reality is a thing. And I would just submit to you that it is much more likely that that idea will take hold in an era where so much is done online, where you don't end up with a skinned knee because you were confused.
(Heather) yeah, prediction people who spent a lot of time hiking or playing sports or doing anything with their hands where they've created something at the end of the day, and they've got a chair that functions or there on the floor, are less likely to buy into the idea that reality is a social construct. If you are engaging with the physical world you know that there's a reality out there that abides by what you do or doesn't. Whereas if you're mostly engaged in the social world, it's much easier to delude yourself into imagining that maybe reality is a construct because social reality is.

Trauma- and Stressor-Related Disorders

Post-Traumatic Stress Disorder
PTSD is a disorder that develops after exposure to a traumatic event that involves actual or threatened death or serious injury.

In psychology, trauma is a type of damage to the psyche that occurs as a result of a severely distressing event. Trauma is often the result of an overwhelming amount of stress that exceeds one’s ability to cope or integrate the emotions involved with that experience. A traumatic event can involve one experience or repeated events or experiences over time.

Traumatizing, stressful events can have a long-term impact on mental and physical health. Situations where an individual is exposed to a severely stressful experience involving threat of death, injury, or sexual violence can result in the development of post-traumatic stress disorder (PTSD). With this disorder, the trauma experienced is severe enough to cause stress responses for months or even years after the initial incident. The trauma overwhelms the victim’s ability to cope psychologically, and memories of the event trigger anxiety and physical stress responses, including the release of cortisol. People with PTSD may experience flashbacks, panic attacks and anxiety, and hypervigilance (extreme attunement to stimuli that remind them of the initial incident).


DSM-5 Diagnostic Criteria
To be diagnosed with PTSD according to the DSM-5 (2013), a person must first have been exposed to a traumatic event that involves a loss of physical integrity, or risk of serious injury or death, to self or others. In addition, the person must experience intrusions (persistent re-experiencing of the event through flashbacks, distressing dreams, etc.); avoidance (of stimuli associated with the trauma, talking about the trauma, etc.); negative alterations in cognitions and mood (such as decreased capacity to feel certain feelings or distorted self-blame); and alterations in arousal and reactivity (such as difficulty sleeping, problems with anger or concentration, reckless behavior, or heightened startle response). These symptoms must last for more than 1 month and result in clinically significant distress or impairment in multiple domains of life, such as relationships, work, or other daily functioning.

Not everyone who experiences trauma will develop PTSD: according to the National Center for PTSD, approximately 20% of women and 8% of men who experience a traumatic event will develop PTSD. Rates of PTSD are higher in combat veterans than than the average rate for men, with a rate estimated at up to 20% for veterans returning from Iraq and Afghanistan.

Treatment
A number of psychotherapies have demonstrated usefulness in the treatment of PTSD and other trauma-related problems. Basic counseling practices common to many treatment responses for PTSD include education about the condition and provision of safety and support. The psychotherapy programs with the strongest demonstrated efficacy include cognitive behavioral therapy (CBT), variants of exposure therapy, stress inoculation training (SIT), variants of cognitive therapy (CT), eye movement desensitization and reprocessing (EMDR), and many combinations of these procedures.

Reactive Attachment Disorder

Reactive attachment disorder (RAD) is described in clinical literature as a severe and relatively uncommon disorder that can affect children. RAD is characterized by markedly disturbed and developmentally inappropriate ways of relating socially in most contexts.

DSM-5 Diagnostic Criteria
In order to be diagnosed with RAD under the DSM-5 criteria, a child under the age of 5 must:

• exhibit emotionally withdrawn and inhibited behaviors in relation to their caregivers (for example, not seeking comfort when they are sad or upset);
• exhibit some kind of emotional or social disturbance (for example, limited responsiveness, lack of positive affect, inexplicable instances of irritability or sadness, etc.); and
• have a history of significant neglect and/or unstable living situations in which they were unable to form stable and secure attachments.

Lumen: Boundless Psychology

Voltaire Quote

It is dangerous to be right in matters on which the established authorities are wrong. – Voltaire

Faces Of Africa - Idi Amin: Famous For the Wrong Reasons

Tanzania’s rogue president

"Since coming to power in the country of 55m on the east coast of Africa in 2015, Mr Magufuli, nicknamed “the bulldozer” from his time as roads minister, has bashed foreign-owned businesses with impossible tax demands, ordered pregnant girls to be kicked out of school, shut down newspapers and locked up “immoral” musicians who criticise him. A journalist and opposition party members have disappeared, political rallies have been banned and mutilated bodies have washed up on the shores of Coco Beach in Dar es Salaam, the commercial capital. Mr Magufuli is fast transforming Tanzania from a flawed democracy into one of Africa’s more brutal dictatorships. It is a lesson in how easily weak institutions can be hijacked and how quickly democratic progress can be undone."

Economist: Tanzania’s rogue president

Brazil Has Nearly 60,000 Murders, And It May Relax Gun Laws

NPR: Brazil Has Nearly 60,000 Murders, And It May Relax Gun Laws

Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is a mental disorder characterized by intrusive thoughts (obsessions) that produce uneasiness, apprehension, fear, or worry, and by repetitive behaviors or rituals (compulsions) aimed at reducing the associated anxiety. People with OCD may have just the obsessions or a combination of obsessions and compulsions.

Obsessions are characterized as persistent, unintentional, and unwanted thoughts and urges that are highly intrusive, unpleasant, and distressing (APA, 2013). Common obsessions include concerns about germs and contamination, doubts (“Did I turn the water off?”), order and symmetry (“I need all the spoons in the tray to be arranged a certain way”), and urges that are aggressive or lustful. Usually, the person knows that such thoughts and urges are irrational and thus tries to suppress or ignore them, but has an extremely difficult time doing so.

Compulsions are ritualistic behaviors that an individual performs in order to mitigate the anxiety that stems from obsessive thoughts. They often include such behaviors as repeated and extensive hand washing, cleaning, checking (e.g., making sure the oven is off), counting things, hoarding, or ordering (e.g., lining up all the pencils in a particular way). They may also include such mental acts as counting, praying, or reciting something to oneself, as well as nervous rituals like touching a doorknob or opening and closing a door a certain number of times before leaving a room. These compulsions can be alienating and time-consuming, often causing severe emotional, interpersonal, and even financial distress. The ability to relieve their stress is often temporary, and individuals may have a hard time switching from one task to another.

The acts of those who have OCD may appear paranoid and potentially psychotic, or disconnected from reality; however, OCD sufferers generally recognize their obsessions and compulsions as irrational. Roughly one-third to one-half of adults with OCD report a childhood onset of the disorder.

DSM-5 Diagnostic Criteria
To be diagnosed with OCD, a person must experience obsessions, compulsions, or both. Such obsessions must be to a degree that lies outside the normal range of worries about conventional problems. A person will tend to recognize the obsessions as idiosyncratic or irrational, but still must perform them. Additionally, the degree of obsessions and compulsions must impair some aspect of the individual’s social, occupational, or daily life functioning.

Other Obsessive-Compulsive Disorders
Obsessive-compulsive and related disorders are a group of overlapping disorders that generally involve intrusive, unpleasant thoughts and repetitive behaviors. Included in this category are body dysmorphic disorder, hoarding disorder, trichotillomania, and excoriation disorder.

1. Body Dysmorphic Disorder
An individual with body dysmorphic disorder is preoccupied with a perceived flaw in their physical appearance that is either nonexistent or barely noticeable to other people (APA, 2013). These perceived physical defects cause the person to think they are unattractive, ugly, hideous, or deformed. These preoccupations can focus on any bodily area, but they typically involve the skin, face, or hair. The preoccupation with imagined physical flaws drives the person to engage in repetitive and ritualistic behavioral and mental acts, such as constantly looking in the mirror, trying to hide the offending body part, comparisons with others, and, in some extreme cases, cosmetic surgery (Phillips, 2005). Severely impairing quality of life, body dysmorphic disorder can lead to social isolation and involves especially high rates of suicidal ideation. An estimated 2.4% of the adults in the United States meet the criteria for body dysmorphic disorder, with slightly higher rates in women than in men (APA, 2013).
2. Hoarding Disorder
Hoarding disorder is a pattern of behavior that is characterized by excessive acquisition and an inability or unwillingness to discard large quantities of objects that cover the living areas of the home and cause significant distress or impairment. Compulsive hoarding behavior has been associated with health risks, impaired functioning, economic burden, and adverse effects on friends and family members. When clinically significant enough to impair functioning, hoarding can prevent typical uses of space, enough so that it can limit activities such as cooking, cleaning, moving through the house, and sleeping. It could also potentially put the individual and others at risk of causing fires, falling, poor sanitation, and other health concerns. Compulsive hoarders may be conscious of their irrational behavior, but the emotional attachment to the hoarded objects far exceeds the motive to discard the items.

Prevalence rates have been estimated at 2-5% in adults, though the condition typically manifests in childhood with symptoms worsening in advanced age. Hoarding appears to be more common in people with psychological disorders such as depression, anxiety, and attention -deficit hyperactivity disorder (ADHD).

Trichotillomania
Trichotillomania (also known as trichotillosis or hair pulling disorder) is an obsessive compulsive disorder characterized by the compulsive urge to pull out one’s hair, leading to hair loss and balding, distress, and social or functional impairment. Trichotillomania may be present in infants, but the peak age of onset is 9 to 13. Owing to social implications the disorder is often unreported and it is difficult to accurately predict its prevalence; the lifetime prevalence is estimated to be between 0.6% and 4.0% of the overall population. Common areas for hair to be pulled out are the scalp, eyelashes, eyebrows, legs, arms, hands, nose and the pubic areas.

Excoriation Disorder
Excoriation disorder is an obsessive compulsive disorder characterized by the repeated urge to pick at one’s own skin, often to the extent that damage is caused. Episodes of skin picking are often preceded or accompanied by tension, anxiety, or stress. During these moments, there is commonly a compulsive urge to pick, squeeze, or scratch at a surface or region of the body, often at the location of a perceived skin defect. The region most commonly picked is the face, but other frequent locations include the arms, legs, back, gums, lips, shoulders, scalp, stomach, chest, and extremities such as the fingernails, cuticles, and toenails. Most patients with excoriation disorder report having a primary area of the body that they focus their picking on, but they will often move to other areas of the body to allow their primary picking area to heal.

Excoriation disorder can cause feeling of intense helplessness, guilt, shame, and embarrassment in individuals, and this greatly increases the risk of self-harm. Studies have shown that excoriation disorder presented suicidal ideation in 12% of individuals with this condition, suicide attempts in 11.5% of individuals with this condition, and psychiatric hospitalizations in 15% of individuals with this condition.

Lumen: Boundless Psychology: Obsessive-Compulsive Disorders

Heather Mac Donald: How Much More Delusional Can University Students Get?

Anxiety Disorders

Defining Anxiety
The difference between normal anxiety and an anxiety disorder is that anxiety disorders cause such severe distress as to interfere with someone’s ability to lead a normal life. “Anxiety disorder” refers to any of a number of specific disorders, including generalized anxiety disorder, phobia, panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, and social anxiety disorder.

Anxiety disorders are defined by excessive worry, apprehension, and fear about future events or situations, either real or imagined. Specifically, symptoms may include:

• feelings of panic, fear, or uneasiness
• uncontrollable and obsessive thoughts
• flashbacks to traumatic events
• problems sleeping
• nightmares
• shortness of breath
• nausea
• muscle tension
• dizziness
• heart palpitations
• dry mouth
• cold or sweaty hands

Anxiety disorders are diagnosed in between 4% and 10% of older adults; however, this figure is likely an underestimate of the true incidence due to the tendency of adults to minimize psychiatric problems and to focus on physical symptoms.

Etiology
Anxiety in and of itself is not a bad thing. In fact, the hormonal response involved in anxiety evolved to help humans react to danger—it better prepares them to recognize threats and to act accordingly to ensure their safety. Such sensory information is processed by the amygdala, which communicates information about potential threats to the rest of the brain. However, anxiety becomes counterproductive and thus is deemed “disordered” when it is experienced with such intensity that it impedes social functioning.

Anxiety disorders develop as the result of the interaction of genetic (inherited) and environmental factors. Neurologically speaking, increased amygdala reactivity is correlated with increased fear and anxiety responses. Low levels of GABA (a neurotransmitter in the brain that reduces central nervous system activity) can contribute to anxiety, and serotonin, glutamate, and the 5-Ht2A receptor have also all been implicated in the development of anxiety disorders.

In addition to biological factors, anxiety disorders can also be caused by various life stresses, such as financial worries or chronic physical illness. Severe anxiety and depression can also be induced by sustained alcohol abuse; with prolonged sobriety these symptoms usually decrease. Even moderate sustained alcohol use may increase anxiety and depression levels in some individuals. Caffeine, alcohol, and benzodiazepine dependence can worsen or cause anxiety and panic attacks.

Treatment
Treatment options for anxiety disorders include lifestyle changes, therapy, and medication. The most common intervention is cognitive behavioral therapy (CBT), which aims to help the person identify and challenge their negative thoughts (cognitions) and change their reactions to anxiety-provoking situations (behaviors).

In terms of medication, SSRIs are most commonly recommended. Benzodiazepines are also sometimes indicated for short-term or “as-needed” use. MAOIs such as phenelzine and tranylcypromine are also considered effective and are especially useful in treatment-resistant cases, but dietary restrictions and medical interactions may limit their use.

I. Generalized Anxiety Disorder
Generalized anxiety disorder (GAD) is characterized by chronic anxiety that is excessive, uncontrollable, often irrational, and disproportionate to the actual object of concern. People with GAD often characterize it as a feeling of “free-floating anxiety”—a term that Sigmund Freud used in his early work. Typically, the anxiety has no definite trigger or starting point, and as soon as the individual resolves one issue or source of worry another worry arises. People with GAD also tend to catastrophize, meaning they may assume the absolute worst in anxiety-inducing situations. Racing thoughts, inability to concentrate, and inability to focus are also characteristic of GAD.

GAD is a particularly difficult disorder to live with; because the individual’s anxiety is not tied to a specific situation or event, they experience little relief. This disorder can contribute to problems with sleep, work, and daily responsibilities and often impacts close relationships.

DSM-5 Diagnostic Criteria
In order for GAD to be diagnosed, a person must experience excessive anxiety and worry—more days than not—for at least 6 months and about a number of events or activities (such as work or school performance). This excessive worry must interfere with some aspect of life, such as social, occupational, or daily functioning, and the person must have trouble controlling the anxiety. The disturbance must not be attributed to the physiological effects of a substance (e.g., a drug or medication) or another medical condition, and must not be better explained by another medical disorder. At least 3 of the following symptoms must be experienced: restlessness or feeling keyed up or on edge; being easily fatigued; difficulty concentrating or mind going blank; irritability; muscle tension; and/or sleep disturbance.

Etiology
In any given year, approximately 2.3% of American adults and 2% of European adults experience GAD. Although there have been few investigations into the disorder’s heritability, a summary of available family and twin studies suggests that genetic factors play a moderate role in its development (Hettema et al., 2001). Specifically, about 30% of the variance for generalized anxiety disorder can been attributed to genes. Individuals with a genetic predisposition for GAD are more likely to develop the disorder, especially in response to a life stressor.

Cognitive theories of GAD suggest that worry represents a mental strategy to avoid more powerful negative emotions (Aikins & Craske, 2001), perhaps stemming from earlier unpleasant or traumatic experiences. Indeed, one longitudinal study found that childhood maltreatment was strongly related to the development of this disorder during adulthood (Moffitt et al., 2007). According to these theories, generalized anxiety may serve as a distraction from remembering painful childhood experiences.

Long-term use of benzodiazepines can worsen underlying anxiety, with evidence that reduction in benzodiazepine use can in turn lead to a lessening of anxiety symptoms. Similarly, long-term alcohol use is associated with the development of anxiety disorders, with evidence that prolonged abstinence can in turn result in the remission of anxiety symptoms.

Treatment
GAD is generally chronic, but it can be managed, or even eliminated, with the proper treatment. While there are many options for treating GAD, full recovery is only seen about 50% of the time, which indicates the need for further research into more effective treatment options.

Pharmaceutical treatments for GAD include selective serotonin reuptake inhibitors (SSRIs), which are more commonly used as antidepressants. SSRIs block the reabsorption of serotonin in the brain so that it can keep activating serotonin receptors, improving the individual’s mood.

II. Panic Disorder and Panic Attacks

A panic attack is defined as a period of extreme fear or discomfort that develops abruptly and reaches a peak within 10 minutes. Its symptoms include accelerated heart rate, sweating, trembling, choking sensations, hot flashes or chills, dizziness or lightheadedness, fears of losing control or going crazy, and fears of dying (APA, 2013). Sometimes panic attacks are expected, occurring in response to specific environmental triggers (such as being in a tunnel); other times, these episodes are unexpected and emerge randomly (such as when relaxing).

People with panic disorder experience recurrent (more than one) and unexpected panic attacks, along with at least one month of persistent concern about additional panic attacks, worry over the consequences of the attacks, or self-defeating changes in behavior related to the attacks (such as withdrawing from social activities out of fear of having an attack) (APA, 2013). Since panic attacks can occur unexpectedly, they can become a cause of ongoing worry and avoidance. People with panic disorder may become so afraid of having panic attacks that they experience what are known as anticipatory attacks—essentially panicking about potential panic attacks and entering a cycle of living in fear of fear.

Panic disorder is very treatable; however, left untreated, it can significantly reduce quality of life. People with untreated panic disorder are at an increased risk for specific phobias, such as agoraphobia (a fear of leaving the house), and they often suffer from one or more additional mental-health conditions, such as depression or substance abuse.


DSM-5 Diagnostic Criteria
In the DSM-5, panic attacks themselves are not mental disorders; instead, they are listed as specifiers for other mental disorders, such as anxiety disorders. Panic attacks are differentiated as being either expected or unexpected; the categories from the previous DSM-IV-TR (situationally bound/cued, situationally predisposed, or unexpected/uncued) have been removed.

In order to be diagnosed with panic disorder, a person must experience unexpected, recurrent panic attacks. These panic attacks must also be accompanied by at least one month of a significant and related behavior change in relation to the attacks, a persistent concern or fear of more attacks, or a worry about the attacks’ consequences. As is the case with other anxiety disorders, the panic attacks cannot result from the physiological effects of drugs and other substances, a medical condition, or another mental disorder. While the previous version of the DSM defined panic disorder as occurring either with or without agoraphobia, the new DSM-5 lists panic disorder and agoraphobia as two distinct disorders.

III. Social Anxiety Disorder (Social Phobia)

Social anxiety disorder (formerly called social phobia) is characterized by extreme and persistent fear or anxiety and avoidance of social situations in which the person could potentially be evaluated negatively by others (APA, 2013). As with specific phobias, social anxiety disorder is common in the United States; a little over 12% of all Americans experience social anxiety disorder during their lifetime (Kessler et al., 2005).

The heart of the anxiety in social anxiety disorder is the person’s concern that they may act in a humiliating or embarrassing way, such as appearing foolish, showing symptoms of anxiety (such as blushing), or doing or saying something that might lead to rejection (such as offending others). The kinds of social situations that may cause distress include public speaking, having a conversation, meeting strangers, eating in restaurants, or using public restrooms. Although many people become anxious in social situations like public speaking, the fear, anxiety, and avoidance experienced in social anxiety disorder are highly distressing and lead to serious impairments in life.

Physical symptoms often accompanying social anxiety disorder include excessive blushing, excessive sweating, trembling, palpitations, and nausea. Stammering may be present, along with rapid speech. Panic attacks can also occur under intense fear and discomfort. Some sufferers may use alcohol or other drugs to reduce fears and inhibitions at social events. Adults with this disorder are more likely to experience lower educational attainment and lower earnings (Katzelnick et al., 2001); more likely to perform poorly at work and to be unemployed (Moitra, Beard, Weisberg, & Keller, 2011); and report greater dissatisfaction with their family lives, friends, leisure activities, and income (Stein & Kean, 2000).

When people with social anxiety disorder are unable to avoid situations that provoke anxiety, they typically perform safety behaviors: mental or behavioral acts that reduce anxiety in social situations by reducing the chance of negative social outcomes. Safety behaviors can include avoiding eye contact, rehearsing sentences before speaking, talking only briefly, and not talking about oneself (Alden & Bieling, 1998). Although these behaviors are intended to prevent the person with social anxiety disorder from doing something awkward that might draw criticism, these actions often exacerbate the problem because they do not allow the individual to disconfirm their negative beliefs, often eliciting rejection and other negative reactions from others (Alden & Bieling, 1998).

One of the most well-established risk factors for developing social anxiety disorder is behavioral inhibition (Clauss & Blackford, 2012). Behavioral inhibition is thought to be an inherited trait, and it is characterized by a consistent tendency to show fear and restraint when presented with unfamiliar people or situations (Kagan, Reznick, & Snidman, 1988). A recent statistical review of studies demonstrated that behavioral inhibition was associated with a greater-than sevenfold increase in the risk of development of social anxiety disorder, indicating that behavioral inhibition is a major risk factor for the disorder (Clauss & Blackford, 2012).

IV. Specific PhobiaA person diagnosed with a specific phobia (formerly known as a “simple phobia”) experiences excessive, distressing, and persistent fear or anxiety about a specific object or situation (such as animals, enclosed spaces, elevators, or flying) (APA, 2013). Even though people realize their level of fear and anxiety in relation to the phobic stimulus is irrational, some people with a specific phobia may go to great lengths to avoid the phobic stimulus (the object or situation that triggers the fear and anxiety). 

When confronted with the object of their phobia, a person will generally enter a state of panic and experience a wide variety of physical symptoms, such as nausea, increased heartbeat, dizziness, and sweaty palms. For this reason, many people with phobias simply avoid the object of their phobia. Such avoidance can range from not wanting to be outside in a lightning storm to being unable to even look at a picture of lightning.

There are five general categories of phobias:

• Environment phobias (e.g., fear of lightning, fear of tornadoes)
• Animal phobias (e.g., fear of snakes, fear of bears)
• Blood-injury phobias, (e.g., fear of getting a shot, fear of the sight of blood)
• Situational phobias (e.g., fear of heights, fear of public speaking)
• Other phobias not otherwise specified (e.g., fear of vomiting)

Lumen: Boundless Psychology: Anxiety Disorders

Heaven on Earth: The Rise and Fall of Socialism

Heaven on Earth: The Rise and Fall of Socialism (2005) is a three-hour PBS documentary film.

The End of the World Cult

End of the World Cult (2007)

Also see: Lord Our Righteousness Church

TOXO A Conversation with Robert Sapolsky

Edge Video: TOXO A Conversation with Robert Sapolsky

Depressive Disorders

Depressive Disorders
Clinical depression is characterized by pervasive and persistent low mood that is accompanied by low self-esteem and a loss of interest.

Major Depressive Disorder

Defining Depression
Everyone occasionally feels sad and may even characterize their mood as depressed every once in a while; however, these feelings are usually short-lived and pass within a couple of days. When you have clinical depression, it interferes with daily life and causes significant pain for both you and those who care about you. Major depressive disorder (also called major depression and clinical depression) is a mood disorder characterized by a pervasive and persistent low mood that is accompanied by low self-esteem and by a loss of interest or pleasure in normally enjoyable activities. The symptoms interfere with a person’s ability to work, sleep, study, eat, and enjoy pleasurable activities.

DSM-5 Diagnostic Criteria
In order to be diagnosed with major depressive disorder (MDD) in the DSM-5, a person must experience at least five listed symptoms over a two-week period. One of the symptoms must either be a depressed mood or an inability to experience pleasure in activities that were formerly enjoyed. The symptoms must significantly interfere with one or more areas of an individual’s life (such as work, relationships, school, etc.) and must not be directly caused by a medical condition or the use of substances.

People with depressive illnesses do not all experience the same symptoms, and the severity, frequency, and duration of symptoms vary. Common symptoms include the following:
persistent sad, anxious, or empty feelings;
feelings of hopelessness or pessimism;
feelings of guilt, worthlessness, helplessness, or self-hatred;
irritability, restlessness;
loss of interest in activities or hobbies once pleasurable, including sex;
fatigue;
difficulty concentrating;
insomnia, or excessive sleeping;
overeating, or appetite loss;
thoughts of suicide, suicide attempts;
aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment.

In 2013, the DSM-5 removed the bereavement clause from the diagnostic criteria of MDD. This controversial decision means those who were previously exempt from a diagnosis of MDD due to bereavement (mourning the loss of a loved one) are now candidates for the MDD diagnosis.

Etiology
Clinical depression is one of the most common mental disorders in the United States. Each year about 6.7% of U.S. adults experience major depressive disorder. Women are 70% more likely than men to experience depression during their lifetime, and non-Hispanic blacks are 40% less likely than non-Hispanic whites. The average age of onset is 32 years old. Additionally, 3.3% of 13 to 18 year olds have experienced a seriously debilitating depressive disorder.

Causes of depression can be broken up into three categories: precipitating causes, perpetuating causes, and predisposing causes.

• A precipitating cause describes an immediate trigger that instigates a person’s action or behavior. This includes acute physical stresses such as diseases or infections, psychological stresses such as bereavement, and social stresses such as work problems or a significant change in social status or living conditions.
• A perpetuating cause is one that worsens an individual’s current condition and can be said to push someone “over the edge” into depression. This may include physical inactivity, emotional disorders, ongoing psychological or social stresses, and abnormalities of sleep.
• A predisposing cause typically describes an individual’s history, both genetic and environmental. For instance, being female and growing up in a lower socioeconomic status are both predisposing factors for depression. The preexisting vulnerability can be either genetic, implying an interaction between nature and nurture, or schematic, resulting from views of the world learned in childhood.

Treatment
The three most common treatments for depression are psychotherapy, medication, and electroconvulsive therapy. Currently, the most effective form of psychotherapy for depression is cognitive-behavioral therapy (CBT), which teaches clients to challenge self-defeating but enduring ways of thinking (cognitions) and change counter-productive behaviors. Antidepressants (usually SSRIs) have been shown to cause significant improvement in the mood of those with very severe depression. Electroconvulsive therapy (ECT) is a procedure whereby pulses of electricity are sent through the brain via two electrodes; studies have found it to be very effective in treating severe forms of depression that have not responded to medication or therapy.

Persistent Depressive Disorder
Diagnosis requires that a person experience depressed moods most of the day nearly every day for at least two years, as well as at least two of the other symptoms of major depressive disorder. People with persistent depressive disorder are chronically sad and melancholy but do not meet all the criteria for major depression. However, episodes of full-blown major depressive disorder can occur during persistent depressive disorder (APA, 2013). The etiology and treatment of persistent depressive disorders is much the same as that of MDD.

Lumen: Depressive Disorders

Bipolar Disorders

Bipolar disorders are debilitating mood disorders characterized by periods of mania/hypomania and periods of depression.

Defining Bipolar Disorders
Bipolar disorder (commonly referred to as manic-depression) is a mood disorder characterized by periods of elevated mood and periods of depression. The elevated mood is significant and is known as mania or hypomania depending on the severity or whether there is psychosis. Both manic and depressive episodes are so intense that they interfere with everyday life. Between cycles of manic and depressive states, the individual will often experience normal functioning. The risk of suicide among those with the disorder is high at greater than 6% over 20 years, while self harm occurs in 30%–40% of patients. Other mental health issues such as anxiety disorders and substance use disorders are commonly associated.

DSM-5 Diagnostic Criteria
While all of us feel highs and lows and may even experience euphoria and depression, bipolar disorder is a much more severe, debilitating clinical disorder. The “bipolar spectrum” refers to the range in which these alternating moods may occur and includes bipolar I, bipolar II, cyclothymia, and other specified bipolar and related disorder. For all of these diagnoses to be made, the symptoms must indicate a major change from the person’s typical mood.

1. Bipolar I
A diagnosis of bipolar I requires the occurrence of one or more manic or mixed episodes that last for at least a week (though less if hospitalization is required). A manic episode is a distinct period of elevated or irritable mood, which can take the form of euphoria. People with mania commonly experience an increase in energy and a decreased need for sleep, with many often getting as little as three or four hours of sleep per night. Some can go days without sleeping. A person experiencing mania may exhibit pressured speech, racing thoughts, low attention span, high distractibility, or poor judgment; they may engage in risky behavior or become aggressive. As mania becomes more severe, individuals begin to behave erratically and impulsively, often making poor decisions due to unrealistic ideas about the future. Many people experience psychotic symptoms.

A mixed episode is a condition during which symptoms of mania and depression occur simultaneously. Typical examples include weeping during a manic episode, experiencing racing thoughts during a depressive episode, or thinking grandiose thoughts while at the same time feeling like a failure. Mixed states are often the most dangerous period of mood disorders, during which the risks of substance abuse, panic disorder, suicide attempts, and other complications significantly increase.

A major depressive episode is not required for diagnosis of bipolar I, although it frequently occurs. The depressive phase includes persistent feelings of sadness, anxiety, guilt, anger, isolation, hopelessness, disturbances in sleep and appetite, fatigue, loss of interest in usually enjoyable activities, problems concentrating, loneliness, self-loathing, apathy, and/or indifference. A major depressive episode persists for at least two weeks.

2. Bipolar II
In order for bipolar II to be diagnosed, the person must not have experienced a full manic episode; however, one or more hypomanic episodes and one or more major depressive episodes are required to merit diagnosis. Hypomanic episodes are a milder version of mania, defined by a mild to moderately elevated mood, optimism, pressure of speech or activity, and decreased need for sleep. Generally, hypomania does not inhibit functioning as mania does, and may even increase productivity. Bipolar II can be more difficult to diagnose because the hypomanic episodes may simply appear as a period of successful high productivity. Hypomania also tends to be reported less frequently than a distressing, crippling depression, and so people with bipolar II are often misdiagnosed with major depressive disorder.

3. Cyclothymic Disorder
Cyclothymia is a milder version of bipolar. A diagnosis requires that a person experience hypomanic episodes with periods of a milder form of depression, known as dysthymia, for at least 2 years. Neither the hypomanic or dysthymic episodes can meet the criteria for bipolar I or II. There is a low-grade cycling of mood which typically appears to the observer as a personality trait and interferes with functioning.

4. Other Specified Bipolar and Related Disorder
Previously known as bipolar disorder NOS (not otherwise specified), this is a catch-all category that is diagnosed when the disorder does not fall within a specific subtype of bipolar (for example, if the time requirements for symptoms are not met but the symptoms are still pervasive and disruptive). These disorders can still significantly impair and adversely affect the quality of life of the patient.

Etiology
It is estimated that roughly 1% of the adult population suffer from bipolar I, a further 1% suffer from bipolar II or cyclothymia, and somewhere between 2% and 5% percent suffer from “sub-threshold” forms of bipolar disorder. Bipolar disorders have been shown to have a strong genetic and biological basis. The possibility of getting bipolar disorder when one parent is diagnosed with it is 15%–30%; risk when both parents have it is 50%–75%. The rate of concordance for bipolar disorder is higher among identical twins than fraternal twins (67% vs. 16%, respectively), suggesting that genetic factors play a strong role in bipolar disorder (Merikangas et al., 2011).

Lumen: Bipolar Disorders

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