The Emotional disorders Have undergone changes and modifications as regards their classification in the Diagnostic Manuals for Mental Disorders (DSM-IV and DSM-V) by the Psychiatric Association of the United States.
It is not the purpose of this article to establish the differences between the two manuals in terms of emotional disturbances, but to offer the reader an explanation of the different emotional disorders that exist, how to recognize them and how to combat them.
Types of Emotional Disturbances in Children and Adults
Major depressive disorder
Symptomatology and Diagnosis
So that it can be recognized as Major depressive disorder You have to feel at least five of the symptoms described above And for a period of at least two weeks.
Depressed mood most of the day.
A marked decrease in interest or ability for pleasure in all or almost all activities, most of the day, almost every day.
Significant weight loss without regimen or weight gain (eg, a change of more than 5% of body weight in 1 month), or loss or increase Of appetite almost every day.
Insomnia or Hypersomnia almost every day.
Psychomotor agitation or slowing almost every day (observable by others, not just feelings of restlessness or being slowed down).
Fatigue or loss of energy almost every day.
Excessive or inappropriate feelings of worthlessness or guilt (which may be delirious) almost every day (not simple self-reproaches or culpability For being sick).
Decreased ability to think or concentrate, or indecision, almost every day (either a subjective attribution or an observation from others).
Recurrent thoughts of death (not just fear of death), recurrent suicidal ideation without a specific plan or suicide attempt or Specific plan for suicide.
The average age of onset of major depression is usually around 25 years old.
Dysthymic disorder
Symptoms and diagnosis
To be diagnosed of Dysthymia You have to give yourself a depressed mood most of the day on most days, during At least two years, without the patient being free of symptoms more than two months in a row.
In addition, you have to feel two or more of the following symptoms:
Loss or increase of appetite.
Insomnia or hypersomnia (sleep too much).
Lack of energy apathy .
Low self-esteem .
Difficulties in concentrating or take decisions .
The average age of onset of dysthymia is somewhat earlier than major depression, around 20 years of age.
Bipolar disorder
Symptoms and diagnosis
He Bipolar disorder Is the tendency of manic episodes to alternate with major depressive episodes on an endless roller coaster ride that Goes from the top of euphoria to the depths of despair.
Within bipolar disorder we can distinguish: bipolar I disorder and bipolar II disorder. Both types are the same, They only differ in one aspect of the manic episode.
The difference is that in bipolar disorder I alternate complete manic episodes with depressive episodes. On the other hand, bipolar II, Alternating hypomanic episodes (milder manic episodes) and depressive episodes.
Despite this differentiation, both symptoms occur in the same way and the following criteria must be met:
Presence of one or more major depressive episodes.
Presence of at least one manic episode (in the case of Bipolar II).
Presence of at least one hypomanic episode (in the case of Bipolar I).
Symptoms of a manic and hypomanic episode
In addition to an irritable, abnormal and expansive mood, there must be at least three of the following symptoms:
Increased self-esteem or grandiosity.
Verbal language.
Flight of ideas , Distraction.
Psychomotor agitation.
Excessive performance of pleasurable activities.
In hypomania these symptoms are not so pronounced.
The average age of onset of bipolar I disorder is usually at 18 years of age, and for bipolar II at 22 years. However, in both there are Cases of onset in infancy.
Cyclothymic disorder
Symptoms and diagnosis
He Cyclothymic disorder Is a milder (but more chronic) version of bipolar II disorder.
To be diagnosed of cyclothymic disorder you must comply with the presence of the following symptoms for at least two years:
Numerous periods of hypomanic symptoms.
Numerous periods of depressive symptoms that do not meet the criteria for a major depressive episode.
About one-third of patients, cyclothymic mood swings become a complete bipolar disorder.
Several studies agree that the average age of onset of cyclothymia is quite early, between 12 and 14 years of age.
Causes of Emotional Disturbances
In general, there is a lot of controversy and uncertainty about knowing the causes that lead to emotional disorders. However, yes That it has been possible to investigate certain factors that influence when suffering them.
It is important to understand that a single factor alone is not enough to develop an emotional disorder, but is the accumulation of Several factors trigger it.
Heritage
There is an increased risk of emotional disturbance when there is a family history of the disease, indicating that a Biological predisposition.
According to studies, people with relatives with mood disorders are 2 to 3 times more likely to develop such Disorder (Gershon, 1990).
However, severe depression can also occur in people who have no family history of the disease.
This suggests that there are additional factors that can cause depression, whether biochemical or environmental factors that cause stress, and other factors Psychosocial.
Biochemical Factors
Brain biochemistry has been shown to play a significant role in depressive disorders.
Neurotransmitters : Research shows the association of low levels of Serotonin In people with depression. Serotonin is A neurotransmitter whose main function is to regulate our emotional reactions (we are more impulsive and more unstable when levels of Serotonin are low).
Endocrine system : There are studies that suggest a relationship between depression and Cortisol . Cortisol is called the stress hormone Because it rises during stressful life events. It has been shown that stress cortisol levels are elevated in patients Depressed
Sleep and circadian rhythms : The most significant is that, in depressed people, there is a significantly shorter period between the time Of falling asleep and the beginning of sleep Rapid eye movements (MOR).
Depressed individuals have reduced slow-wave sleep, which is the deepest and most restful part of sleep.
An interesting discovery is that depriving depressed sleep patients, particularly during the second half of the night, generates an improvement Of their condition, although depression returns when patients return to normal sleep again.
Specifically in bipolar disorder, they have found that these patients have a greater sensitivity to light (Nurnberger et al. 1988), which means that they exhibit greater suppression of melatonin when exposed to light at night.
Stressful situations
Between 60% and 80% of the origin of emotional disorders are attributed to psychological experiences. Stress and traumas are among the More striking contributions to the aetiology of psychological disorders.
By asking patients about significant events experienced before they suffered from depression, most report having lost their jobs, To have divorced, to have had a son, to have started a career...
This does not mean that the origin of the emotional disorder is directly related to this specific cause but that the person already had a Vulnerability to depression and this stressful situation has triggered depression.
The origin of any emotional disorder has more to do with trauma or with significant relationships experienced as threatening. However, they are Difficult to know since often the person himself has covered those painful memories.
Personality
People with negative mental patterns, low self-esteem, Feeling of lack of control over the circumstances of life and tendency to excessive worry are more likely to suffer from depression.
The Arbitrary inference and the Overgeneralization Are two common cognitive errors in depressed people. Inference Arbitrary is evident when an individual highlights the negative aspects of a situation rather than the positive.
Overgeneralization is a type of thinking that is characterized by the tendency to draw a general conclusion from a specific event That has happened to us and surroundings to which, unconsciously, we create a whole philosophy of life that is not adaptive.
Apparently, negative thought patterns typically are established in childhood or adolescence and are conforming over time a pattern Of depressive thought.
Treatment of emotional disorders
Pharmacological
Antidepressants
There are three types of drugs that are used to treat depression: Tricyclic antidepressants , the Monoamine oxidase inhibitors (MAO) and the Selective serotonin reuptake inhibitors (SSRIs).
These drugs work by increasing in the brain the activity and levels of certain chemicals called neurotransmitters, which Help improve your State of mind .
Different types of drugs have different modes of action but work equally well. The important thing is that with the help of your doctor Find the drug that has the best results in your body.
Lithium
Lithium Is a common salt present in the natural environment. It is found in the water we drink, in very small quantities to have a very important.
Lithium is used as a mood-regulating drug effective for the prevention and treatment of manic episodes of bipolar disorder. However, the side effects of the therapeutic doses are potentially more serious than the other antidepressants.
Researchers are not sure how lithium works. What they have observed is that 30 and 60% of bipolar patients respond very well to Lithium initially, between 30 and 50% show a partial response and between 10 and 20% have a poor response.
For a greater efficacy of bipolar disorders one should also prescribe antidepressants to control depressive episodes.
The Antipsychotics As the Haloperidol Are also used for bipolar disorder in patients who have not responded to lithium.
Psychotherapy
Psychotherapy has proven effective in treating depression and to a lesser extent bipolar disorder (although necessary).
In bipolar or cyclothymic disorder, the treatment of choice is the combination of drugs with psychotherapy.
In the case of depression and dysthymia, psychotherapy may be sufficient, except in the most severe forms that a treatment is advisable Combined with drugs.
In a study conducted in the United States by the Consumer Reports About the efficacy of psychological therapy, 54% considered that therapy Had helped them a lot and 36% had helped them.
A similar study carried out in Spain, 4.78 out of 6 considered that the treatment was effective, and 4.59 out of 6 that the therapy solved the reason Of your query.
Electroconvulsive Therapy
When someone does not respond to medication (or in very serious cases), clinicians may consider electroconvulsive therapy.
During electroconvulsive therapy (ECT), electrical current causes a seizure in the brain. Doctors believe that convulsive activity Can help the brain"reconnect"itself, which helps relieve symptoms.
It is a practice that has received much controversy because of the side effects, such as memory loss, which can cause. Therefore, it only applies in cases
Severe conditions in which other treatments have not worked.
However, in recent years the amount of electricity used in the procedure has been considerably reduced. This has greatly reduced
The side effects of this procedure, including memory loss.
Phototherapy
Phototherapy has proven its efficacy as an additional treatment for the Seasonal affective disorder Or seasonal depression. That is, a depression that only takes place in a season of the year and occurs every year in that same period.
Seasonal depression usually occurs in winter but can also occur in spring or summer. For these people, sit for 30 Minutes a day in front of a light of a determined light intensity helps them to treat depression.
Light therapy regulates the sleep-wake cycle, activates the Serotonin (A mood-regulating neurotransmitter) and suppresses the Melatonin , a A chemical that reduces the effects of serotonin.
References
- Diagnostic and Statistical Manual of Mental Disorders (DSM).