Theme 4: Depressive Disorders and Adult Depression.
In the past, the DSM-IV-TR, depressive and bipolar disorders were seen to be variations of mood
and were classified together. The DSM-5 distinguishes the Bipolar and Depressive disorders into
two distinct categories. Mood disorders are the most common in developing countries and could
be considered to be the most under-treated group of disorders. The fact that human suffering
and the risk of suicide accompanies these disorders, it should be essential therefore that they are
diagnosed correctly to ensure effective treatment.
Table 5.1: common terms used to refer to mood.
Term Description/ Definition
Emotion In its most general definition, can be considered to be a
complex psychological process that:
• Arises spontaneously, rather than through conscious
effort, and
• Evokes either a positive or negative psychological
response, as well as;
• Physical expressions, and
• These responses are often involuntary.
Feeling Conveys information about situations, on both conscious and
subconscious levels.
Affect The scientific term used to describe a person’s mood as
displayed in their behavioral response. You will notice in
psychopathology that there is often reference to ‘blunted’
affect (reduction in emotional reactivity) or ‘labile’ affect
(unstable display of emotion). The ICD-10 typically uses the
term affect, e.g. Bipolar affective disorder.
Mood Differs from emotions in that moods are considered to be
sustained emotional states that are less specific and intense,
longer lasting and less likely to be triggered by a particular
stimulus or event. The DSM-5 typically uses mood, e.g.
depressed mood.
The descriptions encompass normal human states and furthermore that emotions, feelings, and
affect could be considered to be transient (reactive, external expressions of emotions) states,
whereas mood is a more prolonged and sustained internal emotional state. A mood disorder
1
, could be defined as a disorder where a person feels depressed and/ or elated, and outwardly
shows signs (affect) of depression and/ or mania for a significant period of time, and which is
severe enough to impair normal functioning, and which occurs in the absence of a clearly
identifiable stressor or trigger.
There are two extreme poles in mood disorders, on the one end, we have extreme dysphoria
(Major Depressive Episode) and on the other, extreme euphoria (Manic Episode). Those cases
where there is only depression, we refer to those categories as unipolar mood disorders, and
those cases where we have an episode of depression and mania we refer to those categories as
bipolar mood disorders. The severity of symptoms refers to feelings, and the resultant changes
in behavior and functioning, are not triggered by clearly identifiable events, or may be abnormally
prolonged following adverse events. It is only once a person’s daily functioning is impaired due
to the severity of the symptoms that one would make the diagnosis of a mood disorder.
• Identifying Major Depressive disorder according to the DSM-5 classification
system.
See summary book.
1. Disruptive Mood Dysregulation Disorder:
This disorder is limited to children between the ages of 6 and 18 years, but typically the age of
onset is before the age of 10 years. The core feature of this disorder is chronic, severe and
persistent irritability that manifests in two ways, i.e. Frequent temper outbursts and persistent
irritability that manifests in two ways, i.e. Frequent temper outbursts and persistent irritable or
angry mood in-between temper outbursts. The fact that this disorder does not convert into a
bipolar disorder later in the lifespan provides credence for the fact that DMDD and Bipolar
disorder are two distinct disorders. There is a higher prevalence of DMDD in boys than girls,
whereas in bipolar disorders there is more or less an equal prevalence rate. Furthermore there
is also a high comorbidity between this disorder and other disorders, and the DSM-5 states that
it is rare to find children with this disorder alone.
DSM-5
A. Severe recurrent temper outbursts manifested verbally (e.g. Verbal rages) and/or
behaviorally (e.g. Physical aggression toward people or property) that are grossly out
of proportion in intensity or duration to the situation or provocation.
B. The temper outbursts are inconsistent with developmental level.
C. The temper outbursts occur, on average, three or more times per week.
2
In the past, the DSM-IV-TR, depressive and bipolar disorders were seen to be variations of mood
and were classified together. The DSM-5 distinguishes the Bipolar and Depressive disorders into
two distinct categories. Mood disorders are the most common in developing countries and could
be considered to be the most under-treated group of disorders. The fact that human suffering
and the risk of suicide accompanies these disorders, it should be essential therefore that they are
diagnosed correctly to ensure effective treatment.
Table 5.1: common terms used to refer to mood.
Term Description/ Definition
Emotion In its most general definition, can be considered to be a
complex psychological process that:
• Arises spontaneously, rather than through conscious
effort, and
• Evokes either a positive or negative psychological
response, as well as;
• Physical expressions, and
• These responses are often involuntary.
Feeling Conveys information about situations, on both conscious and
subconscious levels.
Affect The scientific term used to describe a person’s mood as
displayed in their behavioral response. You will notice in
psychopathology that there is often reference to ‘blunted’
affect (reduction in emotional reactivity) or ‘labile’ affect
(unstable display of emotion). The ICD-10 typically uses the
term affect, e.g. Bipolar affective disorder.
Mood Differs from emotions in that moods are considered to be
sustained emotional states that are less specific and intense,
longer lasting and less likely to be triggered by a particular
stimulus or event. The DSM-5 typically uses mood, e.g.
depressed mood.
The descriptions encompass normal human states and furthermore that emotions, feelings, and
affect could be considered to be transient (reactive, external expressions of emotions) states,
whereas mood is a more prolonged and sustained internal emotional state. A mood disorder
1
, could be defined as a disorder where a person feels depressed and/ or elated, and outwardly
shows signs (affect) of depression and/ or mania for a significant period of time, and which is
severe enough to impair normal functioning, and which occurs in the absence of a clearly
identifiable stressor or trigger.
There are two extreme poles in mood disorders, on the one end, we have extreme dysphoria
(Major Depressive Episode) and on the other, extreme euphoria (Manic Episode). Those cases
where there is only depression, we refer to those categories as unipolar mood disorders, and
those cases where we have an episode of depression and mania we refer to those categories as
bipolar mood disorders. The severity of symptoms refers to feelings, and the resultant changes
in behavior and functioning, are not triggered by clearly identifiable events, or may be abnormally
prolonged following adverse events. It is only once a person’s daily functioning is impaired due
to the severity of the symptoms that one would make the diagnosis of a mood disorder.
• Identifying Major Depressive disorder according to the DSM-5 classification
system.
See summary book.
1. Disruptive Mood Dysregulation Disorder:
This disorder is limited to children between the ages of 6 and 18 years, but typically the age of
onset is before the age of 10 years. The core feature of this disorder is chronic, severe and
persistent irritability that manifests in two ways, i.e. Frequent temper outbursts and persistent
irritability that manifests in two ways, i.e. Frequent temper outbursts and persistent irritable or
angry mood in-between temper outbursts. The fact that this disorder does not convert into a
bipolar disorder later in the lifespan provides credence for the fact that DMDD and Bipolar
disorder are two distinct disorders. There is a higher prevalence of DMDD in boys than girls,
whereas in bipolar disorders there is more or less an equal prevalence rate. Furthermore there
is also a high comorbidity between this disorder and other disorders, and the DSM-5 states that
it is rare to find children with this disorder alone.
DSM-5
A. Severe recurrent temper outbursts manifested verbally (e.g. Verbal rages) and/or
behaviorally (e.g. Physical aggression toward people or property) that are grossly out
of proportion in intensity or duration to the situation or provocation.
B. The temper outbursts are inconsistent with developmental level.
C. The temper outbursts occur, on average, three or more times per week.
2
