Emotional Disorders: Diagnosis, Causes and Treatment

Table of Contents

Last Updated on April 13, 2023 by Mike Robinson

Emotional disorders have undergone changes and modifications in their classification in the Diagnostic Manual of 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 disorders 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

In order to be recognized as having major depressive disorder, you have to experience at least five of the symptoms described below for a duration of at least two weeks.

depressive 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 (e.g., a change of more than 5% of body weight in 1 month) or a loss or increase in appetite almost every day
almost every day.
Psych0m0tor agitation or slowing occurs almost every day (observable by others, not just mere feelings of restlessness or being slowed down).
almost every day.
Excessive or inappropriate feelings of worthlessness or guilt (which may be delusional) almost every day (not simple self-reproaches or guilt about being ill)
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 a specific suicide plan.

The average age of onset of major depression is usually around 25 years old.

Dysthymic disorder

Symptomatology and diagnosis

To be diagnosed with dysthymia, a depressed mood must last most of the day on most days for at least two years without the patient being symptom-free for 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 hypersonic sleep (sleeping too much)
lack of energy or apathy.
Low self-esteem.
Difficulty concentrating or making decisions

The average age of onset of dysthymia is somewhat earlier than that of major depression, around 20 years of age.

Bipolar disorder

Symptomatology and diagnosis

The bipolar disorder is a manic tendency to alternate with major depressive episodes in a round of endless roller coaster episodes that goes from the top of the 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 differ only in one aspect of the manic episode.

The difference is that in bipolar disorder, I alternate complete manic episodes with depressive episodes. In contrast, bipolar II, alternate hippomanic episodes (milder manic episodes), and depressive episodes

Despite this differentiation, both symptoms occur in the same way, and the following criteria must be met:

The 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 hippomanic episode (in the case of Bipolar I).

Symptoms of a manic-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.
leakage of ideas, distraction.
Psych0m0tor 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 18 years of age, and for bipolar II, it is 22 years. However, in both cases, there are cases of onset in infancy.

Cyclothymiacs disorder

Cyclothymia symptomatology and diagnosis

The cyclothymia disorder is one (although chronic) milder version of bipolar disorder II.

To be diagnosed with cyclothymiacs disorder, you must have at least two years of the following symptoms:

Numerous periods of hippomanic symptoms
Numerous periods of depressive symptoms that do not meet the criteria for a major depressive episode

About one-third of patients with cyclothymia’s mood swings develop 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 as to what the causes that lead to emotional disorders are. However, it has been possible to investigate certain factors that influence the time of suffering them.

It is important to understand that a single factor alone is not enough when developing an emotional disorder; it is the accumulation of several factors that trigger it.

Family Hereditary Factors

There is an increased risk of emotional distress when there is a family history of the disease, indicating that a biological predisposition may have been inherited.

According to studies, people with relatives with mood disorders are 2–3 times more likely to develop such a disorder (Garson, 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 produce stress or other psychosocial factors.

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 serotonin levels are low).
Endocrine System: There are studies that suggest a relationship between depression and cortical hormones. Cortisol is called the stress hormone because it rises during stressful life events. It has been shown that cortical stress levels are elevated in depressed patients.
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 the rapid eye movement (REM) dream.

Depressed individuals have reduced slow-wave sleep, which is the deepest and most restful part of sleep.

An interesting finding is that depriving depressed sleep patients of sleep, particularly during the second half of the night, generates a temporary improvement in 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 (Nurnberg et al., 1988), which means that they exhibit greater suppression of melatonin when exposed to light at night.

Stressful situations and emotional disorders

Between 60% and 80% of the origins of emotional disorders are attributed to psychological experiences. Stress and trauma are among the most striking contributions to the etiology of psychological disorders.

When asking patients about significant events experienced before they suffered from depression, most report having lost their job, being divorced, having a child, having undertaken 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 a trauma or with significant relationships experienced as threatening. However, they are difficult to know because often the person himself has covered those painful memories.

Personality and emotional disorders

People with negative mental patterns, low self-esteem, a sense of lack of control over life circumstances, and a tendency for excessive worry are more likely to suffer from depression.

Arbitary inference and overgeneralization are two common cognitive errors in depressed people. Arbitrary inference is evident when an individual highlights the negative aspects of a situation rather than the positive ones.

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 to which, unconsciously, we create a whole philosophy of life that is not adaptive.

Negative thought patterns typically appear to be established in childhood or adolescence and, over time, form a pattern of depressive thinking.

Treatment of emotional disorders

Antidepressants

There are three types of drugs that are used to treat depression: tricyclic antidepressants, monoamine oxidase (MAO) inhibitors, and selective serotonin reuptake inhibitors (SSRIs).

These drugs work by increasing in the brain the activity and levels of certain chemicals called neurotransmitters, which help to improve your mood.

Different types of drugs have different modes of action but work equally well. The important thing is that, with the help of your doctor, you 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 but has a very important effect.

Lithium is used as a mood-regulating drug that is 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 those of the other antidepressants.

Researchers are not sure how lithium works. What they have observed is that between 30 and 60% of bipolar patients initially respond very well to lithium. Additionally, between 30 and 50% show a partial response, and between 10 and 20% have a poor response.

For increased efficacy in bipolar disorders, antidepressants should also be prescribed to control depressive episodes.

Antipsychotic drugs like haloperidol are also used for bipolar disorder in patients who have not received a response to lithium.

Psychotherapy

Psychotherapy has proven effective in treating depression and, to a lesser extent, bipolar disorder (although necessary).

For bipolar or cyclothymiasis disorders, the treatment of choice is a combination of drugs and psychotherapy.

In the case of depression and dysthymia, psychotherapy may be sufficient, except in the most severe forms, where a combined treatment with drugs is recommended.

In a US study by Consumer Reports on the effectiveness of psychological therapy, 54% felt that the therapy had helped them a lot, and 36% felt that it had helped them.

There was a similar study performed in Spain, where 4.78 out of 6 considered the treatment to be effective. Also, 4.59 out of 6 felt that the therapy solved the reason for their consultation.

Electroconvulsive Therapy

When someone does not respond to medication (or in very serious cases), clinicians may consider electroconvulsive therapy.

During electroconvulsive therapy (ECT), an electric 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. Which include memory loss, that it can cause. Therefore, it only applies in severe cases.

where the 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 seasonal affective disorder or seasonal depression. Which only takes place during a certain season of the year and occurs every year during that same period.

Seasonal depression usually occurs in the winter but can also occur in the spring or summer. For these people, sitting for 30 minutes in front of a certain intensity light helps them treat depression.

Light therapy regulates the sleep-wake cycle and activates serotonin (a mood-regulating neurotransmitter). It also suppresses melatonin, a chemical that reduces the effects of serotonin.