Download ISSUES SURROUNDING CLASSIFICATION AND DIAGNOSIS OF

Depression
PSYCHOPATHOLOGY
Learning objectives
 Understand the issues surrounding the
classification and diagnosis of depression
Issues surrounding
classification and diagnosis
 Depression should not ‘medicalised’
 All humans have mood levels.
 But mood can be extreme
 It is a question of degree
 We all experience sadness but mood can
sometimes cause serious impairment and
functioning.
 The symptoms as outlined in the DSM could be
experienced by a range of people in unhappy
situations or with abnormal personalities.
 A minimum of 5 symptoms are required for
diagnosis.
 Five is a relatively undemanding requirement and
 Two different individuals could score their 5 from a
completely different set of alternatives.
 This means that depression could look very
different in two different people.
 It can be difficult for clinicians to make the
distinction even between
 Unipolar and bipolar depression
 About 10% diagnosed with major depressive
disorder go on to develop bipolar episodes.
 Also someone with dysthymic (minor) disorder
can have a major depressive episode.
 This is called ‘double depression’ and is not
uncommon.
 Some diagnostic categories have not been
validated.
 E.g. premenstrual dysphoric disorder are
mentioned in the appendix of the DSM-IV to
help researchers and clinicians but it remains
a controversial area.
 Mood has a seasonal variation in normal
people.
 Seasonal Affective Disorder (SAD) has come
to be used for a depressive disorder that
occurs only or mainly in the winter.
 It remains a controversial area.
 Clinicians have recognised other distinctions apart
from the formal diagnostic sub-types used in the
manuals.
 Endogenous (melancholic) depression – arises from
internal, biological factors and
 Non-endogenous (or reactive) depression – arises
from environmental stressors
 endogenous depression has more severe symptoms
and greater suicide rates. This one responds more
positively to ECT and antidepressant medications.
 Little conclusive evidence to support the distinction.
 Depression in children is included in the
diagnostic criteria, but can remain
undetected.
 Partly because of coexisting disorders
involving conduct problems and disruptive
behaviour.
 Also, irritability is often found in normal
young people
 When other medical conditions are present
such as dementia, cancer, thyroid disorders
etc. it is difficult to be sure whether mood
disorder symptoms are secondary to this or
the side effects of treatment for it, or
whether it is the result of a primary mood
disorder and unrelated to the medical
condition.
 Depression frequently occurs alongside other
disorders such as substance abuse,
alcoholism, eating disorders and
schizophrenia.
 Anxiety frequently coexists with depression
to the extent that a new category has
appeared in the DSM – anxiety not otherwise
specified – which is a mixture of
anxiety/depression symptoms.
 Approx 3% of the general population in the
UK are treated by their GP for depression.
 Approx half the people who go to their GP
with symptoms are not recognised as having
depression (Holdberg and Huxley, 1992)
 Cultural background should be taken into
account.
 People from non-western cultures often
present with more bodily complaints rather
than subjective stress (which could be easily
misinterpreted)
 Depression occurs more frequently in women
than in men.
 Men may be less likely to admit to symptoms
of depression and may be more likely to
forget symptoms/
 There does seem to be a genuine difference
accounted for by psychological and biological
attributes of women.
KEY POINTS
 A number of issues surround the classification and diagnosis
of depression. There is overlap with some other disorders
and it is also likely that there are different sub-types but not
all are seen as valid.
 There are slight cultural and gender differences which can
get in the way of accurate diagnosis.
Summary questions
 1. Identify three issues that surround the
classification and diagnosis of depression.
 5. Depression is a very common disorder and can be
quite mild. It is self limiting in that the symptoms
usually disappear even if not treated (although they
tend to recur at a later point). If this is the case, why
do you think that it is important to classify and
diagnose the depression?