Table Of ContentDepression
Second Edition
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Depression
Causes and Treatment
Second Edition
Aaron T. Beck, M.D., and
Brad A. Alford, Ph.D.
UniversityofPennsylvaniaPress
Philadelphia
Copyright(cid:1)2009AaronT.Beck
Allrightsreserved.Exceptforbriefquotationsusedforpurposesofrevieworscholarlycitation,
noneofthisbookmaybereproducedinanyformbyanymeanswithoutwrittenpermissionfrom
thepublisher.
Publishedby
UniversityofPennsylvaniaPress
Philadelphia,Pennsylvania19104-4112
PrintedintheUnitedStatesofAmericaonacid-freepaper
10 9 8 7 6 5 4 3 2 1
LibraryofCongressCataloging-in-PublicationData
Beck,AaronT.
Depression:causesandtreatment/AaronT.BeckandBradA.Alford.—
2nded.
p. cm.
Includesbibliographicalreferencesandindex.
ISBN978-0-8122-1964-7(alk.paper)
1.Depression,Mental. I.Alford,BradA. II.Title.
[DNLM:1.DepressiveDisorder. WM171B393d2008]
RC537.B4 2008
616.85(cid:1)27—dc22 2008025522
Contents
PrefacetotheSecondEdition xvii
PartI.ClinicalAspectsofDepression 1
1. TheDefinitionofDepression 3
ParadoxesofDepression 3
PrevalenceofDepression 4
prevalenceandseveritybytypesandageatonset 5
DescriptiveConceptsofDepression 6
SemanticsofDepression 8
DepressionandNormalMoods 9
2. SymptomatologyofDepression 12
PreviousSystematicStudies 12
ChiefComplaint 13
Symptoms 15
emotionalmanifestations 17
DejectedMood 18
NegativeFeelingsTowardSelf 19
ReductioninGratification 19
LossofEmotionalAttachments 20
CryingSpells 21
LossofMirthResponse 22
cognitivemanifestations 22
LowSelf-Evaluation 22
NegativeExpectations 24
Self-BlameandSelf-Criticism 25
Indecisiveness 25
DistortionofBodyImage 26
motivationalmanifestations 27
ParalysisoftheWill 28
Avoidance,Escapist,andWithdrawalWishes 29
vi Contents
SuicidalWishes 30
IncreasedDependency 31
vegetativeandphysicalmanifestations 33
LossofAppetite 33
SleepDisturbance 34
LossofLibido 34
Fatigability 35
delusions 36
Worthlessness 36
CrimeandPunishment 37
NihilisticDelusions 37
SomaticDelusions 37
Poverty 38
hallucinations 38
ClinicalExamination 39
appearance 39
retardation 40
agitation 41
VariationsinSymptoms 42
childrenandadolescents 42
culturalvariations 43
3. CourseandPrognosis 44
DepressionasaClinicalEntity 44
ImportanceofCourseandOutcome 44
SystematicStudies 45
onsetofepisodes 47
remissionandchronicity 48
RemissionfromDysthymicDisorder 49
RemissionfromFunctionalImpairments 50
duration 51
BriefAttacksofManic-DepressivePsychosis(BipolarDisorder) 52
recurrence 53
intervalsbetweenattacks 54
outcomefor‘‘endogenous’’versus‘‘neurotic’’
depression 56
schizophrenicoutcome 56
suicide 57
SuicideRiskinBipolarDisorder 59
predictorsofchronicdepression 60
DevelopmentalFactors 60
PersonalityDisorders 60
PsychologicalStressors 60
Contents vii
ComorbidDisorders 60
BiologicalFactors 61
CognitiveFactors 61
Conclusions 62
4. ClassifyingMoodDisorders 64
TheOfficialNomenclature 64
DerivationofSystemofClassification 65
ReliabilityandValidityofClassification 68
DichotomiesandDualisms:PastandPresent 69
endogenusversusexogenous 69
autonomousversusreactive 69
agitatedversusretarded 69
psychoticversusneurotic 69
EndogenousandExogenousDepressions 70
originofendogenous-exogenousmodel 70
‘‘thegreatdebates’’ 71
distinctionbetweenendogenousandreactive
depressions 72
systematicstudies 72
MethodologicalProblems 74
StudiesofSymptomatology 75
PhysiologicalResponsesandTests 75
BodyBuild 76
ResponsetoTreatment 76
DepressiveEquivalents 76
DepressionsSecondarytoSomaticDisorders 77
5. PsychoticVersusNonpsychoticDepression 80
‘‘Psychoneurotic’’DepressiveReaction 81
definition 81
evolutionoftheconcept 82
SevereDepressionwithPsychoticFeatures(PsychoticDepressive
Reaction) 85
case1 86
case2 86
case3 87
ContemporaryDiagnosis 89
6. BipolarDisorders 90
HistoryandDefinition 90
CurrentCriteriaforBipolarDisorder 92
RelationshipofManictoDepressiveEpisodes 93
SymptomatologyofManicPhase 94
viii Contents
emotionalmanifestations 95
Elation 95
IncreasedGratification 96
Self-Love 96
IncreasedAttachmenttoPeopleandActivities 96
IncreasedMirthResponse 97
cognitivemanifestations 97
PositiveSelf-Image 97
PositiveExpectations 97
AssignmentofBlame 97
Denial 98
Arbitrariness 98
Delusions 98
motivationalmanifestations 98
Impulse-Driven 98
Action-Oriented 99
DriveforIndependence 99
DriveforSelf-Enhancement 99
physicalandvegetativemanifestations 99
Hyperactivity 99
HighToleranceforFatigue 99
Appetite 100
IncreasedLibido 100
Insomnia 100
BehavioralObservationsofManicPhase 100
PeriodicityofManic-DepressiveBehavior 102
PremorbidPersonalityofManic-DepressivePatients 102
IssuesforFurtherStudy 103
classificationproblems 103
goalachievementandmanicsymptoms 104
7. InvolutionalDepression 105
HistoryoftheConcept 105
Etiology 106
Age 108
Symptomatology 108
PremorbidPersonality 110
Conclusion 111
8. SchizoaffectiveDisorder 113
Definition 113
EvolutionoftheConcept 113
catatoniaandmanic-depressivepsychosis 114
Contents ix
benignstupor 115
Inactivity 115
Negativism 115
Affect 115
Catalepsy 115
IntellectualProcesses 115
IdeationalContent 116
Follow-upStudies 116
acuteschizoaffectivepsychosis 117
acuteremittingschizophrenia 118
studiesofreviseddiagnoses 118
DifferentiationofDepressionandSchizophrenia 119
Prognosis 122
affectivefactorsandprognosisinschizophrenia 123
ManifestAffect 123
ContentofDelusions 123
Hallucinations 124
Manic-DepressiveHeredityandOutcomeinSchizophrenia 124
PresenceofDepression 124
PatternsofAggressioninOvertBehavior 124
PresentClassificationofSchizoaffectiveDisorder 125
UnresolvedIssuesforContinuingResearch 126
CourseofIllness 127
SymptomandCognitiveProfiles 127
FamilyandGeneticStudies 128
BertelsenandGottesman’sReview 129
Conclusion 130
PartII.ExperimentalAspectsofDepression 133
9. BiologicalStudiesofDepression 135
Earlystudies 135
Manic-DepressiveDisorderandConstitution 137
HeredityinManic-DepressiveDisorder 139
identicaltwinstudies 139
identicaltwinsrearedseparately 140
pedigreestudies 141
summary 143
BipolarDisorder 143
UnipolarDepression 143
BiochemicalStudiesofDepression 143
earlystudies 143
BloodGlucose 144
