Hysteroid dysphoria

Last updated

Hysteroid dysphoria is a name given to repeated episodes of depressed mood in response to feeling rejected. [1]

Contents

There is a common misconception surrounding whether hysteroid dysphoria and rejection sensitivity are the same disorder. Hysteroid dysphoria was previously defined in psychiatry as ‘Rejection Sensitive Hysteroid Dysphoria’. This definition was changed to hysteroid dysphoria. Thus, hysteroid dysphoria and rejection sensitivity are sometimes used interchangeably. [2]

Currently, hysteroid dysphoria is regarded as an outdated term amongst most psychiatric diagnostic manuals, such as the DSM-5. [3] Thus, this disorder is not formally classified as a social personality disorder. However, the symptoms of hysteroid dysphoria remain prevalent across a variety of social personality and mood disorders. [4]

Symptoms

Hysteroid dysphoria has been described in outpatient populations and is thought to be a subtype of atypical depression involving rejection sensitivity and therapeutic response to monoamine oxidase inhibitors. [5]

The most prominent symptoms associated with hysteroid dysphoria include low-self esteem and intense feelings of rejection. [2] In response to this, individuals may feel a tendency to withdraw from social situations.

As a result, individuals with hysteroid dysphoria are susceptible to experiencing social isolation, loneliness, and difficulties with forming and sustaining romantic relationships. [2]

Notably, symptoms of hysteroid dysphoria may vary in how they are displayed. The symptoms can be categorised as either ‘internal’ or ‘external’. The internal symptoms refer to the cognitive and emotional experiences that may not be observable to others. The external symptoms of hysteroid dysphoria effect social interactions. They can be displayed as a physiological expression of the internal mental processes that are a consequence of the disorder. [4]

Studies

The term ‘hysteroid dysphoria’ was first introduced into the field of psychiatry by Klein and Liebowitz in 1979. Their pioneering work derived from research conducted on a subgroup of depressed patients, reporting a consistent pattern of "repeated depressed moods in response to feeling rejected" among the participants. [6]

Other studies have examined the symptoms associated with hysteroid dysphoria and found that while the symptoms are observable, they are not unique or distinct enough to be considered their own condition. [7] In 2006, Spitzer and Williams conducted research to identify the syndromal validity of hysteroid dysphoria. In a sample of 1,324 patients identified with symptoms of mild depression, 3.1% displayed atypical features. These patients were not more likely to display more atypical features than others. Thus, Spitzer and Williams concluded that hysteroid dysphoria does not meet criteria to be acknowledged as a distinct syndrome. [7]

Contributing factors

Biological factors

The biological explanations of the causes of hysteroid dysphoria remain limited. However, it has been suggested that the dysregulation of the production of the oxytocin receptor gene (OXTR) is associated with the onset of hysteroid dysphoric symptoms. [8] This has been suggested due to the oxytocin hormone being associated with regulating behaviours related to social affiliation and emotional regulation. [8] Thus, the dysfunction of this hormone can lead to difficulties with social bonding and social cognition, specifically the ability to interpret social cues.

Additional research indicates that cortical association influences the development of symptoms associated with hysteroid dysphoria. Feelings of social rejection activate cortical regions that are also linked to physical pain, including the anterior insula and the dorsal anterior cingulate cortex. [9]

Environmental factors

Wider societal changes have been identified as influencing factors in the onset of hysteroid dysphoria. For instance, recent research has discovered that the COVID-19 pandemic has enhanced psychiatric symptoms. Individuals reported a lack of social connectedness as a response to the periods of social isolation. This reinforced the symptoms of hysteroid dysphoria, specifically intense feelings of social rejection. [10]

Social interactions with others also contribute to the development of symptoms associated with hysteroid dysphoria . The role of peer victimisation has been discovered as a possible influence in heightened rejection sensitivity amongst individuals. [11] A study of 1039 adolescents analysed the multiple dimensions of peer victimisation: experience of bullying, physical and social aggression, and sexual harassment. The correlational findings displayed that peer victimisation is strongly associated with higher levels of rejection sensitivity amongst participants. [11]

Treatment

While some research shows that hysteroid dysphoria responds well to MAOIs, other research has suggested that the difference actually comes from the condition being less sensitive to tricyclic antidepressants. [12] Tricyclic antidepressants are regarded as unsuccessful treatment for hysteroid dysphoria particularly due to this medication being specialised for treating typical forms of depression, rather than atypical forms, such as hysteroid dysphoria. [13]

MAOIs have been identified as a successful biological treatment for hysteroid dysphoric individuals. This is due to MAOIs catering to forms of treatment-resistant depression. The side effects of MAOIs vary across users, and may include insomnia, weight gain, and sexual dysfunction. [13]

If the use of MAOIs have proven to be ineffective in reducing the symptoms of hysteroid dysphoria, other forms of treatment include psychotherapy. [14] This enables individuals with such symptoms learn how to effectively process their emotions and exert greater control of their emotional responses.

Criticisms

Co-morbidity

The inability for hysteroid dysphoria to be classified as its own unique condition is attributed to its co-morbidity with other disorders. The symptoms of hysteroid dysphoria share similarities with a variety of mood disorders. [4] Some of which include:

ADHD has been identified as highly co-morbid with hysteroid dysphoria. [15] One notable similarity lies in the comparable structure of the neuroendocrine system. Neuroimaging research has revealed that ADHD targets hypothalamic pituitary adrenal (HPA), a region of the brain that governs and regulates bodily stress. This has shown to induce symptoms of hysteroid dysphoria among individuals. [16] Further analysis of brain scans suggests that both disorders result from interference in the brain’s communication systems, specifically systems that govern emotion and attention. [17]

Methodological issues

Much of the understanding of hysteroid dysphoria is based on research with predominantly female participants. Consequently, this has led to a common misconception that hysteroid dysphoria is most prevalent amongst women. However, some research has suggested that the symptoms of hysteroid dysphoria manifest differently across men and women. [18] The degree of rejection sensitivity in participants was measured using a ‘rejection sensitive questionnaire’ and attitudes towards intimacy were identified using a ‘fear of intimacy scale’. Analysis of the gender differences in intimate relationships has shown that females with higher rejection sensitivity display greater fear of intimate relationships compared to their male counterparts.Some differences included females displaying greater hostility in relationships whereas men may display subtle signs of jealousy. [18]

Some research has suggested that the symptoms of hysteroid dysphoria may be sufficient to define this as a distinct disorder. Research has discovered some differences between ADHD and hysteroid dysphoria, particularly in terms of the duration of the disorders. ADHD has been identified as a life-long disorder whereas symptoms associated with hysteroid dysphoria are regarded as “brief” and tend to “dissipate rapidly.” [19] This observation has prompted a focus on the potential for hysteroid dysphoria to be distinct from ADHD, with some suggestion that this disorder may instead be a sub-symptom of ADHD. [4]

See also

Related Research Articles

<span class="mw-page-title-main">Antidepressant</span> Class of medication used to treat depression and other conditions

Antidepressants are a class of medications used to treat major depressive disorder, anxiety disorders, chronic pain, and addiction.

<span class="mw-page-title-main">Monoamine oxidase inhibitor</span> Type of medication

Monoamine oxidase inhibitors (MAOIs) are a class of drugs that inhibit the activity of one or both monoamine oxidase enzymes: monoamine oxidase A (MAO-A) and monoamine oxidase B (MAO-B). They are best known as effective antidepressants, especially for treatment-resistant depression and atypical depression. They are also used to treat panic disorder, social anxiety disorder, Parkinson's disease, and several other disorders.

<span class="mw-page-title-main">Attention deficit hyperactivity disorder</span> Neurodevelopmental disorder

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterised by executive dysfunction occasioning symptoms of inattention, hyperactivity, impulsivity and emotional dysregulation that are excessive and pervasive, impairing in multiple contexts, and developmentally-inappropriate.

<span class="mw-page-title-main">Borderline personality disorder</span> Personality disorder of emotional instability

Borderline personality disorder (BPD), also known as emotionally unstable personality disorder (EUPD), is a personality disorder characterized by a pervasive, long-term pattern of significant interpersonal relationship instability, a distorted sense of self, and intense emotional responses. People diagnosed with BPD frequently exhibit self-harming behaviours and engage in risky activities, primarily due to challenges regulating emotional states to a healthy, stable baseline. Symptoms such as dissociation, a pervasive sense of emptiness, and an acute fear of abandonment are prevalent among those affected.

<span class="mw-page-title-main">Avoidant personality disorder</span> Personality disorder

Avoidant personality disorder (AvPD) or anxious personality disorder is a Cluster C personality disorder characterized by excessive social anxiety and inhibition, fear of intimacy, severe feelings of inadequacy and inferiority, and an overreliance on avoidance of feared stimuli as a maladaptive coping method. Those affected typically display a pattern of extreme sensitivity to negative evaluation and rejection, a belief that one is socially inept or personally unappealing to others, and avoidance of social interaction despite a strong desire for it. It appears to affect an approximately equal number of men and women.

<span class="mw-page-title-main">Mood swing</span> Extreme or rapid change in mood

A mood swing is an extreme or sudden change of mood. Such changes can play a positive part in promoting problem solving and in producing flexible forward planning, or be disruptive. When mood swings are severe, they may be categorized as part of a mental illness, such as bipolar disorder, where erratic and disruptive mood swings are a defining feature.

Dysphoria is a profound state of unease or dissatisfaction. It is the semantic opposite of euphoria. In a psychiatric context, dysphoria may accompany depression, anxiety, or agitation.

Child psychopathology refers to the scientific study of mental disorders in children and adolescents. Oppositional defiant disorder, attention-deficit hyperactivity disorder, and autism spectrum disorder are examples of psychopathology that are typically first diagnosed during childhood. Mental health providers who work with children and adolescents are informed by research in developmental psychology, clinical child psychology, and family systems. Lists of child and adult mental disorders can be found in the International Statistical Classification of Diseases and Related Health Problems, 10th Edition (ICD-10), published by the World Health Organization (WHO) and in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published by the American Psychiatric Association (APA). In addition, the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood is used in assessing mental health and developmental disorders in children up to age five.

Atypical depression is defined in the DSM-IV as depression that shares many of the typical symptoms of major depressive disorder or dysthymia but is characterized by improved mood in response to positive events. In contrast to those with atypical depression, people with melancholic depression generally do not experience an improved mood in response to normally pleasurable events. Atypical depression also often features significant weight gain or an increased appetite, hypersomnia, a heavy sensation in the limbs, and interpersonal rejection sensitivity that results in significant social or occupational impairment.

Cognitive disengagement syndrome (CDS) is a syndrome characterized by developmentally-inappropriate, impairing and persistent levels of decoupled attentional processing from the ongoing external context and resultant hypoactivity. Symptoms often manifest in difficulties with staring, mind blanking, withdrawal, mental confusion and maladaptive mind wandering alongside delayed, sedentary or slow motor movements. To scientists in the field, it has reached the threshold of evidence and recognition as a distinct syndrome.

Oppositional defiant disorder (ODD) is listed in the DSM-5 under Disruptive, impulse-control, and conduct disorders and defined as "a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness". This behavior is usually targeted toward peers, parents, teachers, and other authority figures, including law enforcement officials. Unlike conduct disorder (CD), those with ODD do not generally show patterns of aggression towards random people, violence against animals, destruction of property, theft, or deceit. One-half of children with ODD also fulfill the diagnostic criteria for ADHD.

Developmental psychopathology is the study of the development of psychological disorders with a life course perspective. Researchers who work from this perspective emphasize how psychopathology can be understood as normal development gone awry. Developmental psychopathology focuses on both typical and atypical child development in an effort to identify genetic, environmental, and parenting factors that may influence the longitudinal trajectory of psychological well-being.

Peter McGuffin was a Northern Irish psychiatrist and geneticist from Belfast.

Social anxiety is the anxiety and fear specifically linked to being in social settings. Some categories of disorders associated with social anxiety include anxiety disorders, mood disorders, autism spectrum disorders, eating disorders, and substance use disorders. Individuals with higher levels of social anxiety often avert their gazes, show fewer facial expressions, and show difficulty with initiating and maintaining a conversation. Social anxiety commonly manifests itself in the teenage years and can be persistent throughout life; however, people who experience problems in their daily functioning for an extended period of time can develop social anxiety disorder. Trait social anxiety, the stable tendency to experience this anxiety, can be distinguished from state anxiety, the momentary response to a particular social stimulus. Half of the individuals with any social fears meet the criteria for social anxiety disorder. Age, culture, and gender impact the severity of this disorder. The function of social anxiety is to increase arousal and attention to social interactions, inhibit unwanted social behavior, and motivate preparation for future social situations.

<span class="mw-page-title-main">Reward dependence</span>

Reward dependence (RD) is characterized as a tendency to respond markedly to signals of reward, particularly to verbal signals of social approval, social support, and sentiment. When reward dependence levels deviate from normal we see the rise of several personality and addictive disorders.

<span class="mw-page-title-main">Social anxiety disorder</span> Anxiety disorder associated with social situations

Social anxiety disorder (SAD), also known as social phobia, is an anxiety disorder characterized by sentiments of fear and anxiety in social situations, causing considerable distress and impairing ability to function in at least some aspects of daily life. These fears can be triggered by perceived or actual scrutiny from others. Individuals with social anxiety disorder fear negative evaluations from other people.

Late-life depression refers to depression occurring in older adults and has diverse presentations, including as a recurrence of early-onset depression, a new diagnosis of late-onset depression, and a mood disorder resulting from a separate medical condition, substance use, or medication regimen. Research regarding late-life depression often focuses on late-onset depression, which is defined as a major depressive episode occurring for the first time in an older person.

Cyclothymia, also known as cyclothymic disorder, psychothemia / psychothymia, bipolar III, affective personality disorder and cyclothymic personality disorder, is a mental and behavioural disorder that involves numerous periods of symptoms of depression and periods of symptoms of elevated mood. These symptoms, however, are not sufficient to indicate a major depressive episode or a manic episode. Symptoms must last for more than one year in children and two years in adults.

<span class="mw-page-title-main">Disruptive mood dysregulation disorder</span> Medical condition

Disruptive mood dysregulation disorder (DMDD) is a mental disorder in children and adolescents characterized by a persistently irritable or angry mood and frequent temper outbursts that are disproportionate to the situation and significantly more severe than the typical reaction of same-aged peers. DMDD was added to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) as a type of depressive disorder diagnosis for youths. The symptoms of DMDD resemble many other disorders, thus a differential includes attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), anxiety disorders, and childhood bipolar disorder, intermittent explosive disorder (IED), major depressive disorder (MDD), and conduct disorder.

<span class="mw-page-title-main">Breastfeeding and mental health</span>

Breastfeeding and mental health is the relationship between postpartum breastfeeding and the mother's and child's mental health. Research indicates breastfeeding may have positive effects on the mother's and child's mental health, though there have been conflicting studies that question the correlation and causation of breastfeeding and maternal mental health. Possible benefits include improved mood and stress levels in the mother, lower risk of postpartum depression, enhanced social emotional development in the child, stronger mother-child bonding and more. Given the benefits of breastfeeding, the World Health Organization (WHO), the European Commission for Public Health (ECPH) and the American Academy of Pediatrics (AAP) suggest exclusive breastfeeding for the first six months of life. Despite these suggestions, estimates indicate 70% of mothers breastfeed their child after birth and 13.5% of infants in the United States are exclusively breastfed. Breastfeeding promotion and support for mothers who are experiencing difficulties or early cessation in breastfeeding is considered a health priority.

References

  1. ↑ Møller, SE (1992). "Serotonin, carbohydrates, and atypical depression". Pharmacology & Toxicology. 71 (Suppl 1): 61–71. doi:10.1111/j.1600-0773.1992.tb01630.x. PMID   1480561.
  2. 1 2 3 Liebowitz, Michael R.; Klein, Donald F. (1979-12-01). "Hysteroid Dysphoria". Psychiatric Clinics of North America. Affective Disorders: Special Clinical Forms. 2 (3): 555–575. doi:10.1016/S0193-953X(18)30996-1. ISSN   0193-953X.
  3. ↑ Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association. 2022. doi:10.1176/appi.books.9780890425787. ISBN   978-0-89042-575-6 – via DSM Library.
  4. 1 2 3 4 "New Insights Into Rejection Sensitive Dysphoria". ADDitude. 2020-07-29. Retrieved 2024-03-19.
  5. ↑ Beeber, AR; Kline, MD; Pies, RW; Manring, JM Jr (1984). "Hysteroid dysphoria in depressed inpatients". Journal of Clinical Psychiatry. 45 (4): 164–166. PMID   6715288.
  6. ↑ Liebowitz, Michael R.; Klein, Donald F. (1979). "Hysteroid Dysphoria". Psychiatric Clinics of North America. 2 (3): 555–575. doi:10.1016/S0193-953X(18)30996-1.
  7. 1 2 Spitzer, R. L. (2006). "Hysteroid dysphoria: an unsuccessful attempt to demonstrate its syndromal validity". American Journal of Psychiatry. 139 (10): 1286–1291. doi:10.1176/ajp.139.10.1286. ISSN   0002-953X. PMID   7124981.
  8. 1 2 Woods, Robbie; Bedard, Marc; McQuaid, Robyn Jane; Matheson, Kim; Anisman, Hymie (2018-05-04). "Rejection sensitivity and multiple group memberships: The moderating role of an oxytocin receptor gene polymorphism". Social Neuroscience. 13 (3): 268–276. doi:10.1080/17470919.2017.1327458. ISSN   1747-0919. PMID   28472899.
  9. ↑ Kross, Ethan; Berman, Marc G.; Mischel, Walter; Smith, Edward E.; Wager, Tor D. (2011-04-12). "Social rejection shares somatosensory representations with physical pain". Proceedings of the National Academy of Sciences. 108 (15): 6270–6275. Bibcode:2011PNAS..108.6270K. doi: 10.1073/pnas.1102693108 . ISSN   0027-8424. PMC   3076808 . PMID   21444827.
  10. ↑ Hsu, David T.; Jarcho, Johanna M. (2021-01-01). ""Next up for psychiatry: rejection sensitivity and the social brain"". Neuropsychopharmacology. 46 (1): 239–240. doi:10.1038/s41386-020-00802-9. ISSN   1740-634X. PMC   7424132 . PMID   32792681.
  11. 1 2 Nepon, Taryn; Pepler, Debra J.; Craig, Wendy M.; Connolly, Jennifer; Flett, Gordon L. (2021). "A Longitudinal Analysis of Peer Victimization, Self-Esteem, and Rejection Sensitivity in Mental Health and Substance Use Among Adolescents". International Journal of Mental Health and Addiction. 19 (4): 1135–1148. doi:10.1007/s11469-019-00215-w. ISSN   1557-1874.
  12. ↑ Thase, M. E. (2006). "New Directions in the Treatment of Atypical Depression". The Journal of Clinical Psychiatry. 67 (12) e18. doi:10.4088/jcp.1206e18. PMID   17201029 . Retrieved 2020-02-13.
  13. 1 2 Sabella, Donna (2018). "MENTAL HEALTH MATTERS: Antidepressant Medications". The American Journal of Nursing. 118 (9): 52–59. doi:10.1097/01.NAJ.0000544978.56301.f6. ISSN   0002-936X. JSTOR   26620874. PMID   30138204.
  14. ↑ Bronswijk, Suzanne van; Moopen, Neha; Beijers, Lian; Ruhe, Henricus G.; Peeters, Frenk (2019). "Effectiveness of psychotherapy for treatment-resistant depression: a meta-analysis and meta-regression". Psychological Medicine. 49 (3): 366–379. doi:10.1017/S003329171800199X. ISSN   0033-2917. PMID   30139408.
  15. ↑ Beaton, Danielle M.; Sirois, Fuschia; Milne, Elizabeth (2022-02-18). "Experiences of criticism in adults with ADHD: A qualitative study". PLOS ONE. 17 (2): e0263366. Bibcode:2022PLoSO..1763366B. doi: 10.1371/journal.pone.0263366 . ISSN   1932-6203. PMC   8856522 . PMID   35180241.
  16. ↑ Chang, Jane Pei-Chen; Su, Kuan-Pin; Mondelli, Valeria; Pariante, Carmine M. (2021-08-19). "Cortisol and inflammatory biomarker levels in youths with attention deficit hyperactivity disorder (ADHD): evidence from a systematic review with meta-analysis". Translational Psychiatry. 11 (1): 430. doi:10.1038/s41398-021-01550-0. ISSN   2158-3188. PMC   8377148 . PMID   34413283.
  17. ↑ Shaw, Philip; Stringaris, Argyris; Nigg, Joel; Leibenluft, Ellen (2014). "Emotion Dysregulation in Attention Deficit Hyperactivity Disorder". American Journal of Psychiatry. 171 (3): 276–293. doi:10.1176/appi.ajp.2013.13070966. ISSN   0002-953X. PMC   4282137 . PMID   24480998.
  18. 1 2 Giovazolias, Theodoros; Paschalidi, Eirini (2022-05-05). "The Effect of Rejection Sensitivity on Fear of Intimacy in Emerging Adulthood". European Journal of Psychology Open . 81 (1): 1–12. doi: 10.1024/2673-8627/a000019 . ISSN   2673-8627.
  19. ↑ Bedrossian, Louise (2021). "Understand and address complexities of rejection sensitive dysphoria in students with ADHD". Disability Compliance for Higher Education. 26 (10): 4. doi:10.1002/dhe.31047. ISSN   1086-1335.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.