2. Triple Whammy—HIV, Mental Disorders, African Americans
For a brief overview of the characteristics of a mental disorder, as set forth in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV, 2000), please see the Introduction to this curriculum. This module will discuss the mental disorders that African Americans experience most often:
Major Depressive Disorder vs Normal Sadness
Major depressive disorder differs significantly from normal sadness or grief, which typically are less pervasive and last for a shorter time. In addition, some symptoms of severe depression—eg, anhedonia, hopelessness, loss of mood reactivity—seldom are features of normal sadness or grief. However, many other depressive symptoms can also appear during periods of stress or bereavement, including sleep disturbances, appetite changes, reduced concentration, and feelings of sadness. A skilled diagnostician will be able to differentiate the characteristics of normal sadness or grief from those of clinical depression (DSM-IV).
Symptoms and Diagnosis
An individual with major depressive disorder will experience at least one major depressive episode, lasting at least 2 weeks (DSM-IV). The central symptoms of major depressive disorder are depressed mood and anhedonia (loss of interest or pleasure). Other symptoms can vary widely, depending on an individual’s diagnostic subtype and may include sleep disturbances, weight change, or anxiety.
The DSM-IV criteria for diagnosis of major depressive disorder are:
Dysthymia is a chronic form of depression, distinguished from major depressive disorder by onset relatively early in life and it's unrelenting, or “smoldering,” course. Dysthymia affects approximately 2% of adults in a given year and is characterized by at least two of the persistent symptoms required to diagnose a major depressive episode and by duration of at least 2 years. People with dysthymia also are susceptible to development of major depression (DSM-IV, 2000).