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Medical Psychology and Sociology: Emotions

The 5 basic human emotions are happiness, sadness, anger, fear, and disgust, identified by psychologist Paul Ekman in 2016. Carroll Izard (1977) described 10 basic emotions (joy, interest-excitement, surprise, sadness, anger, disgust, contempt, fear, shame, and guilt), most of which are present in infancy. Others Love and pride are considered by some as separate basic emotions but Izard believes these other emotions are combinations of these 10; for example, he believes love is a mixture of joy and interest-excitement. How do emotions arise, and how can they be measured? What anatomic correlations are important to know? What are the most important theories about emotions? This article addresses connections to anxiety and depressive disorders commonly seen in clinical medicine. Be familiar with the basics to prepare for exams in which general scientific, anatomical, physiologic, and psychological knowledge is tested.

Last updated: Aug 19, 2022

Editorial responsibility: Stanley Oiseth, Lindsay Jones, Evelin Maza

Definition and Components of Emotion

Definition

An emotion is a mental state that arises spontaneously rather than through conscious effort and is often accompanied by physiologic changes. Situations, actions, or concrete objects can invoke various negative or positive emotions in different individuals.

The 3 components of the hypothetical construct of emotion

  • Physiologic: a state of functional activation, such as an increase in heart rate Heart rate The number of times the heart ventricles contract per unit of time, usually per minute. Cardiac Physiology and respiratory rate Respiratory rate The number of times an organism breathes with the lungs (respiration) per unit time, usually per minute. Pulmonary Examination
  • Cognitive: the mind’s ability to think about the emotional stimulus; involves an appraisal or interpretation of the situation
  • Behavioral: results in expressive behaviors, such as facial expression, body language, and tone of voice

Darwin assumed that emotions had a solid biologic basis. He argued that they evolved via natural selection Natural Selection Population Genetics and have a universal cross-cultural expression. This theory has been validated and supported by studying preliterate cultures. There are 5 basic universal emotions: fear, anger, disgust, sadness, happiness, and happiness.

Visual representations of different emotions

Visual representations of different emotions

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Distinction of the terms feeling, mood, and affect from emotion

  • Feeling: a subjective, affective state of consciousness with a shorter duration than mood
  • Mood: a pervasive and sustained emotional state that can influence an individual’s behavior; longer duration than feelings
  • Affect: the external expression of emotion attached to ideas or mental representations of objects; the observable emotional state of a person

The adaptive role of emotion

The Yerkes-Dodson law states that a graph representing the relationship Relationship A connection, association, or involvement between 2 or more parties. Clinician–Patient Relationship between performance and emotional arousal is U-shaped. In the “optimal” range, arousal provides a benefit; this range varies with the individual. Emotion may enhance survival by increasing arousal and priming for quick decisions (e.g., fear, anger). Emotions can influence daily life decisions by providing framework and consequences.

Yerkes-dodson law curve
Curve demonstrating the Yerkes-Dodson law
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Theories of emotion

James-Lange theory

  • Physiologic changes come first and form the basis of an emotional experience.
  • Perception Perception The process by which the nature and meaning of sensory stimuli are recognized and interpreted. Psychiatric Assessment of emotion-arousing stimulus → specific physiologic changes (e.g., fight-or-flight response) → interpretation of physiologic changes according to the emotion
  • Physiologic and behavioral responses to stimuli trigger Trigger The type of signal that initiates the inspiratory phase by the ventilator Invasive Mechanical Ventilation the cognitive aspect of emotion.
  • Weaknesses in the theory include that it assumes that:
    • Each emotion originates from a specific physiologic state. Many emotional states share similar physiologic patterns (e.g., fear and sexual arousal).
    • We possess the ability to label physiologic states accurately. Physiologic states can be interpreted differently based on context (e.g., anxiety Anxiety Feelings or emotions of dread, apprehension, and impending disaster but not disabling as with anxiety disorders. Generalized Anxiety Disorder vs. excitement).

Visual representation of encountering a frightening stimulus

Visual representation of encountering a frightening stimulus

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Cannon-Bard theory

  • Physiologic and cognitive responses to stimuli occur simultaneously and independently → behavioral reaction
  • This model can explain the overlap in physiologic states between emotions (e.g., fear and sexual arousal).
  • This theory cannot explain the phenomenon in which a behavioral response influences the physical and cognitive aspects of emotion (e.g., smiling leads to happiness).
Cannon-bard theory

Cannon-Bard theory

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Cannon-bard theory: response algorithm for an emotionally induced stimulus

Cannon-Bard theory: Response algorithm for an emotionally induced stimulus

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Schachter-Singer 2-factor theory of emotion

  • Emotion is a function of both cognitive factors and physiologic arousal.
  • We cognitively label the physical response and associate it with emotion.
Schachter-singer theory response algorithm for an emotionally induced stimulus

Schachter-Singer theory: Response algorithm for an emotionally induced stimulus

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Summary

Table: Theories of emotions
Theory Pattern
James-Lange theory:
“We don’t cry because we are sad, we are sad because we cry.”
Physical changes are the reason for emotions.
  • Perception Perception The process by which the nature and meaning of sensory stimuli are recognized and interpreted. Psychiatric Assessment of the object
  • Triggering of physical reactions
  • Perception Perception The process by which the nature and meaning of sensory stimuli are recognized and interpreted. Psychiatric Assessment as emotion
Cannon-Bard theory Emotions are possible only via the perception Perception The process by which the nature and meaning of sensory stimuli are recognized and interpreted. Psychiatric Assessment of stimuli in the brain Brain The part of central nervous system that is contained within the skull (cranium). Arising from the neural tube, the embryonic brain is comprised of three major parts including prosencephalon (the forebrain); mesencephalon (the midbrain); and rhombencephalon (the hindbrain). The developed brain consists of cerebrum; cerebellum; and other structures in the brain stem. Nervous System: Anatomy, Structure, and Classification.
  • Perception Perception The process by which the nature and meaning of sensory stimuli are recognized and interpreted. Psychiatric Assessment of the object
  • Activation of the thalamus Thalamus The thalamus is a large, ovoid structure in the dorsal part of the diencephalon that is located between the cerebral cortex and midbrain. It consists of several interconnected nuclei of grey matter separated by the laminae of white matter. The thalamus is the main conductor of information that passes between the cerebral cortex and the periphery, spinal cord, or brain stem. Thalamus: Anatomy
  • Simultaneous physiologic and emotional excitation (“preprogrammed” reflex)
Schachter-Singer 2-factor theory:
“There is no emotion without cognition.”
The precondition for emotion is a nonspecific physiologic stimulus.
  • Stimulus
  • Nonspecific physiologic excitement
  • Cognitive assessment
  • Emotion

Classification of Emotions

Emotions are classified into primary emotions and secondary emotions. Current scientific knowledge states that the first development of primary emotions is of genetic origin.

The 5 primary emotions

  • Happiness
  • Sadness
  • Anger
  • Fear
  • Disgust

Facial expressions of basic emotions are the same across different cultures. A comprehensive, anatomically based system—the Facial Action Coding System (FACS)—has been developed; it lists the individual groups of muscles responsible for showing each emotion. Individual facial muscle movements are encoded by the system from slight changes in facial appearance, systematically categorizing the physical expression of emotions.

Secondary emotions: blended emotions or “learned” emotions

To a large extent, genetics Genetics Genetics is the study of genes and their functions and behaviors. Basic Terms of Genetics may be responsible for the development of the primary emotions. However, social and cultural influences shape the subsequent experience of emotions.

A culturally specific example is the appropriateness of emotions in certain situations. Anger is either manifested (e.g., rage) or controlled. Social roles shape emotional behavior even further (e.g., “boys shouldn’t cry”).

Measuring Emotions: Quality and Intensity

Principles of mental causality Causality Causality is a relationship between 2 events in which 1 event causes the other. Simply because relationships are observed between 2 variables (i.e., associations or correlations) does not imply that one variable actually caused the outcome. Demonstrating causality between an exposure and an outcome is the main objective of most published medical research. Causality, Validity, and Reliability were described by psychologist Wilhelm Wundt in the late 19th century. His concepts were developed over several decades of research Research Critical and exhaustive investigation or experimentation, having for its aim the discovery of new facts and their correct interpretation, the revision of accepted conclusions, theories, or laws in the light of newly discovered facts, or the practical application of such new or revised conclusions, theories, or laws. Conflict of Interest and related individual psychology to cultural psychology. His theory of emotions includes the following 3 qualitative dimensions:

  • Pleasant–unpleasant
  • Excited–depressed
  • Tense–relaxed

Psychophysiologic methods

The FACS can measure emotions by observing muscle activity.

Table: Ekman and Friesen’s classification of six emotions and facial expressions (1978)
Basic emotion Facial expression
Happiness Tense lower eyelid, raised corners of the mouth
Surprise Raised eyebrows, raised upper eyelid, open mouth
Anger Lowered eyebrows, frowning, raised upper eyelid, tense lower eyelid
Disgust Tense lower eyelid, raised upper lip Upper Lip Melasma
Fear Partly raised/partly lowered eyebrows, frowning, raised upper eyelid, open mouth
Sadness Partly raised/partly lowered eyebrows, lowered corner of the mouth
Disdain Tense corner of the mouth raised on 1 side

Neurobiological Basis of Emotions

Anatomical correlations to the generation and processing of emotions:

  • Parasympathetic and sympathetic nervous system Nervous system The nervous system is a small and complex system that consists of an intricate network of neural cells (or neurons) and even more glial cells (for support and insulation). It is divided according to its anatomical components as well as its functional characteristics. The brain and spinal cord are referred to as the central nervous system, and the branches of nerves from these structures are referred to as the peripheral nervous system. Nervous System: Anatomy, Structure, and Classification: control of the physiological components via catecholamines Catecholamines A general class of ortho-dihydroxyphenylalkylamines derived from tyrosine. Adrenal Hormones (noradrenaline and adrenaline)
  • Frontal Frontal The bone that forms the frontal aspect of the skull. Its flat part forms the forehead, articulating inferiorly with the nasal bone and the cheek bone on each side of the face. Skull: Anatomy lobe: lesions in this area of the brain Brain The part of central nervous system that is contained within the skull (cranium). Arising from the neural tube, the embryonic brain is comprised of three major parts including prosencephalon (the forebrain); mesencephalon (the midbrain); and rhombencephalon (the hindbrain). The developed brain consists of cerebrum; cerebellum; and other structures in the brain stem. Nervous System: Anatomy, Structure, and Classification lead to unusual behavior. 
    • When affected, social interactions are reduced or inappropriate. 
    • The frontal Frontal The bone that forms the frontal aspect of the skull. Its flat part forms the forehead, articulating inferiorly with the nasal bone and the cheek bone on each side of the face. Skull: Anatomy lobe also diminishes facial expressions and gestures (“poker face”).
  • Hypothalamus Hypothalamus The hypothalamus is a collection of various nuclei within the diencephalon in the center of the brain. The hypothalamus plays a vital role in endocrine regulation as the primary regulator of the pituitary gland, and it is the major point of integration between the central nervous and endocrine systems. Hypothalamus and limbic system Limbic system The limbic system is a neuronal network that mediates emotion and motivation, while also playing a role in learning and memory. The extended neural network is vital to numerous basic psychological functions and plays an invaluable role in processing and responding to environmental stimuli. Limbic System: Anatomy: control the release Release Release of a virus from the host cell following virus assembly and maturation. Egress can occur by host cell lysis, exocytosis, or budding through the plasma membrane. Virology of hormones Hormones Hormones are messenger molecules that are synthesized in one part of the body and move through the bloodstream to exert specific regulatory effects on another part of the body. Hormones play critical roles in coordinating cellular activities throughout the body in response to the constant changes in both the internal and external environments. Hormones: Overview and Types and neurotransmitters. The limbic system Limbic system The limbic system is a neuronal network that mediates emotion and motivation, while also playing a role in learning and memory. The extended neural network is vital to numerous basic psychological functions and plays an invaluable role in processing and responding to environmental stimuli. Limbic System: Anatomy is not an anatomical but a functional unit for emotion, drive, and learning.
  • Amygdala Amygdala Almond-shaped group of basal nuclei anterior to the inferior horn of the lateral ventricle of the temporal lobe. The amygdala is part of the limbic system. Limbic System: Anatomy: if the amygdalae are removed on both sides, fear is reduced, and otherwise dangerous stimuli are no longer perceived as aversive. Without the amygdalae, there is no fight-or-flight reaction to conditioned fear stimuli.
  • Hippocampus: responsible for storing long-term memory Memory Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. Psychiatric Assessment and acquisition of spatial information. Normal functioning is necessary to utilize contextual cues. Without the hippocampus, vital avoidance behavior Avoidance behavior Specific Phobias is severely impaired.

Fear as Emotion

Fear is an unpleasant emotional state involving physiological and psychological responses to an external threat. It is described as apprehension, dread, or alarm and is differentiated from anxiety Anxiety Feelings or emotions of dread, apprehension, and impending disaster but not disabling as with anxiety disorders. Generalized Anxiety Disorder which does not always have an easily identifiable stimulus.

The components mentioned above usually express themselves as follows (with some variability between individuals):

  • Physiological component: tachycardia Tachycardia Abnormally rapid heartbeat, usually with a heart rate above 100 beats per minute for adults. Tachycardia accompanied by disturbance in the cardiac depolarization (cardiac arrhythmia) is called tachyarrhythmia. Sepsis in Children, tremor Tremor Cyclical movement of a body part that can represent either a physiologic process or a manifestation of disease. Intention or action tremor, a common manifestation of cerebellar diseases, is aggravated by movement. In contrast, resting tremor is maximal when there is no attempt at voluntary movement, and occurs as a relatively frequent manifestation of parkinson disease. Myotonic Dystrophies, chills Chills The sudden sensation of being cold. It may be accompanied by shivering. Fever, nausea Nausea An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. Antiemetics, urge to urinate
  • Cognitive component: worry, speculation, and concern
  • Observable behavior: raising the lower lip and eyelids Eyelids Each of the upper and lower folds of skin which cover the eye when closed. Blepharitis

Infants develop their first expression of fear with the fear of strangers at age 6 months and separation anxiety Anxiety Feelings or emotions of dread, apprehension, and impending disaster but not disabling as with anxiety disorders. Generalized Anxiety Disorder at age 8 months. Fear is a functional emotion that warns and protects us against dangerous situations, and excess fear is seen in individuals with anxiety Anxiety Feelings or emotions of dread, apprehension, and impending disaster but not disabling as with anxiety disorders. Generalized Anxiety Disorder disorders. Although the complete lack of fear may be desirable at first glance, it leaves the affected person without needed protection.

Other types of fear:

  • Concrete fear: an unpleasant emotional state with qualities of apprehension, dread, distress, and uneasiness, which occurs when exposed to a specific object (“ anxiety Anxiety Feelings or emotions of dread, apprehension, and impending disaster but not disabling as with anxiety disorders. Generalized Anxiety Disorder” is similar to fear but it is objectless and vaguely unpleasant).
  • Phobia Phobia A phobia can be defined as an irrational fear that results in avoidance of the feared subject, activity, or situation. Social Anxiety Disorder: an uncontrollable, irrational, and lasting fear of a certain object, situation, or activity (e.g., insects such as spiders, called “ arachnophobia Arachnophobia Specific Phobias.”

Anxiety Anxiety Feelings or emotions of dread, apprehension, and impending disaster but not disabling as with anxiety disorders. Generalized Anxiety Disorder state vs. trait

  • State: acute, situational state of fear
  • Trait: long-lasting characteristic, a disposition that is stable over time

Sensitizer vs. repressor

Individuals who are “sensitizers” try to gather as much information as possible about the situation, the object, or the circumstances that frighten them (e.g., reading drug package information in great detail).

Repressors” expose themselves to factors that trigger Trigger The type of signal that initiates the inspiratory phase by the ventilator Invasive Mechanical Ventilation fear as little as possible. Both behaviors are possible means to cope with fear.

Physicians Physicians Individuals licensed to practice medicine. Clinician–Patient Relationship must learn to recognize both types of coping with fear. Conversations need to be customized to the patient’s coping strategy about how much detail is provided.

Anxiety Anxiety Feelings or emotions of dread, apprehension, and impending disaster but not disabling as with anxiety disorders. Generalized Anxiety Disorder disorders

Generalized anxiety disorder Generalized anxiety disorder Generalized anxiety disorder (GAD) is a common mental condition defined by excessive, uncontrollable worrying causing distress and occurring frequently for at least 6 months. Generalized anxiety disorder is more common in women. Clinical presentation includes fatigue, low concentration, restlessness, irritability, and sleep disturbance. Generalized Anxiety Disorder

Affected individuals worry about typical life experiences such as work, health, and interpersonal relations. Their symptoms are out of proportion to the impact of the anticipated event. Other presenting symptoms may include autonomic hyperactivity Hyperactivity Attention Deficit Hyperactivity Disorder, irritability, hyperarousal, poor sleep Sleep A readily reversible suspension of sensorimotor interaction with the environment, usually associated with recumbency and immobility. Physiology of Sleep, and unexplained pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways or muscle tension.

Panic disorder Panic disorder Panic disorder is a condition marked by recurrent and episodic panic attacks that occur abruptly and without a trigger. These episodes are time-limited and present with cardiorespiratory (palpitations, shortness of breath, choking), GI (nausea, abdominal distress), and neurologic (paresthesias, lightheadedness) symptoms. Panic Disorder

Panic disorder Panic disorder Panic disorder is a condition marked by recurrent and episodic panic attacks that occur abruptly and without a trigger. These episodes are time-limited and present with cardiorespiratory (palpitations, shortness of breath, choking), GI (nausea, abdominal distress), and neurologic (paresthesias, lightheadedness) symptoms. Panic Disorder is characterized by unexpected recurrent attacks of intense fear or discomfort. Panic attacks reach a peak within minutes and are associated with somatic symptoms Somatic symptoms Major Depressive Disorder. Patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship may describe panic attacks but often do not present during an episode.

Specific phobias Specific Phobias Specific phobia is irrational fear or anxiety arising from a specific object or situation, leading to avoidance. The main types of phobias are animal (e.g., spiders, dogs), natural environment (e.g., water, storms), blood-injection injury (e.g., needles), situational (e.g., enclosed spaces), and others not categorized under the preceding specifiers. Specific Phobias

With specific phobias Specific Phobias Specific phobia is irrational fear or anxiety arising from a specific object or situation, leading to avoidance. The main types of phobias are animal (e.g., spiders, dogs), natural environment (e.g., water, storms), blood-injection injury (e.g., needles), situational (e.g., enclosed spaces), and others not categorized under the preceding specifiers. Specific Phobias, fears, and respective avoidance strategies, focus on a specific object or situation. A few common examples that quite frequently occur in exam questions are the following:

Social phobias Phobias Neurological Examination

Social phobias Phobias Neurological Examination describe the fear of social situations in which one could disgrace oneself or be humiliated. They are characterized by a fear of being assessed negatively by others in interaction and performance situations.

Agoraphobia Agoraphobia Agoraphobia is fear or anxiety in a situation that would be difficult to leave or to obtain help in the event that one develops panic-like symptoms. Situations include being in public or open spaces, lines, crowds, or public transport. Agoraphobia

People who have agoraphobia Agoraphobia Agoraphobia is fear or anxiety in a situation that would be difficult to leave or to obtain help in the event that one develops panic-like symptoms. Situations include being in public or open spaces, lines, crowds, or public transport. Agoraphobia are afraid of public places, crowds, and means of transport, as well as other situations where an escape Escape With constant immune mechanisms holding unstable tumor cells in equilibrium, tumor-cell variants may emerge. These cancer cells may express fewer antigens on their surfaces or lose their MHC class I expression.Variants may also protect themselves from T-cell attack via expression of IC molecules on their surfaces, like normal cells.Creation of an immunosuppressive state in the microenvironment is another way to grow without immunologic interference. Cancer Immunotherapy could be difficult or embarrassing. Agoraphobia Agoraphobia Agoraphobia is fear or anxiety in a situation that would be difficult to leave or to obtain help in the event that one develops panic-like symptoms. Situations include being in public or open spaces, lines, crowds, or public transport. Agoraphobia has high comorbidity with panic disorders.

Obsessive-compulsive disorders

Obsessive-compulsive disorders are based on fear as well. Patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship suffering from compulsions Compulsions Repetitive behaviors or mental acts that the individual is driven to perform in relation to an obsession. Obsessive-compulsive Disorder (OCD) are afraid that terrible things will happen if they cannot carry out the compulsive act (“If I do not tie my shoelaces 7 times, my grandfather will die.”). Usually, the compulsive acts consume most of the day and significantly impair the patient’s quality Quality Activities and programs intended to assure or improve the quality of care in either a defined medical setting or a program. The concept includes the assessment or evaluation of the quality of care; identification of problems or shortcomings in the delivery of care; designing activities to overcome these deficiencies; and follow-up monitoring to ensure effectiveness of corrective steps. Quality Measurement and Improvement of life.The most common obsessions Obsessions Recurrent thoughts, images, or urges that are intrusive and recognized as unwanted, causing significant anxiety and distress . Obsessive-compulsive Disorder (OCD) are:

  • Washing obsession (e.g., continuous hand Hand The hand constitutes the distal part of the upper limb and provides the fine, precise movements needed in activities of daily living. It consists of 5 metacarpal bones and 14 phalanges, as well as numerous muscles innervated by the median and ulnar nerves. Hand: Anatomy washing out of fear of being unclean)
  • Control obsession (e.g., continuous checking of electronic devices in the apartment)

Aggression as Emotion: Instinct or Learned?

Definition: the motive to harm oneself or others

Explanations on the development of aggression Aggression Behavior which may be manifested by destructive and attacking action which is verbal or physical, by covert attitudes of hostility or by obstructionism. Oppositional Defiant Disorder

Psychoanalytical perspective:

According to psychoanalytic theory, Thanatos, the death instinct, is responsible for aggression Aggression Behavior which may be manifested by destructive and attacking action which is verbal or physical, by covert attitudes of hostility or by obstructionism. Oppositional Defiant Disorder. Humans are compared to “steam boilers” that build up pressure until the pressure has to be released.

Aggressive venting is a purification process (catharsis hypothesis Hypothesis A hypothesis is a preliminary answer to a research question (i.e., a “guess” about what the results will be). There are 2 types of hypotheses: the null hypothesis and the alternative hypothesis. Statistical Tests and Data Representation) that reduces tension. Watching aggressive scenes in a film may be seen as a substitute for the real release Release Release of a virus from the host cell following virus assembly and maturation. Egress can occur by host cell lysis, exocytosis, or budding through the plasma membrane. Virology of aggression Aggression Behavior which may be manifested by destructive and attacking action which is verbal or physical, by covert attitudes of hostility or by obstructionism. Oppositional Defiant Disorder. This view contradicts the theory that the original form of aggressive behavior is learned.

Ethological perspective:

Ethology interprets aggression Aggression Behavior which may be manifested by destructive and attacking action which is verbal or physical, by covert attitudes of hostility or by obstructionism. Oppositional Defiant Disorder as an animalistic instinct that serves the defense of habitat, the protection of the community, and the creation/preservation of social hierarchy.

Learned behavior-perspective:

This theory assumes that aggressive behavior is acquired through theoretical learning mechanisms. Special emphasis is placed on learning from role models.

Dollard and Miller’s frustration-aggression hypothesis Hypothesis A hypothesis is a preliminary answer to a research question (i.e., a “guess” about what the results will be). There are 2 types of hypotheses: the null hypothesis and the alternative hypothesis. Statistical Tests and Data Representation (1950)

The frustration-aggression hypothesis Hypothesis A hypothesis is a preliminary answer to a research question (i.e., a “guess” about what the results will be). There are 2 types of hypotheses: the null hypothesis and the alternative hypothesis. Statistical Tests and Data Representation focuses on the conditions responsible for the development of aggression Aggression Behavior which may be manifested by destructive and attacking action which is verbal or physical, by covert attitudes of hostility or by obstructionism. Oppositional Defiant Disorder. Frustration is experienced if an aspired goal is not reached because external factors act as obstacles.

People with high frustration tolerance Tolerance Pharmacokinetics and Pharmacodynamics are better at handling restrictions on their way to achieving a goal without having their physical and psychological well-being offended; hence, they do not need to release Release Release of a virus from the host cell following virus assembly and maturation. Egress can occur by host cell lysis, exocytosis, or budding through the plasma membrane. Virology tension through aggression Aggression Behavior which may be manifested by destructive and attacking action which is verbal or physical, by covert attitudes of hostility or by obstructionism. Oppositional Defiant Disorder.

Depression

Unipolar Unipolar Nervous System: Histology major depression is an affective disorder characterized by a history of one or more major depressive episodes Depressive episodes Depressive states usually of moderate intensity in contrast with major depression present in neurotic and psychotic disorders. Bipolar Disorder. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), at least 4 other symptoms must be present in addition to depressed mood or loss of interest or pleasure to make the diagnosis of major depressive disorder Major depressive disorder Major depressive disorder (MDD), commonly called depression, is a unipolar mood disorder characterized by persistent low mood and loss of interest in association with somatic symptoms for a duration of ≥ 2 weeks. Major depressive disorder has the highest lifetime prevalence among all psychiatric disorders. Major Depressive Disorder:

  • Depressed mood most of the day, nearly every day
  • Loss of interest or pleasure in most activities, nearly every day
  • Insomnia Insomnia Insomnia is a sleep disorder characterized by difficulty in the initiation, maintenance, and consolidation of sleep, leading to impairment of function. Patients may exhibit symptoms such as difficulty falling asleep, disrupted sleep, trouble going back to sleep, early awakenings, and feeling tired upon waking. Insomnia or hypersomnia Hypersomnia Disorders characterized by hypersomnolence during normal waking hours that may impair cognitive functioning. Subtypes include primary hypersomnia disorders (e.g., idiopathic hypersomnolence; narcolepsy; and kleine-levin syndrome) and secondary hypersomnia disorders where excessive somnolence can be attributed to a known cause (e.g., drug affect, mental disorders, and sleep apnea syndrome). Whipple’s Disease
  • Significant weight loss Weight loss Decrease in existing body weight. Bariatric Surgery or gain, or change in appetite
  • Psychomotor slowing or agitation Agitation A feeling of restlessness associated with increased motor activity. This may occur as a manifestation of nervous system drug toxicity or other conditions. St. Louis Encephalitis Virus
  • Fatigue Fatigue The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. Fibromyalgia or low energy
  • Thought of worthlessness or inappropriate guilt
  • Difficulty concentrating
  • Suicidal thoughts

When depression alternates with cycles of mania Mania A state of elevated excitement with over-activity sometimes accompanied with psychotic symptoms (e.g., psychomotor agitation, inflated self esteem and flight of ideas). It is often associated with mental disorders (e.g., cyclothymic disorder; and bipolar diseases). Bipolar Disorder, this is referred to as bipolar disorder Bipolar disorder Bipolar disorder is a highly recurrent psychiatric illness characterized by periods of manic/hypomanic features (distractibility, impulsivity, increased activity, decreased sleep, talkativeness, grandiosity, flight of ideas) with or without depressive symptoms. Bipolar Disorder. Mania Mania A state of elevated excitement with over-activity sometimes accompanied with psychotic symptoms (e.g., psychomotor agitation, inflated self esteem and flight of ideas). It is often associated with mental disorders (e.g., cyclothymic disorder; and bipolar diseases). Bipolar Disorder is characterized by extreme euphoria Euphoria An exaggerated feeling of physical and emotional well-being not consonant with apparent stimuli or events; usually of psychologic origin, but also seen in organic brain disease and toxic states. Hepatic Encephalopathy, hyperactivity Hyperactivity Attention Deficit Hyperactivity Disorder, and a lack of critical faculties.

Explanatory models: How does depression develop?

Besides the genetic component (especially in individuals with bipolar disorder Bipolar disorder Bipolar disorder is a highly recurrent psychiatric illness characterized by periods of manic/hypomanic features (distractibility, impulsivity, increased activity, decreased sleep, talkativeness, grandiosity, flight of ideas) with or without depressive symptoms. Bipolar Disorder), neurochemical and environmental factors play a major role. Risk factors contributing to developing depression are female sex Sex The totality of characteristics of reproductive structure, functions, phenotype, and genotype, differentiating the male from the female organism. Gender Dysphoria, serious loss (e.g., divorce, death of important attachment figures, loss of work), and low socioeconomic status.

Depression

Depression

Image: “Man holding his face” by G. Altmann. License: Public Domain
Table: Models for the development of depression
Model for the development of depression Example
Lewinsohn’s loss-of-reinforcement theory Little positive reinforcement Positive reinforcement Psychotherapy in everyday life through:
  • Scarcity of reinforcing events
  • Insufficient skill level in the social and/or professional sector
Feeling pleasure in cooking for one’s partner. No motivation after separation because the positive reinforcement Positive reinforcement Psychotherapy is missing.
Beck’s cognitive explanation Depression is a consequence of a distorted view of reality: negative evaluation of oneself, the environment and the future (cognitive triad) ‘I’m just incapable of a relationship Relationship A connection, association, or involvement between 2 or more parties. Clinician–Patient Relationship, everybody else thinks that and that’s never going to change.’
Seligman’s learned helplessness theory Basic assumption derived from experimental animal research Research Critical and exhaustive investigation or experimentation, having for its aim the discovery of new facts and their correct interpretation, the revision of accepted conclusions, theories, or laws in the light of newly discovered facts, or the practical application of such new or revised conclusions, theories, or laws. Conflict of Interest is a lack of avoidance behavior Avoidance behavior Specific Phobias. Symptoms of learned helplessness:
  • Emotional deficit
  • Motivational deficit
  • Cognitive deficit
  • Neurobiological changes
Even after rats were unharnessed from the electric shock Shock Shock is a life-threatening condition associated with impaired circulation that results in tissue hypoxia. The different types of shock are based on the underlying cause: distributive (↑ cardiac output (CO), ↓ systemic vascular resistance (SVR)), cardiogenic (↓ CO, ↑ SVR), hypovolemic (↓ CO, ↑ SVR), obstructive (↓ CO), and mixed. Types of Shock plate and could have fled to the safe part of the cage, they continued to sit in the danger zone where they were exposed to pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways.

Pain

The International Association for the Study of Pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways (IASP) defines pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways as an “unpleasant sensory Sensory Neurons which conduct nerve impulses to the central nervous system. Nervous System: Histology and emotional experience associated with actual or potential tissue damage.” The subjectivity of pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways differs greatly between individuals with regard to pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways susceptibility and sensitivity.

The 5 components of pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways

There are 5 different components of pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways:

  • Affective: emotions relating to pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways
  • Cognitive: intellectual assessment of the pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways experience
  • Motor Motor Neurons which send impulses peripherally to activate muscles or secretory cells. Nervous System: Histology: motor Motor Neurons which send impulses peripherally to activate muscles or secretory cells. Nervous System: Histology reaction to pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways
  • Sensory Sensory Neurons which conduct nerve impulses to the central nervous system. Nervous System: Histology: activity of nociceptors Nociceptors Peripheral afferent neurons which are sensitive to injuries or pain, usually caused by extreme thermal exposures, mechanical forces, or other noxious stimuli. Their cell bodies reside in the dorsal root ganglia. Their peripheral terminals (nerve endings) innervate target tissues and transduce noxious stimuli via axons to the central nervous system. Pain: Types and Pathways
  • Autonomic: reaction of the autonomic nervous system Autonomic nervous system The ANS is a component of the peripheral nervous system that uses both afferent (sensory) and efferent (effector) neurons, which control the functioning of the internal organs and involuntary processes via connections with the CNS. The ANS consists of the sympathetic and parasympathetic nervous systems. Autonomic Nervous System: Anatomy

Important terms

Sensitivity to pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways or “algesia” is interrupted by analgesia Analgesia Methods of pain relief that may be used with or in place of analgesics. Anesthesiology: History and Basic Concepts (medications that relieve pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways) or anesthesia Anesthesia A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. Anesthesiology: History and Basic Concepts (artificially induced loss of ability to feel pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways).

Threshold Threshold Minimum voltage necessary to generate an action potential (an all-or-none response) Skeletal Muscle Contraction” defines the point beyond which a stimulus is perceived as painful.

The point in time when a patient starts taking measures against the pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways is their intervention threshold Threshold Minimum voltage necessary to generate an action potential (an all-or-none response) Skeletal Muscle Contraction. The tolerance Tolerance Pharmacokinetics and Pharmacodynamics threshold Threshold Minimum voltage necessary to generate an action potential (an all-or-none response) Skeletal Muscle Contraction is the maximum intensity of pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways a person can endure (exceeding this threshold Threshold Minimum voltage necessary to generate an action potential (an all-or-none response) Skeletal Muscle Contraction can result in loss of self-control, shock Shock Shock is a life-threatening condition associated with impaired circulation that results in tissue hypoxia. The different types of shock are based on the underlying cause: distributive (↑ cardiac output (CO), ↓ systemic vascular resistance (SVR)), cardiogenic (↓ CO, ↑ SVR), hypovolemic (↓ CO, ↑ SVR), obstructive (↓ CO), and mixed. Types of Shock, and coma Coma Coma is defined as a deep state of unarousable unresponsiveness, characterized by a score of 3 points on the GCS. A comatose state can be caused by a multitude of conditions, making the precise epidemiology and prognosis of coma difficult to determine. Coma). “Phantom pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways” persists after body parts have been removed (e.g., after amputations). Phantom pains are explained by the reorganization of the sensory Sensory Neurons which conduct nerve impulses to the central nervous system. Nervous System: Histology cortex areas. Chronic pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways refers to pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways that lasts longer than 6 months.

The experience of pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways is more intense for people dealing with depression and social isolation than it is for aged people and those with reduced vigilance.

References

  1. Albin, R. S. (1983). Emotions. Philadelphia: Westminster Press.
  2. Carey, M. (1992). Emotions. Milwaukee, WI: H. Leonard Pub. Corp.
  3. Delgado, J. M. (1969). Emotions. Dubuque, IA: W.C. Brown.
  4. Griffiths, P. E. (n.d.). Basic emotions, complex emotions, machiavellian emotions. Philosophy and the Emotions, 39-68. doi:10.1017/cbo9780511550270.004
  5. McCann, T. B. (2004). Emotions. New York: Dafina Books.
  6. Ekman, P. (2016). What scientists who study emotion agree about. Perspectives on Psychological Science, 11(1), 31-4.
  7. Dukes, D., Abrams, K., et al. (2021). The rise of affectivism. Nature Human Behaviour, 5(7), 816-20.
  8. Turan, B., Foltz, C., et al. (2015). Anticipatory sensitization to repeated stressors: the role of initial cortisol reactivity and meditation/emotion skills training. Psychoneuroendocrinology, 52, 229-38.

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