Emotional Disorders: Causes, Symptoms, and Treatment

Emotional disorders refer to the condition of experiencing abnormal and prolonged fluctuations in emotions that exceed the normal range in both duration and intensity. Currently, the underlying cause of the disorder is not fully understood, and there are significant challenges in the process of treatment and prevention of relapse.

Emotional disorder (mood disorder) is a common form of mental disorder today.

What are emotional disorders?

Emotions are human reactions to external and internal factors. When these influences are received, the brain generates corresponding neurotransmitters to produce emotions that align with perception and behavior. In reality, emotions, thoughts (perception), and behavior are three interconnected factors that influence each other.

The intensity of emotions varies for each individual depending on circumstances, mental well-being, quality of life, personality traits, physical health status, and more. When faced with different events, emotions fluctuate, creating both negative and positive moods.

This fluctuation typically occurs within a certain limit in terms of intensity and duration. When emotions are disrupted, either significantly reduced or excessively heightened over an extended period, it is referred to as an emotional disorder.

Simply put, an emotional disorder or mood disorder is a condition where emotions experience abnormal elevation or reduction for a specific period. Reduced emotions are known as depression, while heightened emotions are known as mania. However, mania rarely occurs in isolation but is typically part of bipolar disorder.

Currently, emotional disorders are clinically classified into two forms:

1. Depression (depressive disorders)
2. Bipolar disorder (including alternating depressive and manic phases)

Additionally, experts categorize emotional disorders based on their characteristics and onset, such as seasonal affective disorder, perinatal/postpartum emotional disorders, adolescent emotional disorders, etc. Although they have different names, the overall characteristics and treatment approaches are similar.

Statistics show that approximately 5% of the global population is facing emotional disorders, and the risk of developing the condition is twice as high in females compared to males. Despite the relatively high prevalence, there is limited understanding within the community about this pathology and psychological issues. As a result, many patients face stigma, criticism, and a lack of timely medical care.

Symptoms of Emotional Disorders

Emotional disorders manifest in diverse ways, classified into two main groups: depression and mania. Bipolar disorder encompasses both of these symptom groups, alternating between them. The severity of symptoms varies depending on the stage of progression and factors such as personality traits, psychosocial factors, and others.

Depressive Emotions

Depression is a distinctive form of emotional disorder characterized by low mood and inhibition. Currently, depression is the most common mental illness and is ranked second by the World Health Organization (WHO) in terms of its impact on health and quality of life, following cardiovascular diseases. This condition is characterized by low mood, sadness, pessimism, and profound, inexplicable despair.

Low mood (depression) is characterized by feelings of sadness, pessimism, diminished interest, and reduced energy.

Depression (depressive emotions) is characterized by the following symptoms:

• Pronounced sadness and melancholy expressed clearly through facial expressions and posture in gait and behavior.
• Reduced or loss of interest in almost everything, including previously enjoyed activities.
• Unintentional weight loss or gain. Many patients tend to engage in indiscriminate eating and rapidly become obese.
• Most depressed patients experience sleep disturbances. However, there are also individuals who sleep excessively (over 12 hours per day).
• Constant feelings of restlessness, anxiety, and an inability to sit still, often engaging in continuous movement to alleviate these sensations.
• Some patients become slow (speaking softly, speaking slowly, monotonous speech, dull thinking), often lying or sitting still for long hours.
• Fatigue and loss of energy, even lacking the motivation to perform any tasks, including personal hygiene.
• Feeling worthless and guilty for committing serious offenses.
• Difficulty maintaining concentration, reduced memory, slow thinking, and difficulty making even simple decisions.
• Prolonged depression can lead patients to develop suicidal thoughts and engage in self-harm.

Depression is characterized by diminished emotional affect. However, beyond the emotional symptoms, patients also face abnormalities in cognition and behavior. These abnormalities lead to a range of physical issues such as urinary disorders, headaches, insomnia, reduced libido, menstrual disorders, shoulder and neck pain, and more.

Elevated Emotions (Mania)

Mania is characterized by heightened emotional states, contrasting with depression. Emotions fluctuate from excitement to elation and transition to a highly agitated state. When in this state, emotions are immediately suppressed and shift to depression. This is why mania only appears in bipolar disorder and never occurs in isolation like depression.

In contrast to feelings of inhibition, depression is characterized by heightened and uncontrollable emotions.

Symptoms when emotions are elevated (mania):

• Excessive and rapid speech, but with unclear and disordered content.
• Often delusional about one’s own abilities, such as being excessively confident, believing oneself to be exceptionally talented and superior to others.
• Abnormally cheerful mood and optimism, unable to control one’s own emotions.
• Occasionally, impulsive thoughts and behaviors without considering the consequences, such as reckless driving, wasteful spending, risky investments, etc.
• Reduced need for sleep, usually only sleeping 2-4 hours per day, but the body remains full of energy and never feels tired.
• Rapid thinking and numerous ideas in the mind. During manic episodes, patients often set numerous goals and plans in life. However, most of these goals lack realism and are delusional.
• Increased instinctual activities such as excessive eating, thoughtless speech, and impulsive actions. Some individuals experience increased sexual desire and may engage in risky sexual behaviors.
• Facial expressions vary, sometimes appearing theatrical and exaggerated. They eat and sleep less but do not feel tired, even increasing physical activities. During a manic episode, patients often walk like parading or adopt seductive poses to provoke sexual desire in others.
• When emotions reach their peak, it can result in irritable mood, aggression, provocation, destructive behavior.

Hypomania/depression rarely leads to suicide. The sole impact of this type of emotional disorder is physical health and financial issues caused by impulsive behaviors such as reckless driving, unsafe sexual activities, and risky investments.

Bipolar disorder

Bipolar disorder is a common mood disorder that occurs after depression. This type of mood disorder is characterized by the alternating episodes of depression and hypomania. Bipolar disorder is often associated with genetic and endogenous factors. As a result, most cases of the illness are chronic and require lifelong management.

Bipolar disorder is categorized into three types:

• Bipolar I disorder
• Bipolar II disorder
• Cyclothymic disorder

The Causes of Emotional Disorders

Currently, the prevalence rate of this condition in the population has reached 5% and is predicted to increase under the pressure of modern life. However, the precise causes of emotional disorders are still not fully understood. Nevertheless, experts have identified several factors that contribute to the pathogenesis and increased risk of developing these disorders, including:

Genetic factors

Genetics have been identified as a factor that increases the risk of emotional disorders, with the heritability rate of depression being 10-15% and of mania being 15-20% if there is a family history of the illness.

Genetics is identified as one of the risk factors that increases the likelihood of developing emotional disorders.

Genetic factors determine the structure and functioning of the brain. Experts believe that abnormalities in the MAOA gene and serotonin transporter gene are the causes of the genetic transmission of emotional disorders.

Imbalance of neurotransmitters

As mentioned, emotions are regulated by neurotransmitters in the brain. Therefore, experts hypothesize that emotional disorders occur due to dysregulation of neurotransmission in cholinergic, serotonergic, catecholaminergic (dopaminergic/noradrenergic), and other systems.

This condition leads to abnormal increases or decreases in intrinsic factors such as serotonin, norepinephrine, dopamine, which result in emotions being excessively elevated or diminished beyond normal limits. This hypothesis is supported by the fact that emotional disorders predominantly occur during periods of hormonal changes such as puberty, pregnancy, postpartum, and perimenopause.

During certain specific stages, endocrine systems such as the hypothalamic-pituitary-adrenal axis, hypothalamic-pituitary-thyroid axis, or growth hormone axis undergo sudden changes. These alterations affect regulation, resulting in an imbalance of neurotransmitters. This mechanism leads to excessively low or high levels of emotions.

Psychosocial factors

Psychosocial factors have been identified by many experts as equally important in the pathogenesis of emotional disorders. Without these factors, the existing factors (genetic factors) rarely lead to emotional disorders.

Traumatic events such as financial debt, accidents, loss of loved ones, etc., are the triggering factors for the onset of emotional disorders.

Typically, emotional disorders arise following traumatic events such as the loss of a loved one, financial crises, parental divorce, unexpected accidents, or fires. When confronted with these events, emotions can be either excessively suppressed or heightened abnormally, leading to emotional disorders.

Physical brain damage

Emotional disorders in general, and depression in particular, often manifest after severe brain injuries such as encephalitis, brain tumors, traumatic brain injuries, and other similar conditions. Physical damage to the brain disrupts the functioning of neurotransmitters, resulting in an imbalance of intrinsic factors.

Other factors

In addition to the aforementioned causes, emotional disorders may also be related to other factors such as:

Alcohol addiction has been identified to increase the risk of respiratory disorders and various other mental health issues.

Regarding gender: Women are more prone to experiencing higher levels of emotional disorders due to heightened responsiveness and greater exposure to stress. On the other hand, men are less affected by stress due to their resilient mentality and less anxious nature. In addition to emotional disorders, women also have a higher risk of developing anxiety disorders, dissociative disorders, and other conditions due to their sensitive psychological disposition.

Thyroid disorders: The thyroid hormone regulates the functioning of organs in the body and has significant influence on other endocrine glands. As a result, it indirectly affects neurotransmitters and causes abnormal changes in emotions. Numerous studies have shown that individuals with thyroid disorders are more susceptible to emotional disorders compared to the general population.

Hormonal changes: Hormonal fluctuations during pregnancy, childbirth, menstruation, and menopause have a close relationship with emotional disorders. These changes in hormones lead to a series of reactions in the body and can result in an imbalance of neurotransmitters.

Other factors: The risk of experiencing emotional disorders can significantly increase due to other factors such as severe physical health issues (diabetes, cancer, lupus, etc.), stress, sedentary lifestyle, history of depression, alcohol or substance abuse, and misuse of drugs affecting the central nervous system.

It is evident that emotional disorders are influenced by various factors, with biological and psychosocial factors playing a primary role.

Emotional disorders and their severe impacts

Emotional disorders are a form of mental disorder that greatly affects health and quality of life. Among them, depression has a more severe impact than mania. During manic episodes, patients face the risk of physical illnesses, injuries due to reckless behaviors, and financial issues resulting from impulsive shopping and risky investments.

On the other hand, depression causes deep and persistent feelings of sadness, diminished interest, and loss of energy. If left untreated, patients may develop suicidal thoughts and self-harm tendencies. The suicide rate among individuals with depression ranges from 2% to 15%, depending on the severity of the condition. Moreover, individuals who abuse alcohol or addictive substances have an even higher risk of suicide.

If not treated early, emotional disturbances can lead to suicidal thoughts and behavior

Emotions play a significant role in shaping an individual’s perception and behavior. Consequently, this disorder can lead to various complications such as alcohol and substance addiction, inability to perform daily activities, difficulties in learning and working, and impaired social interactions.

Individuals with emotional disorders often choose to live in isolation, detached from others, and heavily reliant on their families. Untreated emotional disorders also increase the risk of developing other conditions like anxiety disorders and somatic disorders. Over time, patients may develop suicidal thoughts as a means to escape profound sadness and feelings of guilt.

Diagnosis of emotional disorders

Emotional disorders are typically diagnosed based on clinical symptoms. Currently, physicians utilize diagnostic criteria such as DSM-5 or ICD-10 to diagnose mental disorders, including emotional disorders. Additionally, doctors may request certain laboratory tests and assess the response to medication to rule out any physical illnesses.

Diagnostic techniques employed include:

• Exploring symptoms, personal history, family background, and screening for predisposing factors.
• Conducting relevant laboratory tests to exclude other potential causes.
• Performing psychological health assessments.

Treatment approaches for emotional disorders

To date, the exact etiology and underlying mechanisms of emotional disorders have not been definitively identified. Therefore, the treatment process and prevention of relapse still present significant challenges. At present, treatment methods can partially manage symptoms and improve patients’ quality of life.

Treatment approaches for emotional disorders include:

Pharmacotherapy

Pharmacotherapy is employed during depressive and manic episodes. For patients with depressive disorders, medications are often used long-term to prevent relapses. The response to medication varies among individuals, so patients may need to try multiple types of medication until they find the one that suits them best.

The use of medication is the primary method in treating emotional disorders

Types of medications used in the treatment of depression:

• Selective serotonin reuptake inhibitors (SSRIs), which are antidepressant medications that selectively inhibit the reuptake of serotonin.
• Serotonin-norepinephrine reuptake inhibitors (SNRIs), which inhibit the reuptake of both serotonin and norepinephrine.
• Tricyclic antidepressants, which are a class of antidepressant medications.
• Monoamine oxidase inhibitors (MAOIs), which inhibit the enzyme monoamine oxidase.
• Nervous system sedatives such as Olanzapine, Risperidone, Quetiapine.
• Mood stabilizers like Lithium, Carbamazepine, Divalproate.
• Some medications or supplements that help regenerate nerve cells and enhance brain function.

These antidepressant medications work by increasing the levels of neurotransmitters in the brain, thereby improving mood. In addition to the mentioned medications, patients may be prescribed certain medications to alleviate physical symptoms. For individuals with bipolar disorder, it is important for their families to be equipped with knowledge to recognize and discontinue antidepressant medication when the patient enters a manic episode.

Medications used in the manic phase include:

• Nervous system sedatives that have antipsychotic effects, such as Tercian, Thioridazine, Levomepromazine.
• Mood stabilizers like Valproate, Lithium, Carbamazepine.
• Potent antipsychotic medications such as Haloperidol.

Psychotherapy

Psychotherapy is an effective method for treating emotional disorders, particularly depression. Controlled trials have demonstrated significant efficacy of psychotherapeutic interventions in improving symptoms and reducing the risk of relapse. Moreover, patients receive support, enhance self-esteem, and acquire essential life skills.

Psychotherapy is performed with the aim of relieving emotions and helping patients find mental balance

The psychological therapy methods applied for patients with emotional disorders include:

• Cognitive-behavioral therapy (CBT)
• Psychoanalytic therapy
• Systemic therapy
• Hypnotherapy

The goals of psychotherapy are to help patients release repressed emotions and adjust distorted beliefs and perceptions. Depending on each patient’s specific condition, the therapist will intervene accordingly. Although the process of therapy may vary, the overall objective is to promote good mental health and well-being for the patient.

Additionally, patients with emotional disorders caused by exposure to stress will be equipped with stress management skills. Besides verbal psychotherapy, the therapist may guide patients in practicing various supportive techniques such as breathing exercises, music therapy, and relaxation training.

Currently, psychotherapy is prioritized as a method in the treatment of many mental disorders, including emotional disorders. This approach does not involve medication or invasive procedures. However, to achieve high effectiveness, patients are often recommended to combine pharmacotherapy with psychotherapy.

Electroconvulsive therapy (ECT)

Electroconvulsive therapy (ECT) is commonly applied to severely depressed patients, particularly those who do not respond to medication and have developed suicidal thoughts and behaviors. This therapy uses controlled electrical currents to induce small seizures within the brain. The purpose of ECT is to improve regulation and balance the levels of neurotransmitters.

Electroconvulsive Therapy (ECT) is applied to patients with severe depression who have developed suicidal thoughts and behaviors.

Typically, after 6 to 10 sessions, there is a noticeable improvement in depressive symptoms. Afterward, the patient will be prescribed medication to prevent relapse. Electroconvulsive therapy (ECT) can be highly effective but carries certain risks. Therefore, ECT is primarily used in cases of severe depression that have been resistant to medication.

Other treatment methods

In addition to the above three methods, patients with emotional disorders may also undergo treatment using other approaches such as:

Repetitive Transcranial Magnetic Stimulation (rTMS) is also considered in the treatment of emotional disorders, particularly during depressive episodes.

• Light therapy: For cases of seasonal affective disorder, light therapy is considered a primary method alongside medication. This approach involves exposing the patient to artificial light to regulate the biological clock and balance neurotransmitters. Light therapy significantly reduces symptoms of seasonal affective disorder that occur during the autumn and winter when sunlight intensity and exposure time decrease.
• Vagus nerve stimulation therapy: This therapy is also considered for treatment-resistant depression. Vagus nerve stimulation therapy is performed by surgically implanting a device in the left chest. The device generates electrical impulses that are sent to the brain to regulate neurotransmitters and alleviate symptoms of emotional disorders.
• Repetitive transcranial magnetic stimulation (rTMS): Repetitive transcranial magnetic stimulation is a non-invasive skull stimulation method similar to electroconvulsive therapy. This method uses magnetic fields to stimulate a specific area of the brain by delivering repeated pulses to balance brain biochemistry. rTMS is effective in improving depressive symptoms and reducing chronic pain associated with emotional disorders.

Alongside the treatment of emotional disorders, patients will receive treatment for physical disorders such as multiple sclerosis, Parkinson’s disease, benign/malignant brain tumors, thyroid disorders, if present.

Care regimen for patients with emotional disorders

Emotional disorders significantly impact quality of life and overall health. Currently, interventions and treatments can help manage the condition and enable patients to normalize their lives. However, in many cases, the disease may relapse under favorable conditions. To strengthen their health and reduce the likelihood of relapse, patients should adopt an appropriate care regimen.

Patients need to have a proper care regimen to improve their health and reduce the risk of disease relapse.

The care regimen for patients with emotional disorders includes:

• Establishing a scientific and balanced diet to maintain overall health. Supplementing with plenty of vegetables, fiber, whole grains, fatty fish, legumes, and seeds can improve symptoms to some extent. Vitamins and minerals found in healthy foods contribute to stabilizing brain neurotransmitter levels, thereby enhancing mood and improving sleep quality.
• Engaging in daily exercise, especially activities like meditation and yoga. Exercise helps patients control physical symptoms caused by emotional disorders while supporting mental well-being and relieving nervous tension.
• Communicating with family members, friends, and colleagues about one’s health condition to seek support. When those around understand the patient’s health condition, they can adopt an appropriate attitude and behavior. This allows patients to feel more reassured during treatment and avoid feelings of isolation and detachment.
• Getting sufficient sleep is a natural remedy that enhances health and alleviates mood. If experiencing sleep issues, patients can follow the guidance of a doctor or try natural remedies such as taking a warm bath, consuming herbal tea, receiving massages, practicing meditation, or using aromatherapy.
• Stress can exacerbate emotional disorders. During treatment, patients should isolate themselves from stressors. If possible, they can directly communicate with superiors to reduce workload during the treatment period.
• Avoiding negative sources of information, as they significantly affect mood. Instead, patients should focus on positive aspects of life to gain motivation in overcoming illness.

The prevalence of emotional disorders has been increasing in recent years. Therefore, actively equipping oneself with useful knowledge is essential. If there are suspicions of oneself or others having this condition, timely interventions should be taken to prevent regrettable consequences.