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Mood and Anxiety Disorders in Women
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Book description

Mood and anxiety disorders in women represent an increasingly important area of research and treatment development. The authors take a broad biopsychosocial and developmental approach to the issues, beginning with anxiety disorders in adolescence and progressing through the life phases of women to menopause and old age. All the disorders are covered, from anxiety and borderline personality disorder to stress and late-life depression. Particular attention is paid to questions of vulnerability; epidemiological and clinical evidence showing gender differences in such disorders; aetiological explanations in terms of biological (including hormonal) as well as psychosocial parameters, and treatment implications.


'… this book covers a wide spectrum of topics relevant to the psychiatrist, psychologist, social worker, and mental health nurse in a straight forward manner, making it a good read for the general practitioner.'

Source: Saudi Medical Journal

' … chapters are beautifully written while remaining rich in research information … I unequivocally recommend this book. It makes an ambitious contribution to our understanding of gender disparity within the filed of women's mental well-being, effectively collating current disparate information into a coherent integrative overview. The result is a collection of meaty essays which should comprehensively satisfy the appetite for an enlightened and broadened perspective.'

Source: British Journal of Psychiatry

'The writing is clear and succinct, and the discussions are broad based and well supported with references to recent research. Developmental, social, cultural, biological, and psychological factors are all considered … I find it difficult to praise one chapter over another because every one was filled with useful data for researchers, clinicians, educators, and health care administrators … [this book] is an excellent overview of selected mental disorders that disproportionately affect women. Clinicians in both inpatient and outpatient mental health practice will find it a valuable guide to understanding these disorders and to current treatment practices.'

Source: Psychiatry Services

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  • 1 - Pubertal development and the emergence of the gender gap in mood disorders: A developmental and evolutionary synthesis
    pp 1-19
    • By Nicholas B. Allen, ORYGEN Research Centre and Department of Psychology, University of Melbourne, Australia, Anna Barrett, ORYGEN Research Centre and Department of Psychology, University of Melbourne, Australia, Lisa Sheeber, Oregon Research Institute, Eugene, OR, USA, Betsy Davis, Oregon Research Institute, Eugene, OR, USA
  • View abstract


    This chapter examines the emergence of the gender gap in depressive disorders at puberty, and to compare alternative theories as to the factors that underpin gender differentiation in depression at this developmental stage. The gender intensification hypothesis suggests that gender role orientations become more differentiated between the sexes over the adolescent years, as a result of exacerbated gender socialisation pressures during this time. The social-risk hypothesis of depression suggests that depressed mood evolved to facilitate a risk-averse approach to social interaction in situations where individuals perceive their social resources to be at critically low levels. Sexual selection has been used to understand the emergence of sex differences in a variety of areas of human behaviour. Research on sex differences in social cognition has supported the prediction that females are more sensitive to the negative social implications of information.
  • 2 - Borderline personality disorder: Sex differences
    pp 20-38
    • By Andrew M. Chanen, ORYGEN Research Centre, Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
  • View abstract


    Borderline personality disorder (BPD) is the most common and the most serious of the personality disorders (PDs) in clinical practice. This chapter overviews sex differences in BPD, covering clinical presentation, longitudinal course, aetiological factors and neurobiological underpinnings. Cross-sectional baseline data from the Collaborative Longitudinal Study of Personality Disorders (CLPS) comparing 175 women with 65 men with BPD found men with BPD to be more likely to present with substance use disorders, along with schizotypal, narcissistic and antisocial personality disorder (ASPD). The aetiological underpinnings of sex differences in PDs in general and BPD in particular are complex, with multi-level interactions of genetic and environmental parameters acting at certain vulnerable stages of neural, emotional and social development. Neuropsychological investigation suggests a dysfunctional prefrontal circuit in impulsive aggression. Three positron emission tomography (PET) studies have found prefrontal cortical hypo metabolism in BPD compared to healthy controls.
  • 3 - Substance use and abuse in women
    pp 39-58
    • By Clare Gerada, Hurley Clinic, Kennington Lane, London, UK, Kristy Johns, Alcohol and Other Drugs Service, Central Coast Health, NSW, Australia, Amanda Baker, Centre for Mental Health Studies, University of Newcastle, NSW, Australia, David Castle, Mental Health Research Institute and University of Melbourne, Parkville, Victoria, Australia
  • View abstract


    This chapter describes how and why women may also be gaining ground on their male counterparts in the consumption of alcohol and illicit substances. Surveys of substance abuse and dependence in the general population fairly consistently show overall rates in females to be lower than those in males. Women with affective and anxiety disorders are more likely to present with alcohol or drug abuse/dependence than are women without such disorders. Antisocial personality disorder (APD) is another psychiatric condition strongly associated with substance abuse and dependence. The impact of substance abuse on reproductive fitness in women is evidenced by higher rates of amenorrhoea and anovulatory cycles. The high rate of treatment dropout for women with drug and alcohol problems is of great concern to clinicians and researchers as there is a powerful association between dropping out and negative outcome.
  • 4 - Anxiety disorders in women
    pp 59-74
    • By Heather B. Howell, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA, David Castle, Mental Health Research Institute and University of Melbourne, Parkville, Victoria, Australia, Kimberly A. Yonkers, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
  • View abstract


    Anxiety disorders are common in that 19% of men and 31% of women will develop some type of anxiety disorder during their lifetime. This chapter reviews sex differences in the epidemiology, clinical characteristics and illness course for the anxiety disorders. It also discusses the influence of the premenstruum, gestation and delivery on the expression of anxiety disorders. Post-traumatic stress disorder (PTSD) occurs after an individual is exposed to "an extreme traumatic stressor". A number of researchers have reported that women are more likely to have a chronic course after first manifesting PTSD. Generalized anxiety disorder (GAD) is more common in women. Social phobia is commonly comorbid with other conditions, particularly panic disorder, GAD, major depressive disorder, obsessive-compulsive disorder (OCD) and agoraphobia. Pregnancy and the postpartum period can be times of worsening or onset of obsessive-compulsive disorder (OCD). The chapter concludes that the anxiety disorders disproportionately affect women.
  • 5 - Posttraumatic stress disorder in women
    pp 75-91
    • By Mark Creamer, Australian Centre for Posttraumatic Mental Health, University of Melbourne, Melbourne, Victoria, Australia, Jessica Carty, Australian Centre for Posttraumatic Mental Health, University of Melbourne, Melbourne, Victoria, Australia
  • View abstract


    This chapter discusses posttraumatic stress disorder (PTSD) in women. The clinical presentation in both men and women is often complex, with high levels of depression, anxiety, and substance use. Several epidemiological studies have indicated that, while men are more likely than women to be exposed to traumatic events, the prevalence of PTSD within the community is approximately twice as high for women. Few studies have investigated psycho physiological differences between men and women in acute reactions to threat that may serve as potential mediators for PTSD vulnerability. A mounting body of empirical research has supported the efficacy of certain types of psychotropic medication in the treatment of PTSD. Finally, while women may be at greater risk for the development of psychiatric sequelae following trauma, preliminary findings from treatment outcome studies indicate that they may benefit from PTSD interventions to a greater extent than men.
  • 6 - Domestic violence and its impact on mood disorder in women: Implications for mental health workers
    pp 92-115
    • By Alison L. Warburton, Centre for Women's Mental Health Research, Division of Psychiatry, University of Manchester, Williamson Building, Manchester, UK, Kathryn M. Abel, Centre for Women's Mental Health Research, Division of Psychiatry, University of Manchester, Williamson Building, Manchester, UK
  • View abstract


    This chapter defines domestic violence and its mental health outcomes. It highlights the barriers that might prevent health professionals' adequate assessment of the problem, and suggests possible solutions. Domestic violence involves a pattern of abusive and controlling behaviour that tends to increase in severity and frequency over time and to continue beyond the ending of the relationship. Being a woman is the single most important risk factor for experiencing domestic violence. One of the times of highest risk for women experiencing domestic violence is during pregnancy. Providing the right environment can be an important incentive to disclosure of domestic violence: confidentiality, privacy, sensitive questioning, and a nonjudgmental attitude are required. Mental health-care professionals should develop formal partnerships with other agencies especially the voluntary sector and build strategies for intervention in consultation with women. Domestic violence affects at least 25% of women and has wide-reaching, longterm physical and mental health consequences.
  • 7 - Depression in women: Hormonal influences
    pp 116-135
    • By Kathryn M. Abel, Senior Lecturer and Honourary Consultant, Centre for Women's Mental Health Research, Division of Psychiatry, University of Manchester, Manchester, UK, Jayashri Kulkarni, Professor of Psychiatry, The Alfred, Melbourne, Australia; Professor Monash University, Faculty of Medicine, Melbourne, Australia
  • View abstract


    Women have an increased vulnerability to depressive disorders during their child-bearing years. Women experience very different physiological changes in gonadal steroids and psychosocial stressors compared to men. This chapter considers hormonal influences on depression and overviews the actions of the gonadal steroids. The gonadal steroid effects are classified into organisational or activational, depending on the duration and timing of the effect. Hormonal treatments for premenstrual dysphoric disorder (PMDD) have encompassed both oestrogen and progesterone. Several studies have now reported that unintentional foetal loss is associated with subsequent risk of depression, post traumatic stress disorder (PTSD) or an exacerbation of obsessive compulsive symptoms. The factors contributing to postnatal depression (PND) include a personal or family history of mood disorder. The use of oestrogen replacement therapy (ERT) is still controversial, particularly with the recent publication of the results of the Women's Mental Health Initiative Randomised Controlled Trial studies.
  • 8 - Anxiety and mood disorders in pregnancy and the postpartum period
    pp 136-162
    • By Anne Buist, Austin Health, Repatriation Campus, Department of Psychiatry, West Heidelberg, Vic., Australia, Lori E. Ross, Women's Mental Health & Addiction Research Section, Centre for Addiction & Mental Health, Toronto, Ont., Canada, Meir Steiner, Department of Psychiatry Behavioural Neurosciences and Obstetrics & Gynecology, McMasters University, St Joseph's Healthcare, Hamilton, Ont., Canada
  • View abstract


    This chapter outlines the ways of identifying women at risk and/or women who already show signs and symptoms of depression/anxiety associated with childbearing; and suggest treatment options and preventive measures. Depression during pregnancy is common, with reports suggesting that approximately 10-20" of pregnant women meet criteria for a major or minor depressive disorder. Postpartum psychosis may have any of the features of acute schizophreniform disorder, but most frequently resembles an episode of bipolar disorder, with an early manic phase and later depressive swing. Prevention is considered to be the first line of treatment for postpartum depression. A majority of women have significant psychological issues associated with their transition to motherhood. Interpersonal psychotherapy (IPT) has also shown promise in the treatment of depression, both during pregnancy and in the postnatal period. A number of studies have looked at hormonal treatment and prevention of perinatal psychiatric disorders.
  • 9 - Pharmacological treatment of anxiety and depression in pregnancy and lactation
    pp 163-184
    • By Seetal Dodd, Department of Clinical and Biomedical Sciences, Barwon Health, The University of Melbourne, Geelong, Victoria, Australia, Jane Opie, Department of Clinical and Biomedical Sciences, Barwon Health, The University of Melbourne, Geelong, Victoria, Australia, Michael Berk, Department of Clinical and Biomedical Sciences, Barwon Health, The University of Melbourne, Geelong, Victoria, Australia; Orygen Youth Health, Parkville, Victoria, Australia
  • View abstract


    Pharmacological treatment during pregnancy and breastfeeding requires serious consideration of safety concerns. This chapter provides the evidence for the safety of agents used in the treatment of mood and anxiety disorders during pregnancy and lactation. Benzodiazepine treatment of anxiety during pregnancy should be secondary to other therapies such as serotonin selective reuptake inhibitors (SSRIs) and psychological approaches. Buspirone is used for its modest anxiolytic effect and low potential for dependence. Hypnotics may be required for short-term use in during pregnancy, or postnatally. Many antidepressants have well-documented records of safety and have a history of use during pregnancy and breastfeeding. SSRIs are often the first choice of antidepressant agent administered to patients presenting with a major depressive episode. The most commonly used mood stabilising agents for the treatment of bipolar disorder are associated with significant risks of foetal malformations and toxicity.
  • 10 - Bipolar affective disorder: Special issues for women
    pp 185-211
    • By Shaila Misri, Department of Psychiatry and OB/GYN, University of British Columbia, Columbia, SC, USA; Reproductive Mental Health Program, St. Paul's Hospital and BC Women's Hospital, Vancouver BC, Canada, Diana Carter, Reproductive Mental Health Program, St. Paul's Hospital and BC Women's Hospital, Vancouver BC, Canada, Ruth M. Little, Reproductive Mental Health Program, St. Paul's Hospital and BC Women's Hospital, Vancouver BC, Canada
  • View abstract


    This chapter describes the gender differences relevant to bipolar disorder (BD), reproductive health issues for women with BD, risk factors for relapse or new onset BD during childbearing, the impact of untreated BD in pregnancy and the postpartum, and the management issues and strategies during preconception and the prenatal, perinatal and post-natal periods. There are differences in the expression of BD in males and females, with women more commonly experiencing rapid cycling, depressive episodes and possibly mixed mania. Experts recommend classifying all pregnant women with BD as "high-risk" pregnancies. The principles of drug administration during pregnancy include using the lowest possible therapeutic dose, monotherapy and using agents with the lowest potential for adverse foetal effects. Pharmacotherapy is the mainstay of treatment for BD. The acute treatment of postpartum psychosis typically involves hospital admission and anti-psychotic medication. During the childbearing era, women with BD face specific risks, particularly illness exacerbation.
  • 11 - Mood and menopause
    pp 212-241
    • By Lorraine Dennerstein, Office for Gender and Health, Department of Psychiatry, The University of Melbourne, Parkville, Vic., Australia, Jeanne Leventhal Alexander, Northern California Kaiser Permanente Medical Group Psychiatry Women's Health Program, CA; Department of Psychiatry, Stanford Medical School, Palo Alto, CA; Alexander Foundation for Women's Health, Alexander Foundation, Berkeley, CA, USA
  • View abstract


    This chapter explores how mood problems relate to the endocrine changes of the natural menopausal transition (MT). It utilizes soundly conducted epidemiological studies to identify any relationship between depressed mood, menopausal status and hormone levels and to determine the relative importance in the aetiology of mid-aged women's depression of hormonal change, chronologic ageing, health problems and other stressors. Clinical conclusions regarding the relationship between menopause and mood are based on a small proportion of self-selecting women who may not be representative of most women's experience. More recent studies such as the USA based Study of 'Women's Health across the Nation' provide an indication of the role of ethnic factors in women's experience of the menopause. The perimenopausal patient requires a dual approach, with the clinician taking into account current research and treatment approaches to menopause and related symptoms, as well as the known research and treatment strategies for mood disorders.
  • 12 - Anxiety and depression in women in old age
    pp 242-266
    • By Robert C. Baldwin, Manchester Mental Health and Social Care Trust, York House, Manchester Royal Infirmary, Manchester, UK, Jane Garner, Department of Old Age Psychiatry, Chase Farm Hospital, The Ridgeway, Enfield, UK
  • View abstract


    Gender, age, ethnicity and class are major dimensions of social inequality in human societies. The higher prevalence of depression among women is due to a higher risk of first onset rather than differential persistence or recurrence. Depressive disorder adds to disability from physical disorder when present and is associated with greater physical decline. Depressive symptoms in older women are associated with both poor cognitive function and subsequent cognitive decline, and female gender is a risk factor for both depression and Alzheimer's disease. Mortality is increased in older patients with depressive disorders. Compared to depression, less is known about risk factors for anxiety disorders in old age, but women are more at risk than men. There is no difference between men and women in terms of antidepressant response. Selective Serotonin Reuptake Inhibitors (SSRIs) are nowadays usually the first line choice. Prevention research is needed throughout the life cycle.


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