<hr />
<p>Whew, OK. I am going to take a crack at this. The question asks about depression <em>diagnoses</em>, so I will interpret and focus on that accordingly. I think we can all agree that making any clear distinction between endogenous and exogenous causes of depression is difficult, since 1) liken to the Nature vs. Nurture question, people generally agree that Major Depression is a result of multiple factors, and 2) clinicians disagree on which (exogenous vs. endogenous) tends to be the &quot;primary&quot; cause of depression [<a href="http://solution.lww.com/synopsisofpsychiatry" rel="nofollow noreferrer">1</a>].</p>
<p>When it comes to making a clinical diagnosis, psychiatrists and other mental health professionals will use the <a href="http://dsm.psychiatryonline.org/book.aspx?bookid=22" rel="nofollow noreferrer">multi-axial</a> system in documentation. <strong>Axis IV</strong> is a part of the system, and is where exogenous factors can be reported as psychosocial and environmental problems that may affect the diagnosis, treatment, and prognosis [<a href="http://dsm.psychiatryonline.org/book.aspx?bookid=22" rel="nofollow noreferrer">2</a>]. In addition, the clinician should know to keep in mind that psychosocial problems may develop <em>as a consequence of the patient's psychopathology</em>!</p>
<p>Examples of commonly listed psychosocial and environmental problems include family problems (illness, death), social environment (<strong>isolation</strong>), educational/occupational problems, economic problems, etc., etc.</p>
<blockquote>
<p>The evaluation of stressors is based on a clinician's assessment of the stress that an average person with similar sociocultural values and circumstances would experience from psychosocial stressors [<a href="http://solution.lww.com/synopsisofpsychiatry" rel="nofollow noreferrer">1</a>].
<em>The judgement is based on the degree of change that the stressor causes in the person's life, the degree to which the event is desired and under the person's control, and the number of stressors.</em></p>
</blockquote>
<hr />
<p><strong>Tidbits</strong></p>
<ul>
<li>To make a quick note about endogenous factors, it is interesting to note that the most consistent abnormality in those with depressive disorders is increased frequency of abnormal <a href="http://en.wikipedia.org/wiki/Hyperintensities" rel="nofollow noreferrer">hyperintensities</a> in subcortical regions of the brain...</li>
<li>A long-standing clinical observation is that stressful life events more often precede first, rather than subsequent, episodes of mood disorders.</li>
<li>^ One theory proposed is that the stress accompanying a first episode results in long-lasting changes in the brain's biology... so a person has a high(er) risk of experiencing subsequent episodes of (a) mood disorder(s), <strong>even without an external stressor</strong> [<a href="http://solution.lww.com/synopsisofpsychiatry" rel="nofollow noreferrer">1</a>].</li>
<li>While some clinicians believe that life events play the primary or principal role in depression, others suggest that life events have only a limited role in the onset and timing of depression.</li>
<li>What may seem to be a relatively mild stressor to outsiders may be devastating to the patient due to particular/personal idiosyncratic meanings the patient attach to the event.</li>
<li><a href="http://www.bostonpsychoanalytic.org/library/coll_bibe.html" rel="nofollow noreferrer">Edward Bibring</a> thought perhaps depression is [the result of] the phenomenon that sets in when a person becomes cognizant of a discrepancy between his high ideals and the inability to meet the goals appropriate to reach said ideals.</li>
</ul>
<hr />
<p>I suppose I did not provide an adequate answer to your question. Given what I have looked into, it appears that individuality plays a ginormous factor in determining one's personal cause(es), and not only do clinicians disagree on the source of depression, but it appears that when clinicians make their diagnosis/diagnoses, a clear distinction between endogenous and exogenous influences is <strong>not</strong> made. At least, generally speaking...</p>
<h3>References</h3>
<ul>
<li><a href="http://solution.lww.com/synopsisofpsychiatry" rel="nofollow noreferrer">Kaplan and Sadock's Synopsis of Psychiatry</a></li>
<li><a href="http://dsm.psychiatryonline.org/book.aspx?bookid=22" rel="nofollow noreferrer">DSM-IV-TR® Diagnostic and Statistical Manual of Mental Disorders</a></li>
</ul>

CC BY-SA 3.0
2012-06-24T06:04:02.923Z
2012-06-24T06:04:02.923Z
2020-06-17T09:55:31.633Z
PheonixEnder
<p>Roughly speaking, we might imagine that people have depression predominantly for one of two reasons:</p>

<ul>
<li><p><strong>Endogenously induced:</strong> The person has some inherent inballance between different neurotransmittors; some part of the persons's brain that regulates emotions is damaged et cetera.</p></li>
<li><p><strong>Exogenously induced:</strong> The person has no friends; the person has been left by several of his/her partners; the person is unemployed and can't get a job et cetera.</p></li>
</ul>

<p>Obviously, in many cases it will not be this black and white. </p>

CC BY-SA 3.0
2012-05-31T18:21:28.807Z
the two are often coupled. Also, you make more than endogenous and exogenous in your distinction. Your first is about the brain, your second is about the mind (well, even further: mind in social context). I would try to make the scope be of the same field. I.e. at least adjust your endogenous reasons to mind-centered/psychological ones and do not try to talk about the brain directly. Especially when you are asking about [tag:psychiatry] (also, good tag to add to this question).
Artem Kaznatcheev
CC BY-SA 3.0
2012-05-31T18:52:19.657Z
Well, the distinction I'm really after is one situation where you either can treat the person with medicines and one situation where you only need to change the external circumstances for the person.
Speldosa
CC BY-SA 3.0
2012-06-01T01:21:32.227Z
Possibly relevant, DSM IV criteria exceptions to major depressive episode: "D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).E. The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation." http://www.mental-health-today.com/dep/dsm.htm
Jeromy Anglim
CC BY-SA 3.0
2012-06-03T09:27:48.863Z
+1 for a nice question, but I don't understand if you care for the distinction **inside-outside** or **brain-mind**. For example, does (lack of) performing psychical activity or exposure to sunlight count as your "exogenous" or "exogenous"? Most likely, most of the time causes are combined. However, I am very interesting in more solid findings.
Piotr Migdal
CC BY-SA 3.0
2012-07-13T19:18:56.950Z
If exogenous factors -> physiological alterations -> depression, then medication can still act on that pathway whether the initiation was at the physiological level or some environmental aspect.  The corollary is that if physiological alterations -> depression, BUT also exogenous factors -> physiological alterations, then phsyiologically initiated depression may be changeable via exogenous pathways.  To wit, both medication and psychotherapy or exogenous factors may play a salutary role in either exogenously or endogenously induced depression.
Joshua
<abnormal-psychology><psychiatry><depression>
For depression diagnoses, does one make a clear distinction between endogenous and exogenous causes of depression?
Speldosa
# For depression diagnoses, does one make a clear distinction between endogenous and exogenous causes of depression?

(Asked by: username_0 on 2012-05-31)

Roughly speaking, we might imagine that people have depression predominantly for one of two reasons:

* **Endogenously induced:** The person has some inherent inballance between different neurotransmittors; some part of the persons's brain that regulates emotions is damaged et cetera.
* **Exogenously induced:** The person has no friends; the person has been left by several of his/her partners; the person is unemployed and can't get a job et cetera.

Obviously, in many cases it will not be this black and white.

**Tags:** abnormal-psychology, psychiatry, depression

> **Comments:**
> **username_1**: the two are often coupled. Also, you make more than endogenous and exogenous in your distinction. Your first is about the brain, your second is about the mind (well, even further: mind in social context). I would try to make the scope be of the same field. I.e. at least adjust your endogenous reasons to mind-centered/psychological ones and do not try to talk about the brain directly. Especially when you are asking about [tag:psychiatry] (also, good tag to add to this question).  
> **username_0**: Well, the distinction I'm really after is one situation where you either can treat the person with medicines and one situation where you only need to change the external circumstances for the person.  
> **username_2**: Possibly relevant, DSM IV criteria exceptions to major depressive episode: "D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).E. The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation." http://www.mental-health-today.com/dep/dsm.htm  
> **username_3**: +1 for a nice question, but I don't understand if you care for the distinction **inside-outside** or **brain-mind**. For example, does (lack of) performing psychical activity or exposure to sunlight count as your "exogenous" or "exogenous"? Most likely, most of the time causes are combined. However, I am very interesting in more solid findings.  
> **username_4**: If exogenous factors -> physiological alterations -> depression, then medication can still act on that pathway whether the initiation was at the physiological level or some environmental aspect.  The corollary is that if physiological alterations -> depression, BUT also exogenous factors -> physiological alterations, then phsyiologically initiated depression may be changeable via exogenous pathways.  To wit, both medication and psychotherapy or exogenous factors may play a salutary role in either exogenously or endogenously induced depression.  

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## 1 answers

### Answer by username_5 on 2012-06-24. Score: 3

---

Whew, OK. I am going to take a crack at this. The question asks about depression *diagnoses*, so I will interpret and focus on that accordingly. I think we can all agree that making any clear distinction between endogenous and exogenous causes of depression is difficult, since 1) liken to the Nature vs. Nurture question, people generally agree that Major Depression is a result of multiple factors, and 2) clinicians disagree on which (exogenous vs. endogenous) tends to be the "primary" cause of depression [[1](http://solution.lww.com/synopsisofpsychiatry)].

When it comes to making a clinical diagnosis, psychiatrists and other mental health professionals will use the [multi-axial](http://dsm.psychiatryonline.org/book.aspx?bookid=22) system in documentation. **Axis IV** is a part of the system, and is where exogenous factors can be reported as psychosocial and environmental problems that may affect the diagnosis, treatment, and prognosis [[2](http://dsm.psychiatryonline.org/book.aspx?bookid=22)]. In addition, the clinician should know to keep in mind that psychosocial problems may develop *as a consequence of the patient's psychopathology*!

Examples of commonly listed psychosocial and environmental problems include family problems (illness, death), social environment (**isolation**), educational/occupational problems, economic problems, etc., etc.

> The evaluation of stressors is based on a clinician's assessment of the stress that an average person with similar sociocultural values and circumstances would experience from psychosocial stressors [[1](http://solution.lww.com/synopsisofpsychiatry)].
> *The judgement is based on the degree of change that the stressor causes in the person's life, the degree to which the event is desired and under the person's control, and the number of stressors.*

---

**Tidbits**

* To make a quick note about endogenous factors, it is interesting to note that the most consistent abnormality in those with depressive disorders is increased frequency of abnormal [hyperintensities](http://en.wikipedia.org/wiki/Hyperintensities) in subcortical regions of the brain...
* A long-standing clinical observation is that stressful life events more often precede first, rather than subsequent, episodes of mood disorders.
* ^ One theory proposed is that the stress accompanying a first episode results in long-lasting changes in the brain's biology... so a person has a high(er) risk of experiencing subsequent episodes of (a) mood disorder(s), **even without an external stressor** [[1](http://solution.lww.com/synopsisofpsychiatry)].
* While some clinicians believe that life events play the primary or principal role in depression, others suggest that life events have only a limited role in the onset and timing of depression.
* What may seem to be a relatively mild stressor to outsiders may be devastating to the patient due to particular/personal idiosyncratic meanings the patient attach to the event.
* [Edward Bibring](http://www.bostonpsychoanalytic.org/library/coll_bibe.html) thought perhaps depression is [the result of] the phenomenon that sets in when a person becomes cognizant of a discrepancy between his high ideals and the inability to meet the goals appropriate to reach said ideals.

---

I suppose I did not provide an adequate answer to your question. Given what I have looked into, it appears that individuality plays a ginormous factor in determining one's personal cause(es), and not only do clinicians disagree on the source of depression, but it appears that when clinicians make their diagnosis/diagnoses, a clear distinction between endogenous and exogenous influences is **not** made. At least, generally speaking...

### References

* [Kaplan and Sadock's Synopsis of Psychiatry](http://solution.lww.com/synopsisofpsychiatry)
* [DSM-IV-TR® Diagnostic and Statistical Manual of Mental Disorders](http://dsm.psychiatryonline.org/book.aspx?bookid=22)


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