Psychological Disorders: Disthymic Disorder
American
Description
A. Depressed mood for most of the day, for more days than not, as
indicated either by subjective account or observation by others, for
at least 2 years. Note: In children and adolescents, mood can be irritable
and duration must be at least 1 year.
B. Presence, while depressed, of two (or more) of the following:
poor appetite or overeating
insomnia or hypersomnia
low energy or fatigue
low self-esteem
poor concentration or difficulty making decisions
feelings of hopelessness
C. During the 2-year period (1 year for children or adolescents) of
the disturbance, the person has never been without the symptoms in
Criteria A and
B for more than 2 months at a time.
D. No Major Depressive Episode has been present during the first 2
years of the disturbance (1 year for children and adolescents); i.e.,
the disturbance is not better accounted for by chronic Major Depressive
Disorder, or Major Depressive Disorder, In Partial Remission.
Note: There may have been a previous Major Depressive Episode provided
there was a full remission (no significant signs or symptoms for 2
months) before development of the Dysthymic Disorder. In addition,
after the initial 2 years (1 year in children or adolescents) of Dysthymic
Disorder, there may be superimposed episodes of Major Depressive Disorder,
in which case both diagnoses may be given when the criteria are met
for a Major Depressive Episode.
E. There
has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode,
and criteria have never been met for Cyclothymic Disorder.
F. The disturbance does not occur exclusively during the course of
a chronic Psychotic Disorder, such as Schizophrenia or Delusional
Disorder.
G. 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).
H. The symptoms cause clinically significant distress or impairment
in social, occupational, or other important areas of functioning.
Criteria
For Mood Episodes
Major
Depressive Episode
A. Five (or more) of the following symptoms have been present during
the same 2-week period and represent a change from previous functioning;
at least one of the symptoms is either (1) depressed mood or (2) loss
of interest or pleasure.
Note: Do not include symptoms that are clearly due to a general medical
condition, or mood-incongruent delusions or hallucinations.
1. depressed
mood most of the day, nearly every day, as indicated by either subjective
report (e.g., feels sad or empty) or observation made by others (e.g.,
appears tearful). Note: In children and adolescents, can be irritable
mood.
2. markedly diminished interest or pleasure in all, or almost all,
activities most of the day, nearly every day (as indicated by either
subjective account or observation made by others)
3. significant weight loss when not dieting or weight gain (e.g.,
a change of more than 5% of body weight in a month), or decrease or
increase in appetite nearly every day. Note: In children, consider
failure to make expected weight gains.
4. insomnia or hypersomnia nearly every day
5. psychomotor agitation or retardation nearly every day (observable
by others, not merely subjective feelings of restlessness or being
slowed down)
6. fatigue or loss of energy nearly every day
7. feelings of worthlessness or excessive or inappropriate guilt (which
may be delusional) nearly every day (not merely self-reproach or guilt
about being sick)
8. diminished ability to think or concentrate, or indecisiveness,
nearly every day (either by subjective account or as observed by others)
9. recurrent thoughts of death (not just fear of dying), recurrent
suicidal ideation without a specific plan, or a suicide attempt or
a specific plan for committing suicide
B. The symptoms do not meet criteria for a Mixed Episode
C. The symptoms cause clinically significant distress or impairment
in social, occupational, or other important areas of functioning.
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.
Manic
Episode
A. A distinct period of abnormally and persistently elevated, expansive,
or irritable mood, lasting at least 1 week (or any duration if hospitalization
is necessary).
B. During the period of mood disturbance, three (or more) of the following
symptoms have persisted (four if the mood is only irritable) and have
been present to a significant degree:
inflated self-esteem or grandiosity
decreased need for sleep (e.g., feels rested after only 3 hours of
sleep)
more talkative than usual or pressure to keep talking
flight of ideas or subjective experience that thoughts are racing
distractibility (i.e., attention too easily drawn to unimportant or
irrelevant external stimuli)
increase in goal-directed activity (either socially, at work or school,
or sexually) or psychomotor agitation
excessive involvement in pleasurable activities that have a high potential
for painful consequences (e.g., engaging in unrestrained buying sprees,
sexual indiscretions, or foolish business investments)
C. The symptoms do not meet criteria for a Mixed Episode
D. The mood disturbance is sufficiently severe to cause marked impairment
in occupational functioning or in usual social activities or relationships
with others, or to necessitate hospitalization to prevent harm to
self or others, or there are psychotic features.
E. The symptoms are not due to the direct physiological effects of
a substance (e.g., a drug of abuse, a medication, or other treatment)
or a general medical condition (e.g., hyperthyroidism).
Mixed
Episode
A. The criteria are met both for a Manic Episode and for a Major Depressive
Episode (except for duration) nearly every day during at least a 1-week
period.
B. The mood disturbance is sufficiently severe to cause marked impairment
in occupational functioning or in usual social activities or relationships
with others, or to necessitate hospitalization to prevent harm to
self or others, or there are psychotic features.
C. The symptoms are not due to the direct physiological effects of
a substance (e.g., a drug of abuse, a medication, or other treatment)
or a general medical condition (e.g., hyperthyroidism).
Hypomanic
Episode
A. A distinct period of persistently elevated, expansive, or irritable
mood, lasting throughout at least 4 days, that is clearly different
from the usual nondepressed mood.
B. During the period of mood disturbance, three (or more) of the following
symptoms have persisted (four if the mood is only irritable) and have
been present to a significant degree:
inflated self-esteem or grandiosity
decreased need for sleep (e.g., feels rested after only 3 hours of
sleep)
more talkative than usual or pressure to keep talking
flight of ideas or subjective experience that thoughts are racing
distractibility (i.e., attention too easily drawn to unimportant or
irrelevant external stimuli)
increase in goal-directed activity (either socially, at work or school,
or sexually) or psychomotor agitation
excessive involvement in pleasurable activities that have a high potential
for painful consequences (e.g., the person engages in unrestrained
buying sprees, sexual indiscretions, or foolish business investments)
C. The episode is associated with an unequivocal change in functioning
that is uncharacteristic of the person when not symptomatic.
D. The disturbance in mood and the change in functioning are observable
by others.
E. The episode is not severe enough to cause marked impairment in
social or occupational functioning, or to necessitate hospitalization,
and there are no psychotic features.
F. The symptoms are not due to the direct physiological effects of
a substance (e.g., a drug of abuse, a medication, or other treatment)
or a general medical condition (e.g., hyperthyroidism).
Note: Hypomanic-like episodes that are clearly caused by somatic antidepressant
treatment (e.g., medication, electroconvulsive therapy, light therapy)
should not count toward a diagnosis of Bipolar II Disorder.
European Description
A chronic depression of mood which does not currently fulfil the criteria
for recurrent depressive disorder, mild or moderate severity, in terms
of either severity or duration of individual episodes, although the
criteria for mild depressive episode may have been fulfilled in the
past, particularly at the onset of the disorder. The balance between
individual phases of mild depression and intervening periods of comparative
normality is very variable. Sufferers usually have periods of days
or weeks when they describe themselves as well, but most of the time
(often for months at a time) they feel tired and depressed; everything
is an effort and nothing is enjoyed. They brood and complain, sleep
badly and feel inadequate, but are usually able to cope with the basic
demands of everyday life. Dysthymia therefore has much in common with
the concepts of depressive neurosis and neurotic depression. If required,
age of onset may be specified as early (in late teenage or the twenties)
or late.
Diagnostic
Guidelines
The essential feature is a very long-standing depression of mood which
is never, or only very rarely, severe enough to fulfil the criteria
for recurrent depressive disorder, mild or moderate severity. It usually
begins early in adult life and lasts for at least several years, sometimes
indefinitely. When the onset is later in life, the disorder is often
the aftermath of a discrete depressive episode and associated with
bereavement or other obvious stress.
Includes:
* depressive neurosis
* depressive personality disorder
* neurotic depression (with more than 2 years' duration)
* persistent anxiety depression
Excludes:
* anxiety depression (mild or not persistent)
* bereavement reaction, lasting less than 2 years (prolonged depressive
reaction)
* residual schizophrenia