Dysthymic disorder is a chronic mood disorder listed in the spectrum of depressive disorders. Characterized by periods of normal mood interrupted by episodes of depression, dysthymic disorder (also referred to as persistent depressive disorder, or PDD) is clinically diagnosed when someone suffers symptoms for two years or more (or one year for teens and children). Since dysthymic disorder may go undiagnosed for many years due to its mild, cyclic nature, many people with dysthymia simply think feeling depressed is part of their personality.
Symptoms of Dysthymic Disorder
A clinical diagnosis of dysthymia requires a person suffer from two or more of these symptoms for at least two years:
- Hypersomnia or insomnia
- Poor concentration
- Sad and hopeless feelings
- Low sex drive
- Suicidal ideation
- Social isolation
Diagnosing dysthymia is often difficult because symptoms resemble physical illnesses such as fibromyalgia or chronic fatigue syndrome. In addition, dysthymia can accompany other psychological or personality disorders that overshadow the symptoms.
Dysthymic Disorder vs. Bipolar Disorder
Dysthymia does not include the manic, up and down symptoms associated with bipolar disorder. If someone suffers from rapid changes in mood, they may have another disorder called cyclothymia. Indications of dysthymia include low-grade, chronic episodes of depression rather than the extremes of mood associated with bipolar disorder. People with dysthymia will feel depressed for periods of time, but they do not exhibit manic or hyperactive behavior indicative of bipolar disorder. Instead, dysthymia patients simply feel less depressed during times when the disorder is not acute enough to cause isolating or suicidal behavior.
Does Dysthymic Disorder Have a Genetic Component?
Like other major depressive disorders, dysthymia is often a generational disease, though many affected people are remaining undiagnosed. Family members may have symptoms of dysthymic disorder without realizing it for years. They may think feeling the way they do is simply part of their family’s “personality” and try to manage their depression without asking for professional help. Researchers are learning that many psychological disorders such as schizophrenia and bipolar disorder are encoded on certain genes that may or may not be “triggered” by stressful life events.
Treating Dysthymic Disorder with Cognitive Behavioral Therapy
When used in combination with medication, research shows cognitive behavioral therapy (CBT) can improve the ability of a patient to manage feelings of sadness, hopelessness, and guilt. A professional CBT counselor can help people with dysthymic disorder by educating them about the trap of self-critical and defeating thinking patterns that can distort self-perception and perceptions of reality. People with mood disorders like dysthymia often see things in a black or white manner, which can make events seem worse than they are. CBT teaches people how to cope with depression, modify negative thought patterns, and understand how thoughts can powerfully impact emotions.
Double Depression and Dysthymic Disorder
Double depression describes a person having a major depressive event on top of dysthymic disorder symptoms. People with double depression report severe feelings of hopelessness and despondency that often lead to suicide ideation or attempts. Psychologists try to prevent and treat double depression by initially treating dysthymic disorder with cognitive behavioral therapy and antidepressants. Research also shows patients with double depression benefit from regular moderate exercise and getting enough sleep. Insomnia or erratic sleep patterns usually worsen symptoms, reduce immune system functioning, and invite recurring illnesses.
Dysthymic Disorder vs. Major Depression
The difference between dysthymic disorder and major depression is that dysthymia symptoms are not as debilitating as those characterizing major depressive disorder. People with major depression often benefit from hospitalization, as episodes may culminate in suicide attempts and a lack of self-care. According to the National Institute of Mental Health, dysthymia affects nearly 11 million adults (5.5 percent) in the United States (approximately one in 24 individuals). Additionally, around 11 percent of children between the ages of 13 and 18 years old experience dysthymic or major depressive disorder, with girls more prone to depression than boys. Many adults and children affected by dysthymia remain undiagnosed or misdiagnosed. As such, researchers think the number of those with dysthymic disorder may be even higher
At What Age Do Symptoms of Dysthymic Disorder Usually Emerge?
Dysthymic depression often appears initially in pre-adolescence and early adolescence but may be attributed to teenage moodiness. Since symptoms like irritability, pessimism, and moodiness are common among teenagers, parents usually dismiss symptoms and cope with them alone. Poor academic performance, behavior problems, and problems interacting with peers may accompany dysthymic disorder symptoms in teens. A professional diagnosis of dysthymia is essential to ensure adolescents receive the treatment that can help them manage their condition.
Complications of Untreated Dysthymic Disorder
When dysthymia remains undiagnosed and untreated, people with this depressive disorder are at risk for self-harming behaviors, substance abuse, and suicide attempts. Dysthymia is also associated with difficulty maintaining employment, increased encounters with law enforcement, and homelessness. In addition, the possibility that children with dysthymic disorder develop major depressive or bipolar disorder as adults increases if professionals fail to diagnose dysthymia at a young age.
Atypical Depression vs. Dysthymic Disorder
A sub-type of dysthymia, atypical depression symptoms focus on the physical aspects of depression in response or reaction to events occurring in one’s life. Diagnostic criteria necessary for a pronouncement of atypical disorder comes from the DSM-V:
- Losing interest in things that were once enjoyable
- Feeling happier or cheered up by events perceived as positive
- Weight gain caused by increased appetite
- Sleeping excessively
- Being inexplicably sensitive to rejection or criticism
- Complaints of extremities feeling abnormally heavy or lethargic
Statistics regarding the prevalence of atypical depression are limited because depression types are generally lumped together with major depressive disorder. In addition, like dysthymic disorder, atypical depression can develop and continue over the course of several years without the individual seeking treatment or realizing depression is not an aspect of their personality.
Medications for Dysthymic Disorder
Symptoms of dysthymic disorder typically respond well to antidepressants. Dysregulation of serotonin and dopamine are heavily implicated in all depressive disorders. Antidepressants work to regulate mood and ease depression by restoring normal brain neurotransmitter levels involved in emotion, sleep, and appetite. When combined with CBT or other psychotherapy, antidepressants can significantly improve quality of life for people with dysthymia by diminishing feelings of sadness and despondency and increasing a sense of well-being.