Dysthymic Disorder

The diagnostic criteria for Dysthymic Disorder includes the following:

• 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.

• Presence, while depressed, of two (or more) of the following:

  • Poor apetite or overeating.

  • Insomnia or hypersomnia

  • Low energy or fatigue.

  • Low self esteem.

  • Poor concentration or difficulty making decisions.

  • Feelings of hopelesness.

• 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.

• No Major Depressive Episode (see Criteria for 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.

• There has never been a Manic Episode (see Criteria for Manic Episode), a Mixed Episode (see Criteria for Mixed Episode), or a Hypomanic Episode (see Criteria for Hypomanic Episode), and criteria have never been met for Cyclothymic Disorder.

• The disturbance does not occur exclusively during the course of a chronic Psychotic Disorder, such as Schizophrenia or Delusional Disorder.

• 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).

• The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Associated Features

Several studies suggest that the most commonly encountered symptoms in Dysthymic Disorder may be feelings of inadequacy; generalized loss of interest or pleasure; social withdrawal; feelings of guilt or brooding about the past; subjective feelings of irritability or excessive anger; and decreased activity, effectiveness, or productivity.

Course

Dysthymic Disorder often has an early and insidious onset (i.e., in childhood, adolescence, or early adult life) as well as a chronic course. In clinical settings, individuals with Dysthymic Disorder usually have superimposed Major Depressive Disorder, which is often the reason for seeking treatment.

Diagnostic criteria summarized from:

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.