Depressive personality disorder

Last updated October 15, 2024

Depressive personality disorder (also known as melancholic personality disorder) is a psychiatric diagnosis that denotes a personality disorder with depressive features.

Originally included in the American Psychiatric Association's DSM-II ^{[ citation needed ]}, depressive personality disorder was removed from the DSM-III and DSM-III-R.^[1]^{[ failed verification ]} The latest description of depressive personality disorder is described in Appendix B in the DSM-IV-TR. Although no longer listed as a personality disorder in the DSM-5, the diagnosis of subclinical Other Specified Personality Disorder and Unspecified Personality Disorder can be used to classify an equivalent of depressive personality disorder.^[2] In the DSM-5, it has been reconsidered for reinstatement as a diagnosis in an alternative approach to personality disorders in the form of "general criteria for personality disorder" which primarily assesses "impairments in personality functioning".^[2]

While depressive personality disorder shares some similarities with mood disorders such as dysthymia, it also shares many similarities with other personality disorders including avoidant personality disorder. Some researchers argue that depressive personality disorder is sufficiently distinct from these other conditions so as to warrant a separate diagnosis.

Characteristics

The DSM-IV defines depressive personality disorder as "a pervasive pattern of depressive cognitions and behaviors beginning by early adulthood and occurring in a variety of contexts." Depressive personality disorder occurs independently of major depressive episodes, making it a distinct diagnosis not included in the definition of either major depressive episodes or dysthymic disorder.^[3]^: 732

Five or more of the following criteria must be present:

usual mood is dominated by dejection, gloominess, cheerlessness, joylessness and unhappiness
self-concept centres on beliefs of inadequacy, worthlessness and low self-esteem
is critical, blaming and derogatory towards self
is brooding and given to worry
is negativistic, critical and judgmental toward others
is pessimistic
is prone to feeling guilty or remorseful ^[3]^: 733

Studies in 2000-2002 have found more of a correlation between depressive personality disorder and dysthymia than a comparable group of people without depressive personality disorder.^[4]^[5]

Millon's subtypes

Theodore Millon identified five subtypes of depression.^[1]^[6] Any individual depressive may exhibit none, or one or more of the following:

Subtype	Description	Personality traits
Ill-humored depressive	Including negativistic features	Patients in this subtype are often hypochondriacal, cantankerous and irritable, and guilt-ridden and self-condemning. In general, ill-humored depressives are down on themselves and think the worst of everything.
Self-derogating depressive	Including dependent features	Patients who fall under this subtype are self-deriding, discrediting, odious, dishonorable, and disparage themselves for weaknesses and shortcomings. These patients blame themselves for not being good enough.
Morbid depressive	Including schizoid and masochistic features	Morbid depressives experience profound dejection and gloom, are highly lugubrious, and often feel drained and oppressed.
Restive depressive	Including avoidant features	Patients who fall under this subtype are consistently unsettled, agitated, wrought in despair, and perturbed. This is the subtype most likely to commit suicide in order to avoid all the despair in life.^[1]
Voguish depressive	Including histrionic and narcissistic features	Patients who fall under this subtype embrace their suffering as ennobling. They view their personal depression as self-glorifying and dignifying; their unhappiness as a stylish expression of social disenchantment.

Not all patients with a depressive disorder fall into a subtype. These subtypes are multidimensional in that patients usually experience multiple subtypes, instead of being limited to fitting into one subtype category. Currently, this set of subtypes is associated with melancholic personality disorders. All depression spectrum personality disorders are melancholic and can be looked at in terms of these subtypes.

DSM-5

Similarities to dysthymic disorder

Much of the controversy surrounding the potential inclusion of depressive personality disorder in the DSM-5 stems from its apparent similarities to dysthymic disorder, a diagnosis already included in the DSM-IV. Dysthymic disorder is characterized by a variety of depressive symptoms, such as hypersomnia or fatigue, low self-esteem, poor appetite, or difficulty making decisions, for over two years, with symptoms never numerous or severe enough to qualify as major depressive disorder. Patients with dysthymic disorder may experience social withdrawal, pessimism, and feelings of inadequacy at higher rates than other depression spectrum patients. Early-onset dysthymia is the diagnosis most closely related to depressive personality disorder.^[7]

The key difference between dysthymic disorder and depressive personality disorder is the focus of the symptoms used to diagnose. Dysthymic disorder is diagnosed by looking at the somatic senses, the more tangible senses. Depressive personality disorder is diagnosed by looking at the cognitive and intrapsychic symptoms. The symptoms of dysthymic disorder and depressive personality disorder may look similar at first glance, but the way these symptoms are considered distinguish the two diagnoses.

Comorbidity with other disorders

Many researchers believe that depressive personality disorder is so highly comorbid with other depressive disorders, manic-depressive episodes and dysthymic disorder, that it is redundant to include it as a distinct diagnosis. Recent studies however, have found that dysthymic disorder and depressive personality disorder are not as comorbid as previously thought. It was found that almost two thirds of the test subjects with depressive personality disorder did not have dysthymic disorder, and 83% did not have early-onset dysthymia.^[1]

The comorbidity with Axis I depressive disorders is not as high as had been assumed. An experiment conducted by American psychologists showed that depressive personality disorder shows a high comorbidity rate with major depression experienced at some point in a lifetime and with any mood disorders experienced at any point in a lifetime. A high comorbidity rate with these disorders is expected of many diagnoses. As for the extremely high comorbidity rate with mood disorders, it has been found that essentially all mood disorders are comorbid with at least one other, especially when looking at a lifetime sample size.^[8]

Related Research Articles

Bipolar I disorder is a type of bipolar spectrum disorder characterized by the occurrence of at least one manic episode, with or without mixed or psychotic features. Most people also, at other times, have one or more depressive episodes. Typically, these manic episodes can last at least 7 days for most of each day to the extent that the individual may need medical attention, while the depressive episodes last at least 2 weeks.

Major depressive disorder (MDD), also known as clinical depression, is a mental disorder characterized by at least two weeks of pervasive low mood, low self-esteem, and loss of interest or pleasure in normally enjoyable activities. Introduced by a group of US clinicians in the mid-1970s, the term was adopted by the American Psychiatric Association for this symptom cluster under mood disorders in the 1980 version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), and has become widely used since. The disorder causes the second-most years lived with disability, after lower back pain.

Melancholia or melancholy is a concept found throughout ancient, medieval, and premodern medicine in Europe that describes a condition characterized by markedly depressed mood, bodily complaints, and sometimes hallucinations and delusions.

A mood disorder, also known as an affective disorder, is any of a group of conditions of mental and behavioral disorder where the main underlying characteristic is a disturbance in the person's mood. The classification is in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD).

Borderline personality disorder (BPD), also known as emotionally unstable personality disorder (EUPD), is a personality disorder characterized by a pervasive, long-term pattern of significant interpersonal relationship instability, a distorted sense of self, and intense emotional responses. People diagnosed with BPD frequently exhibit self-harming behaviours and engage in risky activities, primarily due to challenges regulating emotional states to a healthy, stable baseline. Symptoms such as dissociation, a pervasive sense of emptiness, and an acute fear of abandonment are prevalent among those affected.

Schizoaffective disorder is a mental disorder characterized by symptoms of both schizophrenia (psychosis) and a mood disorder - either bipolar disorder or depression. The main diagnostic criterion is the presence of psychotic symptoms for at least two weeks without prominent mood symptoms. Common symptoms include hallucinations, delusions, disorganized speech and thinking, as well as mood episodes. Schizoaffective disorder can often be misdiagnosed when the correct diagnosis may be psychotic depression, bipolar I disorder, schizophreniform disorder, or schizophrenia. This is a problem as treatment and prognosis differ greatly for most of these diagnoses. Many people with schizoaffective disorder have other mental disorders including anxiety disorders.

Obsessive–compulsive personality disorder (OCPD) is a cluster C personality disorder marked by a spectrum of obsessions with rules, lists, schedules, and order, among other things. Symptoms are usually present by the time a person reaches adulthood, and are visible in a variety of situations. The cause of OCPD is thought to involve a combination of genetic and environmental factors, namely problems with attachment.

Avoidant personality disorder (AvPD) or anxious personality disorder is a Cluster C personality disorder characterized by excessive social anxiety and inhibition, fear of intimacy, severe feelings of inadequacy and inferiority, and an overreliance on avoidance of feared stimuli as a maladaptive coping method. Those affected typically display a pattern of extreme sensitivity to negative evaluation and rejection, a belief that one is socially inept or personally unappealing to others, and avoidance of social interaction despite a strong desire for it. It appears to affect an approximately equal number of men and women.

Adjustment disorder is a maladaptive response to a psychosocial stressor. It is classified as a mental disorder. The maladaptive response usually involves otherwise normal emotional and behavioral reactions that manifest more intensely than usual, causing marked distress, preoccupation with the stressor and its consequences, and functional impairment.

Dysthymia, also known as persistent depressive disorder (PDD), is a mental and behavioral disorder, specifically a disorder primarily of mood, consisting of similar cognitive and physical problems as major depressive disorder, but with longer-lasting symptoms. The concept was used by Robert Spitzer as a replacement for the term "depressive personality" in the late 1970s.

Atypical depression is defined in the DSM-IV as depression that shares many of the typical symptoms of major depressive disorder or dysthymia but is characterized by improved mood in response to positive events. In contrast to those with atypical depression, people with melancholic depression generally do not experience an improved mood in response to normally pleasurable events. Atypical depression also often features significant weight gain or an increased appetite, hypersomnia, a heavy sensation in the limbs, and interpersonal rejection sensitivity that results in significant social or occupational impairment.

A major depressive episode (MDE) is a period characterized by symptoms of major depressive disorder. Those affected primarily exhibit a depressive mood for at least two weeks or more, and a loss of interest or pleasure in everyday activities. Other symptoms can include feelings of emptiness, hopelessness, anxiety, worthlessness, guilt, irritability, changes in appetite, difficulties in concentration, difficulties remembering details, making decisions, and thoughts of suicide. Insomnia or hypersomnia and aches, pains, or digestive problems that are resistant to treatment may also be present.

Depressive disorder not otherwise specified (DD-NOS) is designated by the code 311 in the DSM-IV for depressive disorders that are impairing but do not fit any of the officially specified diagnoses. According to the DSM-IV, DD-NOS encompasses "any depressive disorder that does not meet the criteria for a specific disorder." In the DSM-5, it is called unspecified depressive disorder.

A spectrum disorder is a disorder that includes a range of linked conditions, sometimes also extending to include singular symptoms and traits. The different elements of a spectrum either have a similar appearance or are thought to be caused by the same underlying mechanism. In either case, a spectrum approach is taken because there appears to be "not a unitary disorder but rather a syndrome composed of subgroups". The spectrum may represent a range of severity, comprising relatively "severe" mental disorders through to relatively "mild and nonclinical deficits".

Bipolar II disorder (BP-II) is a mood disorder on the bipolar spectrum, characterized by at least one episode of hypomania and at least one episode of major depression. Diagnosis for BP-II requires that the individual must never have experienced a full manic episode. Otherwise, one manic episode meets the criteria for bipolar I disorder (BP-I).

Minor depressive disorder, also known as minor depression, is a mood disorder that does not meet the full criteria for major depressive disorder but at least two depressive symptoms are present for a long time. These symptoms can be seen in many different psychiatric and mental disorders, which can lead to more specific diagnoses of an individual's condition. However, some of the situations might not fall under specific categories listed in the Diagnostic and Statistical Manual of Mental Disorders. Minor depressive disorder is an example of one of these nonspecific diagnoses, as it is a disorder classified in the DSM-IV-TR under the category Depressive Disorder Not Otherwise Specified (DD-NOS). The classification of NOS depressive disorders is up for debate. Minor depressive disorder as a term was never an officially accepted term, but was listed in Appendix B of the DSM-IV-TR. This is the only version of the DSM that contains the term, as the prior versions and the most recent edition, DSM-5, does not mention it.

Late-life depression refers to depression occurring in older adults and has diverse presentations, including as a recurrence of early-onset depression, a new diagnosis of late-onset depression, and a mood disorder resulting from a separate medical condition, substance use, or medication regimen. Research regarding late-life depression often focuses on late-onset depression, which is defined as a major depressive episode occurring for the first time in an older person.

Cyclothymia, also known as cyclothymic disorder, psychothemia / psychothymia, bipolar III, affective personality disorder and cyclothymic personality disorder, is a mental and behavioural disorder that involves numerous periods of symptoms of depression and periods of symptoms of elevated mood. These symptoms, however, are not sufficient to indicate a major depressive episode or a manic episode. Symptoms must last for more than one year in children and two years in adults.

The diagnosis of schizophrenia, a psychotic disorder, is based on criteria in either the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, or the World Health Organization's International Classification of Diseases (ICD). Clinical assessment of schizophrenia is carried out by a mental health professional based on observed behavior, reported experiences, and reports of others familiar with the person. Diagnosis is usually made by a psychiatrist. Associated symptoms occur along a continuum in the population and must reach a certain severity and level of impairment before a diagnosis is made. Schizophrenia has a prevalence rate of 0.3-0.7% in the United States.

Disruptive mood dysregulation disorder (DMDD) is a mental disorder in children and adolescents characterized by a persistently irritable or angry mood and frequent temper outbursts that are disproportionate to the situation and significantly more severe than the typical reaction of same-aged peers. DMDD was added to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) as a type of depressive disorder diagnosis for youths. The symptoms of DMDD resemble many other disorders, thus a differential includes attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), anxiety disorders, and childhood bipolar disorder, intermittent explosive disorder (IED), major depressive disorder (MDD), and conduct disorder.

References

1 2 3 4 Millon, T. (2006). Personality subtypes. Retrieved from http://millon.net/taxonomy/summary.htm Archived 2013-10-23 at the Wayback Machine
1 2 Diagnostic and statistical manual of mental disorders : DSM-5. American Psychiatric Association, American Psychiatric Association. DSM-5 Task Force (5th ed.). Arlington, VA: American Psychiatric Association. 2013. ISBN 978-0-89042-554-1. OCLC 830807378.{{cite book}}: CS1 maint: others (link)
1 2 Diagnostic and Statistical Manual of Mental Disorders (4th ed.). American Psychiatric Association. 1994.
↑ Ryder, Andrew G.; Bagby, R. Michael; Schuller, Deborah R. (17 June 2002). "The Overlap Of Depressive Personality Disorder and Dysthymia: A Categorical Problem With a Dimensional Solution". Harvard Review of Psychiatry. 10 (6): 337–352. doi:10.1080/10673220216230. ISSN 1067-3229. PMID 12485980. S2CID 8825180.
↑ Kwon, J. S.; Kim, Y. M.; Chang, C. G.; Park, B. J.; Kim, L; Yoon, D. J.; Han, W. S.; Lee, H. J.; Lyoo, I. K. (2000). "Three-year follow-up of women with the sole diagnosis of depressive personality disorder: Subsequent development of dysthymia and major depression". The American Journal of Psychiatry. 157 (12): 1966–72. doi:10.1176/appi.ajp.157.12.1966. PMID 11097962.
↑ Millon, Theodore, Personality Disorders in Modern Life, 2004
↑ University of Michigan Psychology Department, . (2006, January 20). Dysthymic disorder. Retrieved from http://www.med.umich.edu/depression/dysthymia.htm Archived 2010-02-27 at the Wayback Machine
↑ Nemeroff C.B. (2002). "Comorbidity of mood and anxiety disorders: the rule, not the expception?". American Journal of Psychiatry. 159 (1): 3–4. doi:10.1176/appi.ajp.159.1.3. PMID 11772680.