Persistent Depressive Disorder, also known as dysthymia, is described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a consolidation of chronic major depressive disorder and dysthymic disorder. The two disorders were described separately in DSM-IV. The diagnosis involves having a depressed mood that lasts for at least two years and includes a variety of symptoms such as poor appetite, low energy, low self-esteem, insomnia, poor concentration, and feelings of hopelessness. A critical analysis of dysthymia in DSM-5 entails a critic of the criteria, application of the 4Ds to the criteria, an overall description of the diagnosis, analysis of the specifiers, and analysis of the severity ratings.
The consolidation of dysthymia in DSM-5 raised several issues that involved the validity of the disorder. According to Rhebergen and Graham (2014), the description of persistent depressive disorder provides a similar diagnosis with other disorders and it limits the identification of the specific causative factors and specialized treatment options. The authors also observe that there is a significant overlap between dysthymic disorder and other mood and anxiety disorders which raises the question of its validity. This could create challenges when predicting the illness outcome.
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From the analysis of the criteria, the main identifying symptom is identified in criteria A where the depressed mood lasts for most days and for more than 2 years. Criteria A is a unique symptom for dysthymia. Criteria B provides symptoms that could be present in anxiety and mood disorders. Nevertheless, there is an allowance made in the ‘ specify’ section where the physician should clearly indicate whether the symptoms are associated with mood and anxiety distress. Criteria C observes that the individual has not been without the symptoms for more than 2 months and criteria D observes that the major depressive disorder is present for 2 years. Criteria C and D are thus used to differentiate it from other illnesses like a major mood disorder. Criteria E observes no symptoms for manic episodes, criteria F observes no schizoaffective disorder symptoms, and criteria G observes no physiological effects symptoms. These criteria are used to differentiate dysthymia from other illnesses caused by manic disorder, schizophrenia disorder, or physiological effects of drugs. Criteria H observes that the symptoms could lead to distress and impair one’s life. This symptom is not specific and could overlap with other disorders.
The 4Ds of deviance, distress, dysfunction, and danger can be applied to the different criteria. Criteria A is specific and meets the distress trait as it involves being moody for most days and for at least 2 years. This is distressful to the emotional wellbeing of an individual. Criteria B meets the danger, dysfunction, and distress traits as it highlights symptoms such as poor appetite that is dangerous to one’s health, difficulty in making decisions meaning that one is dysfunctional and feelings of hopelessness that indicate one is in distress. Criteria C meets the distress and dysfunction traits since the individual has not been without the symptoms for more than 2 months. Criteria D meets distress trait with the major depressive disorder being present for 2 years. Criteria E, F, and G were not specific about the traits being described as they provided symptoms that one should not display. Criteria E involved not having symptoms for manic disorder, F involving not having schizophrenia symptoms, and G involving not having physiological effects from substances (“Diagnostic and statistical manual of mental disorders (DSM-5)”, 2013). Criteria H meets the deviance and dysfunction trait as it involved an impairment in one’s social order, occupations, and normal functioning in daily activities.
The analysis of most of the symptoms in the given criteria made sense. People say that one of the key factors that makes persistent depressive disorder be described as abnormal functioning is the prolonged moodiness. The prolonged low mood can make one to be described as having a gloomy personality and incapable of having fun. Criteria A described an individual being in a depressed mood for most of the day for more than 2 years. Another key factor that makes dysthymia be described as abnormal functioning is the interference of one’s relationships, work, daily activities, and school. The specific symptoms are identified in Criteria B and most of them are dangerous to one’s health, social well-being, and occupation. Criteria H also showed that it could impact one’s social and occupational functions showing that it is disruptive to one’s normal life. Criteria D showed that persistent depressive disorder could develop from a major depressive disorder that has lasted for at least 2 years. 2 years is a long time for one to experience a constant symptom of low moods indicating that the criteria made sense.
The specify section was used for different reasons and one of them was to differentiate the disorder from other illnesses. The symptoms of persistent depressive disorder could overlap with other symptoms and it was important to identify whether it was coupled with other by specifying it. It was also critical to identify whether it was an early onset and a late onset where the distinctive age was 21 years. The persistent depressive disorder also came about after major depressive episodes had lasted for more than 2 years. It was thus important to specify how an individual encountered major depressive episodes such as whether it was consistent or whether one had gone for some time without the full symptoms.
The severity ratings were divided into mild, moderate, and severe. The descriptions of the severity rating were not specific but it could be beneficial in making a successful diagnosis. Mild involved having symptoms being manageable, moderate involved having the intensity of the symptoms varying between mild and severe, and severe involved the intensity of the symptoms being seriously distressing. The rating can be successfully used to understand the severity of one’s condition. For instance, an individual that has their symptoms as severe would raise a high alert and require immediate attention for care and treatment.
In conclusion, DSM-5 outlined the criteria that can be used to make a diagnosis for persistent depressive disorder. The analysis of the 4Ds showed that the different criteria met at least one of the traits. The symptoms that were identified also led to an abnormal function and interfere significantly with one’s life. The symptoms to be used for diagnosis thus made sense and could be applied for a successful diagnosis.
References
Diagnostic and statistical manual of mental disorders (DSM-5). (2013). American Psychiatric Pub.
Rhebergen, D., & Graham, R. (2014). The re-labeling of dysthymic disorder to persistent depressive disorder in DSM-5: old wine in new bottles? Current opinion in psychiatry, 27(1), 27-31.
