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Dysthymia:A Comprehensive Analysis
Depression is a state of mind indicative of a persistent state of sadness in which symptoms are severe enough to affect different functional aspects of an individual’s life. The most common of these are Dysthymia and Major Depressive Disorder (MDD). Although both share many similar symptoms the major difference between the two is the length of time in which the symptoms persist. Individuals suffering from MDD usually only experience symptoms no longer than a few months. However, individuals suffering from dysthymia experience symptoms for 2 years or longer (psyweb.com, 2013).
Dysthymia is a depressive mood disorder that has affected as much as 6% of the United States populous at some point in their lives (Harvard Mental Health Letter, 2005). This disorder is chronic in nature and can have long term effects of employment, social life and family. The criterion set forth by the Diagnostic Statistical Manual IV (DSM) stipulates that for a diagnosis of Dysthymia and individual must meet the following criteria;
Dysthymia can affect anyone regardless or culture, age, or gender although the prevalence and expression of each may differ. The most prominently influential factor is that of age. In late life (65+), it is more difficult to diagnose dysthymia and other forms of depression due to the multitude of factors that have to be considered when determining etiology. It has been found for example, that adults are less likely to report feelings of depression or anxiety than young adults with the same level of symptoms indicative of depression. Older adults have also been shown to be more likely to report somatic symptoms than young adults (Encyclopedia of Applied Psychology (EAP), 2004). This creates difficulty in the diagnostic process due to the difficulty differentiating between psychologically induced phenomena vs. naturally present physiological effects of aging and differentiating between Dysthymic and MDD symptoms. . Other issues that should be accounted for include but are not limited to the individuals reduction is social contact as their peers pass away and the symptoms resulting from prescription medications use, both of which can result in the manifestation of depression like symptoms that can give the impression of a long-term state of feeling tired, detached and unmotivated, all being characteristic of Dysthymia. The prevalence of Dysthymia old age is around 2% with MDD reported at 0.8% (EAP, 2004).
In opposition, young adults showed a 3% average of Dysthymia with MDD at 2% and show prevalence to express less somatic symptoms yet also tend to have a longer duration of symptoms with regards to major depressive episodes and a higher propensity for future development of dysthymia. The Concise Corsini Encyclopedia of Psychology and Behavioral Science reports the duration of episodes ranging from 34-36 weeks and even longer for females (2004). Females, along with the mentally disabled and individuals suffering from a physical ailment have a higher risk of developing Dysthymia most probably due to increased social and environmental stress.
There are 5 areas of causation that must be examined when evaluating an individual for Dysthymia. These areas are inclusive of biological, behavioral, socio-cultural, psychodynamic and genetic influences. Genetics has been shown to be a relevant factor in the development of both MDD and Dysthymia. Although the level of influence in comparison to familial dysfunction is unclear, children suffering from a mood or anxiety disorder are more likely to have psychiatric disorders in “first and second degree relatives” (Comprehensive Handbook of Psychopathology (CHP), 2004). Biological factors also play an important role as they can heavily effect our perception of self and our perceptions of viability. This is a particularly important factor for those individuals in later life who suffer from a physical ailment or debilitation. This is evidenced by the much higher rate of depressive disorders in elderly receiving residential care that that of those living in the community (CHP, 2004). Biological factors could include advanced aging, illness, loneliness or a variety of other stressors. Stressful and failure events in an individual’s life can trigger a neurochemical changes that will increasingly favor a depressed mood (Anisman, H., Griffiths J, Merali Z., & Ravindran A. V., 2000).
As with most mental disorders there are certain psychodynamic characteristics that are exhibited, in particularly the display of a depressive attributional styles and inappropriate strategies used to deal with stressors. This type of psychodynamic can lead do difficulties socially and even create cultural anxiety if the behavior is not conducive to the individual’s social and cultural environment (Anisman H., et al. 2000).
With the multitude of causational factors involved in the development of dysthymia is has been an ongoing effort to more effectively diagnose and treat this disorder. A challenge in diagnosis is present due to the disorders similarities in symptoms to other MDD’s and the social and environmental causational factors that can lead to misdiagnosis (CHP, 2004). As a case example imagine an elderly women who has been experiencing a reduction in energy levels, difficulty focusing, and a persistent state of feeling “down”. These “symptoms” have been persisting for 3 years and started shortly after an accident in which she broke her hip.
It could be reasonable to ascertain from the data presented that she could be suffering from dysthymic disorder. However, presented with information regarding her medical treatment, specifically the pain management program they have placed her on to enable her to remain mobile. Long-term use of such medications can have similar effects as dysthymia and therefore is integral data for diagnosis. In addition to this, factors such as the individual’s physical, mental and social health should be considered also. It would seem that the appropriate process for diagnosis of a mental disorder of any kind is to establish criteria set forth by the DSM IV and then try to rule it out with inquisitional data.
As this disorder can affect anyone regardless of ethnicity, age or gender it is imperative that treatment options increasingly become more effective. Currently the most successful treatment is the use of cognitive behavior therapy or CBT. CBT proposes that depressive mindsets are established through cognitive thought patters and belief systems (Carlos, P. Z., & Andrea, N. S., 2006). By conceptualizing the individual’s cognition and perception of events in their past and current lives the individual can then recognize the behaviors and learn skills to change them. This is especially effective for mood disorders such as dysthymia as the chronicity of the disorder is cognitively based although sometimes resulting in physical manifestation. The use of pharmacopeia treatment such as the use of sleep aids could also be effective as a supportive treatment in the early stages of therapy to help the individual establish a consistent and restful sleep pattern which may help with other symptoms such as lack of focus and irritability. Treatment for this disorder maintains congruency between age groups only differing in social, environmental and familial factors.
Current research on the disorder is still suffering from an absence of data as a result of not only the multitude of causational factors but also the disparity between reported and unreported cases. Because of the more subtle and chronic nature of this disorder it is often left undiagnosed. Research is suggestive of early childhood trauma as causation and even genetics plays its role. As with many mental disorders determining early causation and pattern conceptualization learned maladaptive behavior should be able to be nurtured to be adaptive through cognitive and behavioral augmentation. Simply put; as with any problem the best avenue to reach a viable solution is to trace back to where the problem started and adapt it at its root.
Anisman H., et al. (2000). Dysthymia: a review of pharmacological and behavioral
factors, Molecular Psychiatry, 5(3), 242.
Carlos, P. Z., & Andrea, N. S. (2006). Psychosocial treatments for major depression and dysthymia in older adults: A review of the research literature. Journal of Counseling and Development: JCD, 84(2), 192-201. Retrieved from http://search.proquest.com/docview/219038535?accountid=34899
psyweb.com, (2013). Dysthymic Disorder, Retrieved on Jan 12th 2013 from http://www.psyweb.com/mdisord/MoodDis/Dysthy.jsp
Harvard Mental Health Letter, (2005). Dysthymia, Harvard Health Publications, Harvard Medical School, Harvard University. Retrieved on Jan 13th 2013 from http://www.health.harvard.edu/newsweek/Dysthymia.htm
Depression in Late Life. (2004). In Encyclopedia of Applied Psychology. Retrieved from http://libproxy.edmc.edu/login?qurl=http%3A%2F%2Fwww.credoreference.com/entry/es tappliedpsyc/depression_in_late_life
Childhood Depression. (2004). In The Concise Corsini Encyclopedia of Psychology and Behavioral Science. Retrieved from http://libproxy.edmc.edu/login?qurl=http%3A%2F%2Fwww.credoreference.com/entry/w ileypsy ch/childhood_depression
Mood Disorders: Unipolar and Bipolar. (2004). In Comprehensive Handbook of Psychopathology. Retrieved from http://libproxy.edmc.edu/login?qurl=http%3A%2F%2Fwww.credoreference.com/entry/s prhp/m ood_disorders_unipolar_and_bipola
Culture, Ethnicity, and Psychopathology. (2004). In Comprehensive Handbook of Psychopathology. Retrieved from http://libproxy.edmc.edu/login?qurl=http%3A%2F%2Fwww.credoreference.com/entry/s prhp/c ulture_ethnicity_and_psychopathology