Depression Series Diagnosing Your Depression Dysthymia
Dysthymia is a milder form of depression than what you typically think of when you think of a depressed patient. You might think of dysthymic disorder as being at the one end of the depression spectrum while major depressive disorder is at the other end. People who suffer from dysthymia might go on with their lives for years without any treatment whatsoever. The casual observer might view a patient and simply state that they are despondent.
Dysthymic disorder affects approximately 1.5 percent of the population with women being affected slightly more than men. Patients have a very hard time finding happiness and satisfaction with the activities of everyday life. They often have low self-esteem and difficulty in making decisions. Fatigue and low-energy also accompany this disorder. More often than not, sleeping and eating patterns will also be affected with the majority of patients sleeping more and eating less.
Although the term “dysthymia” was first used in 1980 in order to bring a clearer understanding of depressive disorders that did not meet the criteria for major depression, were more chronic and less severe, and implied a temperamental dysphoria, the term is often imprecise. Perhaps a good definition is that of a chronic, low-grade depression that lasts more than 2 years.
Dysthymia is about as common as major depression. Given its chronic nature, that makes it one of the disorders most often seen by psychotherapists. About 6% of the population of the United States has had an episode of dysthymia at some time, 3% in the last year. As many as a third of patients in psychotherapy may be suffering from dysthymia. Like major depression, it is more common in women than in men, but it tends to arise earlier in life. The American Psychiatric Association distinguishes between this early-onset form and a form that occurs later in life and often comes on less gradually.
Dysthymia runs in families and probably has a hereditary component. The rate of depression in the families of people with dysthymia is as high as 50% for the early-onset form of the disorder. There are few twin or adoption studies, so it’s uncertain how much of this family connection is genetic. Nearly half of people with dysthymia have a symptom that also occurs in major depression, shortened REM latency — that is, they start rapid eye movement (vivid dreaming) sleep unusually early in the night.
Psychological theories relate to early developmental problems while cognitive theories revolve around diminished self-esteem and sense of helplessness. In helping make the diagnosis one must take care to be sure that the person does not have major depression, and if one does, it is known as double depression. Also, it is important to note that there is no mania or hypomania. About half of those with dysthymia have gradual onset prior to age 25. They are at increased risk for major depression or for bipolar I or II. Women with dysthymia are also at risk for premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), and pregnancy-related depressions.
At least three-quarters of patients with dysthymia also have a chronic physical illness or another psychiatric disorder such as one of the anxiety disorders, drug addiction, or alcoholism. In these cases, it is difficult to distinguish the original cause, especially when there is a vicious cycle in which, say, depression exacerbates alcoholism or heart disease exacerbates depression.