Persistent depressive disorder, formerly known as dysthymic disorder (also known as dysthymia or chronic depression), was renamed in the DSM-5 (American Psychiatric Association, 2013). Dysthymia is also known as chronic depression, because the primary feature of persistent depressive disorder is a depressed mood that doesn’t go away over a long period of time.
The essential feature of persistent depressive disorder (dysthymia) is a depressed mood that occurs for most of the day, for more days than not, for at least 2 years (at least 1 year for children and adolescents).
This disorder represents a consolidation of DSM-IV-defined chronic major depressive disorder and dysthymic disorder. Major depression may precede persistent depressive disorder, and major depressive episodes may occur during persistent depressive disorder. Individuals whose symptoms meet major depressive disorder criteria for 2 years should be given a diagnosis of persistent depressive disorder as well as major depressive disorder.
Individuals with persistent depressive disorder describe their mood as sad or “down in the dumps.” During periods of depressed mood, at least two of the following six symptoms from are present:
- Poor appetite or overeating
- Insomnia or hypersomnia
- Low energy or fatigue
- Low self-esteem
- Poor concentration or difficulty making decisions
- Feelings of hopelessness
Because these symptoms have become a part of the individual’s day-to-day experience, particularly in the case of early onset (e.g., “I’ve always been this way”), they may not be reported unless the individual is directly prompted. During the 2-year period (1 year for children or adolescents), any symptom-free intervals last no longer than two months.
In children and adolescents, their mood may also be marked by increased and significant irritability for a year or longer.
Furthermore, in order to be diagnosed with persistent depressive disorder, there has to have never been a manic episode, a mixed episode, or a hypomanic episode in the first 2 years, and criteria have never been met for cyclothymic disorder.
A person diagnosed with this condition may also be diagnosed with associated features. These features include:
- With anxious distress
- With mixed features
- With melancholic features
- With atypical features
- With mood congruent psychotic features
- With mood incongruent psychotic features
- With peripartum onset
As well as these specifiers:
- With pure dysthymic syndrome – full criteria for a major depressive episode have not been met in previous 2 years
- With persistent major depressive episode – full criteria for a major depressive episode have been met throughout the previous 2 years
- With intermittent major depressive episodes, with current episode – times of 8 weeks or more where person did not meet the full criteria for a major depressive episode in previous 2 years, but does meet the criteria at present
- With intermittent major depressive episodes, without current episode – times of 8 weeks or more where person did not meet the full criteria for a major depressive episode in previous 2 years, and does not meet the criteria at present
In order to meet the diagnostic criteria for dysthymic disorder, the symptoms may not be due to the direct physiological effects of the use or abuse of a substance (for instance, alcohol, drugs, or medications) or a general medical condition (e.g., cancer or a stroke). The symptoms must also cause significant distress or impairment in social, occupational, educational or other important areas of functioning.
Between 0.5% and 1.5% of adults in the U.S. experience this disorder in any given year, according to the American Psychiatric Association (2013).
If the disorder is diagnosed before age 21, it is associated with a higher risk of the person having a personality disorder or substance use disorder. This disorder is, by its very definition, chronic and can be challenging to treat.
Treatment of Dysthymia
For more information about treatment, please see general treatment guidelines for persistent depressive disorder.
This criteria has been adapted for DSM-5. Diagnostic code: 300.4.