Persistent depressive disorder, formerly known as dysthymic disorder (also known as dysthymia or chronic depression), was renamed in the updated 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).
Symptoms of Chronic Depression
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 irritability for a year or longer.
Furthermore, in order to be diagnosed with persistent depressive disorder, there has 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.
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.
For more information about treatment, please see general treatment for dysthymic disorder.
This criteria has been adapted for DSM-5. Diagnostic code: 300.4.