285 Dysthymic Disorder (300.4)
DSM-IV-TR criteria
- A. Depressed mood for most of the day, for more days than not, as indicated either by subjective account or observation by others, for at least 2 years. NOTE: In children and adolescents, mood can be irritable and duration must be at least 1 year. The individual must have been depressed for at least 22 months during the past 2 years. This type of disorder is classified as unipolar, where there is only severe depression.
- B. Presence, while depressed, of two (or more) of the following:
- poor appetite or overeating
- insomnia or hypersomnia
- low energy or fatigue
- low self-esteem
- poor concentration or difficulty making decisions
- feelings of hopelessness
- C. During the 2-year period (1 year for children or adolescents) of the disturbance, the person has never been without the symptoms in Criteria A and B for more than 2 months at a time.
- D. No Major Depressive Episode has been present during the first 2 years of the disturbance (1 year for children and adolescents); i.e., the disturbance is not better accounted for by chronic Major Depressive Disorder, or Major Depressive Disorder, In Partial Remission.
- NOTE: There may have been a previous Major Depressive Episode provided there was a full remission (no significant signs or symptoms for 2 months) before development of the Dysthymic Disorder, there may be superimposed episodes of Major Depressive Disorder, in which case both diagnoses may be given when the criteria are met for a Major Depressive Disorder
- E. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode, and criteria have never been met for Cyclothymic Disorder.
- F. The disturbance does not occur exclusively during the course of a chronic Psychotic Disorder, such as Schizophrenia or Delusional Disorder.
- G. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
- H. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- Specify If:
- Early Onset: if onset is before age 21 years
- Late Onset: if onset is age 21 years or older
Specify (for most recent 2 years of Dysthymic Disorder):
- With Atypical Features
Associated features
Many of the associated features of Dysthymic Disorder are similar to features of Major Depressive Disorder. Changes in sleep patterns, appetite, significant weight gain or loss, and psychomotor symptoms are seen less than in those patients with Major Depressive Disorder. Some of the most common symptoms to be associated with Dysthymic Disorder are feelings with inadequacy; social withdrawal; general loss of interest or pleasure; feelings of guilt or brooding about the past; excessive anger; decreased activity; productivity; or effectiveness. Around 75 percent of people who develop Dysthymic Disorder without ever having Major Depressive Disorde