Depressive personality disorder
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Depressive personality disorder is a psychiatric diagnosis that denotes a personality disorder with depressive features. It is a controversial disorder described in an appendix to the American Psychiatric Association's DSM-IV-TR as worthy of further study. It is not listed in the manual's personality disorder category.
Diagnostic criteria (DSM-IV-TR)
The DSM-IV-TR, a widely used manual for diagnosing mental disorders, defines depressive personality disorder as:
A pervasive pattern of depressive cognitions and behaviors beginning by early adulthood and present in a variety of contexts, as indicated as five (or more) of the following:
- usual mood is dominated by dejection, gloominess, cheerlessness, joylessness, unhappiness
- self-concept centers around beliefs of inadequacy, worthlessness, and low self-esteem
- is critical, blaming, and derogatory toward self
- is brooding and given to worry
- is negativistic, critical, and judgmental towards others
- is pessimistic
- is prone to feeling guilty or remorseful
- does not occur exclusively during Major Depressive Episodes and is not better accounted for by dysthymia.
Behavioral Level
- Expressively Disconsolate (e.g., appearance and posture conveys being forlorn, somber, heavy-hearted, woebegone, if not grief-stricken quality; irremediably dispirited and discouraged, portraying a sense of permanent hopelessness and wretchedness).
- Interpersonally Defenseless (e.g., owing to feeling vulnerable, assailable, and unshielded, will beseech others to be nurturant and protective; fearing abandonment and desertion, will not only act in an endangered manner, but seek, if not demand assurances of affection, steadfastness, and devotion).
Phenomenological Level
- Cognitively Pessimistic (e.g., possesses defeatist and fatalistic attitudes about almost all matters, sees things in their blackest form and invariably expects the worst; feeling weighed down, discouraged, and bleak, gives the gloomiest interpretation of current events, despairing as well that things will never improve in the future).
- Worthless Self-Image (e.g., judges oneself of no account, valueless to self or others, inadequate and unsuccessful in all aspirations; barren, sterile, impotent, sees self as inconsequential and reproachable, if not contemptible, a person who should be criticized and derogated, as well as feel guilty for possessing no praiseworthy traits or achievements).
- Forsaken Objects (e.g., internalized representations of the past appear jettisoned, as if life's early experiences have been depleted or devitalized, either drained of their richness and joyful elements, or withdrawn from memory, leaving one to feel abandoned, bereft, and discarded, cast off and deserted).
Intrapsychic Level
- Asceticism Mechanism (e.g., engages in acts of self-denial, self-punishment, and self-tormenting, believing that one should exhibit penance and be deprived of life's bounties; not only is there a repudiation of pleasures, but there are harsh self-judgments, as well as self-destructive acts).
- Depleted Organization (e.g., the scaffold for morphologic structures is markedly weakened, with coping methods enervated and defensive strategies impoverished, emptied and devoid of their vigor and focus, resulting in a diminished, if not exhausted capacity to initiate action and regulate affect, impulse, and conflict).
Biophysical Level
- Melancholic Mood (e.g., is typically woeful, gloomy, tearful, joyless, and morose; characteristically worrisome and brooding, the low spirits and dysphoric state rarely remits).
Treatment
Since this is a developmental defect, the impact of antidepressant medications is currently unknown. Psychological care is complicated by the patients not being wholly compliant with ongoing care.
References
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) (4th ed., text revision). Washington, DC: American Psychiatric Association. Template:SIB