Depressive Personality or Dysthymia?
By:
THEODORE MILLON and
Seth Grossman
Carrie Millon
Sarah Meagher
Rowena Ramnath
In
the DSM-IV, the depressive personality is not classified with the other
Axis II disorders, but instead is listed in the appendix as a disorder
requiring further research. The depressive is controversial, in part, because
its proper location in the multiaxial system is uncertain.
Some
suggest that it should be considered a characterological variant of depression.
Here, pessimism and a temperamental disposition to negative affective states would
create a vulnerability to depression as a mood disorder.
Others
argue that the depressive personality is redundant—that it merely reflects the
influence of a background depression so long-standing and pervasive that its
symptoms have become crystallized as trait-like features.
The
usual objections involve the perceived overlap between depressive personality
and dysthymia and the clinical utility of the new construct (Sherman, 1995). The
results of the Mood Disorders Field Trials (M. Keller, Hanks, & Klein,
1996) go a long way in clarifying this controversy. Although there was
substantial overlap between subjects diagnosed as dysthymic and those diagnosed
as having a depressive personality, many dysthymics did not meet criteria for
depressive personality. Thus, the overlap was not complete. In fact, the
proportion of those with depressive personality disorder who had never met
criteria for dysthymia was high (Shea & Hirschfeld, 1996), providing strong
support that the depressive personality describes a domain of functioning that
cannot be accounted for by dysthymia alone.
Furthermore,
a personality dimension described as negative affectivity (Tellegen, 1985; D.
Watson & Tellegen, 1985) captures many of the experiences of those
diagnosed as depressive personalities. Also called neuroticism, negative
affectivity refers to a persistent proneness to negative experiences, namely
moodiness, nervousness, stress, a low threshold for becoming annoyed or
irritated, excessive worry, and difficulty concentrating. High scores on this
dimension contribute negatively to subjective well-being (DeNeve & Cooper,
1998).
Taken
together, the Field Trials, along with research using measures of negative affectivity
and neuroticism, point to a crucial taxonomic distinction: The disposition to
experience negative emotional states must be separated from the emotional
states themselves. The first is an Axis II disorder; the second belongs to Axis
I.
References
Personality Disorders in Modern Life,
second edition, 2000, 2004 by John Wiley & Sons, Inc.
No comments:
Post a Comment