A CASE OF Depressive Personality Disorder
By: THEODORE MILLON
et al.
Notes:
(1) Numbers mark aspects of the case most consistent with DSM
criteria as follow, and
do not necessarily indicate that the
case “meets” diagnostic criteria in this respect.
(2) Patient's name has been changed in respect to
confidentiality, and names mentioned are not of a real existent person.
Case of Evan
“I
don’t know why I bother,” Evan says. “I’ve tried therapy five times before, but
it never works out. Nothing ever works outs. I wasn’t getting any better and the
therapists don’t really care. I don’t really blame them, I guess. If I were
someone else, I wouldn’t like me either.” (6) He called at the suggestion
of a coworker at the video store, where he works part-time. His manager complains
that he works slowly and shows no enthusiasm for customer relations. “Even the
other guys are starting to avoid me,” he says. (3)
Evan
seems focused on some inner wound. He is overweight and his skin looks pasty.
He looks tired and complains of hours each night spent brooding instead of sleeping.
His speaks slowly and uses words such as depressing, futile, and hopeless. (4)
The overall impression he creates is
that this could well be the last time he may be able to muster up some hope for
change. (1)
Evan
has almost no social support. He acknowledges a few acquaintances at the store
where he works, but says that they cannot really be considered friends. When asked
why this is, he maintains that he is fundamentally different from other people.
For others, the world is an adventure, he states, but for him it is
threatening, lonely, and disappointing. (3) He believes others are
frightened away because “they can sense, even smell, that I am not right, that
I’ve fallen so far short of what could have been.” (2)
His
words are forced out with great guilt. “I know it is my fault if my life is not
right, but I just can’t seem to do anything about it, I’m a worthless human
being. I’m at my best when I’m zoned out in front of the TV,” he continues.
“That way, I can distract myself from the misery of who I am.” (7)
In
addition to his job at the video store, Evan has been taking classes at the
local community college off and on for the past 10 years. Nevertheless, he is still six credits short of an associate’s degree.
His C-
average
is attributed to difficulty concentrating, which makes reading a chore. “A single
chapter seems like an eternity,” he says. Worse, Evan states, “I have fallen so
far short of what I wanted to do and be in life.” (3) He states again,
“I can never make up for that lost time, I can never repair the damage, and the
clock just keeps ticking. Sometimes, it’s all I can think about.” (4)
Evan
is the youngest of four children. All his siblings are older by at least nine
years. “We don’t have anything in common,” he laments. “They’re from a
different generation, they don’t understand me. I don’t think they’d even miss
me. They were a complete family before I got here, and they’ll be a complete
family if I was gone. That will never change.” His father is a pilot for a
major airline who never bonded with his son. His mother had a successful real
estate career, “but she says she had to give that up for me.” He is currently
“disconnected” from his family, although they all live in the area. “They were
not the family I was supposed to have,” he observes. “I tried to keep in touch.
When I first became depressed, things got a little better, but everyone seems
to avoid me now.”
DSM-IV Criteria
A. A pervasive pattern of depressive cognitions and behaviors beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: (1) usual mood is dominated by dejection, gloominess, cheerlessness, joylessness, unhappiness (2) self-concept centers around beliefs of inadequacy, worthlessness, and low self-esteem (3) is critical, blaming, and derogatory toward self (4) is brooding and given to worry (5) is negativistic, critical, and judgmental toward others (6) is pessimistic (7) is prone to feeling guilty or remorseful B. Does not occur exclusively during Major Depressive Episodes and is not better accounted for by Dysthymic Disorder.References
(1) Personality Disorders in Modern Life, second edition,
2000, 2004 by John Wiley & Sons, Inc.
(2)Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition. Copyright
1994 American Psychiatric Association.
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