Depressive Personality Disorder

Depressive Personality Disorder

Definition

Depressive personality disorder (DPPD) is a pervasive pattern of depressive cognitions and behaviors that have been evident since adolescence and characteristic of everyday functioning (American Psychiatric Association, 2000). These are personswho characteristically display a gloominess, cheerlessness, pes-simism, brooding, rumination and dejection. DPPD would be diagnosed by the presence of five or more of the seven criteria presented in the DSM criteria for DPPD.

A field trial by the DSM-IV Mood Disorders Work Group indicated that many persons do meet diagnostic criteria for DPPD rather than early-onset dysthymia (Phillips et al., 1995; Widiger, 1999). In addition, many persons diagnosed with early-onset dys-thymia may not be adequately described as having a disorder that is confined to the regulation or control of their mood. However, the DSM-IV diagnostic criteria for DPPD lack sufficient empiri-cal support to warrant full recognition

Etiology and Pathology

DPPD may represent a characterologic variant of mood dis-order, in the same manner that STPD is perhaps a charactero-logic variant of schizophrenia. Support for this hypothesis is provided by recent family history and biogenetic studies. Trait depression is also a facet of the personality trait of neuroticism or negative affectivity, which has demonstrated substantial heri-tability within the general population. A characteristically low self-esteem, self-criticism, pessimism, brooding and guilt may also result from continued, sustained criticism, derogation and discouragement by a significant parental figure that is accepted and incorporated by the child.

Assessment and Differential Diagnosis

Most of the DSM-IV-TR semi-structured interviews include items for the assessment of DPPD (First et al., 1997; Pfohl et al., 1997; Widiger et al., 1995; Zanarini et al., 1995) and there is also available a semi-structured interview that is devoted to its assessment, the Diagnostic Interview for Depressive Personality (Gunderson et al., 1994).

DPPD overlaps substantially with early-onset dysthymia. Early-onset dysthymia was in fact conceptualized previously as depressive personality or a characterologic depression prior to DSM-III-R and the alternative criteria for dysthymia that were placed in the appendix to DSM-IV-TR were developed in part on research on DPPD. It is in fact noted in DSM-IV that there may not be a meaningful distinction between these diagnoses (Ameri-can Psychiatric Association, 2000). Some may prefer to use the diagnosis of early-onset dysthymia, but a dysregulation in mood may not adequately explain why some persons are characterized by chronic attitudes of pessimism, negativism, hopelessness and dejection.

Epidemiology and Comorbidity

There are not yet published data on the prevalence of DPPD within the general population. DPPD is likely to be comorbid with early onset dysthymia, although not all cases of DPPD will meet the DSM-IV-TR criteria for dysthymia. Many of the persons who meet the DSM-IV-TR criteria for DPPD will also likely meet the DSM-IV-TR criteria for PAPD and BPD.

Course

As children, persons with DPPD are pessimistic, gloomy, pas-sive and withdrawn. Performance in school is often inadequate to poor. This behavior pattern continues essentially unchanged into and through adulthood. Some, however, may eventually become good workers, exhibiting tremendous discipline and devotion to their work. Relationships with peers and sexual partners, how-ever, are invariably problematic. They are gloomy and irritable company, and have difficulty finding pleasure, joy, or satisfac-tion in leisure activities. They may also be quite withdrawn and lonely, but lack an apparent motivation or energy to seek or main-tain relationships.

Treatment

Many persons with DPD are referred or seek treatment for a depressive mood disorder. It is important in such cases to rec-ognize the extent to which the depressed mood reflects their fundamental view of themselves and the world. Their pes-simism involves more than simply a dysregulation of mood. Cognitive–behavioral techniques have demonstrated effi-cacy in the treatment of depressive personality traits (Beck and Freeman, 1990). The depressive individual’s pessimistic view of themselves and their future should be systematically challenged. Explorations of the faulty reasoning, arbitrary inferences, selective perceptions and misattributions can be influential in overcoming the pessimistic, gloomy, critical and negativistic attitudes. Audio- or videotaped role playing is useful in helping the person recognize the occurrence and pervasiveness of the depressive cognitions, and in generating, developing and rehearsing more realistic and accurate reason-ing. However, exploration of the source for and historical de-velopment of self-defeating behaviors may also be helpful, not only to undermine their credibility and validity within current relationships and situations but also to address any motivation for their perpetuation. Persons with DPPD will also be respon-sive to antidepressant pharmacotherapy, particularly tricyclic antidepressants..