What Is Dysthymic Disorder? Five Signs And Symptoms
Note: Dysthymic disorder was a mood disorder in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-4). However, in the most recent version of the DSM, the DSM-5, this condition has been renamed persistent depressive disorder (PDD).
Persistent depressive disorder, often called dysthymia, is a depressive disorder that lasts for over two years for adults and over a year for children and adolescents. To understand dysthymic disorder, it can be helpful to look at the diagnostic criteria for this condition and how to find support if you believe you are living with it.
What is dysthymia?
Dysthymia, properly called persistent depressive disorder (PDD), is a depressive disorder lasting for over two years. It causes similar symptoms to major depressive disorder (MDD). However, the symptoms are often milder and last for longer. Try thinking of it as a milder but chronic major depressive disorder. The word “dysthymia” comes from the Greek language and roughly translates to “bad state of mind.”
PDD is sometimes referred to as a “low-grade” or low-level” depression” by psychiatrists. However, this labeling doesn’t mean that the condition is not severe or does not cause functional impairments. Although the symptoms may be less harsh, their chronic nature can interfere with a person’s livelihood.
Those with major depressive disorder often know they have a more baseline mood that can sometimes be considered positive. In addition, major depressive episodes may not last every day for years. Those with a chronic condition like dysthymia may not experience any positive emotions for years. In addition, many people living with PDD experience major depressive disorder.
Based on statistics, PDD is rarer than major depression. Approximately 1.5% of adults in the US are diagnosed with PDD annually, while 7% of those with major depressive disorder are diagnosed. In addition, to receive a diagnosis of persistent depressive disorder, symptoms must occur non-stop for at least two years. To be diagnosed with MDD, symptoms must occur every day for at least two weeks.
What are the symptoms of PDD?
According to the DSM-5, individuals must have at least two of the following symptoms for two years or more to be diagnosed with PDD.
A poor appetite or overeating
Appetite changes can be a common symptom of depression and may go both ways. Some people with PDD may struggle to eat enough to remain healthy, whereas others may overeat. Some of the foods people crave when anxious, stressed, or depressed may be unhealthy, which can lead to adverse health impacts and cause a desire to eat even when one is not hungry. In some cases, over or undereating leads to weight loss or gain, which may have health impacts for some people.
Insomnia or hypersomnia
Like appetite changes, it can be typical for those with depression to struggle to sleep or wake up. Struggling to fall or stay asleep is called insomnia, whereas sleeping too much or struggling to wake up in the morning is called hypersomnia, which may be associated with the fatigue that often accompanies depression.
Some people experience both insomnia and hypersomnia. For example, someone may struggle to fall asleep at night. Still, when they fall asleep late in the night or early morning, they may struggle to wake up on time and could sleep for over eight hours, which is higher than average for adults.
Treating sleep conditions may require the assistance of a doctor who can prescribe sleeping medication or offer treatment plan recommendations. Consult your provider before starting, changing, or stopping any medication or treatment.
Low energy and fatigue
Having little to no energy can make performing daily tasks difficult. If a person has the strength to complete tasks when they wake up, depression can cause their energy to be quickly expended, causing fatigue later in the day. Excess fatigue can be dangerous and may cause a person to fall asleep at work, on the road, or in other dangerous situations.
These symptoms, sleep disturbances, and concentration challenges can make PDD like chronic fatigue syndrome (CFS). However, to get a diagnosis of CFS, an individual must have memory issues or experience headaches, dizziness, lightheadedness, or blurry vision. Talk to your doctor to understand what may be causing your fatigue.
Poor concentration and difficulty making decisions
Sleep disturbances and fatigue can manifest in difficulty focusing, which can make performing tasks challenging. For example, doing homework for school or completing an assignment for a job can seem impossible due to depression. The thoughts and feelings associated with this condition can distract and get in the way of completing tasks.
Some individuals with depressive disorders may also exhibit poor decision-making skills or indecisiveness. Difficulty with decision-making may occur because the individual wants to avoid a negative outcome or anxiety, even if the topic is positive or beneficial. Risk aversion can also be a factor, and an individual with depressive symptoms may turn down a job promotion because they don’t believe they are competent or that there is hope for them.
Thoughts of hopelessness and low self-esteem
Those with dysthymic disorder may experience low self-esteem and thoughts of hopelessness consistently. Although these thoughts may not be as severe as they are in major depressive disorder, these symptoms can be a sign of suicidal thoughts, and they may worsen over time.
Finding treatment as soon as possible can be crucial when experiencing long-term hopelessness. Treatment aims to help individuals improve their mood and meet their goals. With support, you may receive a boost of hope from someone else, which you can start reincorporating into your life.
If you are experiencing suicidal thoughts or urges, call the 988 Suicide & Crisis Lifeline at 988 or text 988 to talk to a crisis provider over SMS. They are available 24/7 to offer support. 988 also offers an online chat for those with an internet connection.
Talking with a therapist can help persistent depressive disorder
Support options
Treating persistent depressive disorder can look similar to treating major depression, and it may consist of medication, therapy, or a combination of the two. Although you must have symptoms for at least two years to receive a diagnosis, you don’t need a diagnosis to seek support from a therapist.
Some people with depression may avoid therapy due to barriers to in-person care, such as a high cost, transportation difficulties, or long distances. In these cases, online platforms like BetterHelp can offer convenient and affordable therapy. Through an online platform, individuals can get matched with a therapist within 48 hours. In addition, you can attend therapy from home and choose between phone, video, or live chat sessions.
Studies show that online therapy is effective for those living with depression. One review of 17 studies found that internet-based interventions were more effective than face-to-face options in treating depression and improving quality of life, with results sustained in the long term.
Takeaway
What are the characteristics of a dysthymic person?
Dysthymia—now called “persistent depressive disorder” (PDD)—is generally a milder but persistent or lasting form of depression. A person with PDD must consistently feel sad or low in terms of mood and experience at least two other symptoms for at least two years in order for a diagnosis of dysthymia to be considered by a clinician. The list of “other symptoms” or dysthymic disorder signs includes trouble concentrating, hopelessness, significantly increased or decreased appetite, fatigue, low energy, significant changes in sleep patterns, and low self-esteem or patterns of being self-critical.
A person with PDD may also be at an increased risk for experiencing comorbid conditions such as major depression and other mood disorders, personality disorders, anxiety disorders, and substance use disorders. Stressful life events and conditions could make symptoms worse or increase the risk of developing a comorbid disorder, so learning to manage difficult emotions with the practical and emotional support of a therapist could be helpful for those living with PDD. With the right treatment, you may be able to prevent persistent depressive disorder from worsening or more significantly impacting your functioning.
What are the types of dysthymic disorder?
Dysthymia, or persistent depressive disorder, has been classified into two types by some researchers based on brain chemistry: anxious and non-anxious (anergic). Anxious dysthymia is thought to be associated with low serotonin, a brain chemical that can help manage mood in the face of stress. That means individuals with this type may experience low self-esteem and insecurity when exposed to stress.
Anergic dysthymia, in contrast, is thought to be associated with low levels of dopamine, a brain chemical that is associated with motor function and motivation. That’s why individuals with this type may have more trouble with lethargy and lack of interest and motivation. Both types tend to show the same core symptoms, however, such as a persistent depressed mood.
What is early onset dysthymia?
Early onset dysthymic disorder (EODD) is a mental illness that can occur in children. It’s related to dysthymia—now known as persistent depressive disorder—in adults. Key features of EODD include “impaired social and relationship functioning,” comorbid mental illnesses, and an increased risk of developing psychiatric conditions as an adult.
How long does a dysthymic episode last?
There’s no typical duration for a dysthymic episode (or episode of persistent depressive disorder, as the condition is now called). It’s characterized by ongoing symptoms over the long term—typically years.
How do people with dysthymia behave?
People with dysthymia, or persistent depressive disorder, are likely to experience at least a few symptoms consistently over the course of years. These can include lethargy, low mood, sadness, low energy, trouble concentrating, significant changes in sleeping and/or eating patterns, and low self-esteem.
What are dysthymic tendencies?
Dysthymic tendencies could refer to a predisposition toward symptoms of dysthymia, or persistent depressive disorder. These could look like consistent low mood, fatigue, and low self-esteem. Having these tendencies does not constitute a clinical diagnosis, however. Speak with your doctor and/or mental health care provider for evaluation, information, and support.
Can people with dysthymia be happy?
While dysthymia, or persistent depressive disorder (PDD), is a condition with lasting, consistent symptoms, this doesn’t mean an individual experiencing it can’t feel happiness. Symptoms of PDD tend to be milder than those of major depressive disorder. That means an individual with this condition might have days where their symptoms are minor or hardly even noticeable, so they may feel happier or more positive or hopeful at some points compared to others.
What is the most important characteristic used to distinguish dysthymia from major depression?
Since dysthymia (now called persistent depressive disorder (PDD)) and major depression show the same types of symptoms, making a diagnosis of one or the other can sometimes be difficult for clinicians. That said, the key criteria is typically the duration of symptoms, with their intensity also being an important factor to consider. Major depression can be diagnosed after two weeks of experiencing symptoms, but a PDD diagnosis requires milder symptoms to be experienced over the course of at least two years.
What is the primary difference between major depressive disorder and dysthymic disorder?
The primary difference between major depressive disorder (MDD) and dysthymic disorder, or persistent depressive disorder (PDD), is the duration of symptoms. PDD tends to have milder, longer-lasting symptoms than major depressive disorder, whose symptoms are typically more intense and debilitating and may not persist as long. To put it another way, a clinician can consider a diagnosis of MDD after the individual has experienced just two weeks of symptoms, but they won’t typically consider a PDD diagnosis until the person has been experiencing symptoms for two years or more.
It’s also worth noting that certain, more serious symptoms can be associated with MDD but are less likely to appear with PDD. One of these is an increased risk of thoughts or behaviors related to self-harm or suicide. If you or someone you know is experiencing any of these, call the suicide hotline/crisis lifeline below immediately.
If you or someone you know is experiencing suicidal thoughts or behaviors, seek help immediately. The National Suicide Prevention Lifeline can be reached 24/7 by dialing 988.
How do you deal with dysthymia?
Long-term treatment for dysthymia, or persistent depressive disorder, typically consists of individual or even family therapy with family, sometimes in combination with medication. If you’re experiencing symptoms of this or another mental illness, it’s typically recommended that you consult with your doctor and/or a mental health professional for treatment advice.
Seeking treatment like talk therapy as soon as possible may help prevent symptoms from worsening to a point where they more significantly impact daily functioning. A qualified treatment provider can also provide an accurate diagnosis, potentially ruling out other possibilities such as another form of depression or a personality disorder.
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