DSM-IV:

Research Criteria for Depressive Personality Disorder:

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 Dysthymic Disorder

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if life's early experiences have been depleted or devitalized, either drained of their richness and joyful elements, or withdrawn from memory, leaving one to feel abandoned, bereft, and discarded, cast off and deserted).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.

Research (Not Plentiful)

Personality dimensions: (Lyoo, Gunderson, & Philips, 1998)

DPD and non-DPD tested

• Tridimensional Personality Questionnaire
• NEO-Five Factor Inventory
• Defense Style Questionnaire
  • scored high for Harm Avoidance and Neuroticism
  • scored low for novelty seeking, extroversion, and adaptive defense mechanisms

Trait independent of depression diagnosis

(Hartlage, Arduino, & Alloy, 1998)

• tested 3 groups with Diagnostic Interview of Depressive Personality
  • depressive mood diagnosed, DPD diagnosed, no diagnosis
• found the self-criticalness was found to be a trait independent of current depression for DPD

• study tested: negative reactivity, remorsefulness, capacity for fun, gloominess, pessimism, difficulty being critical or angry, unassertive, self-denial, and seriousness (all found to be present in depressive mood and DPD groups)

• concluded that if DPD is placed on Axis II, it should be defined by traits at least independent of depression

3. Family Factors (Klein, & Miller, 1993)

• found that patients with DPD were more likely to have first degree relatives with mood disorders than individuals without DPD

Is Depressive Personality Disorder worthy of the DSM-V??

In my opinion, it should be included due to its differentiation from dysthymia and major depressive episode. I do believe, however, that more research should be done on this disorder. As stated, this has been noted as difficult due to the nature of the disorder.

Interested in this subject?

Here are some references that may not have been specifically mentioned in this presentation, but were helpful:

Hartlage, S. , Arduino, K., & Alloy, L. B. (1998). Depressive personality characteristics: state dependent concomitants of depressive disorder and traits independent of current depression. Journal of Abnormal Psychology, 107 (2), 349-354.

Hirschfield, R. M., & Holzer, C. E. (1994). Depressive personality disorder: Clinical Implications. Journal of Clinical Psychiatry, 55 (4), 10-17.

Klein, D. N., & Miller, G. A. (1993). Depressive personality in nonclinical subjects. The American Journal of Psychiatry, 150, 1718-1724.

Klein, D. N., & Smith, J. H. (1998). Depressive personality: Associations with DSM-III-R mood and personality disorders and negative and positive affectivity, 30-month stability, and prediction of course of axis I depressive disorders. Journal of Abnormal Psychology, 107 (2), 319-328.

Lyoo, I. K., Gunderson, J. G., & Philips, K. A. (1998). Personality dimensions associated with depressive personality disorder. Journal of Personality Disorders, 12 (1), 46-55.

Philips, K. A., Gunderson, J. G., Triebwasser, J., Kimble, C. R., Faedda, G., Lyoo, I. K., & Renn, J. (1998). Reliability and validity of depressive personality disorder. American Journal of Psychiatry, 155 (8), 1044-1048.