Depressive Personality Disorder
BY: T. Franklin Murphy | September 12, 2022 (modified January 16, 2023)
BY: T. Franklin Murphy | September 12, 2022 (modified January 16, 2023)
Definition, history, and arguments for and against inclusion of depressive personality disorder in the DSM.
Depressive personality disorder is a psychiatric diagnosis, not included in the latest DSM release (DSM-V). Depressive personality disorder is a personality disorder characterized by cognitions that put an individual at higher risk of experiencing other mood disorders, such as major depressive disorder.
DSM-IV defined depressive personality disorder as "a pervasive pattern of depressive cognitions and behaviors that beginning in early adulthood and occurring in a variety of contexts." Depressive personality disorder has a high comorbidity rate with both other personality disorders and mood disorders.
Because depressive personality disorder typically occurs before, during, and after major depressive episodes, it is considered a distinct diagnosis, with symptomology not included in either of the mood disorders of major depressive disorder or the dysthymic disorder.
The depressive personality dates back to at least the time of Emil Kraepelin (1921). Kraepelin used the term "depressive temperament" to describe "fundamental states" that predispose individuals to the depressive disorder. Kraepelin's description of these states is almost mirrored by the diagnostic criteria for depressive personality disorder over a half a century later.
Kraepelin characterized the depressive temperament as "being predominantly depressed, gloomy, and despairing, as well as overly serious, guilt-ridden, self reproaching, self-denying, and lacking confidence..." (Bagley, et al. 2003).
The depressive personality "has been used by clinical theorist from diverse perspectives and has been used by clinicians for years" writes Phillips, Hirschfeld, Shea, & Gunderson. They continue that the concept of a depressive personality has been referred to by a variety of names, such as "typus melancholicus, melancholic temperament, dysthymic temperament, characterologic depression, sub-affective dysthymia, dysthymic psychopathy, and anankastic personality disorder with depressive features" (1993).
Depressive personality disorder is characterized by a pervasive pattern of depressive cognitions and behaviors beginning by early adulthood.
Individuals with depressive personality disorder exhibit affective, cognitive, and interpersonal attributes that substantially deviate from cultural norms. These attributes, to be considered pathological, must be more than just a exhibiting a negative tone. In order to amount to the level of a personality disorder they must be rigid and inflexible, creating what Theodor Millon refers to as vicious circles.
Vicious circles, Millon explains is when a "person's habitual perceptions, needs and behaviors perpetuate and intensify preexisting difficulties" (2016). In order to qualify as depressive personality disorder, one's dejected, gloomy, worrying would be to a level that it interfered with life, intensifying "preexisting difficulties."
Individuals suffering from this disorder would "find it difficult to relax and find enjoyment, or to be anything but 'work mode.'" They would have a "marked sense of personal inadequacy, with harsh self-judgements" (Bagley, et al. 2003). Depressive thoughts are central to this diagnosis, guilt and regret take central stage, repeatedly intruding on the moment through unhealthy ruminations. Their harsh self-judgments may also be extended to others.
People with this disorder may have exhibit self-sabotaging behaviors, motivated by a core belief that they don't deserve happiness (2003).
Diagnosis of Depressive Personality Disorder
According to DSM-IV-TR diagnostic criteria (the last version of DSM to include depressive personality disorder), depressive personality disorder is:
1. A pervasive pattern of depressive cognitions and behaviors beginning in early adulthood and present in a variety of contexts, as indicated by five or more of the following:
2. Does not occur exclusively during Major Depressive Episodes; and is not better accounted for by Dysthymic Disorder.
Aaron Beck's Cognitive Triad and Depressive Personality Disorder
Aaron Beck's cognitive triad of depression shares many of the cognitive characteristics of depressive personality disorder. Beck's triad includes negative views of:
Beck theorized that "depressed persons have distorted negative perceptions of themselves, their world, and their future." Researchers Beckham, Leber, and colleagues explain that "negative cognitions in these areas, known as the cognitive triad, lead to feelings of depression" (1986. p. 566).
This gives a clue of the role of the personality disorder in connection with a diagnosis of a mood disorder. The personality disorder is a style of cognitions (such as the cognitive triad) and behaviors (such as self-sabotage) that leads to depression.
DSM History of Depressive Personality Disorder
Originally depressive personality disorder was listed in included in American Psychiatric Association's DSM-II. The disorder was later removed from the subsequent versions DSM-III and DSM-III-R. The latest entry for depressive personality disorder was description of depressive personality disorder was included in Appendix B in the DSM-IV-TR.
The disorder was completely removed from all subsequent versions (DSM-VI; DSM-V-TR).
There are plenty of passionate arguments for and against inclusion of depressive personality order in the DSM. Which is of little surprise, since personality disorders, in general, are often seen as second class citizens in diagnosis. Until later versions of the DSM, personality disorders were designated on a different axis (Axis-II disorders).
Personality disorders are diagnosed primarily by cognitions and behaviors as compared with normal symptomology of other psychiatric disorders.
Depressive Personality Disorders Comorbidity with other Disorders
Many researchers believe that depressive personality disorder is so highly comorbid with other depressive disorders, such as manic-depressive episodes and dysthymic disorder, that having a separate category as a personality disorder as a distinct diagnosis is redundant.
Bagley, Rider, and Schuller argue there is no need for the inclusion of depressive personality disorder because the extent of the overlap between DPD and dysthymic disorder. They wrote that "the greatest challenge to the validity of DPD--is the extent to which it is distinct from dysthymic personality disorder (dysthymia)" (2003).
However, many studies have found that dysthymic disorder and depressive personality disorder are not as comorbid as previously thought. It was found that almost two thirds of the test subjects with depressive personality disorder did not have dysthymic disorder.
Katherine Phillips and John Gunderson explain, "the features of depressive personality disorder are more personologic, cognitive, and psychological than the largely somatic symptoms of dysthymic disorder." They continue "it would be difficult to conceptualize dysthymic disorder's primarily somatic features of appetite disturbance, sleep disturbance, fatigue, poor concentration, and feelings of hopelessness and low self-esteem as constituting a personality type" (1999).
Phillips and Gunderson argue "comorbidity rates between Axis I disorders that are similar to those for depressive disorder and other personality disordered are not typically taken to mean that one of the Axis I disorders does not exist" (1999).
In a 2003 study, McDermut, Zimmerman, & Chelminski found that "although dysthymic disorder was significantly more common with participants with versus without DPD, only a minority of the participants diagnosed with DPD were also diagnosed with dysthymic disorder" (p. 51).
The arguments for including or excluding depressive personality disorder from the DSM are moot since the disorder has been missing from the diagnostic text for nearly a decade. According to Wikipedia, since the personality disorder is no longer listed as a personality disorder, "the diagnosis of subclinical Other Specified Personality Disorder and Unspecified Personality Disorder can be used to classify an equivalent of depressive personality disorder" (Depressive Personality Disorder).
Bagby, R., Ryder, A., & Schuller, D. (2003). Depressive personality disorder: A critical overview. Current Psychiatry Reports, 5(1), 16-22.
Beckham, E., Leber, W., Watkins, J., Boyer, J., & Cook, J. (1986). Development of an Instrument to Measure Beck’s Cognitive Triad: The Cognitive Triad Inventory. Journal of Consulting and Clinical Psychology, 54(4), 566-567.
Huprich, S., Chen, Y., & Hsiao, W. (2011). Affect Regulation and Depressive Personality Disorder. Journal of Personality Disorders, 25(6), 755-764.
McDermut, W., Zimmerman, M., & Chelminski, I. (2003). The Construct Validity of Depressive Personality Disorder. Journal of Abnormal Psychology, 112(1), 49-60.
Millon, Theodore (2016) What Is a Personality Disorder?. Journal of Personality Disorders 30.3 (2016): 289-306.
Phillips, K., & Gunderson, J. (1999). Depressive Personality Disorder: Fact or Fiction?. Journal of Personality Disorders, 13(2), 128-134.
Phillips, K., Hirschfeld, R., Shea, M., & Gunderson, J. (1993). Depressive Personality Disorder: Perspectives For DSM-IV. Journal of Personality Disorders, 7(1), 30-42.
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