Depressive disorders are a set of psychopathological conditions included in the diagnostic classifications DSM-5 (American Psychiatric Association) and ICD-11 (World Health Organization). In all of them, patients feel pathological sadness that is accompanied by other symptoms and that occurs with greater or lesser duration and intensity.
Dysthymia is a very well-studied disorder, with extensive publications regarding its clinical characteristics, evaluation, treatment, etc. and that is closely related to “depression”. In the following Psychology-Online article, we explain the relationship between both concepts and we tell you the differences between dysthymia and depression.
In order to see in depth the difference between depression and dysthymia, we will first see the main characteristics of both diagnoses.
What is depression?
At a colloquial level, we use the label “depression” to refer to a low state of mind. When we say that someone is depressed we are usually describing a person in a state of deep sadness. Beyond this colloquial use, we usually use the term “depression” to refer to:
- To the set of depressive disorders (“That person has depression” referring to having a diagnosis from this group) among which we find, among others, major depressive disorder and dysthymia.
- To the major depressive disorder (a disorder with which we compare dysthymic disorder in this article), which is a depressive disorder whose episodes can appear in other disorders, such as bipolar disorder or schizoaffective disorder.
Causes of depression
Depressive disorders constitute a group of complex problems whose cause must be taken into account from different perspectives and theories.
At a biological level, although explanations such as those related to genetics or those related to the endocrine system have been postulated, theories that focus on the functioning of neurotransmitters stand out. These indicate dysfunction in the neurotransmission systems as a cause of mood problems. In this article we talk about.
On the other hand, different explanations and theories have been established from psychological models that explain the origin, development and maintenance of depressive problems. These theories include:
- The cognitive modelsamong which we find Beck’s theory and the theory of learned helplessness.
- The behavioral modelswhich focus on aspects such as the decrease in positive reinforcement.
- The psychoanalytic theory It also has an explanatory model of depression.
Symptoms of depression
Depressive symptoms and the clinical picture of depression are as extensive as they are complex. Since in this article we are going to compare major depressive disorder with dysthymic disorder, we are going to look at the diagnostic criteria necessary for each one according to the DSM-5 (APA).
Regarding the symptoms that may appear are:
- Depressed mood.
- Decreased interest or pleasure in all or almost all activities.
- Significant weight loss.
- Insomnia or hypersomnia.
- Psychomotor agitation or retardation.
- Fatigue or loss of energy.
- Feeling of worthlessness or excessive or inappropriate guilt.
- Decreased ability to think or concentrate and make decisions.
- Recurrent thoughts of death and suicidal ideas.
Another type of depressive disorder is dysthymia. We will detail its characteristics below:
What is dysthymia
Dysthymia is a diagnostic category included within depressive disorders. In this case we are referring to a disorder that lasts longer than major depressive disorder and is of lesser intensity.
Causes of dysthymia
As we have pointed out in the previous section, the origin of depressive disorders corresponds to multiple and complex causes. In this regard, as has been stated, the different currents of psychology and biology have provided explanatory models to understand its causes.
Symptoms of dysthymia
The symptoms that the DSM-5 proposes for dysthymic disorder would be the following:
- Depressed mood.
- Little appetite or overeating.
- Insomnia or hypersomnia.
- Low energy or fatigue.
- Low self-esteem.
- Lack of concentration or difficulty making decisions.
- Feelings of hopelessness.
Despite having many similarities, major depressive disorder and dysthymia have several differences that we detail below:
1. Duration
Major depressive disorder requires that symptoms be present for at least two weeks so that the diagnosis can be made.
Unlike this, the diagnosis of dysthymia requires that the symptoms be present for at least two years (one year for children and adolescents) and requires that there have been no more than two months without symptoms being present.
2. Appearance in other diagnostic conditions
Episodes of major depression can appear in the context of other mental disorders, such as and . Dysthymia, on the other hand, does not appear as part of these disorders.
3. Seasonality specification
Given that in major depressive disorder we talk about episodes and dysthymia is a more lasting disorder, in the first we can specify whether These episodes appear with a certain seasonalitya specification that we will not make in the case of dysthymia.
4. Prevalence
The ESEMeD study (ESEMeD/MHEDEA 2000 Investigators, 2004; Haro et al., 2006; seen in Caballo) provided prevalence data in European countries on depressive disorders collected in the DSM-IV. These data indicated that major depressive disorder had a lifetime prevalence of 12.7% and dysthymia 3.6%.
5. Requirement of symptoms for diagnosis
From the list of symptoms, major depression requires five or more, while dysthymic disorder only requires two or more.
6. Nuclear symptoms
Nuclear symptoms refer to those that must necessarily appear to establish the diagnosis. In this regard, to diagnose DSM-5 major depressive disorder, it is necessary that the patient experience a depressed mood or experience a decrease in interest or pleasure in the activities that he usually does. Unlike this, only a depressed mood is required for the diagnosis of dysthymia.
7. Other required symptoms
For the diagnosis of dysthymic disorder, in the DSM-5, it is required that feelings of hopelessness and low self-esteem be present that are not present for the diagnosis of major depression (although in this case symptoms related to the feeling of worthlessness, guilt, excessive).
Regarding weight, a significant weight loss is required for the diagnosis of major depressive disorder, while for dysthymic disorder, poor appetite or overeating may appear.
Finally, one of the proposed criteria for the diagnosis of major depressive disorder is recurrent thoughts of death or suicidal ideation, which does not appear for the diagnosis of dysthymic disorder.
8. Intensity
Given the symptoms, it is assumed that the intensity with which a major depressive disorder is shown will be greater than the intensity with which a dysthymic disorder can appear (more symptoms are required in less time for major depressive disorder and fewer but longer lasting symptoms are required for dysthymic disorder).