Regarded are the gold standard diagnostic tool for mental disorders, the Diagnostic and Statistical Manual of Mental Disorders (DSM), was engineered by the American Psychiatric Association (Maddux & Winstead, 2012). This tool provides a common language, as well as, standardized criteria for the categorization of mental disorders. DSM is widely used by a host of professionals including guides researchers, clinicians, pharmaceutical firms, health insurance companies, legal entities, policy makers and other entities such as the World Health Organization during the evaluation of mental disorders (Maddux & Winstead, 2012). The most recent version of DSM was published in May 2013, and it is the fifth edition. Since its invention in 1952, this tool has undergone a host of revisions. The latest version of this tool is the DSM-5. This paper will evaluate the characteristics of a female patient with dysthymia on the count of DSM-5.
The latest version of DSM-IV-TR has a five-part axial system. The first and second axes contain a guide for clinical disorders and intellectual and personality disorders respectively (Maddux & Winstead, 2012). On the other hand, the other axes contain guides for childhood, environmental, psychosocial, environmental, and medical factors that are useful in healthcare assessments (Maddux & Winstead, 2012). In line with this, this paper discusses the symptoms, diagnosis and management of dysthymia on the basis of DSM-5. Dysthymia is a psychosocial disease, and thus falls under second half of the DSM axis.
Dysthymia and DSM-5
Dysthymia is a mood disorder, and at times, it is also termed as chronic depression, dysthymic disorder or neurotic depression (Ishizaki & Mimura, 2011). This disorder has the same physical and cognitive problems like depression. However, the symptoms of dysthymia are less severe but last for a long time. On the account of DSM-5, dysthymia refers to a serious state of chronic depression and persists for up to 2 years (Ishizaki & Mimura, 2011). In adolescents and children, it may last for a year. In addition, it is not as severe and acute as depressive disorder. On top of that, this condition is chronic, and affected individuals may exhibit its symptoms for years before it is diagnosed. At times, it may never be diagnosed. Consequently, affected individuals tend to think depression is part of their character. For these reasons, affected people find it hard to discuss their experiences with their friends, relatives or family doctors.
Furthermore, this condition always co-occurs with other mental challenges. For instance, one may suffer from depression, as well as, dysthymia; this is often termed as double depression. Another example is when one has alternating dysthymic and hypomanic moods; this is an indication of a mild bipolar disorder commonly known as cyclothymia. The latest version of DSM-5 has termed dysthymia as persistent depressive disorder.
Irrespective of their age or gender, individuals with dysthymia exhibit low self-esteem, have low energy and drive, exceptionally low capacity for pleasure in life (Ishizaki & Mimura, 2011). Those with mild dysthymia may try to avoid stress, as well as, opportunities for fear of failure. Those who withdraw from the daily activities have severe dysthymia. Such people find past times and initially favorite activities less interesting. Affected individuals’ significant relationships become lose. For example, they find it hard to hang out with partners, friends, workmates, family members or peers. In terms of public presentation, people with severe dysthymia have a poor demeanor. Patients with dysthymia find have troubled formal relationships with other members of the society such as the police, family doctors, landlords, and administrates among others; they tend to avoid coming into contact with such people. Patients with dysthymia have a low self-esteem, low attitude, and this can be illuminated by the careless dressing; they no longer care about their appearance or grooming.
On the account of mental stability, dysthymia patients have feelings of hopelessness, pessimism, negative perceptions of themselves, as well as, poor decision making. Many of these patients have poor insights and base their conclusions on speculation. In terms of physical health, the effects might vary. Patients with chronic insomnia and poor appetite may lose weight. On the other hand, those with increased appetite may have a sharp increase in their weight. Fatigue is a common physical problem that patients with dysthymia face. In some cases, those with severe dysthymia may misuse drugs or alcohol as a way of running away from their personal troubles. The diagnosis of this condition is challenging because its symptoms are hard to detect. In addition, co-occurs with other mental disorders (Ishizaki & Mimura, 2011).
However, the majority of affected individuals have suicidal tendencies (Ishizaki & Mimura, 2011). During the diagnosis of this disorder, it is important to screen for signs of personality disorder, generalized anxiety, panic disorder, alcohol and substance abuse, and major depression. Moreover, there are no biological causes of this disorder and perhaps this explains the diverse nature of this condition. Lack of social support, social isolation and stress are linked to this dysthymia. They may trigger the development of dysthymia.
On the account of DSM-5, a person suffering from dysthymia appears to be depressed for most of the days in the window of two years (Ishizaki & Mimura, 2011). When depressed, the affected person exhibits fluctuations in appetite: increased or decreased. Affected individuals may have hypersomnia or insomnia, low self-esteem and fatigue. These individuals have low concentration and express pessimism. During this two-year window, the affected person exhibits the aforementioned symptoms at least for two consecutive months. In addition, prior to the two-year window, the patient did not have any major depression, hypomanic, manic or mixed episodes.
Treatment and Management
A combination of medication and psychotherapy it is the best treatment for dysthymia (Ishizaki & Mimura, 2011). In terms of medication, selective serotonin re-uptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), selective serotonin norepinephrine inhibitors (SNRIs) are regarded as the most appropriate options (Ishizaki & Mimura, 2011). The use of these medications points to the hint that noradrenergic and serotoninergic systems are involved in the biochemistry of dysthymia. Systemic reviews of the aforementioned medications have shown that monoamine oxidase inhibitors, TCAs and SSRIs are all equally up to the task, but SSRs are better tolerated than the other medications. In addition, noradrenergic agents such as bupropion, duloxetine, venlafaxine, nefazodone, and mirtazapine. Moreover, second generation antipsychotics are equally effective, but are poorly tolerated, particularly due to sedation, prolactin increase and weight gain.
On the other hand, the combination of medication and psychotherapy has shown better results than the use of medications alone (Ishizaki & Mimura, 2011). A number of psychotherapies can be employed in the management of people with dysthymia. The most commonly used psychotherapies in the management of dysthymia include interpersonal psychotherapy, insight oriented psychotherapy, psychodynamic psychotherapy, and cognitive behavioral therapy. However, Cognitive Behavioral Analysis of Psychotherapy (CBASP) has been seen as a more effective approach in the treatment of chronic depression (Ishizaki & Mimura, 2011). It is based on the concept of situational analysis.
CBASP approach assists affected persons to deal with problematic interpersonal challenges (Ishizaki & Mimura, 2011). Patients are taught to focus on the consequences of their behavior. They are encouraged to use a social problem solving algorithm as a tool of solving their interpersonal difficulties. Since it is more directive and structured, CBASP has registered more success than other psychotherapies. Its success has been attributed to the concentration on interpersonal experiences including patients’ interactions with their psychotherapists (Ishizaki & Mimura, 2011). In addition, this tool helps patients to realize how their behavioral and cognitive patterns influence their interpersonal experiences. Patients are taught how to avert their maladaptive interpersonal patterns.
DMS-5 Pros and Cons: Focus on Dysthymia
The current version of DSM-5 has not only revised diagnoses. It has both broadened and narrowed definitions. The current DSM-5 has clarity with respect to revision numbers following the discontinuation of Roman numerals. Assumptions have been excluded in this version, and absolute boundaries in each category of mental disorders have been defined. In addition, non-criterion and low grade symptoms have been neglected, and qualifiers are employed, for instance, severe, moderate or mild. These features have been illuminated in the categorization and diagnosis of dysthymia.
As noted, Dysthymia is a mood disorder, and at times, it is also termed as chronic depression, dysthymic disorder or neurotic depression. This disorder has the same physical and cognitive problems like depression. However, the symptoms of dysthymia are less severe but last for a long time. DSM-5 suggests that persons with dysthymia have either severe or mild fluctuations in appetite and sleep or low energy levels.
Dsm-5 is a vital tool in the diagnosis of mental disorders. However, it has some weaknesses. It provides limited information on the causes of various disorders under its jurisdiction. DSM-5 fails to provide a pathophysiological understanding of psychiatric disorders. In fact, DSM-IV-TR relies on symptoms but does not account for the etiology of mental disorders.
In conclusion, this paper has shown that latest version of DSM-IV-TR has a five-part axial system. The first and second axes contain a guide for clinical disorders and intellectual and personality disorders respectively. On the other hand, the other axes contain guides for childhood, environmental, psychosocial, environmental, and medical factors that are useful in healthcare assessments. Dysthymia is a psychosocial disease and thus falls under second half of the DSM axis. Irrespective of their age or gender, individuals with dysthymia exhibit low self-esteem, have low energy and drive, exceptionally low capacity for pleasure in life. The diagnosis of dysthymia is challenging because it co-occurs with other mental disorders. On the account of DSM-5, a person suffering from dysthymia appears to be depressed for most of the days in the window of two years. A combination of medication and psychotherapy it is the best treatment for dysthymia.
Maddux, J. E., and Winstead, B.A. (2012). Psychopathology: Foundations for a Contemporary Understanding. London: Routledge.
Ishizaki, J., & Mimura, M. (2011). Dysthymia and Apathy: Diagnosis and Treatment. The Journal of Depression Research and Treatment, pp.1-7. http://dx.doi.org/10.1155/2011/893905