Personality, identity and temperamental characteristics of dysthymic and depressive patients

Purpose: Dysthymic disorder (DD) is a mild, chronic depressive condition. Proposedly, dysthymia will be defined as chronic depressive disorder together with chronic major depression in the DSM-5. The present study aims to investigate in a comparative manner the personality disorders, identity problems, and affective temperaments associated with episodic depressive disorder and chronic depressive disorder.Method: Participants were 92 outpatients or inpatients under treatment for depressive symptoms at the psychiatry clinic of the Adnan Menderes University Research Hospital. Each participant was assessed clinically by means of semi-structured SCID-I and SCID-II interviews, Hamilton Depression Scale, DSM-5 criteria for personality functioning, and a series of self-report inventories for affective temperament (TEMPS-A) and identity confusion (IFAIC).Findings: Of 92 participants, 85 % were diagnosed with major depression (68 % acute, 17 % chronic) and 51 % with dysthymic disorder. Sixty eight percent of patients with DD have the comorbid MDD and 51 % of patients with MD have the comorbid DD. Eighty one percent of the patients have at least one DSM-3-R personality disorders, and 63 % of the patients have general personality disorder according to the DSM-5 criteria. Paranoid personality disorder is the most common personality disorder in all groups (44 %), borderline personality disorder is found more common (38 %) in early onset dysthymia (EOD) as compared with late onset dysthymia. Depressive personality disorder (DPD) was diagnosed in 30 % of all the participants, 43 % of dysthymic patients, 50 % of the patients suffering from double depression, and 65 % of the patients with early onset dysthymia. No significant difference was found among the diagnostic groups in terms of affective temperaments and identity confusion scores. In contrast, the cyclothymic, depressive-anxious and hyperthymic temperament scores of the early onset dysthymics were found to be higher than those of the late onset dysthymics. Likewise, IFAIC scores of the early onset dysthymics were significantly higher than those of late onset dysthymics.Conclusion: Dysthymia is diagnosed in approximately half of the patients suffering from depressive symptoms. Two thirds of the patients with dysthymia seek for psychiatric help during acute exacerbations of major depression. Two thirds of all the participants have chronic depressive disorder as a new category proposed for the DSM-5 to cover both dysthymia and chronic major depression. The validity of this new diagnostic category is supported by the similarity of dysthymic and chronic major depressive patients with respect to personality disorders, identity disturbance and affective temperamental characteristics. Nevertheless, given the closer association of early onset dysthymia with borderline and depressive personality disorders, disturbed sense of identity, and all but the hyperthymic temperament in present study, it might be appropriate to preserve early onset dysthymia and late onset dysthymia in the DSM-5 as clinical subtypes of chronic depression.