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Dysthymic disorder is a subaffective disorder characterized by long-standing fluctuating low-grade depression with the following characteristics: (1) low-grade chronicity for at least two years, (2) insidious onset with origin often in childhood or adolescence, and (3) persistent or intermittent course. Although not part of the formal definition of dysthymic disorder, the family history is typically replete with both depressive and bipolar disorders, which is one of the more robust findings supporting its link to primary mood disorder. Most cases are of early onset, beginning in childhood or adolescence.

Social adjustment

Dysthymic disorder is typically an ambulatory disorder compatible with relatively stable social functioning. However, the stability is precarious; recent data have documented that many of the patients invest whatever energy they have in work, leaving none for leisure and family or social activities, which results in the characteristic marital friction.

Epidemiological studies have demonstrated that some persons with protracted dysthymic complaints, extending over many years, have never experienced clear-cut depressive episodes. Some of them may seek outpatient counseling and psychotherapy for dysthymic disorder.


An insidious onset of depression dating back to late childhood or the teens, preceding any superimposed major depressive episodes by years, or even decades, represents the most typical developmental background of dysthymic disorder. A return to the low-grade depressive pattern is the rule following recovery from superimposed major depressive episodes, if any.

Patients with dysthymic disorder often complain of having been depressed since birth or of feeling depressed all the time. They seem to view themselves as belonging to an aristocracy.

Clinical picture

The profile of dysthymic disorder overlaps with that of major depressive disorder, but differs from it in that symptoms tend to outnumber signs (more subjective than objective depression). Thus marked disturbances in appetite and libido are uncharacteristic, and psychomotor agitation.

Although dysthymic disorder as defined here represents a more restricted concept than does its parent, neurotic depression, it is still quite heterogeneous. Anxiety is not a necessary part of its clinical picture, yet dysthymic disorder is often diagnosed in patients with anxiety and neurotic disorders. That clinical situation is perhaps to be regarded as a secondary or anxious dysthymic disorder or even as a general neurotic syndrome.

Treatment of Dysthymic Disorder

Treatment of dysthymic disorder includes the modification of psychotherapeutic approaches specifically for the treatment of dysthymic disorder, as well as preliminary open trial studies investigating the effectiveness of the modified psychotherapies for dysthymic patients. The chronic interpersonal and social deficits associated with dysthymic disorder provide a strong rationale for the use of IPT with dysthymic patients, and a manual has recently been developed.

Another psychotherapeutic approach that has recently been developed specifically for the treatment of dysthymic disorder is the Cognitive-Behavioral Analysis System of Psychotherapy (C-BASP). The focus of this treatment approach is on problematic cognitive and behavioral patterns associated with dysthymic disorder. A situational analysis procedure that includes performance feedback.