Persistent Depressive Disorder (Dysthymia)

Posted on by Greg E. Gifford

By David Wong

I. Definition

  1. Biblical Perspective
    1. Persistent Depressive Disorder is “a continuous long-term (chronic) form of depression.”[1] Asher and Asher say that “the primary diagnostic feature is clinical depression (see Depression) that lasts more or less continuously for two years (one year in children and adolescents).”[2]
    2. Persistent Depressive Disorder is similar in nature to Major Depression, but Persistent Depressive Disorder “usually has fewer or less serious symptoms than major depression”[3]
      1. Major distinctive characteristic is the time frame and severity of the disorder.
  2. Secular Perspective
    1. DSM V
      1. “Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years.”[4]
        1. 1 year for adolescents and children
      2. Treatments/Methodologies
        1. One of the significant treatments applicable to those diagnosed with Persistent Depressive Disorder through Psychology is Psychotherapy.
          1. Psychotherapy refers to therapeutic treatment of mental disorders without the use of medication.
          2. Some common therapies include[5]:
            1. Cognitive Behavioral Theory
            2. Interpersonal Therapy
            3. Dialectic Behavioral Therapy
            4. Psychodynamic Therapy
            5. Psychoanalytical Therapy
            6. Supportive Therapy
            7. Other Therapies include:
              1. Animal Assisted Therapy
              2. Creative Arts Therapy
              3. Play Therapy
              4. Yoga
              5. Psychotherapy does not necessarily have to be strict as to the type of psychotherapy being used. Psychologists may combine elements from several styles of psychotherapy, “they blend elements from different approaches and tailor their treatment according to each client’s needs.”[6]
        2. Medication
          1. Psychology also advocates for the use of anti-depressants as medication for depression as well. Some common medicines include[7]:
            1. Selective Serotonin reuptake inhibitors (SSRIs)
            2. Tricyclic Antidepressants (TCAs)
            3. Serotonin and norepinephrine reuptake inhibitors (SNRIs)
            4. Other Types[8]
            5. Atypical Antidepressants
            6. Monoamine oxidase inhibitors (MAOIs)

II. History

  1. DSM III
    1. Categorized as Dysthymic Disorder (Depressive Neurosis) under 300.40 in Affective Disorders.
    2. Dysthymia was originally introduced in the DSM III[9]
    3. Dysthymia occurs when, during the last two years, the “individual has been bothered most or all of the time by symptoms characteristic of the depressive syndrome but that are not of sufficient severity and duration to meet the criteria for a major depressive episode.”[10]
      1. Duration of 2 years for adults
      2. Duration of 1 year for children and adolescents
    4. “The manifestations of the depressive syndrome may be relatively persistent or separated by periods of normal mood lasting a few days to a few weeks, but no more than a few months at a time”[11]
  2. DSM V
    1. Classified as Persistent Depressive Disorder (Dysthymia) under 300.4 (F34.1) as a Depressive Disorder.
    2. The major change from the DSM IV to the DSM V is that Dysthymia is gone, replaced with persistent depressive disorder
      1. This new condition includes both chronic major depression and dysthymia because of the “inability to find scientifically meaningful differences between these two conditions”[12]
    3. Evidence of the Problem
      1. The DSM V says that those experiencing two (or more) of the following are likely to have Persistent Depressive Disorder[13]:
        1. Poor appetite or overeating
        2. Insomnia or Hypersomnia
        3. Low energy or fatigue
        4. Low self-esteem
        5. Poor concentration or difficulty making decisions
        6. Feelings of hopelessness

III. Etiology

  1. Potential Causes of Persistent Depressive Disorder (Psychological View)
    1. The exact cause of Persistent Depressive Disorder is unknown. However, it could be a result of such causes as:
      1. Biological Differences or Brain Chemistry[14]
        1. Scientists have identified many different neurotransmitters that may play a role in depression, and this includes neurotransmitters like[15]
          1. Acetylcholine
          2. Serotonin
          3. Norepinephrine
          4. Dopamine
          5. Glutamate
          6. Gamma-aminobutyric acid (GABA)
  1. Inherited Traits
    1. “Depression does not have a clear pattern of inheritance in families.”[16]
    2. However, “people who have a first-degree relative with depression appear to have a two to three times greater risk of developing the condition than the general public”[17]
  2. Life Events
    1. “Traumatic events such as the loss of a loved one, financial problems or a high level of stress can trigger persistent depressive disorder in some people”[18]
  3. Potential Causes of Persistent Depressive Disorder (Spiritual)
    1. Biblical counselors must recognize that physical, physiological, and biological issues occurring with the counselee do have the ability to influence the response of the counselee.
      1. However, while physical, physiological, and biological issues can influence a person, they cannot force a person to respond with sin.
    2. “Depression unrelated to drugs or a physical illness are often indicative of wrong thinking or other spiritual problems”[19]
      1. The person must respond to their sin with confession to the Lord and repentance from their sin
        1. Persistent depressive disorder is not, in and of itself, a sin
          1. Sinful actions and habits may lead to persistent depressive disorder, and persistent depressive disorder may result in sinful actions and habits
          2. However, Persistent depressive disorder is not, in and of itself, a sin
        2. Spiritual Symptoms
          1. Guilt
          2. Anxiety
          3. Suffering
          4. Feelings of Inferiority
          5. Hopelessness
  4. Physical Symptoms
    1. Poor appetite or overeating
    2. Insomnia or Hypersomnia
    3. Low energy or fatigue

IV. Examining the Heart

  1. Heart Themes
    1. Fear of Man
      1. “Instead of a biblically guided fear of the Lord, we fear others”[20]
      2. The most radical treatment for the fear of man is the fear of the Lord.
        1. The sufferer must first “know that God is awesome and glorious, not other people”[21]
      3. The action the counselee must take to remedy the fear of man is to “need them less and love them more”[22]
      4. Relevant Passages
        1. Proverbs 29:25
        2. Matthew 10:28
        3. Galatians 1:10
        4. Mark 12:30-31
      5. Control
        1. Wrong thinking and belief that control will bring us satisfaction or happiness.
        2. “We don’t know what’s best for us because we’re not the Creator.”[23]
        3. Show counselee that God is in control and that He is working for good
          1. God is Sovereignly in control
          2. God is Good and acts according to His goodness
          3. God is Faithful and always fulfills His promises for our good
  2. Comfort
    1. Obedience to God oftentimes means stepping outside of your comfort zone
      1. John 14:15
      2. 1 John 5:3
      3. Romans 12:1-2
    2. Chief end of man is to glorify God and enjoy Him forever.
  3. Biblical Solutions
    1. Counseling Agenda
      1. Involvement
        1. Seek to build a relationship with the counselee
          1. Enter the person’s world[24]
            1. Includes listening to the counselee to discern where they are struggling[25]
          2. Incarnate the love of Christ[26]
            1. “As Christ’s ambassadors, it’s not just what we say that God uses to encourage change in people; it’s also who we are and what we do”[27]
          3. Inspiration
            1. Provide hope to the counselee that Scripture has answers to their problems and that lasting change is possible
              1. “Hope is more than convincing people that things will get better, or helping them decide what to do”[28]
              2. Hope “helps people who are dealing with the unthinkable to view life from the perspective of God’s glory and grace and their identity as His children”[29]
                1. Romans 15:4
                2. 1 Corinthians 10:13
                3. Galatians 3:26
                4. John 1:12
    2. Inventory
      1. Gather physical data
        1. Sleep
        2. Diet
        3. Exercise
        4. Illness
        5. Medication
      2. Discern their heart through speaking and asking appropriate questions to better understand them
      3. Information the counselor wants to know[30]
        1. The situation
        2. The responses
        3. The thoughts
        4. The motives
    3. Interpretation
      1. Involves “accurately analyzing or conceptualizing the data and explaining it to the counselee” [31]
        1. Discern biblical categories that best describe the counselee [32]
          1. Saved or Unsaved?
          2. Spiritually mature or immature
          3. Unruly, fainthearted, weak?
            1. 1 Thessalonians 5:14
      2. Formulate a Working Interpretation[33]
      3. Determine possible reasons for the problem
      4. Consider the Counselee’s heart
      5. Test the Validity of Your Interpretation[34]
    4. Instruction
      1. Instruction should be biblically based[35]
        1. “Counseling that is faithful to the Bible effectively communicates the original meaning of the biblical text in a way that is relevant to the situation and heart of the person you are counseling”[36]
      2. Specific Instruction as to Depression
        1. Physical and Physiological Issues
          1. The counselor must provide biblical instruction as it relates to the physical or physiological aspects of their lives
            1. The extent of this counsel should be to counsel the counselee against unhealthy actions and habits as well as instructing the counselee to undertake healthy living (i.e. sleeping habits, eating habits, exercising, etc.)
              1. For issues that are medical, or may require more professional attention, the counselor should encourage the counselee to see their medical practitioner
            2. Instruct on the heart
              1. Potential heart themes for those struggling the Dysthymia
                1. Control
                2. Comfort
                3. Fear of Man
              2. The role of feelings
              3. Various problems and issues the counselee may be struggling with[37]
                1. Guilt
                2. Anxiety
          2. Suffering
            1. Inferiority
            2. Hopelessness
            3. Laziness
            4. Self-control
    5. Inducement[38]
      1. Fire up the counselee to make certain decisions and commitments that will facilitate change
      2. “Bring counselees to the realization that biblical change involves personal choice”[39]
      3. Promotes a concern about heart sins as well as behavioral sins[40]
        1. “Nothing less than heart repentance and heart change will please God and produce change that is genuine and lasting”
      4. “Secure a commitment from counselees to put off the desires, thoughts, and actions that hinder biblical change and to replace them with ones that promote biblical change”[41]
    6. Implementation
      1. Ephesians 4 Model
        1. Put off the Old
          1. Identify factors that hinder biblical change and take steps to eliminate them[42]
        2. Renewal of the Mind
          1. Provide practical action for the counselee to engage in, in the hopes that the counselee would be personally engaged with Scripture and contain a renewed perspective pertaining to their issues and problems as well as their heart
            1. Prayer
            2. Bible Reading
            3. Biblical instruction
          2. Put on the New[43]
            1. Should be specific as to the counselee according to the Ephesians 4 model
          3. Homework
            1. Homework should provide specific and practical action for the counselee to take
            2. Assigned Bible Reading for the counselee to do and meditate upon
              1. Ephesians 4
              2. 1 Corinthians 10:13
              3. Romans 15:4
            3. Homework should “assist the counselee to apply the truths learned about God, self, and others to the specifics of his living situation, making biblical corrections and instituting new biblical habits”[44]
    7. Integration
      1. Ensure that they are getting involved in their local Church
        1. Sunday Service
        2. Bible Studies
        3. Fellowship Groups
        4. Accountability
      2. At this point, the counselor would like their local church to be shepherding and guiding this person
        1. This includes ongoing discipleship and accountability within the Church
        2. Ensuring that the counselee is surrounded by strong believers that are devoted to the Word and are committed to discipling and keeping the counselee accountable in their living
      3. Recommended Books
        1. How to Help People Change by Jay E. Adams
        2. Counseling: How to Counsel Biblically by The Master’s College
        3. Instruments in the Redeemer’s Hands by Paul David Tripp
        4. When People are Big and God is Small by Edward T. Welch
        5. The Christian’s Guide to Psychological Terms by Marshall and Mary Asher
  1. Recommended Homework Resources
    1. A Homework Manual for Biblical Living by Wayne Mack
    2. Depression Homework Assignment Samples from IBCD
      1. https://ibcd.org/depression-homework-assignment-samples/

 

 

Bibliography

American Psychiatric Association. 1987. Diagnostic and Statistical Manual of Mental       Disorders : Dsm-Iii-R. 3Rd edition, revised. Washington, DC: American Psychiatric      Association.

American Psychiatric Association. 1994. Diagnostic and Statistical Manual of Mental       Disorders : Dsm-Iv. 4th ed. Washington, DC: American Psychiatric Association.

American Psychiatric Association. 2013. Diagnostic and Statistical Manual of Mental Disorders:             Dsm-5. 5th ed. Arlington, VA: American Psychiatric Association.

“Antidepressants: Selecting One That’s Right for You.” Mayo Clinic. November 17, 2017.           Accessed April 16, 2019. https://www.mayoclinic.org/diseases-conditions/depression/in-       depth/antidepressants/art-20046273.

Daniel Wiswede, et al. 2014. “Tracking Functional Brain Changes in Patients with Depression     under Psychodynamic Psychotherapy Using Individualized Stimuli.”                     https://doi.org/10.1371/journal.pone.0109037.

“DSM5 Diagnostic Criteria Persistent Depressive Disorder.” 2013.

“Dysthymia – Harvard Health Publications.” 2010. January 6, 2010.                       https://web.archive.org/web/20100106064958/http://www.health.harvard.edu/newsweek/ Dysthymia.htm.

Edward T. Welch, 1997. When People Are Big and God Is Small : Overcoming Peer Pressure,     Codependency, and the Fear of Man. Resources for Changing Lives. Phillipsburg, N.J.: P      & R Pub.

Marshall Asher and Mary Asher. The Christian’s Guide to Psychological Terms. Focus Pub.,        2014.

Moore, Beverly. “The Illusion of Control.” Biblical Counseling Coalition. February 02, 2018.      Accessed April 18, 2019. https://www.biblicalcounselingcoalition.org/2018/02/02/the-           illusion-of-control/.

 “Persistent Depressive Disorder (Dysthymia) – Symptoms and Causes.” n.d. Mayo Clinic.           Accessed February 16, 2019. https://www.mayoclinic.org/diseases-conditions/persistent- depressive-disorder/symptoms-causes/syc-20350929.

Publishing, Harvard Health. n.d. “What Causes Depression?” Harvard Health. Accessed   February 19, 2019. https://www.health.harvard.edu/mind-and-mood/what-causes-        depression.

Reference, Genetics Home. n.d. “Depression.” Genetics Home Reference. Accessed February      19, 2019. https://ghr.nlm.nih.gov/condition/depression.

Robin L. Cautin and Scott O. Lilienfeld, eds. 2014. The Encyclopedia of Clinical Psychology.     Hoboken, NJ, USA: John Wiley & Sons, Inc. https://doi.org/10.1002/9781118625392.

Tripp, Paul David. 2002. Instruments in the Redeemer’s Hands : People in Need of Change          Helping People in Need of Change. Resources for Changing Lives. Phillipsburg, N.J.: P      & R Pub.

 “Understanding Psychotherapy and How It Works.” n.d. Https://Www.Apa.Org. Accessed          February 17, 2019. https://www.apa.org/helpcenter/understanding-psychotherapy

[1] “Persistent Depressive Disorder (Dysthymia) – Symptoms and Causes.” n.d. Mayo Clinic. Accessed February 16, 2019. https://www.mayoclinic.org/diseases-conditions/persistent-depressive-disorder/symptoms-causes/syc-20350929.

[2] Marshall Asher and Mary Asher. The Christian’s Guide to Psychological Terms. Focus Pub., 2014, 143.

[3] “Dysthymia – Harvard Health Publications.” 2010. January 6, 2010. https://web.archive.org/web/20100106064958/http://www.health.harvard.edu/newsweek/Dysthymia.htm.

[4] American Psychiatric Association. 2013. Diagnostic and Statistical Manual of Mental Disorders: Dsm-5. 5th ed. Arlington, VA: American Psychiatric Association, 168.

[5] Daniel Wiswede, et al. 2014. “Tracking Functional Brain Changes in Patients with Depression under Psychodynamic Psychotherapy Using Individualized Stimuli.”  https://doi.org/10.1371/journal.pone.0109037.

[6] “Understanding Psychotherapy and How It Works.” n.d. Https://Www.Apa.Org. Accessed February 17, 2019. https://www.apa.org/helpcenter/understanding-psychotherapy.

[7] Robin L. Cautin and Scott O. Lilienfeld, eds. 2014. The Encyclopedia of Clinical Psychology. Hoboken, NJ, USA: John Wiley & Sons, Inc. https://doi.org/10.1002/9781118625392.

[8] “Antidepressants: Selecting One That’s Right for You.” Mayo Clinic. November 17, 2017. Accessed April 16, 2019. https://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20046273.

[9] American Psychiatric Association. 1994. Diagnostic and Statistical Manual of Mental Disorders : Dsm-Iv. 4th ed. Washington, DC: American Psychiatric Association, 209.

[10] American Psychiatric Association. 1987. Diagnostic and Statistical Manual of Mental Disorders : Dsm-Iii-R. 3Rd edition, revised. Washington, DC: American Psychiatric Association, 222.

[11] Ibid.

[12] American Psychiatric Association. 2013. Diagnostic and Statistical Manual of Mental Disorders: Dsm-5. 5th ed. Arlington, VA: American Psychiatric Association, 168.

[13] “DSM5 Diagnostic Criteria Persistent Depressive Disorder.” 2013, 3.

[14] “Persistent Depressive Disorder (Dysthymia) – Symptoms and Causes.” n.d. Mayo Clinic. Accessed February 16, 2019. https://www.mayoclinic.org/diseases-conditions/persistent-depressive-disorder/symptoms-causes/syc-20350929.

[15] Publishing, Harvard Health. n.d. “What Causes Depression?” Harvard Health. Accessed February 19, 2019. https://www.health.harvard.edu/mind-and-mood/what-causes-depression.

[16] Reference, Genetics Home. n.d. “Depression.” Genetics Home Reference. Accessed February 19, 2019. https://ghr.nlm.nih.gov/condition/depression.

[17] Ibid.

[18] “Persistent Depressive Disorder (Dysthymia) – Symptoms and Causes.” n.d. Mayo Clinic.

[19] Marshall Asher and Mary Asher. The Christian’s Guide to Psychological Terms. Focus Pub., 2014, 61.

[20] Edward T. Welch, 1997. When People Are Big and God Is Small : Overcoming Peer Pressure,   Codependency, and the Fear of Man. Resources for Changing Lives. Phillipsburg, N.J.: P & R Pub, 14.

[21] Ibid., 95.

[22] Ibid., 193.

[23] Moore, Beverly. “The Illusion of Control.” Biblical Counseling Coalition. February 02, 2018. Accessed April 18, 2019. https://www.biblicalcounselingcoalition.org/2018/02/02/the-illusion-of-control/.

[24] Tripp, Paul David. 2002. Instruments in the Redeemer’s Hands : People in Need of Change Helping People in Need of Change. Resources for Changing Lives. Phillipsburg, N.J.: P & R Pub, 126.

[25] Ibid., 128.

[26] Ibid., 133.

[27] Ibid., 134.

[28] Ibid., 157.

[29] Ibid.

[30] Ibid., 189.

[31] Master’s College. 2005. Counseling : How to Counsel Biblically,147.

[32] Ibid., 150.

[33] Ibid., 157-160

[34] Ibid., 159-160.

[35] Ibid., 163.

[36] Street, John D. 2013. Men Counseling Men. Eugene, Or.: Harvest House, Chapter 2.

[37] Marshall Asher and Mary Asher. The Christian’s Guide to Psychological Terms. Focus Pub., 2014, 61-62

[38] Master’s College. 2005. Counseling: How to Counsel Biblically, 176-177

[39] Ibid.

[40] Ibid.

[41] Ibid.

[42] Ibid., 190.

[43] Ibid., 193.

[44] Tripp, Paul David. 2002. Instruments in the Redeemer’s Hands: People in Need of Change Helping People in Need of Change, 343.