Longitudinal comparison of depressive personality disorder and dysthymic disorder

Markowitz, John C.; Skodol, Andrew E.; Petkova, Eva; Xie, Hui; Cheng, Jianfeng; Hellerstein, David J.; Gunderson, John G.; Sanislow, Charles A.; Grilo, Carlos M.; McGlashan, Thomas H.

doi:10.1016/j.comppsych.2004.09.003

« Previous Next »Comprehensive Psychiatry
Volume 46, Issue 4 , Pages 239-245, July 2005

Longitudinal comparison of depressive personality disorder and dysthymic disorder

John C. Markowitz
- New York State Psychiatric Institute and Columbia University, New York, NY 10032, USA
- Corresponding author. Tel.: +1 212 543 6283; fax: +1 212 746 5951.
Andrew E. Skodol
- New York State Psychiatric Institute and Columbia University, New York, NY 10032, USA
Eva Petkova
- New York State Psychiatric Institute and Columbia University, New York, NY 10032, USA
Hui Xie
- New York State Psychiatric Institute and Columbia University, New York, NY 10032, USA
Jianfeng Cheng
- New York State Psychiatric Institute and Columbia University, New York, NY 10032, USA
David J. Hellerstein
- New York State Psychiatric Institute and Columbia University, New York, NY 10032, USA
John G. Gunderson
- McLean Hospital and Harvard Medical School, Belmont, MA 02478, USA
Charles A. Sanislow
- Yale Psychiatric Research Institute and Yale University, New Haven, CT 06519, USA
Carlos M. Grilo
- Yale Psychiatric Research Institute and Yale University, New Haven, CT 06519, USA
Thomas H. McGlashan
- Yale Psychiatric Research Institute and Yale University, New Haven, CT 06519, USA

Received 27 May 2004; accepted 17 September 2004.

Abstract

Background

Few studies have compared the related diagnostic constructs of depressive personality disorder (DPD) and dysthymic disorder (DD). The authors attempted to replicate findings of Klein and Shih in longitudinally followed patients with personality disorder or major depressive disorder (MDD) in the Collaborative Longitudinal Personality Disorders Study.

Methods

Subjects (N = 665) were evaluated at baseline and over 2 years (n = 546) by reliably trained clinical interviewers using semistructured interviews and self-report personality questionnaires.

Results

Only 44 subjects (24.6% of 179 DPD and 49.4% of 89 early-onset dysthymic subjects) met criteria for both disorders at baseline. Depressive personality disorder was associated with increased comorbidity of some axis I anxiety disorders and other axis II diagnoses, particularly avoidant (71.5%) and borderline (55.9%) personality disorders. Depressive personality disorder was associated with low positive and high negative affectivity on dimensional measures of temperament. Depressive personality disorder subjects had lower likelihood of remission of baseline MDD at 2-year follow-up, whereas DD subjects did not. The DPD diagnosis appeared unstable over 2 years of follow-up, as only 31% (n = 47) of 154 subjects who had DPD at baseline and also had follow-up assessment met criteria on blind retesting.

Limitations

Results from this sample may not generalize to other populations.

Conclusions

Depressive personality disorder and dysthymic disorder appear to be related but differ in diagnostic constructs. Its moderating effect on MDD and predicted relationship to measures of temperament support the validity of DPD, but its diagnostic instability raises questions about its course, utility, and measurement.