Comorbidity Of Depression And Pds

Patients diagnosed with PDs are likely to experience Axis I disorders/symptoms, typically Axis I presentations of mood, anxiety, and substance-related disorders (Robinson, 2003). Comorbid conditions can impede therapeutic interventions focused on treating either Axis I or Axis II disorders by complicating the symptom picture. Patients may present with "symptom profusion," wherein they appear to have multiple problems and multiple diagnoses. For example, in the National Institute of Mental Health (NIMH) study on the co-occurrence of PDs among depressed patients, 74% of the patients diagnosed with major depression also had PDs (Shea et al., 1990).

Comorbidity of depression and personality disorders in the adult population is gaining interest among clinicians (Farmer & Nelson-Gray, 1990; Ruegg & Frances, 1995). A number of studies have found that depression often co-occurs with Axis II disorders among adult patients in mental health clinics (e.g., Marin, Kocsis, Frances, & Klerman, 1993; Pepper, Klein, Anderson, Riso, Ouimette, & Lizardi, 1995; Pfohl, Stangl, & Zimmerman, 1984; Sanderson, Wetzler, Beck, & Betz, 1992; Zimmerman, Pfohl, Coryell, Corenthal, & Stangl, 1991). The depression that is most often noted is a diagnosis of major depressive disorder (MDD). It is essential in this discussion to address the issue ofintegrating dysthymia into the diagnostic picture. Many patients have "double depression," in which they experience a major depressive episode superimposed upon a history of dysthymia. These patients may be helped to deal with the depression, which then allows them to return to their more pervasive and persistent dysthymic style. The high prevalence rates ofdepression and comorbid conditions lead one to consider revisiting the possibility of reclassifying dysthymia as a PD instead of a mood disorder that is identified as depressive PD (DPD; American Psychiatric Association, 2000, pp. 788-789). Although these disorders have differing diagnostic criteria, in creativity either in combining both or in creating a separate diagnosis might be reasonable options. As DSM-IV-TR states, "It remains controversial whether the distinction between depressive personality disorder and Dysthymic Disorder is useful" (American Psychiatric Asso ciation, 2000, p. 788). Perhaps, the chronic, low-grade depressive symptoms that are a part of the dysthymic-pattern PD might be better viewed as a disorder that is not co-occurring, but rather a pervasive and persistent style that must be viewed as a separate entity.

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