The Overlap Of Depressive Personality Disorder and Dysthymia: A Categorical Problem With a Dimensional Solution

REFERENCES

• American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: Ameri- can Psychiatric Association, 1994.
   Google Scholar
• Akiskal HS. Dysthymic disorder: psychopathology of proposed chronic depressive subtypes. Am J Psychiatry 1983;140:11–20.
   PubMed Web of Science ®Google Scholar
• Akiskal HS. Validating affective personality types. In: Robins LN, Barrett JE, eds. The validity of psychiatric diagnosis. New York: Raven, 1989:217–27.
   Google Scholar
• Phillips KA, Hirschfeld RMA, Shea MT, Gunderson JG. De- pressive personality disorder. In: Widiger TA, Francis AJ, Pincus HA, Ross R, First MB, Davis WW, eds. DSM-IV source- book, vol 2. Washington, DC: American Psychiatric Press, 1996:799–811.
   Google Scholar
• Ryder AG, Bagby RM. Diagnostic viability of depressive per- sonality disorder: theoretical and conceptual issues. J Personal Disord 1999;13:99–117.
   PubMed Web of Science ®Google Scholar
• Huprich SK. The overlap of depressive personality disorder and dysthymia, reconsidered. Harv Rev Psychiatry 2001;9:158–68.
   PubMed Web of Science ®Google Scholar
• Klein DN. Commentary on Ryder and Bagby’s “Diagnostic via- bility of depressive personality disorder: theoretical and con- ceptual issues.” J Personal Disord 1999;13:118–27.
   Google Scholar
• Phillips KA, Gunderson JG. Depressive personality disorder: fact or fiction? J Personal Disord 1999;13:128–34.
   PubMedGoogle Scholar
• Robins E, Guze SB. Establishment of diagnostic validity in psy- chiatric illness: its application to schizophrenia. Am J Psychia- try 1970;126:983–7.
   PubMed Web of Science ®Google Scholar
• Widiger TA, Shea T. Differentiation of Axis I and Axis II disor- ders. J Abnorm Psychol 1991;100:399–406.
   PubMedGoogle Scholar
• Bagby RM, Ryder AG. Personality and the affective disorders: past efforts, current models, and future directions. Curr Psy- chiatry Rep 2000;2:465–72.
   Google Scholar
• Brieger P, Marneros A. Dysthymia and cyclothymia: historical origins and contemporary development. J Affect Disord 1997; 45:117–26.
   PubMed Web of Science ®Google Scholar
• Huprich SK. Depressive personality disorder: theoretical is- sues, clinical findings, and future research questions. Clin Psy- chol Rev 1998;18:477–500.
   PubMed Web of Science ®Google Scholar
• Phillips KA, Gunderson JG, Hirschfeld RM, Smith LE. A review of the depressive personality. Am J Psychiatry 1990;147:830–7. 15. Kraepelin E. Manic depressive insanity and paranoia. Chicago: Chicago Medical Book, 1921.
   PubMed Web of Science ®Google Scholar
• Sass H, Herpertz S, Ernst W. Personality disorders. In: Berrios GE, Porter R, eds. A history of clinical psychiatry: the origin and history of psychiatric disorders. New York: New York Uni- versity Press, 1995:633–55.
   Google Scholar
• Kretschmer E. Physique and character: an investigation of the nature of constitution and the theory of temperament. New York: Harcourt, Brace, 1925. 18. Schneider K. Clinical psychopathology. New York: Grune & Stratton, 1959.
   Google Scholar
• Tellenbach H. Melancholy: history of the problem, endogeneity, typology, pathogenesis, clinical considerations. Pittsburgh: Duquesne University Press, 1980.
   Google Scholar
• Arieti S, Bemporad JR. The psychological organization of de- pression. Am J Psychiatry 1980;137:1360–5.
   PubMed Web of Science ®Google Scholar
• Berliner B. Psychodynamics of the depressive character. Psy- choanal Forum 1966;1:244–51.
   Google Scholar
• Kahn E. The depressive character. Folia Psychiatr Neurol Jpn 1975;29:291–303.
   PubMedGoogle Scholar
• Blatt SJ. Levels of object representation in anaclitic and intro- jective depression. Psychoanal Study Child 1974;29:109–57.
   Google Scholar
• Blatt SJ. A cognitive morphology of psychopathology. J Nerv Ment Dis 1991;179:449–58.
   PubMed Web of Science ®Google Scholar
• Kernberg O. Clinical dimensions of masochism. In: Glick RA, Meyers DI, eds. Masochism: current psychoanalytic perspec- tives. Hillsdale, New Jersey: Analytic, 1988:61–79.
   Google Scholar
• Bowlby J. The making and breaking of affectional bonds, I: Aetiology and psychopathology in the light of attachment the- ory. An expanded version of the Fiftieth Maudsley Lecture, de- livered before the Royal College of Psychiatrists, 19 November 1976. Br J Psychiatry 1977;130:201–10.
   Google Scholar
• Beck AT. Cognitive therapy of depression: new perspectives. In: Clayton PJ, Barrett JE, eds. Treatment of depression: old controversies and new approaches. New York: Raven, 1983: 265–90.
   Google Scholar
• Wilson M. DSM-III and the transformation of American psy- chiatry: a history. Am J Psychiatry 1993;150:399–410.
   Google Scholar
• Frances A. The DSM-III personality disorders section: a com- mentary. Am J Psychiatry 1980;137:1050–4.
   Google Scholar
• Gunderson JG. DSM-III diagnosis of personality disorders. In: Forsh JP, ed. Current perspectives on personality disorders. Washington, DC: American Psychiatric Press, 1983:20–39.
   Google Scholar
• Kernberg OF. Severe personality disorders: psychotherapeutic strategies. New Haven, Connecticut: Yale University Press, 1984.
   Google Scholar
• Akiskal HS, Hirschfeld RM, Yerevanian BI. The relationship of personality to affective disorders. Arch Gen Psychiatry 1983;40:801–10.
   PubMed Web of Science ®Google Scholar
• Keller MB, Russell CW. Dysthymia. In: Widiger TA, Francis AJ, Pincus HA, Ross R, First MB, Davis WW, eds. DSM-IV source- book, vol 2. Washington, DC: American Psychiatric Association, 1996:21–35.
   Google Scholar
• Widiger TA. Depressive personality traits and dysthymia: a commentary on Ryder and Bagby. J Personal Disord 1999; 13:135–41.
   Google Scholar
• Ball SA. Reconceptualizing personality disorder categories us- ing personality trait dimensions: introduction to special sec- tion. J Pers 2001;69:147–53.
   PubMed Web of Science ®Google Scholar
• Livesley WJ. Suggestions for a framework for an empirically based classification of personality disorder. Can J Psychiatry 1998;43:137–47.
   PubMed Web of Science ®Google Scholar
• Klein DN. Depressive personality: reliability, validity, and re- lation to dysthymia. J Abnorm Psychol 1990;99:412–21.
   PubMed Web of Science ®Google Scholar
• Hirschfeld RM, Holzer CE III. Depressive personality disorder: clinical implications. J Clin Psychiatry 1994;55(suppl):10–17.
   Google Scholar
• Phillips KA, Hirschfeld RM, Shea MT, Gunderson JG. Depres- sive personality disorder: perspectives for DSM-IV. J Personal Disord 1993;7:30–42.
   Google Scholar
• Clark LA, Watson D. Personality, disorder, and personality dis- order: towards a more rational conceptualization. J Personal Disord 1999;13:142–51.
   PubMed Web of Science ®Google Scholar
• McLean P, Woody S. Commentary on depressive personality disorder: a false start. In: Livesley WJ, ed. The DSM-IV per- sonality disorders. New York: Guilford, 1995:303–11.
   Google Scholar
• Blashfield R. Commentary on Ryder and Bagby. J Personal Dis- ord 1999;13:152–6.
   Google Scholar
• American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed, text revision. Washington, DC: American Psychiatric Association, 2000.
   Google Scholar
• Hirschfeld RM. Major depression, dysthymia and depres- sive personality disorder. Br J Psychiatry 1994;165(suppl 26): 23–30.
   Google Scholar
• Klein DN, Miller GA. Depressive personality in nonclinical sub- jects. Am J Psychiatry 1993;150:1718–24.
   PubMed Web of Science ®Google Scholar
• Phillips KA, Gunderson JG, Triebwasser J, Kimble CR, Faedda G, Lyoo IK, et al. Reliability and validity of depressive person- ality disorder. Am J Psychiatry 1998;155:1044–8.
   PubMed Web of Science ®Google Scholar
• Huprich SK. Object loss and object relations in depressive per- sonality analogues. Bull Menninger Clin 2001;65:549–59.
   PubMed Web of Science ®Google Scholar
• Klein DN, Shih JH. Depressive personality: associations with DSM-III-R mood and personality disorders and negative and positive affectivity, 30-month stability, and prediction of course of Axis I depressive disorders. J Abnorm Psychol 1998;107:319–27.
   PubMed Web of Science ®Google Scholar
• Skodol AE, Stout RL, McGlashan TH, Grilo CM, Gunderson JG, Shea MT, et al. Co-occurrence of mood and personality disor- ders: a report from the Collaborative Longitudinal Personality Disorders Study (CLPS). Depress Anxiety 1999;10:175–82.
   Google Scholar
• Bagby RM, Ryder AG. Diagnostic discriminability of dysthymia and depressive personality disorder. Depress Anxiety 1999; 10:41–9.
   PubMed Web of Science ®Google Scholar
• Ryder AG, Bagby RM, Dion KL. Chronic, low-grade depression in a nonclinical sample: depressive personality or dysthymia? J Personal Disord 2001;15:84–93.
   PubMed Web of Science ®Google Scholar
• Akiskal HS, Mallya G. Criteria for the “soft” bipolar spectrum: treatment implications. Psychopharmacol Bull 1987;23:68–73.
   PubMed Web of Science ®Google Scholar
• Gunderson JG, Phillips KA, Triebwasser J, Hirschfeld RM. The Diagnostic Interview for Depressive Personality. Am J Psychi- atry 1994;151:1300–4.
   PubMed Web of Science ®Google Scholar
• Klein DN, Vocisano C. Depressive and self-defeating (masochis- tic) personality disorders. In: Millon T, Blaney PH, Davis RD, eds. Oxford textbook of psychopathology. New York: Oxford Uni- versity Press, 1999:653–73.
   Google Scholar
• Klein DN, Norden KA, Ferro T, Leader JB, Kasch KL, Klein LM, et al. Thirty-month naturalistic follow-up study of early- onset dysthymic disorder: course, diagnostic stability, and pre- diction of outcome. J Abnorm Psychol 1998;107:338–48.
   Google Scholar
• Kwon JS, Kim YM, Chang CG, Park BJ, Kim L, Yoon DJ, et al. Three-year follow-up of women with the sole diagnosis of depressive personality disorder: subsequent development of dysthymia and major depression. Am J Psychiatry 2000; 157:1966–72.
   PubMed Web of Science ®Google Scholar
• Cassano GB, Dell’Osso L, Frank E, Miniati M, Fagiolini A, Shear K, et al. The bipolar spectrum: a clinical reality in search of diagnostic criteria and an assessment methodology. J Affect Disord 1999;54:319–28.
   PubMed Web of Science ®Google Scholar
• Klein DN, Clark DC, Dansky L, Margolis ET. Dysthymia in the offspring of parents with primary unipolar affective disorder. J Abnorm Psychol 1988;97:265–74.
   PubMed Web of Science ®Google Scholar
• Klein DN. Depressive personality in the relatives of outpatients with dysthymic disorder and episodic major depressive disor- der and normal controls. J Affect Disord 1999;55:19–27.
   PubMed Web of Science ®Google Scholar
• Cloninger CR, Svrakic DM, Przybeck TR. A psychobiological model of temperament and character. Arch Gen Psychiatry 1993;50:975–90.
   PubMed Web of Science ®Google Scholar
• Hauri P, Sateia MJ. REM sleep in dysthymic disorders [Ab- stract]. Sleep Res 1984;13:119.
   Google Scholar
• Costa PT Jr, McCrae RR. Revised NEO Personality Inventory (NEO PI-R) and NEO Five-Factor Inventory (NEO-FFI): pro- fessional manual. Odessa, Florida: Psychological Assessment Resources, 1992.
   Google Scholar
• Huprich SK. Describing depressive personality analogues and dysthymics on the NEO–Personality Inventory—Revised. J Clin Psychol 2000;56:1521–34.
   PubMed Web of Science ®Google Scholar
• Lyoo IK, Gunderson JG, Philips KA. Personality dimensions associated with depressive personality disorder. J Personal Dis- ord 1998;12:46–55.
   Google Scholar
• Frances A, Cooper AM. Descriptive and dynamic psychiatry: a perspective on DSM-III. Am J Psychiatry 1981;138:1198–202.
   PubMed Web of Science ®Google Scholar
• Goldstein WN, Anthony RN. The diagnosis of depression and the DSMs. Am J Psychother 1988;42:180–96.
   Google Scholar
• Blashfield RK, Draguns JG. Toward a taxonomy of psy- chopathology: the purpose of psychiatric classification. Br J Psy- chiatry 1976;129:574–83.
   Google Scholar
• Alden LE, Laposa JM, Taylor CT, Ryder AG. Avoidant person- ality disorder: current status and future directions. J Personal Disord 2002;16:1–29.
   PubMed Web of Science ®Google Scholar
• Tyrer P. What’s wrong with the DSM-III personality disorders? J Personal Disord 1988;2:281–91.
   Google Scholar
• Westen D. Divergences between clinical and research methods for assessing personality disorders: implications for research and the evolution of Axis II. Am J Psychiatry 1997;154:895– 903.
   Google Scholar
• Dolan-Sewell RT, Krueger RF, Shea MT. Co-occurrence with syndrome disorders. In: Livesley WJ, ed. Handbook of person- ality disorders: theory, research, and treatment. New York: Guilford, 2001:84–104.
   Google Scholar
• Clark LA, Livesley WJ. Two approaches to identifying the di- mensions of personality disorder: convergence on the five-factor model. In: Costa PT Jr, Widiger TA, eds. Personality disorders and the five-factor model of personality. 2nd ed. Washington, DC: American Psychological Association, 2002:161–76.
   Google Scholar
• Clark LA, Livesley WJ, Morey L. Personality disorder assess- ment: the challenge of construct validity. J Personal Disord 1997;11:205–31.
   PubMed Web of Science ®Google Scholar
• Clark LA, McEwan JL, Collard LM, Hickok LG. Symptoms and traits of personality disorder: two new methods for their as- sessment. Psychol Assess 1993;5:81–91.
   Google Scholar
• Livesley WJ. The classification of personality disorder, I: The choice of category concept. Can J Psychiatry 1985;30:353–8.
   PubMed Web of Science ®Google Scholar
• Widiger TA. Personality and depression: assessment issues. In: Klein MH, Kupfer DJ, eds. Personality and depression: a cur- rent view. Mental health and psychopathology. New York: Guil- ford, 1993:77–118.
   Google Scholar
• Widiger TA, Frances A. The DSM-III personality disorders: perspectives from psychology. Arch Gen Psychiatry 1985;42:615–23.
   PubMed Web of Science ®Google Scholar
• Blashfield RK, Breen MJ. Face validity of the DSM-III-R per- sonality disorders. Am J Psychiatry 1989;146:1575–9.
   PubMed Web of Science ®Google Scholar
• Linde JA, Clark LA. Diagnostic assignment of criteria: clini- cians and DSM-IV. J Personal Disord 1998;12:126–37.
   PubMed Web of Science ®Google Scholar
• Westen D, Arkowitz-Westen L. Limitations of Axis II in diag- nosing personality pathology in clinical practice. Am J Psychi- atry 1998;155:1767–71.
   PubMed Web of Science ®Google Scholar
• Clark LA, Watson D, Reynolds S. Diagnosis and classification of psychopathology: challenges to the current system and future directions. Ann Rev Psychol 1995;46:121–53.
   PubMed Web of Science ®Google Scholar
• Gunderson JG, Ronningstam E, Smith LE. Narcissistic per- sonality disorder: a review of data on DSM-III-R descriptions. J Personal Disord 1991;5:167–77.
   Web of Science ®Google Scholar
• Hirschfeld RM, Shea MT, Weise RE. Dependent personality dis- order: perspectives for DSM-IV. J Personal Disord 1991;5:135–49.
   Web of Science ®Google Scholar
• Mulder RT, Joyce PR, Cloninger CR. Temperament and early environment influence comorbidity and personality disorders in major depression. Compr Psychiatry 1994;35:225–33.
   PubMed Web of Science ®Google Scholar
• Widiger TA, Rogers JH. Prevalence and comorbidity of person- ality disorders. Psychiatr Ann 1989;19:132–6.
   Web of Science ®Google Scholar
• Oldham JM, Skodol AE, Kellman HD, Hyler SE, Rosnick L, Davies M. Diagnosis of DSM-III-R personality disorders by two structured interviews: patterns of comorbidity. Am J Psychiatry 1992;149:213–20.
   PubMed Web of Science ®Google Scholar
• Fabrega H, Ulrich R, Pilkonis P, Messich JE. Pure personality disorders in an intake psychiatric setting. J Personal Disord 1992;6:153–61.
   Google Scholar
• Clark LA. Schedule for Nonadaptive and Adaptive Personality (SNAP). Minneapolis: University of Minnesota Press, 1993.
   Google Scholar
• Schroeder ML, Livesley WJ. An evaluation of DSM-III-R per- sonality disorders. Acta Psychiatr Scand 1991;84:512–9.
   Google Scholar
• Harris GT, Rice ME, Quinsey VL. Psychopathy as a taxon: evi- dence that psychopaths are a discrete class. J Consult Clin Psy- chol 1994;62:387–97.
   PubMed Web of Science ®Google Scholar
• Korfine L, Lenzenweger MF. The taxonicity of schizotypy: a replication. J Abnorm Psychol 1995;104:26–31.
   PubMed Web of Science ®Google Scholar
• Lenzenweger MF, Korfine L. Confirming the latent structure and base rate of schizotypy: a taxometric analysis. J Abnorm Psychol 1992;101:567–71.
   PubMed Web of Science ®Google Scholar
• Tyrka AR, Cannon TD, Haslam N, Mednick SA, Schulsinger F, Schulsinger H, et al. The latent structure of schizotypy, I: Premorbid indicators of a taxon of individuals at risk for schizophrenia-spectrum disorders. J Abnorm Psychol 1995; 104:173–83.
   PubMed Web of Science ®Google Scholar
• Haslam N, Beck AT. Subtyping major depression: a taxometric analysis. J Abnorm Psychol 1994;103:686–92.
   PubMed Web of Science ®Google Scholar
• Ruscio AM, Borkovec TD, Ruscio J. A taxometric investigation of the latent structure of worry. J Abnorm Psychol 2001; 110:413–22.
   PubMed Web of Science ®Google Scholar
• Ruscio J, Ruscio AM. Informing the continuity controversy: a taxometric analysis of depression. J Abnorm Psychol 2000; 109:473–87.
   PubMed Web of Science ®Google Scholar
• Ruscio AM, Ruscio J, Keane TM. The latent structure of post- traumatic stress disorder: a taxometric investigation of reac- tions to extreme stress. J Abnorm Psychol 2002;111:290– 301.
   Google Scholar
• Widiger TA. Official classification systems. In: Livesley WJ, ed.Handbook of personality disorders: theory, research, and treat- ment. New York: Guilford, 2001:60–83.
   Google Scholar
• Barnett PA, Gotlib IH. Psychosocial functioning and depres- sion: distinguishing among antecedents, concomitants, and con- sequences. Psychol Bull 1988;104:97–126.
   PubMed Web of Science ®Google Scholar
• Livesley WJ, Jackson DN, Schroeder ML. A study of the facto- rial structure of personality pathology. J Personal Disord 1989;3:292–306.
   Google Scholar
• Widiger TA, Trull TJ. Personality and psychopathology: an ap- plication of the five-factor model. J Pers 1992;60:363–93.
   PubMed Web of Science ®Google Scholar
• Lynam DR, Widiger TA. Using the five-factor model to repre- sent the DSM-IV personality disorders: an expert consensus approach. J Abnorm Psychol 2001;110:401–12.
   PubMed Web of Science ®Google Scholar
• Costa PT Jr, McCrae RR. The NEO Personality Inventory man- ual. Odessa, Florida: Psychological Assessment Resources, 1985.
   Google Scholar
• John OP, Angleiter A, Ostendorf F. The lexical approach to per- sonality: a historical review of trait taxonomic research. Eur J Pers 1988;2:171–203.
   Web of Science ®Google Scholar
• John OP, Srivastava S. The Big Five Trait taxonomy: history, measurement and theoretical perspectives. In: Pervin LA, John OP, eds. Handbook of personality: theory and research. 2nd ed. New York: Guilford, 1999:102–38.
   Google Scholar
• McCrae RR, John OP. An introduction to the five-factor model and its applications. J Pers 1992;60:175–215.
   PubMed Web of Science ®Google Scholar
• Trull TJ, Widiger TA. Structured Interview for the Five-Factor Model of Personality (SIFFM): professional manual. Odessa, Florida: Psychological Assessment Resources, 1997.
   Google Scholar
• Bagby RM, Costa PT Jr, McCrae RR, Livesley WJ, Kennedy SH, Levitan RD, et al. Replicating the five factor model of person- ality in a psychiatric sample. Pers Indiv Diff 1999;27:1135–9.
   Google Scholar
• Bagby RM, Ryder AG. New directions in the assessment of per- sonality pathology: the five-factor model of personality. Psychi- atry Rounds 2000; 4:1–6[Available on the World Wide Web: http://www.psychiatryrounds.ca/cgi_bin/templates/framesets/ psychiatryRoundsCa/fs_snell.cfm].
   Google Scholar
• O’Connor BP, Dyce JA. A test of models of personality disorder configuration. J Abnorm Psychol 1998;107:3–16.
   PubMed Web of Science ®Google Scholar
• Clark LA, Harrison JA. Assessment instruments. In: Livesley WJ, ed. Handbook of personality disorders: theory, research, and treatment. New York: Guilford, 2001:277–306.
   Google Scholar
• Widiger TA, Trull TJ, Clarkin JF, Sanderson C, Costa PT Jr. A description of the DSM-IV personality disorders with the five- factor model of personality. In: Costa PT Jr, Widiger TA, eds. Personality disorders and the five-factor model of personality. 2nd ed. Washington, DC: American Psychological Association, 2002:89–99.
   Google Scholar
• Clark LA, Livesley WJ, Schroeder ML, Irish SL. Convergence of two systems for assessing specific traits of personality disorder. Psychol Assess 1996;8:294–303.
   Web of Science ®Google Scholar
• Harkness AR, McNulty JL. The Personality Psychopathology Five (PSY-5): issues from the pages of a diagnostic manual in- stead of a dictionary. In: Strack S, Lorr M, eds. Differentiating normal and abnormal personality. New York: Springer, 1994: 291–315.
   Google Scholar
• Clark LA, Watson D. Tripartite model of anxiety and depres- sion: psychometric evidence and taxonomic implications. J Ab- norm Psychol 1991;100:316–36.
   PubMed Web of Science ®Google Scholar
• Reynolds SK, Clark LA. Predicting dimensions of personality disorder from domains and facets of the five-factor model. J Pers 2001;69:199–222.
   PubMed Web of Science ®Google Scholar
• Bagby RM, Joffe RT, Parker JDA, Kalemba V, Harkness KL. Major depression and the five-factor model of personality. J Per- sonal Disord 1995;9:224–34.
   Web of Science ®Google Scholar
• Bagby RM, Bindseil KD, Schuller DR, Rector NA, Young LT, Cooke RG, et al. Relationship between the five-factor model of personality and unipolar, bipolar and schizophrenic patients. Psychiatry Res 1997;70:83–94.
   PubMed Web of Science ®Google Scholar
• Harkness KL, Bagby RM, Levitt AJ, Joffe RT. Major depres- sion, chronic minor depression and the five factor model of per- sonality. Eur J Pers 2002;16:271–81.
   Web of Science ®Google Scholar
• Spitzer RL, Endicott J, Robins E. Research Diagnostic Cri- teria: rationale and reliability. Arch Gen Psychiatry 1978;35:773–82.
   PubMed Web of Science ®Google Scholar