By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

What if you don’t ever remember being happy?

Persistent Depressive Disorder – PDD (F34.1) is new to the DSM-5. The DSM is the book professionals use to identify mental illnesses. This diagnosis is the result of merging Dysthymia and another group of symptoms which was being researched as Chronic Major Depression. Some other variations on the depressive theme were being called Minor Depressive Disorder, which did not get recognized as such but kind of fits here.

While we may label these conditions as chronic or minor, there is nothing minor about them if you are someone who has this condition?

The defining characteristic of Persistent Depressive Disorder – PDD, is a pervasive sadness that just won’t go away. People who have this condition are always sad or unhappy. They may describe themselves as “always down” or having the blues. While this can cause a lot of impairment, people who have PDD come to think of their chronic sadness as “Just the way I am.”

It is estimated that about two percent of the U. S. population has PDD. Many people with PDD also experience a substance use disorder. There is also an overlap between PDD and Cluster B and Cluster C personality disorders, both of which, to my way of thinking, may have their roots in negative childhood experiences.

Persistent Depressive Disorder (PDD) is more disabling than Major Depressive Disorder.

PDD has been identified on brain scans and seems to affect at least four separate brain regions. PDD is long-lasting, at least two years, often more. During this time someone with PDD may also experience an episode of Major Depressive Disorder. While the major depressive episode may come and go the PDD often remains relatively constant. Because of this constant feature, people with PDD may not be able to ever feel really happy and their functioning, day-to-day, is more impacted than those with Major Depressive Disorder only.

Persistent Depressive Disorder (PDD) is chameleon-like.

Chronic unending depression has a lot of variations. This disorder can exhibit itself a great many ways. As a result, there are eighteen separate specifiers that can and should be added after the F43.1 These specifiers are not exclusive, so one person may also get several specifiers added to the Persistent Depressive Disorder (PDD) diagnosis.

Specifiers include with:

Anxious distress – anxiety commonly co-occurs with depression.

Mixed features

Melancholy features

Atypical features

Mood-congruent psychotic features

Mood-incongruent psychotic features

Peripartum features

In partial remission

In full remission

Early onset – before 21

Late onset – at or after age 21

Pure dysthymia syndrome

Persistent major depressive episode

Intermittent major depressive episode, currently with MDD

Intermittent major depressive episode, currently without MDD

Mild

Moderate

Severe

The symptoms of Persistent Depressive Disorder.

To qualify for PDD a person should have the following symptoms:

1. Felt depressed or down, or had others see them this way, most of the day, most days, over a two-year period.
2. Had at least two of the following six symptoms. These symptoms should be caused by emotions not by dieting or working long hours, etc.
3. Change in appetite either up or down.
4. Changes in sleep either too much or too little.
5. Felt low in energy or fatigued a lot.
6. Low self-esteem.
7. Difficulty deciding things or poor concentration.
8. Hopeless.
9. Most of the usual exclusions. This has to be causing problems with work, school, relationships, should interfere with important activities or upset the client. It should not overlap Bipolar Disorder or Psychotic Disorder but may overlap Major Depressive Disorder. These symptoms should not be the result of medical or substance use issues.
10. These symptoms have been constant and not gone away for two months or more over the required two-year period.

Be careful with the PDD label.

Calling Persistent Depressive Disorder by the label PDD could be problematic. In the past, we had another PDD – Pervasive Developmental Delay which is now recognized as a part of the Autism Spectrum. Persistent Depressive Disorder – PDD is about depression and has nothing to do with Autism. Be careful in reading articles that if they use the label PDD you know which of these two they are talking about. From here on I will call Persistent Depressive Disorder – PDD.

As with the other things we are calling a mental illness this needs to interfere with your ability to work or go to school, your relationships, your enjoyable activities, or cause you personal distress. Otherwise, you may have the issues but you will not get the diagnoses if this is a personal characteristic, not a problem. If the only time this happens is when you are under the influence of drugs or medicines or because of some other physical or medical problem these symptoms need to be more than your situation would warrant. These other issues may need treating first, then if you still have symptoms you could get this diagnosis.

FYI These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching, and related disciplines in a plain language way. Many are based on the new DSM-5; some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions please consult the DSM or other appropriate references.

More “What is” posts will be found at “What is.”  and Depression  

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

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