Persistent Depressive Disorder – PDD (F34.1)

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

What is

What is Persistent Depressive Disorder?
Photo courtesy of pixabay.

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

Three David Joel Miller Books are available now!

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.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

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

Books are now available on Amazon, Kobo, iBooks, Barnes & Noble, and many other online stores.

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Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

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What are Minor Depressive Disorder and Depressive Disorder NEC?

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

Depressed person

Depression.
Photo courtesy of Pixabay.com

UPDATE – changes in the DSM.

You can erase most of this post from your memory. During the process of updating the Diagnostic and Statistical Manual of Mental Disorders (DSM) from the DSM-IV to the DSM-5 a lot of things were proposed. Some of those suggested changes were instituted and others were left out. This post includes mostly ideas that did not make it to the final DSM-5. Because these ideas were included in a lot of research articles and other blog posts I have left the post up, but need to tell you that this information is now out of date.

Minor Depressive Disorder is out.

It did not even make the maybe section of disorders needing more study that is in the back of the DSM.

NEC or Not Elsewhere Classified is one of those left out ideas.

It was discussed as an improvement over the old Not Otherwise Specified (NOS.) A lot of people were receiving NOS diagnosis rather than a more precise or accurate diagnosis. In retrospect, I can see how NEC like NOS could have turned into another Fuzzy catchall diagnosis.

The final decision was for the DSM-5 to have two miscellaneous designations for things that do not fit nicely into a particular category. These two new designations are; Other Specified and Other Unspecified.  When those two specifiers get used will need a whole other post but for now, just know that:

NOS is out

NEC is not in and does not replace NOS

 Here is the old post:

The new sort-of depressive disorders

Minor Depressive Disorder is another one of those disorders that were proposed as somehow different from other depressive disorders. It was proposed in the DSM-4-TR as a condition needing further study.

The reason some researchers suggested this one is that the diagnoses in the DSM are yes or no things. You either meet criteria or you don’t, give or take some judgment calls we could describe as “clinical judgment.”

People do not come with discrete specific mental illnesses very often. They have problems and suffering and want help. To get that help we need to give them a “diagnosis.” The labels do not always fit well.

Minor Depressive Disorder was hard to tell from the other Depressive Disorders and does not seem to have made the cut for the DSM-5. (I am reading the on-line version; the paper version will not be out until next year.)

What we will have is a new group of Depressive Disorders Not Elsewhere Classified (NEC.) Here is my quickie version of the new categories. For the full version check the APA website for the DSM-5 or wait for the Book or the Movie version.

Recurrent Brief Depression

Every month for a year they have 2-13 days of depressive symptoms. This comes with a list of reasons to not give this one or other diagnosis that it might be.

Mixed Subsyndromal Anxiety and Depression

Lots of people who are anxious get depressed and people who get depressed can become anxious. This happens so often that a new Mixed Anxiety and Depression diagnosis was proposed. That one did not make the cut. So for full-on Depression and full Anxiety looks like we will continue to use both diagnoses. It will be interesting to read the full text on this one when the DSM-5 comes out. Somehow this Subsyndromal mix got its own label.

Short duration (4-13 days) Depressive Episode

So if your brief depression does not recur every month you can still get a depressive diagnosis. This one concerns me and I will need to learn more. It seems to open the door for anyone who has ever had a “blue week” to now get a diagnosis of a mental illness. Wonder if this will get used a lot or very little?

Subthreshold Depressive Episode with insufficient symptoms

With only a few exclusions everyone now gets to be depressed.

Uncertain Depressive Disorder

This works for anyone else that would like a depression diagnosis but has not yet gotten one.

The conclusion

In my estimation, there will be a lot more people who can qualify for a depressive disorder diagnosis under the new system. I will need to study this one some more before we implement the new DSM-5. This may mean that a lot of people who need help but used to get turned away because they did not meet criteria for a diagnosis will get help. Or it could mean that everyone will get one of the depressive diagnoses and that a Depressive Disorder Diagnosis will stop meaning anything. Only time will tell.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

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.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

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

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

What is Reactive Depression?

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

Depressed person

Depression.
Photo courtesy of Pixabay.com

Do you have Reactive Depression?

Reactive depression is one of those terms, like Manic-Depressive Disorder, that still gets used even though we have come up with new, presumably more precise names. The underlying assumption, which is often hiding here, is that if we could find ways to categorize the various mental, emotional and behavioral problems, we should be able to find precise treatments, medication or therapy for your specific ailment. If only it was that simple.

The Reactive Depression terms meaning has changed over time. Most recently it was in use to describe times when a person became depressed as a result of a specific stressor. Say you lose your job, that loss might make you sad. A small amount of sadness for a while is normal. Staying a lot sad for a long time is excessive and so you are sort of depressed. In this view reactive depression is depression caused by your specific reaction to an identifiable event. That event might be a one-time thing or it might be repeated exposure to the same sorts of events. Some people have called this Situational Depression.

This is not the same thing as Posttraumatic Stress Disorder (PTSD.) A person with PTSD may or may not have depression but Depression is not part of the definition of PTSD. People with PTSD can’t get the thoughts of the event out of their head. It is as if they are continually re-experiencing the trauma. Anything that reminds them of the trauma is upsetting and they will try to avoid things that trigger those reminders. PTSD usually disturbs sleep. Other symptoms include disturbing dreams, nightmares, trouble falling asleep and more trouble staying asleep. PTSD is an ANXIETY disorder as opposed to an Anxiety disorder. It also includes a lot of stress and trauma-related features.

There is another idea, similar to reactive depression, currently called Minor Depressive Disorder which is currently listed as a disorder listed for further study. While Reactive Depression is in response to something that happened to you, Minor Depressive Disorder is a sad or depressed period with some symptoms but it is just not as deep or severe a depression as a Major Depressive Disorder. So far neither of these ideas are accepted diagnosis under the current text, the DSM-4-TR. Some of these ideas will change when the DSM-5 comes out but that is very controversial at this time.

There is another name and criteria set that we are currently using to cover both of these issues. We call this disorder or group of six disorders – Adjustment Disorders. There are good reasons why people might suffer from adjustment disorders and need treatment but still not have all the symptoms of Major Depressive Disorder or Bipolar Disorder.

In my experience, Adjustment Disorders result in more people in crisis than most of the other disorders. By definition, Adjustment Disorders should be time-limited. If it goes on too long after the event or if the symptoms continue to be severe or worsen, then the diagnosis will get increased to Major Depressive Disorder.

That does not mean that a Reactive Depression or Adjustment Disorder is not dangerous. People, who find out their partner is leaving them or has cheated or those who lose a job or house they love, can and sometimes do get violent towards themselves and others.

So let’s return to the person who just lost their job, or spouse or has a sick family member. Might that make them sad? Might they be scared and anxious? Hey, what if they got both depressed and anxious?

This is why we have diagnoses of Adjustment Disorder with Depressed Mood, with Anxiety, and with Anxiety and Depressed Mood. What else might happen?

Could a person who lost their spouse start drinking and get arrested?  Maybe a teen that fails a class or gets in trouble might run away from home or get mad and break windows? So one reaction to a problem, one adjustment difficulty, could be to behave in ways that make society disapprove of you. We would call that Adjustment Disorder with Disturbance of Conduct.

Think about this for a moment. That teen, might he be depressed, anxious and act badly? What about his unemployed father who gets scared he won’t find another job, starts drinking and gets into a fight. We call these sets of behavior Adjustment Disorder with Disturbance of Emotions and Conduct. Lots of names for the ways in which adjusting to a problem could affect someone.

If you have been counting that is only five diagnoses and I promised you six.

We always need a loophole. We call that Adjustment Disorder Unspecified when we can’t figure out which other one it is.

Regardless of the name the preferred treatment for these issues in counseling. Cognitive Behavioral Therapy or solution-focused counseling is recommended. The main direction of this kind of therapy is on problem-solving and changing the ways in which you think about your problems.

So whether you call it Reactive Depression, Minor Depression or an Adjustment Disorder, the way we react to life’s stresses can result in crises that require and often bring people to counseling.

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

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.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

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

Books are now available on Amazon, Kobo, iBooks, Barnes & Noble, and many other online stores.

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.