Depressive Personality Disorder:

Here we have a story involving past heads of DSM task forces, including the head of the current version of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition: DSM-IV (*cough* paradigm, I guess) pitted against the people in charge of bringing in the next manual, the DSM-V.

Take a look at the DSM-IV-TR, the current “text revision” being used prior to the publication of DSM-V in May, 2012.
Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR Fourth Edition (Text Revision)

You say you want a revolution? I’ve heard this interesting story before.

There has been a lot of talk about “paradigm shifts” lately, which has made me eager to dust off the Thomas Kuhn books on my book shelf, most notably The Structure of Scientific Revolutions. We get the picture from the book that science does not advance in a linear, objective fashion by standing on the shoulders of the researchers before us, but that it proceeds by alternately creating and destroying paradigms. While the term ‘paradigm’ itself may have become overused, no one can argue that it hasn’t been used lately.

In fact, Maser and others (2009) wrote an article for the March, 2009 journal Clinical Psychology: Science and Practice titled specifically “Psychiatric Nosology Is Ready for a Paradigm Shift in DSM-V.” They called for a mixed/hybrid categorical-dimensional system, which would be a shift from the paradigm and assumptions that were ushered in in 1980.  They join the call for including more dimensional features in DSM-V. Clinicians of course, must think on a continuum (or spectrum), and I do agree with their call for a mixed  categorical-dimensional format for personality disorders, particularly since it appears to be how clinicians think and practice now in terms of using personality disorder nos either to note the traits or features (but not full criteria of) one or more personality disorders. It could be interesting to allow for other maladaptive traits to be placed on Axis II as well, but likely more useful if standardized prototypes or “categories” continue to be used (such as depressive pd

The term “paradigm” was also brought out this week by the MD who led the creation of DSM-IV and by the current “framers” of DSM-V.

On June 26, 2009; Allen Frances, MD, the head of the task force that developed the DSM-IV wrote an article for Psychiatric Times: A Warning Sign on the Road to DSM-V: Beware of its unintended consequences as well as a Q&A interview. He suggested “grave problems in the DSM-V goals, methods and products…” He noted “I believe that the work on DSM-V has displayed the most unhappy combination of soaring goals and weak methodology” and noted that “excessive ambition” has “encouraged an excessive tolerance for risk taking.” He noted that the “DSM-V goal to effect a paradigm shift in psychiatric diagnosis is absurdly premature” and “There can be no dramatic improvements in psychiatric diagnosis until we make a fundamental leap in our understanding of what causes mental disorders.”

There is talk about basing diagnoses on biological findings, yet the evidence is not yet there to support this. It is certainly important to focus on underlying and shared factors across disorders, though they may not all be biological.  Interestingly, a reductionist trend might also be hidden within the notion of including dimensional personality traits and similar suggestions. One suggestion would be incorporating an assessment of traits and/or facets of the Five-Factor Model of Personality instead of or in addition to personality disorders, in effect attempting to reduce larger abstract concepts like personality disorders and other maladaptive expressions of personality in to other, theorized abstract concepts which are on a more “basic” level (though arguably more in line with current theories about “normal” personality). 

Getting back to Dr. France’s article, he charges that “A further problem is that almost everyone responsible for revising the DSM-V has spent a career working in the atypical setting of university psychiatry,” suggetsing they lack more real world experience (my words there). The author worries that subthreshold diagnoses  (and presumably the lower ends of dimensional ratings) may “flood the world with tens of millions of newly labeled false-positive “patients.” “  The rates of DSM-V mental disorders would “skyrocket” and there would be a “medicalization of normality” which… wait for it… would be a “bonanza for the pharmaceutical industry.” He compares his perception of the DSM-IV development process with that of DSM-V and suggested that “DSM-V is continuing to veer badly off course…” “What is needed now is a profound midterm correction toward greater openness, conservatism, and methodological rigor.” The first concern he lists in his conclusion is “their ambition to achieve a paradigm shift when there is no scientific basis for one.”  

On July 1, 2009 “Setting the Record Straight: A Response to Frances Commentary on DSM-V” appeared, signed by all the essentials : Alan F. Schatzberg, MD, James H. Scully Jr, MD, David J. Kupfer, MD, Darrel A. Regier, MD, MPH( Dr Schatzberg is President of the American Psychiatric Association. Dr Scully is Medical Director, CEO, of the American Psychiatric Association. Dr Kupfer is Chair, DSM-V Task Force Dr Regier is Vice Chair, DSM-V Task Force).

They describe the DSM-V development process and note it to be open and inclusive (admittedly, I do like that comments could be submitted through the dsm5.org website.  Interestingly, they also note that “Recognizing changes in technology and the need for continued updates and revisions of DSM-V, we are setting up a process that will allow the new DSM to change with new developments, rather than being reified for a decade or more. New publishing technologies, not even imagined in the early 1990s, will help make this possible.” This reminds me of the ICD-10 which has a between revisions “updating process” (and presumably the future ICD-11 will as well, and there has been talk of attempting to get the two to mesh a bit more closely together). Its not clear what business model might be used in terms of publications of updates to the DSM (i.e. free on a website?). The authors note that “Science has advanced, treatments have advanced, and clinical practice has advanced since Dr. France’s work on DSM-IV. The DSM will become irrelevant if it does not change tor reflect these advances.” However the author’s concluding argument is hardly a scientific one, the shot they fire is “Both Dr. Frances and Dr. Spitzer have more than a personal ““pride of authorship”” interest in preserving the DSM-IV and its related case book and study products. Both continue to receive royalties on DSM-IV associated products. The fact that Dr. Frances was informed at the APA Annual Meeting last month that subsequent editions of his DSM-IV associated products would cease when the new edition is finalized, should be considered when evaluating his critique and its timing.” Apparently, conflicts of interest charges are especially powerful in psychiatry righyt now, but this one was broadened away from the “pharmaceutical industry” at least. Perhaps what was worst was that they called him Frances.

Of course, Dr. Spitzer was called out so then we have the follow up commentary: “APA and DSM-V: Empty Promises” who of course couldn’t help but notice the “ugly turn” the DSM-V debate has taken. Dr. Spitzer takes issue with the description of the DSM-V process being open and inclusive, and notes that although field trials are expected to begin, a laundry list of questions about those trials remain unanswered. As an aside, I did submit my e-mail address as someone willing to help with any trials but I haven’t heard anything back (though that really isn’t too surprising ;). He suggests that they either know the answers and aren’t telling, or if they don’t know, then it is “inconceivable” that the May, 2012 “deadline could realistically be met.”

Maybe there’ll be no more fireworks over the July 4th holiday, but I’ll keep an eye on it as are quite a few others, check out all the tweets on twitter Follow @DrFinnerty and I’ll pass them along to you when I see them (send me what you find too).

The DSM hasn’t been revised that many times, and certainly there are countless ramifications (some intended and some “unintended”) which will come from any revisions as well as any status quo that is maintained. Its expected to be published in May, 2012, and the “battles” leading up to that time, if recent articles are any indication, will likely prove to be interesting for both the combatants and spectators alike. I hope they give it their all and keep us as entertained as they have this week. I’m just reminded of the revolutionary words from the movie Braveheart that go something like ‘…and dying in your beds many years from now, would you be willing to trade all the days from this day to then, to come back here, and tell our enemies, that you may take our lives, but you’ll never take- our freeedom!’ Sorry, perhaps I got a little carried away. Its been a little while since I’ve witnessed scientists with their faces painted up so much for battle. I guess we have Thomas Kuhn’s work acted out for us on display, the naked realities of scientific progress made plain before our very eyes. Its not always facts speaking for themselves, sometimes communities of scientists must decide how to organize the abstract concepts involved and as can be seen from an example like DSM-V, come together in committee (apparently sometimes behind closed doors).

Meanwhile, I need more popcorn ;) 

You can “get the latest” in Psychiatric Time’s DSM-V Topic Center

Check out the primer for understanding why science (even psychiatry and psychology) may be sloppier and more entertaining than you thought:

The Structure of Scientific Revolutions

Take a look at the DSM-IV-TR, the current “text revision” being used prior to the publication of DSM-V in May, 2012.
Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR Fourth Edition (Text Revision)

RE: Conceptualizing “depressive traits” (and depressive personality disorder) for DSM-V

The diagnoses of Depressive Personality Disorder and “depressive traits/features” (to take liberties) can be conceptualized in a hybrid categorical and dimensional manner for DSM-V. The diagnosis itself is categorical, but the severity and underlying DSM-IV-TR criteria can be treated dimensionally. This opens the door to a wealth of research not just on depressive pd, but on cognitive vulnerabilities to depression and other relatively stable factors that have been found to be independent of depression. These factors or maladaptive “depressive traits” are in many ways also quite similar to the diagnostic criteria for depressive pd, and depressive pd has also been found to be relatively stable and independent of depression.  The depressive pd construct would be more useful than crafting a laundry list of maladaptive characteristics in individuals who would have otherwise qualified for a depressive pd diagnosis. It also focuses the attention of practitioners on more specific and independent traits which would be useful for practitioners of cognitive-behavioral therapy (to name just one), as opposed to more nebulous constructs such as neuroticism. We should keep in mind that personality traits are also abstract concepts without distinct physical findings at this point, and are not necessarily the only building blocks involved in the presentation of individuals with personality disorders. We also should not ignore a proven framework for incorporating depressive traits (such as cognitive and other vulnerabilities to depression) in to DSM-V.

Depressive PD was included for further study in an appendix of the DSM-IV, but was also given as an example of a diagnosis which can be made under personality disorder nos. The criteria reflect a negativistic individual who tends to be critical towards themselves and judgmental towards others. They are pessimistic and tend to brood and worry in addition to feeling guilty and remorseful. Per DSM-IV their “usual mood is dominated by dejection, gloominess, cheerlessness, joylessness, unhappiness” (pg. 733). Depressive pd has repeatedly been found to be a valid diagnosis which can be differentiated from other disorders (Huprich, 2009). It has a degree of stability similar to other personality disorders and is present even when a mood disorder such as depression is not. The criteria which construct depressive pd can be viewed as consistent with cognitive vulnerabilities to depression, and these underlying vulnerability concepts have also been found to be distinct from depression.

While the depressive pd criteria may sound similar to depression or anxiety symptoms, they are also relatively stable, maladaptive personality characteristics which create vulnerability to emotional problems. The depressive pd criteria reflect characteristics which can be assessed dimensionally and create impairment at more extreme levels. While at lower levels the depressive pd criteria may be seen as minor variations of normal personality characteristics, at higher levels they lead to significant difficulties. Coding features of depressive pd offers clinicians the ability to communicate the presence of stable depressive traits which have had increased research attention. For example, Hankin (2008) found cognitive vulnerabilities to depression to be fairly stable, enduring processes. A negative cognitive style, such as is seen in depressive pd, tended to be one of the most stable vulnerabilities studied. Ryder, at. al. (2008) found depressive pd to be related to all depression vulnerabilities assessed in their study. This would be an expected finding considering the depressive pd criteria generally look like these “vulnerabilities.” These cognitive vulnerabilities can be viewed as relatively stable depressive traits on a continuum with depressive personality disorder. These factors alone can create interpersonal problems and functional limitations and when they are present to a sufficient degree a depressive personality disorder diagnosis can be made.

Depressive pd is also correlated with neuroticism. Neuroticism is related mildly to many of these independent vulnerability constructs which make up the depressive pd criteria, but it is generally more associated with depression when factor analyses have been conducted. While neuroticism is sometimes treated as a cognitive vulnerability, it may be a nonspecific collection that includes these factors. Per Hankin, et. al.’s (2007) factor analyses, “cognitive vulnerability is not reducible to general trait neuroticism.” The many maladaptive expressions of depressive traits are not adequately covered by neuroticism alone but can be expressed through a depressive pd or depressive traits diagnosis. As DSM-V moves towards a more dimensional view of disorders, including depressive pd would increase attention on these underlying dimensional trait structures which should not be overlooked. It would also highlight factors with a profound impact on prognosis. In addition to creating distress and interpersonal problems in their extreme form, depressive pd is constructed of clinically useful concepts that suggest a risk for the onset of other problems, a longer course and risk of recurrence. As these vulnerabilities/maladaptive characteristics drift away from normal personality in to the maladaptive and the more vulnerabilities that are present, they become depressive traits and create depressive personality disorder in their most extreme form. It includes more information than the simple description of course in dysthymic disorder. It is also not surprising given it’s underlying constructs that depressive pd is functionally impairing in itself, creates interpersonal difficulties and should be considered a severe personality disorder that includes distress and possibly anxiety and affective complaints, and is not the same as a sub-threshold or minor depressive disorder.  I invite you to read through the manuscript (in POD book form) that I have been working on related to depressive personality disorder and thank you for your time. I also would like to let you know that a briefer article on depressive pd similar to this letter will likely soon be published in a national print publication. It will generally convey the same opinion that including these stable “depressive traits” which are independent of depression via depressive personality disorder will have the most beneficial effect on practice and be the most useful approach for DSM-V.

A link to an electronic copy of the book is available online for free in PDF format at http://www.worldwidementalhealth.com or http://www.depressivepersonality.com

Or please feel free to contact me and I would be happy to send you a free print review copy of the manuscript (in POD book form) if you do not have one already.

Thank you,

Todd Finnerty, Psy.D.

toddfinnerty@toddfinnerty.com

1360 Boswall Dr

Worthington, OH43085

(330)495-8809

References:

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental

Disorders, fourth edition (DSM-IV). Washington, DC: American Psychiatric Association.

Finnerty, Todd (2009). Depressive Personality Disorder: Understanding Current Trends

in Research and Practice.Columbus, OH: WorldWideMentalHealth.com

Hankin, Benjamin L. (2008). Stability of Cognitive Vulnerabilities to Depression: A

Short-Term Prospective Multiwave Study. Journal of Abnormal Psychology, 117(2), 324-333.

Hankin, Benjamin L.; Lakdawalla, Zia; Carter, Ingrid Latchis; Abela, John R. Z. &

Adams, Phillipe (2007). Are Neuroticism, Cognitive Vulnerabilities and Self-Esteem Overlapping or Distinct Risks for Depression? Evidence from Exploratory and Confirmatory Factor Analyses. Journal of Social and Clinical Psychology, 26(1), 29-63.

Huprich, Steven K. (2009). What Should Become of Depressive Personality Disorder in

DSM-V? Harvard Review of Psychiatry, 17(1), 41-59.

Ryder, Andrew G.; McBride, Carolina; Bagby, R. Michael (2008). The Association of

Affilliation and Achievement Personality Styles with DSM-IV Personality Disorders. Journal of Personality Disorders, 22(2), 208-216. 

Todd Finnerty, Psy.D. is a Psychologist in Columbus, OH. He also maintains a website and blog at www.depressivepersonality.com

This letter is copyright Todd Finnerty ©2009, it has been adapted from a shorter article which will be published this summer in a national print publication. While many changes have been made for the purpose of this letter, please do not redistribute it widely without the author’s permission due to the impending publication and inclusion of some paragraphs from that article. Thank you for your understanding. Please let me know if you’re interested and I’d be happy to send you an actual copy of the printed story on depressive pd later this summer after publication. Thank you again for your time.

For a limited time you can download or skim through a PDF version of the book Depressive Personality Disorder: Understanding Current Trends in Research and Practice online at no cost though this link: http://www.worldwidementalhealth.com/dpdcspace.pdf

With the talk from the DSM-V Personality Disorders workgroup regarding incorporating a more dimensional approach to personality traits in general with a personality domain (that you could assess with all disorders), as well as incorporating personality prototypes including revised prototypes related to current personality disorders, a prototype/diagnosis based on depressive personality disorder and depressive traits would seem fitting. You can read more about DSM-V revision activities:

http://www.psych.org/MainMenu/Research/DSMIV/DSMV/DSMRevisionActivities.aspx

The authors of a new article suggest that dysthymic disorder can easily escape detection:

http://www.psychiatrymmc.com/dysthymic-disorder-forlorn-and-overlooked/

I think not only are the symptoms which make up dysthymic disorder often overlooked, but also underlying maladaptive personality characteristics such as cognitive vulnerabilities to depression which increase risk for depression, prolong depression and increase the potential for relapse (as well as co-occurring disorders). It would seem that in more pathological forms or higher on the hypothetical “dimensional” scale of these depressive traits, we would find the DSM-IV diagnosis of depressive personality disorder. Its fair to argue that since it hasn’t been officially recognized these maladaptive expressions of personality traits often go unrecognized and unaddressed.

Thanks to all the Psychiatrists who have been stopping by after seeing the plug in Psychiatric News, with any luck there may be some interesting news about the DSM-V coming from the American Psychiatric Association Conference.

If you want to know more check out http://www.depressivepersonality.com 

Admittedly, this is really just a test post to see if the blog will update my twitter account at http://twitter.com/DrFinnerty

but thanks for stopping by

Tomorrow- “I ruminate therefore I am [what? fill in the blank here]. A more in depth discussion about brooding and worrying as representing both an anxiety symptom and also in some circumstances potentially reflecting a more stable cognitive vulnerability to depression and other difficulties.

There is a lot of divergent research and theory which can come together with constructs underlying the depressive personality disorder. Schema therapy and other cognitive-behavioral approaches look to address early maladaptive schemas  (see http://www.schematherapy.com for some examples).

Hankin (2008) studied adolescents and found cognitive vulnerabilities like a negative cognitive style, dysfunctional attitudes and rumination and these vulnerabilities tended to be enduring and relatively stable over time with a negative cognitive style exhibiting the greatest degree of stability.  Reference: Hankin, Benjamin L. (2008) Stability of Cognitive Vulnerabilities to Depression: A Short-Term Prospective Multiwave Study. Journal of Abnormal Psychology, 117(2), 324-333. I will be focusing more in depth on some of Hankin’s and others’ work on the stability of cognitive vulnerabilities to depression as they may be additional independent factors which can be viewed dimensionally to some extent with the factors involved in depressive personality disorder. For example, the negative cognitive style referred to in Hankin’s study is frokm Hopelessness theory and is comprised of “the tendency to make negative inferences about the causes of negative events (stable, global aatributions),” “the tendency to catastrophize about the consequenced of negative events” and “the tendency to infer negative characteristics about the self following negative events.”  The ruminative response style in this study was the process by which “individualks repetitively focus attention on their depressive symptoms and the implications of their symptoms” and dysfunctional attitudes come from Beck’s theory and suggest “rigid and extreme beliefs about the self and the world.”   

I’m starting to think that brooding and worrying may be present in individuals with anxiety, but individuals who are seens as tending to brood and worry may also exhibit some forms of these maladaptive cognitive vulnerabilities which have tended to be stable over time despite level of depression.

It appears that factors about your personality may make you at a greater risk for depression, a greater risk for your depression (and other problems) lasting longer, and a greater risk that you will slip back in to depression.

These same maladaptive personality characteristics may each be viewed dimensionally (or at least on a collective continuum of severity)  and when present to a sufficient degree to interfere with daily life, interpersonal interactions, etc. The collection of these maladaptive characteristics themselves may create significant distress and functional impairment enough to warrant a diagnosis of depressive personality disorder or personality disorder nos with depressive traits/features.

One interesting proposal for DSM-V is to incorporate models of “normal personality” dimensionally in to the structure of personality disorders (or more radically to toss out the DSM-IV categories all together).  One trait of the Five-Factor Model of Personality (FFM) which has gained attention in personality disorders is Neuroticism. Neuroticism may also potentially be a broad conglomeration of independent or semi-independent factors made up of smaller “facets” in this model. It has a tendency to load across other cognitive vulnerabilities and is associated with depression. While Neuroticism and Depressive PD show a correlation, they are not distinct entities. Other PDs are also correlated with Neuroticism and its facets such as avoidant personaity disorder. Levels found on specific facets on measures like the NEO-PI-R may not reliably predict an individuals presentation or their degree of functional impairment. While understanding underlying factors in depressive pd suggests also studying the FFM in some part, this should not be done exclusively as the many relatively stable maladaptive expressions of these traits may not be adequately addressed. Simply measuring and coding the facets of Neuroticism may prove too general for clinical use or sufficiently capture characteristic maladaptations such as those seen in depressive personality disorder.

 Portions of this blog post are adapted from Chapter 4 of Dr. Finnerty’s book which is (C) Copyright Todd Finnerty, though some of the studies cited are protected by their own copyright, additional references appear at http://www.depressivepersonality.com/references.html

One of the more salient of the FFM personality dimensions in relation to DPD is Neuroticism. Costa & Widiger (2002) note that high Neuroticism “identifies individuals who are prone to psychological distress.” It also includes “having unrealistic ideas, excessive cravings or difficulty in tolerating the frustration caused by not acting on one’s urges, and maladaptive coping responses.” The facet scales for Neuroticism are anxiety, angry hostility, depression, self-consciousness, impulsivity, and vulnerability.” The concept of Neuroticism also has some relationship to concepts described as cognitive vulnerabilities later in this chapter, and has itself been described as a cognitive vulnerability to depression [though it may be better represented as a collection of ‘traits’ (facets) that may be related to such factors]. Costa & Widiger (2005) include an appendix describing these facets on Pg. 463. Their descriptions of individuals with facet N1: Anxiety includes that they are “prone to worry.” Interestingly, criterion #4 of Depressive PD in the DSM-IV-TR (American Psychiatric Association, 2000, pg. 789) includes “given to worry.” Facet N2: Angry Hostility, per Costa & Widiger, includes the “tendency to experience anger” as well as “frustration and bitterness. They note that “…disagreeable people often score high on this scale.” The DSM-IV-TR DPD criteria include criteria for both being critical and derogatory toward the self (#3) and negativistic and critical toward others (#5). Facet N3: Depression, per Costa & Widiger, is the “tendency to experience depressive affect.” They note that individuals high on this scale would be “prone to feelings of guilt.” This would appear to be fairly consistent with DSM-IV-TR DPD criterion #1 describing the patient’s “usual mood,” and certainly criterion #7 which includes almost the same phrase “prone to feeling guilty…”Costa & Widiger’s  description of Facet N4: Self-Consciousness included “shame and embarrassment,” feeling uncomfortable around others, sensitive to ridicule and feeling inferior. The DSM-IV-TR DPD criterion #2 includes “self-concept centers around beliefs of inadequacy…” Costa & Widiger noted this facet was also similar to “shyness and social anxiety.” Facet N5: is Impulsiveness, and Costa and McCrae describe it as an “inability to control cravings and urges.” They note that “Low scorers find it easier to resist such temptations, having a high tolerance for frustration” (pg. 464). After a visual inspection of the criteria for DPD a specific criterion does not immediately jump out at you for this one, however the tendency to feel anger/frustration was also a factor in the description of N2: Angry Hostility. In addition, Costa & Widiger’s description of this facet of neuroticism also includes that they “…may later regret their behavior” and DSM-IV-TR DPD criterion #7 includes “prone to feeling guilty or remorseful” as noted in the discussion for N3: Depression. The last Neuroticism facet described by Costa & Widiger is N6: Vulnerability (to stress). They suggest that individuals scoring high on this facet will “feel unable to cope with stress, becoming dependent, hopeless, or panicked when facing emergency situations.” Given the many theorized cognitive vulnerabilities to depression and depressive personality styles described later in this chapter, it is not entirely clear if this facet would include many variables which have been found to potentially be independent of each other. The only DSM-IV-TR DPD criterion I have not yet mentioned in this discussion of the descriptions of Neuroticism facets and descriptions of DSM-IV criteria is DPD DSM-IV-TR criterion #6, “is pessimistic.” I would not argue that pessimism and hopelessness are exactly the same construct given its relationship to depressogenic inferences about the self and consequences (Adams, et. al., 2007), however hopelessness may potentially be considered a similar notion. The notion of hopelessness appears to be considered by Costa & Widiger under the description of two different facets, i.e. [“hopelessness” (N3: Depression) and “hopeless” (N6: Vulnerability)]. In addition, Costa & Widiger describe a facet of Extraversion (E6: Positive Emotions), as predicting whether individuals will “experience positive emotions such as joy, happiness, love, and excitement.” This would likely not describe an individual with DPD given criterion #1’s inclusion of “usual mood is dominated by… joylessness…” There is some face validity to the assumption that the criteria for depressive personality disorder load across the different facets of Neuroticism, and the correlation with the concept of Neuroticism’s facets (though not excessive overlap) is demonstrated by studies cited elsewhere in this text.

McCrae; Lockenhoff and Costa (2005) reviewed articles suggesting that while the “facets” of the NEO-PI-R assess distinct “traits,” they “cannot and do not claim to be a comprehensive listing of traits.” This certainly opens the door to questions about the many different lines of research on depressive styles and cognitive vulnerabilities to depression, many of which have been found to be stable tendencies. In addition, the characteristic maladaptive expressions of these underlying traits and facets of traits may lead to a wide disparity of presentations in individuals scoring highly on particular facets of the NEO-PI-R. The broad traits of the Five-Factor Model of Personality will miss the many subtle distinctions inherent in disorders, and simply adopting a system of expressing the underlying facets of the Five-Factor Model as opposed to personality disorders may oversimplify and damage clinician’s abilities to convey the many maladaptive expressions of traits and conceptualize with more relevant clinical information. This is particularly true when higher-order personality presentations may occur with different combinations of personality facets and traits, including personality variables that may or may not be well-represented by the NEO-PI-R facets.

Additional References:
Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR Fourth Edition (Text Revision)

Personality Disorders and the Five-Factor Model of Personality

Depressive Personality Disorder: Understanding Current Trends in Research and Practice

Why am I talking about rumination and depressive personality disorder in the same sentence? Particularly when in the past research on depressive pd has been geared toward trying to separate depressive pd from chronic depression and dysthymic disorder (though of course depressive pd may actually be a factor causing those symptoms or at least prolonging them). Depressive pd may be a collection of extreme forms of relatively stable maladaptive personality characteristics which produce distress, depression and anxiety and make an individual more susceptible to recurrence of these problems and others like it.  In addition, even in the absence of depression, DPD remains leading to interpersonal difficulties, mood problems and functional impairment.

Why talk about rumination and Depressive PD? Well, I’m going to blog about a number of independent factors often referred to as “cognitive vulnerabilities to depression” as well as related concepts including a theoretical personality trait known as Neuroticism which, under the Five-Factor Model of Personality can be broken down in to smaller facets.

While rumination can be treated as a symptom of disorders, in some instances depending on how it is conceptualized is can be viewed as a stable personality characteristic- or a maladaptive response related to a personality characteristic.  Many clinician’s think “dimensionally” about personality disorders, such as that while someone may not meet the full DSM-IV criteria, they may have traits or features of the disorder which are worthy of clinical attention.

The DSM-IV and DSM-IV-TR allow you to diagnose Depressive PD as well as depressive traits or depressive features under PD NOS. The DSM-IV criteria (pg 732 in your DSM-IV; 788 in your DSM-IV-TR) includes “is brooding and given to worry?” tonight I’m going to think over and over again about whether or not this has anything to do with rumination, a cognitive vulnerability to depression, etc. and I’ll get back to you tomorrow

Reference:
Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR Fourth Edition (Text Revision)

As a way of kicking off this blog I will be periodically focusing on different topics related to depressive personality disorder including different cognitive and other vulnerabilities to depression and other maladaptive character traits which make up depressive personality disorder. This week I will be focusing on rumination, with both original posts and excerpts from the book.

Since the book is out there now I’ll be periodically making blog posts here.

Amusingly, this very morning I received a Google alert related to depressive personality disorder featuring an article from a Chicago newspaper: http://www.dailyherald.com:80/story/?id=290664

Expert” Accused babysitter killer in a ‘psychotic state.’ Apparently Juan Rivera was in a “stress-induced acute psychotic state” when he killed a babysitter. What was his diagnosis other than his IQ of 79? Accoring to the article, the psychiatrist taking the stand indicated he had Depressive Personality Disorder.

You can buy the book now! Find all the different options at http://www.depressivepersonality.com