Abstract
Research output indicates that a very high percentage op people with depressive disorders do not improve after a period of two years. One can thus assume that poor identification of the symptomatology and the factors involved in the etiology and maintenance thereof could lead to a generalised diagnosis and a less successful intervention.
Although the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) has explicit criteria for both Dysthymia and Unipolar Major Depression it is sometimes difficult for clinical therapists to distinguish between them because of/due to the symptom similarities. Against this background the question is often asked whether Dysthymia is entitled to an unique diagnostic status. A few international investigations, as well as the preceding study (Smit 1994) have indicated that they are in fact different disorders. Each of these research findings however only focuses on specific areas of these disorders. The main purpose of the present study is however to identify the differences and similarities between the two depressive groups. An in-depth study was done to get an indication of the different comorbid personality and syndrome disorders as well as the unconscious defence mechanisms these patients tend to use.
Two hundred and fifty five patients from the TARA, the H. Moross Centre, Weskoppies Hospital and Vista Private Clinic was evaluated. The DSM-IV was used to distinguish between the subjects of the different groups. Thereafter Hamilton's Depression Rating Scale was applied to get an indication whether the chosen patients weren't too little or too seriously depressed, as this could have influenced the results. The patients were then tested with Millon's Clinical Multi-Axial Inventory II to determine their comorbid personality and syndrome disorders. Finally they were assessed with Ihilevich and Gleser's Defence Mechanism Inventory to establish the defence style they usually unconsciously use.
The results indicate that both groups tend to have comorbid anxiety and somatoform disorders. The findings also suggested that the Schizoid, Dependent and Borderline personality disorders would be the best indicators/predictors for the diagnosis of Unipolar Major Depression. According to the results the Dysthymic group had significantly higher measures on the Self-Defeating, Schizoid, Schizotypal, Avoidant, Borderline, Paranoid, Somatoform, Dysthymic, Thought Disorder, Major Depressive, Delusional and Aggressive style sub-scales. The best predictors/indicators for the Dysthymic Depressive Disorder are the Anxiety, Drug dependence, Thought Disorder, Major Depression and Somatoform syndrome disorders, the Anti-Social, Self-Defeating, and Schizotypal personality disorders, as well as the Aggressive, Projective, Intellectual, Intrapunitive and Reversal defence mechanisms.
The results also indicate that the Dysthymic males had significantly higher measures than the females on 19 of the 27 subscales. The females subjects of the Unipolar Major Depressive group had significantly higher scores than the males on the Dependent and Somatoform sub-scales, while the males of the Major Depressive group had significantly higher scores than the females of this group on the Anti-Social, Aggressive-Sadistic, Alcohol dependence and Drug dependence sub-scales. One can come to the conclusion that the Dysthymic group (especially the males) are much more affected than the Unipolar Major Depressive group. These findings thus support the view that Dysthymia is entitled to a own unique diagnostic status, at least for a South African population.
Dr. A. Burke