Dysthymic Disorder and Marital Conflict

What is Dysthymic Disorder?

Dysthymic Disorder is a relatively new way to understand a particular type of depressive behavior. There are 7 million Americans for whom the sun will not come up tomorrow. They will not bet their bottom dollar. There have no silver lining playbook. They can see no upside to their problems. These people live in a depressive fog and possess little resilience. They suffer from a treatable, but often ignore medical condition called Dysthymic Disorder.

dysthymic disorder

I remember way back in 1962 when I was a kid I watching a cartoon called Lippy the Lion. Lippy had a sidekick, a hyena named Hardy Har Har. Hardy Har Har’s name is ironic, as it suggests the sound of laughter. But Hardy was an eternally moaning pessimist. It’s clear to me in retrospect that Hardy was suffering from Dysthymic Disorder. But it would be about 18 years until he could get a proper diagnosis. Because Dysthymic Disorder is a relatively modern idea.

Dysthymic Disorder and Marital Conflict

Dysthymia is like mood music in the soundtrack of your life. And the mood is dismal, dark, and depressing. Dysthymia is a chronic, muted form depression that spreads a dark cloud of hopelessness, negativity, and pessimism. Your spouse may experience you as critical, unmotivated, chronically complaining, and perpetually exhausted. People diagnosed with Dysthymic Disorder describe themselves as profoundly dissatisfied and pessimistic. Research tells us that dysthymics are less likely to experience limerence, feel the excitement of romantic love, or enter into committed relationships. If they do marry, they are more prone to divorce. It’s tough living with a dysthymic.

So if you have been “depressed” for more than two years, and every day pretty much sucks and feeling “down” is the new normal for you most days… and if your partner is commenting on how dark your moods are…you just might have Dysthymic Disorder.

dysthymic disorder

Dysthymic Disorder Is Easy to Miss

Dysthymic Disorder is more subtle than other forms of depression. When you are miserable, isolated, tired and irritable, you might be as resigned to this situation as your intimate partner has become. Unlike most other depressive disorders, most dysthymics can “function” professionally, especially men, who often develop elaborate defensive ramparts with chronic irritability, passive-aggression, and a pessimistic stance toward their partner.

Another marital stressor is that Dysthymic Disorder often wrecks havoc with ambition. Dysthymics are often underemployed, or unemployed. However, as with Developmental Trauma, some people with Dysthymic Disorder achieve at a very high level. They might have been born into wealth and privilege, or some other confluence of forces might have swept them to wealth and position.

How is Dysthymic Disorder Different from Plain Old Depression?

With a Major Depressive Disorder, we often find the co-morbidities (other bad stuff that comes with the disorder) of both poor appetite and sleep disorders. But Dysthymics tend not to have these particular problems. But they sometimes report various aches and pains, headaches, and chronic fatigue. Dysthymics may seek medical help for these challenges, but they rarely get relief, because, absent a treatment that is Dysthmically informed, medical science is at a loss to understand how these complaints arise in the first place. It is common for Dysthymics to numb out on SSRI’s such as Prozac. And many do report that anti-depressants seem to lift the fog of their dysthymia.

History of the Idea of Dysthymia

We used to think of the constellation of symptoms we now call Dysthymia as “neurotic depression” or having a “depressive personality.” Dr. Robert Spitzer, a psychiatrist at the New York State Psychiatric Institute in New York, coined the term Dysthymic Disorder in the late 1970’s. It quickly found its way into the DSM III in 1980. The disorder was carefully researched in the 80’s, and as a result, we now understand a lot more about it.

Research by Dr. Myrna Weissman indicated that about 3% of the adult US population suffer from dysthymia. More recent studies have bumped that to maybe double that number. When you consider that 17 million Americans suffer from some form of clinical depression, 7 million dysthymics represents over 40% of the total number of those Americans afflicted with depression.

Where is Dysthymic Disorder on the Continuum of Depressive Disorders?

Depression involves a major disturbance in your emotional life and moods. It’s not readily apparent. That’s why it’s called an Internal Disorder (McKenry, 2005).  Morrison (2003) did research that shows where Dysthymic Disorder fits into the Depression Continuum.

Most Common Types of Depression

  • Major Depression. These folks are utterly non-reactive. They can’t be cajoled or cheered up in any way shape or form. People with Major Depression have very disturbed sleep patterns. They can’t think concentrate or have a clear understanding of their situation. Exhaustion is a common complaint. They ruminate frequently and obsessively. Major Depression is a highly dangerous condition as thoughts of death and dying may lead some of the afflicted to commit suicide.
  • Bipolar Depression.  Those afflicted with a Bipolar Disorder experience cyclical moods of manic euphoria followed by a depressive crash. But for some, these two extremes may be broken up by a period of a more stable mood for some duration. It’s important for someone suffering from Bipolar Disorder to become intimately acquainted with their own particular pattern. Bipolar Disorder starts in very early adulthood, while Dysthymic Disorder tends to be noticed earlier, often in childhood. There is growing evidence that Bipolar disorder has a genetic component to its expression. As in the case of Major Depressive Disorder, The depression experienced by those with Bipolar Disorder is often so profound that some will attempt to commit suicide if they are untreated.
  • Psychotic Depression.  This is a particular variation of major depression. Those afflicted develop delusions hallucinations, or sometimes both. Psychotic Depression may result in hearing voices which may urge the sufferer act in a dangerous and violent manner.
  • Atypical Depression. Unlike people with a Major Depression, Atypical Depression is, like Dysthymia, a milder form. Mild enough so that the afflicted might be able to recognize their state, respond to an intervention, and bounce back. Individuals suffering from Atypical Depression have the ability to respond to external stimuli such as caring intimates or positive events and can snap back to a more normal mood. However, these mood shifts don’t last. They typically slip back into their depression when the positive external stimuli are no longer present. A key feature of Atypical Depression is an acute sensitivity to criticism, excessive rumination, and a tendency to oversleep and overeat. Most Postpartum Depression can be thought of in this category.
  • Dysthymia. The key diagnostic indicator for Dysthymic Disorder is when the afflicted who been depressed continually for at least two years, but has been able to function despite their depression. The difference between Dysthymia and the other disorders is that the afflicted becomes so acclimated to being depressed that their depression has become their baseline “normal” state. Dysthymics are the walking wounded of the depressive disorder spectrum.

 Possible Genetic Links to Dysthymic Disorder

Research tells us that many dysthymics were irritable and difficult as children, and often fell short in school both academically and socially. Other dysthymics do not begin to show symptoms until they are teenagers, young adults or even middle-aged. Dysthymia may be triggered by a grief experience such as a death of a loved one, job loss, financial reversal, or divorce.  Sometimes dysthymia begins as an apparent Major Depressive Disorder that, whether treated or not, diminishes in intensity but never entirely disappears.

People with dysthymia are also prone to occasional bouts of Major Depression, a condition called Double Depression. If anything, it is often the new low brought on by the major depressive episode, not the ongoing dysthymia, that persuades a spouse with dysthymia to seek therapy.

Treating Dysthymic Disorder

Research tells us that about two-thirds of dysthymics improve when they take antidepressants. The drugs used to treat Dysthymic disorder are exact same drugs used to treat Major Depression, including tricyclic antidepressants like imipramine (Tofranil), MAO inhibitors like phenelzine (Nardil) and serotonin uptake inhibitors like fluoxetine (Prozac), These drugs are all effective treatments for dysthymia.

Despite the fact that many people with Dysthymic Disorder take anti-depressants and SSRI’s, many patients find the side effects too high a cost to pay. Many patients drop drugs and enter into individual therapy. The two therapies that have been most effective in treating depression are CBT (cognitive-behavioral therapy), developed by Dr. Aaron Beck at the University of Pennsylvania in Philadelphia, and interpersonal therapy, developed by the late Dr. Gerald L. Klerman at Cornell and now being studied for possible applications for treating Dysthymia.

Interpersonal psychotherapy utilizes a time-limited approach, where the emphasis is in the here and now. It centers around the four common problem areas; role disputes, role transitions, unresolved grief, and social deficits. Research conducted over the last few years has suggested that this type of therapy may be just as effective as using antidepressants in mild to moderate depression cases such as Dysthymia.
 Both approaches are “talking Cures” But they are not psychodynamic. CBT is not an “insight-based” treatment. These cognitive therapies pragmatically help patients to notice their depressive thought patterns and challenge negativistic thinking and self-defeating behavior characteristic of Dysthymic Disorder and other depressive disorders. New research tells us that regular exercise and dietary supplements of Omega 3 oils are also very helpful in supporting a patient suffering from Dysthymia.

If Your Partner Has Dysthymic Disorder

Please remember that you can’t cure your partner’s Dysthymic Disorder with your words and love and support. In fact, research shows that this approach might even backfire.

The most you can do is to learn everything you can about this debilitating condition and circle the wagons.

Yeah, that puts a lot on your plate. And if there are other marital issues besides your partner’s dysthymia, well frankly, that’s an additional burden too.

Marital problems and depression are related. The more you squabble the more likely you both are to become depressed. Bickering and arguments are often reported as the events prior to the onset of depression (Kung, 2000).

Over 40% of couples presenting in couples therapy have some problem with depression with either or both partners. It’s a chicken and egg problem. Research also indicates that depression may induce bickering between partners, which may cause additional stress resulting in increased levels of depression (Gordon, 2005). In sum, research has found the relationship between depression and marital conflict to be a demon dance feedback loop (Papp, 2003).

It’s another case of the Protest Polka, (the more the more…)

The deck is stacked against the couple for as long as the illness goes untreated.  Anne Sheffield

Dysthymia and Divorce

17 million Americans suffer from some form of depression. Depression is an enormously important topic in science-based couples therapy.

Researchers are beginning to accept the notion that in many cases, depression is often the cause rather than the result of a divorce (Sheffield, 2003). For example, the marriage suffers a one-two-three punch. The Intimate bond is impacted by the depression first, then the couple bickers, fights, and then escalates. Eventually, the partners develop an internal working model that the “spouse in their head” is more of an enemy than a friend (Heene, 2005). This reminds me of the research on Kitchen Sinking and Kitchen Thinking.

The key is to help your partner gain increasing awareness over time. It will probably take a lot more than just your efforts to help your partner to recover. You may find that it will take the combined efforts of friends and family, combined with your own herculean efforts to get your depressed partner to begin to perceive their true state. That’s what I mean by “circle the wagons.”

But remember only your spouse can do the actual work. Only your spouse can pursue the awareness that they are in the clutches of an illness that is sapping the joy and meaning out of their lives.

Major Recent Research Papers on Depression and Marital Conflict

Benazon, N. R., & Coyne, J. C. (2000). Living with a depressed spouse. Journal of Family Psychology14, 71-79.

Duncan, S. F. (2000). Practices for building marriage and family strengths. In D. C. Dollahite (Ed.), strengthening our families: An in-depth look at the proclamation on the family (295-303). Salt Lake City, UT: Bookcraft.

Gordon, K. C., Friedman, M. A., Miller, I. W., & Gaertner, L. (2005). Marital attributions as moderators of the marital discord-depression link. Journal of Social and Clinical Psychology24, 876-893.

Heene, E. L.D., Buysse, A., & Van Oost, P. (2005). Indirect pathways between depressive symptoms and marital distress: The role of conflict communication, attributions, and attachment style. Family Process, 44, 413-440.

Jeglic, E. L., Pepper, C. M., Ryabchenko, K. A., Griffith, J. W., Miller, A. B., &Johnson, M. D. (2005). A caregiving model of coping with a partner’s depression. Family Relations54, 37-45.

Johnson, S. L., & Jacob, T. (2000). Sequential interactions in the marital communication of depressed men and women. Journal of Consulting and Clinical Psychology, 68, 4-12.

Kung, W. W. (2000).The intertwined relationship between depression and marital distress: Elements of marital therapy conducive to effective treatment outcome. Journal of Marital and Family Therapy, 26, 51-63.

Morrison, A. B. (2005). Mental illness in the family. In C. H. Hart, L. D. Newell, E. Walton,& D. C. Dollahite (Eds.). Helping and healing our families (pp. 288-294). Salt Lake City, UT: Deseret Book Company.

Morrison, A. B. (2003). Valley of Sorrow: A layman’s guide to understanding mental illness. Salt Lake City, UT: Deseret Book Company.

Papp, P. (2003). Feminist family therapy: Empowerment in the social context. Washington, DC: American Psychological Association.

Roby, J. L., Buxton, M. S., Harrison, B. K., Roby, C. Y., Spangler, D. L., Stallings, N. C., & Walton, E. (2000). Awareness of abuse in the family. In D. C. Dollahite (Ed.), strengthening our families: An in-depth look at the proclamation on the family (pp. 253-265). Salt Lake City, UT: Bookcraft.

Sheffield, A. (2003). Depression Fallout: The impact of depression on couples and what you can do to preserve the bond. New York, NY: HarperCollins Publishers Inc.

Sheffield, A. (1998). How you can survive when they’re depressed. New York, NY: Harmony Books.

Wittmund, B., Wilms, H. U., Mory, C., & Angermeyer, M. C. (2002). Depressive disorders in spouses of mentally ill patients. Social Psychiatry and Psychiatric Epidemiology37, 177-182.

 

About the Author Daniel Dashnaw

Daniel is a Marriage and Family Therapist. He currently sees couples at Couples Therapy Inc. in Boston, Massachusetts, three seasons in Cummington (at the foothills of the Berkshires...) and in Miami during joint retreats with his wife, Dr. Kathy McMahon. He uses EFT, Gottman Method, Solution-focused and the Developmental Model in his approaches.

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