Diagnostic viability of depressive personality disorder: theoretical and conceptual issues

Depressive personality disorder (DPD) is being considered for inclusion in future editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM). In this paper, we review the theoretical and empirical literature on DPD, and examine a number of issues concerning its viability as an Axis II disorder. Three criteria were used as necessary preconditions for the inclusion of DPD on Axis II: (a) substantial theoretical distinctiveness from other disorders, (b) established empirical distinctiveness from other disorders, and (c) sufficient deviation from a "normal temperament." We argue that it is improbable that this disorder could be diagnosed independently of dysthymia, and that there is also considerable symptom overlap with several Cluster C disorders. Although there appears to be sufficient deviation from normality among the entire group of individuals with DPD, those persons whose symptoms are not severe enough to cause overlap with dysthymia may not so deviate. We conclude that the current conceptualization of DPD does not have sufficient discriminative validity or clinical utility to warrant inclusion in future editions of the DSM.