The overlap of depressive personality disorder and dysthymia: a categorical problem with a dimensional solution

In this paper we review the research literature on depressive personality. We begin with a brief discussion of the historical antecedents of the current debate, noting the long-standing uncertainty about the relation of this construct to both major mood disorders and normal temperament. Then we examine the DSM-IV Appendix B construct of depressive personality disorder, in particular its controversial overlap with dysthymic disorder. This overlap is discussed within the construct validation criteria proposed by Robins and Guze (1970), highlighting recent developments and responding to criticisms of our previous theoretical review. Finally, we examine dimensional alternatives to the current proposed depressive personality disorder construct using the framework of the five-factor model. We conclude that, despite persuasive evidence for the existence of depressive personality traits, support is insufficient for the inclusion of depressive personality disorder as currently defined. Instead, we propose that depressive traits are best conceptualized dimensionally, and as part of an overarching model of personality structure, rather than as a discrete diagnostic entity. Since this conclusion could also be drawn for many existing personality disorders, the issues raised here are relevant to the construction of DSM-V.