MOOD DISORDERS A 32-year old female Janice Butterfield, who came in at the insistence of her husband Jed Butterfield for a consultation concerning her suicidal attempt due to dysthymia. American Heritage Dictionary defines that dysthymia is a chronic disturbance of mood lasting at least two years in adults or one year in children, characterized by recurrent periods of mild depression and such symptoms.
Although the symptoms of dysthymia may be less intense than those of depression, dysthymia can actually affect the client’s life more seriously because it lasts so long. With dysthymia, he or she may lose interest in normal daily activities, feel hopeless, lack productivity and has a low self-esteem. Therefore, dysthymia prevents the client from living life to its fullest and overall quality of life may be low. Dysthymia is also known as dysthymic disorder and sometimes as chronic depression and minor depression.
The characteristic of Janice was clearly fit to the term of dysthymic disorder. During the psychotherapist’s visit, Dr Tobin noticed that Janice was staring the floor blankly and was static in her sitting position as if she was in an altered state. Nevertheless, with her condition as such, she managed to dress well and groomed herself but though she could not hide her depression as was clearly fixed on her face. She might be suffering from inner pain. As Janice’s characteristics, clearly correspond the criteria of an abnormal behavior person.
Janice certainly engaged in behavior that put her at risk, who had turned on the car’s ignition with the sense to suffocate herself. She felt depressed and felt “hopeless loser”, who had no reason to live. Even she was experiencing persistent feelings of distress of losing her mother, which greatly affected her life and moreover, she felt depressed as she was risking her relationship with her husband who constantly complained about Janice’s neglecting her responsibilities towards her family, as she could not imagined of losing both her loved ones.
Furthermore, she felt misery, as she could not engage on sexual intimacy with her husband. Therefore, it had triggered her emotion even more, she was feeling intense and where the emotion impaired her daily functioning that affects the quality of life by fulfilling the expectation of her mother and now her husband. Based on the diagnosis, Janice showed no psychotic symptoms or any history of a manic episode. But however, genetic factors could answer to her problem, as her mother was also experienced severe depression due to her father’s death.
Therefore, this could have been brought forward into Janice’s life, as she was very attached to her mother, looking after her mother and sisters after her father’s death, made her to cave in her feelings. She was relatively happy after the marriage with her husband but however, she would some how tumbled into her depression mode, thinking over the loss of her parents. Janice felt guilty for not having been more caring to her mother, which regarded to be angrier with herself.
Her new family life has added more stress to her as she was already in the lowest level of emotional functioning. Janice’s conflict on mother-daughter’s relationship was in unpleasant and with the pressure from husband to be more assertive in their business. Therefore she claimed suicide was a way to escape from the unsatisfying trap of her life. The American Psychological Association (APA)’s Diagnostic and Statistical Manual Disorder, 4th Edition text revised the following criteria for Dysthymic Disorder.
A person has depressed mood for most the time almost every day for at least two years. Children and adolescents may have irritable mood, and the time frame is at least one year. When depressed, two or more of the following are also present: decreased appetite or overeating, too much or too little sleep, low energy level, low self-esteem, decreased ability to concentrate, difficulty making decisions, and feelings of hopelessness. During the two years of the disorder, the patient has never been without symptoms listed for more than two months at a time.
No major depressive episode (a more severe form of depression) has been present during the first two years of the disorder. There has never been a manic disorder, and criteria for a less severe depression called cyclothymic disorder has never been established. The disorder does not exclusively occur with psychosis, schizophrenia or delusional illnesses. The symptoms of depression cause clinically significant impairment and distress in occupational, social, and general functioning. Dysthymic disorder can be escribed as “early onset” (onset before age 21 years), “late onset” (onset is age 21 years or older), and “with atypical features” (features that are not commonly observed). Therefore, Janice fits the criteria for dysthymic disorder spelled out in DSM-IV, where she was severely depressed and the sign of suicidal. Axis I:- Disorder involving distortion on physical and mentally and the urge to suicide- Major Depressive Disorder Axis II:- No evidence of personality disorder Axis III:- No physical disorders or conditions
Axis IV:- Problems with primary support group ( marital tensions) Axis V:- Current Global Assessment of Functioning: 45 Highest Global Assessment of Functioning (past year):90 According to Janice’s case, she had attempted suicide; therefore, she ought to be hospitalized for period of time for constant assessment and mood stabilization. Later, psychotherapy is the treatment for choice for this psychological problem. Often, antidepressant medication is also recommended for Janice because of the chronic nature of the depression in Dysthymia (Halgin, R. P & Whitbourne, S. K,2008).
Psychotherapy is used to treat this depression in several ways. Firstly, Janice has to attend supportive counseling, which can help to ease the pain and can address the feelings of hopelessness. Secondly, she ought to go for cognitive therapy, which is used to change the pessimistic ideas, unrealistic expectations, and overly critical self-evaluations that create the depression and sustain it. Cognitive therapy can help Janice recognize which life problems are critical and which are minor. It also helps her to learn how to accept the life problems that cannot be changed.
Third, problem-solving therapy is usually needed to change the areas of the person’s life that are creating significant stress, and contributing to the depression. Behavioral therapy can help Janice to develop better coping skills, and interpersonal therapy can assist in resolving relationship conflicts (Depression, 2008). Also, the couple therapy is required for Janice and Jed, in particularly working on the problems aroused and her husband had to be supportive in raising their child. In general, I would say there is no one best method to treat dysthymic disorder individual.
It is depend on the individual itself, whether she wants recover fully from the depression. However, she could do very well with a short course of medication if she has a desire to follow psychotherapy treatment recommendations with full dedication and strong will power could make Janice to live as normal person, without impaired emotional, social and physical functioning. Tough she was willing to take psychiatric help, she was not keen to admit herself at the psychiatric hospital which she referred it as “nut house” due to lack of understanding of what it meant to be at psychiatric hospital.
But however, after listening to her therapist advises and reasoning, she got herself admitted at the hospital and diligently followed the recommendation for recovery. She did not encounter many obstacles during recovery because she understood her seriousness of her physical and mental state. Eventually, her mood improved as the antidepressant medication began to take effect and she was ready to go home, as she felt capable of managing her responsibilities. Finally, she regained her self-esteem and had the ability to live life as happy and fulfilled person, which led to her successful recovery.
Reference:- American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed. Text Rev. ). Washington, DC: Author. Depression. Retrieved November 16,2008, from http://www. mayoclinic. com/health/dysthymia/DS01111/DSECTION=treatments-and-drugs. Halgin, R. P. , & Whitbourne, S. K ( 2008). Abnormal Psychology: Clinical Perspectives on Psychological Disorders. New York: McGraw Hill. The American Heritage® Stedman’s Medical Dictionary. Retrieved November 16, 2008, from Dictionary. com website: http://dictionary. reference. com/browse/dysthymic disorder.