Internet Mental Health

PERSISTENT DEPRESSIVE DISORDER (DYSTHYMIA)



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Diagnostic Features of Persistent Depressive Disorder

SYMPTOM DEFINITION SELF-DESCRIPTION
2-YEARS OF DEPRESSIVE SYMPTOMS
Depressed Mood Feeling down or depressed "I often feel down or depressed."
(While depressed must have at least 2 of the following:)
Hopelessness A feeling of despair; lack of hope "I feel my future is hopeless and cannot improve."
Distractibility Difficulty concentrating on doing something for 10 minutes; easily distracted; poor attention span "I am easily distracted." "I can't focus on things for very long."
Fatigue Tired; lack of energy "Im tired all the time."
Abnormal Sleep Under- or over-sleeping "My sleep is a problem."
Abnormal Appetite Under- or over-eating "My eating is a problem."
Loss of Interest or Pleasure Lacking interest or pleasure in doing one’s usual activities "I rarely get enthusiastic about anything."

Onset:

Persistent Depressive Disorder consists of at least 2 years of chronic mild unhappiness which causes significant distress or disability. This disorder is best thought of as a mild form of Major Depressive Disorder in which the criteria for a major depressive episode has never been met. The spells of unhappiness consist of mild: Low Intellect (e.g., distractibility), emotional distress (e.g., depressed mood, low self-esteem), and physical symptoms (e.g., fatigue, altered sleep and appetite).

Treatment:

Although there are no randomized controlled trials, cognitive behavioral therapy (CBT), interpersonal therapy (IPT), and cognitive behavioral analysis system of psychotherapy (CBASP) are believed to be effective for the treatment of patients with this disorder. The rate of relapse/recurrence of symptoms has been shown to be reduced by long-term treatment with antidepressant medication and with long-term use of these psychotherapies.

Prognosis:

In adults, up to 75% of individuals with this disorder will develop Major Depressive Disorder within 5 years. The spontaneous recovery rate for this disorder is approximately 10% per year (which is much lower than that of Major Depressive Disorder). This recovery rate is significantly better with active treatment.

SAPAS Personality Screening Test

Individuals with this disorder would have a significant impairment in the behaviors that are displayed in red :

Most of the time and in most situations:

      In general, do you have difficulty making and keeping friends?
      Would you normally describe yourself as a loner?
      In general, do you trust other people? ("No")
      Do you normally lose your temper easily?
      Are you normally an impulsive sort of person?
      Are you normally a worrier?
      In general, do you depend on others a lot?
      In general, are you a perfectionist?

Answer "Yes" or "No" to each of these 8 questions.



7-Question Well-Being Screening Test (By P. W. Long MD, 2020

Individuals with this disorder would have a significant impairment in the behaviors that are displayed in red :

      Agreeableness: I was kind and honest.
      Conscientiousness: I was diligent and self-disciplined. (Instead had distractibility)
      Openness/Intellect: I showed good problem-solving and curiosity.
      Sociality: I was gregarious, enthusiastic, and assertive. (Instead had loss of interest or pleasure)
      Emotional Stability: I was emotionally stable and calm. (Instead had depressed mood, hopelessness)
      Physical Health: I was physically healthy. (Instead had fatigue, weight gain/loss, increased/decreased sleep)
      Role Functioning: I functioned well socially and at school/work.

How often in the past week did you do each of these 7 behaviors:

Problems

Occupational-Economic Problems:

  • Causes significant impairment in academic, occupational and/or social functioning

Emotional Distress (Negative Emotion):

  • While depressed almost continuously for at least 2 years, had 2 or more of the following:

    • Poor appetite or overeating

    • Insomnia or Hypersomnia

    • Low energy or fatigue

    • Low self-esteem or low self-confidence

    • Poor concentration or difficulty making decisions

    • Feelings of hopelessness

Medical Problems:

  • Chronic or disabling medical conditions increase risk of this disorder


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Diagnose Persistent Depressive Disorder

Diagnose Mood Disorders

Limitations of Self-Diagnosis

Self-diagnosis of this disorder is often inaccurate. Accurate diagnosis of this disorder requires assessment by a qualified practitioner trained in psychiatric diagnosis and evidence-based treatment.

However, if no such professional is available, our free computerized diagnosis is usually accurate when completed by an informant who knows the patient well. Computerized diagnosis is less accurate when done by patients (because they often lack insight).

Example Of Our Computer Generated Diagnostic Assessment

Persistent Depressive Disorder 300.4 (Early Onset)

This diagnosis is based on the following findings:

  • Never had psychotic symptoms in the absence of prominent mood disturbances (when off drugs)

  • This long-lasting depression was not better accounted for by Schizoaffective Disorder

  • This long-lasting depression was not superimposed on Schizophrenia or Schizophreniform Disorder

  • This long-lasting depression was not superimposed on Delusional Disorder or Psychotic Disorder N.O.S.

  • This long-lasting depression never met the criteria for a Manic, Mixed, or Hypomanic Episode

  • This long-lasting depression never met the criteria for Cyclothymic Disorder

  • Criteria for Major Depressive Disorder may be continuously present for 2 years

  • Depressed mood for most of at least 2 years (still present)

  • During this long-standing depression, never had a 2-month depression-free period

  • This long-lasting depression was not due to a general medical condition

  • This long-lasting depression was not due to a drug of abuse, a medication, or other treatment

  • For most of this long-lasting depression, had poor appetite or overeating (still present)

  • For most of this this long-lasting depression, had insomnia or hypersomnia (still present)

  • For most of this this long-lasting depression, had low energy or fatigue (still present)

  • For most of this this long-lasting depression, had low self-esteem (still present)

  • For most of this this long-lasting depression, had poor concentration or indecisiveness (still present)

  • For most of this long-lasting depression, had feelings of hopelessness (still present)

  • This long-lasting depression started before age 21 years

Treatment Goals:

  • Goal: prevent depressed mood.
    If this problem worsened: She could feel sad, hopeless, discouraged, "down in the dumps", or "blah". She could emphasize somatic complaints (e.g., bodily aches and pains) rather than reporting feelings of sadness. She could exhibit increased irritability (e.g., persistent anger, a tendency to respond to events with angry outbursts or blaming others, or an exaggerated sense of frustration over minor matters).

  • Goal: prevent appetite or weight disturbance.
    If this problem worsened: She could have either abnormally decreased or increased appetite. This could progress to significant loss or gain in weight.

  • Goal: prevent insomnia or hypersomnia.
    If this problem worsened: She could sleep too little or too much. Typically she could have middle insomnia (i.e., waking up during the night and having difficulty returning to sleep) or terminal insomnia (i.e., waking too early and being unable to sleep). Initial insomnia (i.e., difficulty falling asleep) could also occur. Less frequently, she could have oversleeping (hypersomnia).

  • Goal: prevent fatigue or loss of energy.
    If this problem worsened: She could experience decreased energy, tiredness, and fatigue. Eventually, even the smallest tasks could seem to require substantial effort. She could find that washing and dressing in the morning are exhausting and take twice as long as usual.

  • Goal: prevent low self-esteem.
    If this problem worsened: She could have unrealistic negative evaluations of her worth. She could often misinterpret neutral or trivial day-to-day events as evidence of her defects. She could become highly self-critical, often seeing herself as uninteresting or incapable.

  • Goal: prevent poor concentration or indecisiveness.
    If this problem worsened: She could have an impaired ability to think, concentrate, or make decisions.

  • Goal: prevent feelings of hopelessness.
    If this problem worsened: She could feel that there is no hope for her life to improve, believing "I've always been this way" or "That's just how I am".


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Diagnostic Features

Persistent Depressive Disorder is characterized by a chronically depressed mood, lasting at least 2 years, which is not sufficiently severe, or in which individual episodes are not sufficiently prolonged, to justify a diagnosis of major depressive disorder. This depressed mood occurs for most of the day, for more days than not, for at least 2 years (or at least 1 year in children and adolescents). During this 2-year period (1 year for children and adolescents), depression-free intervals last no longer than 2 months. Accompanying the chronically depressed mood, there are 2 (or more) of the following: appetite disturbance, sleep disturbance, low energy, low self-esteem, poor concentration or difficulty making decisions, and feelings of hopelessness. Episodes of Major Depressive Disorder may precede Persistent Depressive Disorder, and Major Depressive Episodes may occur during Persistent Depressive Disorder; in which case both are diagnosed. To be diagnosed, this disorder must cause significant impairment in an individual's life, and not be due to Cyclothymic Disorder, Bipolar Disorder, a psychotic disorder, Substance Use Disorder or another medical condition.

Complications

In childhood, this disorder is often associated with impaired school performance and poor social interaction. Children and adolescents with this disorder are usually irritable and cranky as well as depressed. They have low self-esteem, poor social skills, and are pessimistic. Adults with this disorder may be as impaired as those with Major Depressive Disorder.

Comorbidity

This disorder increases the risk for psychiatric comorbidity in general, and for Anxiety Disorders and Substance Use Disorders in particular. Onset before age 21 of this disorder is strongly associated with the following personality disorders: Borderline PD, Narcissistic PD, Antisocial PD, Avoidant, Dependent PD and Obsessive-Compulsive PD.

Associated Laboratory Findings

No laboratory test has been found to be diagnostic of this disorder.

Prevalence

The U.S. 12-month community prevalence is 0.5%. In adulthood, women are 2-3 times more likely to develop this disorder than men.

Course

This chronic disorder usually has an early and insidious onset in childhood, adolescence or early adult life. By definition, it has a chronic course. Personality Disorders and Substance Use Disorders are more likely to be associated with this disorder if Persistent Depressive Disorder starts before age 21.

Outcome

In adults, up to 75% of individuals with this disorder will develop Major Depressive Disorder within 5 years. The spontaneous recovery rate for this disorder is approximately 10% per year (which is much lower than that of Major Depressive Disorder). This recovery rate is significantly better with active treatment.

Familial Pattern

First-degree relatives of individuals with Persistent Depressive Disorder have increased rates of Persistent Depressive Disorder and Major Depressive Disorder.

Controlled Clinical Trials Of Therapy

Click here for a list of all the controlled clinical trials of therapy for this disorder.

Effective Therapy

The effectiveness of psychotherapy or pharmacotherapy for Persistent Depressive Disorder is unknown because there are no randomized controlled trials of therapy. However, amongst clinicians, there is a consensus that individuals with this disorder may respond to psychotherapy, pharmacotherapy, or a combination of both. The medications that are effective in treating Major Depressive Disorder are believed to be also effective in Persistent Depressive Disorder. These individuals require a longer treatment period, more psychotherapy sessions, and/or higher doses of antidepressant medication than do patients with acute forms of depression. Treatment is less effective in elderly individuals with this disorder.

Although there are no randomized controlled trials, cognitive behavioral therapy (CBT), interpersonal therapy (IPT), and cognitive behavioral analysis system of psychotherapy (CBASP) are believed to be effective for the treatment of patients with this disorder. The rate of relapse/recurrence of symptoms has been shown to be reduced by long-term treatment with antidepressant medication and with long-term use of specific psychotherapies.

Ineffective therapies

Vitamins, dietary supplements and acupuncture are all ineffective for depressive disorders.

Trustworthy Research (PubMed.gov)


A Dangerous Cult


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Videos

General Information

Stories

Rating Scales

Lack Of Social Skills During Persistent Depressive Disorder

There are social skills that are essential for healthy social functioning. During persistent depressive disorder, individuals lack the essential social skills of self-confidence, optimism, belonging, and sociability. These are the same social skills that are lacking in individuals with major depressive disorder, avoidant personality disorder and social anxiety disorder.
    SOCIAL SKILL MAJOR DEPRESSION NORMAL
    Self-Confidence Feeling inferior or shy Having a good opinion of one's self and abilities; socially confident and out-going
    Optimism Pessimism or expecting the worst Having a positive outlook on life; expecting a good outcome; hopeful
    Belonging Fearing rejection by others Feeling liked and accepted by friends, and included in their group; not fearing rejection
    Sociality Social withdrawal Friendly; interested in social contacts and activities

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ABNORMAL BIG-6 DIMENSION OF MENTAL ILLNESS DIAGNOSTIC FEATURE IN PERSISTENT DEPRESSIVE DISORDER
DISINHIBITION: Being distractible, impulsive and disorganized.
Distractibility
DETACHMENT: Being detached, unassertive, and unenthusiastic.
Loss of Interest or Pleasure
EMOTIONAL DISTRESS: Being emotionally volatile or distressed.
Depressed Mood
Hopelessness
Low Self-Esteem
PHYSICAL ILLNESS: Being physically unfit or ill.
Fatigue
Increased / Decreased Sleep
Increased / Decreased Appetite


(Note: Recovery = symptomatic remission + full-time gainful employment + weekly contact with friends)


Dysthymia F34.1 - ICD10 Description, World Health Organization

A chronic depression of mood, lasting at least several years, which is not sufficiently severe, or in which individual episodes are not sufficiently prolonged, to justify a diagnosis of severe, moderate, or mild recurrent depressive disorder (F33.-).

Persistent Depressive Disorder (Dysthymia) - Diagnostic Criteria, American Psychiatric Association

This disorder represents a consolidation of DSM-IV-defined chronic major depressive disorder and dysthymic disorder. An individual diagnosed with persistent depressive disorder (dysthmia) needs to meet all of the following criteria:

  • Depressed mood for most of the day, for more days than not, as indicated either by subjective account or observation by others, for at least 2 years.
    Note: In children and adolescents, mood can be irritable and duration must be at least 1 year.

  • Presence, while depressed, of two (or more) of the following:

    • Poor appetite or overeating.

    • Insomnia or Hypersomnia.

    • Low energy or fatigue.

    • Low self-esteem.

    • Poor concentration or difficulty making decisions.

    • Feelings of hopelessness.

  • During the 2-year period (1 year for children or adolescents) of the disturbance, the person has never been without the above symptoms for more than 2 months at a time.

  • Criteria for a major depressive disorder may be continuously present for 2 years.

  • There has never been a manic episode or a hypomanic episode, and criteria have never been met for cyclothymic disorder.

  • The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.

  • The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hypothyroidism).

  • The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

    • Note: Because the criteria for a major depressive episode include four symptoms that are absent from the symptom list for persistent depressive disorder (dysthymia), a very limited number of individuals will have depressive symptoms that have persisted longer than 2 years but will not meet criteria for persistent depressive disorder. If full criteria for major depressive episode have been met at some point during the current episode of illness, they should be given a diagnosis of major depressive disorder. Otherwise, diagnosis of other specified depressive disorder or unspecified depressive disorder is warranted.

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Treatment

Treatment Is Identical To That Of Major Depressive Disorder





















World Health Organization Depression Treatment Guidelines



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Self-Help Resources

Self-Blaming vs. Self-Compassion

Some individuals are constantly at war with themselves.

They believe: "I am stupid", "I am a failure", "Nothing goes right for me". They constantly analyze themselves and their behavior for flaws. They are cynical and pessimistic. Because of their gloomy, depressed or angry mood, they withdraw and socially isolate themselves. This lack of cooperation with others makes them feel even more hopeless, depressed or angry.

These individuals are at a high risk for developing Persistent Depressive Disorder or Major Depressive Disorder. Healthy people are self-confident, optimistic, sociable, and feel accepted and supported by friends. Individuals suffering from excessive self-blaming are pessimistic, socially withdrawn, and feel rejected by others.

If you suffer from excessive self-blaming; here are ways you can remedy this by learning increased self-compassion and social cooperation:

  • Self-Confidence vs. Self-Blaming:
    You must be kind towards yourself, instead of always blaming yourself for everything. Accept and love yourself for who you are - with all your human imperfections. You must strive to have a good opinion of yourself and your abilities, and to be socially confident. Quit constantly comparing yourself to others.

  • Optimism vs. Pessimism:
    Strive to replace your unrealistic, pessimistic, negative thinking with more realistic, optimistic, positive thinking.

  • Sociality vs. Social Withdrawal:
    In order to feel good, you have to do good. Thus to feel better, you have to get out and help others (and remember to frequently smile).

  • Feeling Accepted vs. Feeling Rejected:
    You can not control how other people behave towards you. All you can do is control how you behave towards other people. Much of your life is not under your control; hence you can not change it. You are only responsible for the small part of your life which is under your control - the part you can change. Thus remain friendly and out-going - especially towards people that haven't accepted you.

Monitoring Your Progress

NOTE: When each of the following presentations finish; you must exit by manually closing its window in order to return to this webpage.

The Healthy Social Behavior Scale lists social behaviors that research has found to be associated with healthy social relationships. You can keep score (totaling its 4-point scale answers) on a separate piece of paper to monitor your progress.



The Mental Health Scale lists behaviors and symptoms that research has found to be associated with mental health (or disorder). You can keep score (totaling its 4-point scale answers) on a separate piece of paper to monitor your progress.



The Life Satisfaction Scale lists the survey questions often used to measure overall satisfaction with life. You can keep score (totaling its 4-point scale answers) on a separate piece of paper to monitor your progress.



Life Satisfaction Scale (5-Minute Video)

The "Big 6" Dimensions of Mental Health

Research has shown that there are 5 major dimensions (the "Big 5 Factors" or Five-Factor Model) of personality disorders and other mental disorders.

This website uses these 5 major dimensions of human behavior (i.e., Agreeableness, Conscientiousness, Openness/Intellect, Extraversion/Sociability, and Emotional Stability) to describe all mental disorders. This website adds one more dimension, "Physical Health", to create the "Big 6" dimensions of mental health.

The behaviors of the "Five Factor Model of Personality" represent five adaptive functions that are vital to human survival. For example, when one individual approaches another, the individual must: (1) decide whether the other individual is friend or foe [ "Agreeableness" ], (2) decide if this represents safety or danger [ "Emotional Stability" ], (3) decide whether to approach or avoid the other individual [ "Extraversion/Sociability" ], (4) decide whether to proceed in a cautious or impulsive manner [ "Conscientiousness" ], and (5) learn from this experience [ "Openness/Intellect" ].



Desiderata (5-Minute Video)



The following "Morning Meditation" allows you to plan your day using these "Big 6" dimensions of mental health.



The following "Evening Meditation" allows you to review your progress on these "Big 6" dimensions of mental health.




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    "In physical science a first essential step in the direction of learning any subject is to find principles of numerical reckoning and practicable methods for measuring some quality connected with it. I often say that when you can measure what you are speaking about and express it in numbers you know something about it; but when you cannot measure it, when you cannot express it in numbers, your knowledge is of a meagre and unsatisfactory kind: it may be the beginning of knowledge, but you have scarcely, in your thoughts, advanced to the stage of science, whatever the matter may be."

    Lord Kelvin (1824 – 1907)

  • The best summary on bad research is given by Laura Arnold in this TEDx lecture. If you read nothing else about research, you owe it to yourself to watch this short video - it is excellent!

  • Economist in grim battle against deceptive scholarship

  • List of Predatory Journals and Publishers

  • The power of asking "what if?"

  • The active placebo effect: 2300 years ago, the Greek Stoic philosophers taught that it is not the objective event, but our subjective judgment about the event, that determines our behavior. The active placebo effect bears witness to this ancient wisdom.

  • Criteria For High Quality Research Studies

    • It is troubling that a recent study found that two-thirds of important psychological research studies couldn't be replicated. High quality research must meet the following criteria:

    • Randomized Controlled Trial:
      Ask: Was the trial randomized? Was the randomization procedure described and was it appropriate? The best research design is to have research subjects randomly assigned to an experimental or control group. It is essential that confounding factors be controlled for by having a control group or comparator condition (no intervention, placebo, care as usual etc.).

    • Representative Sample:
      Ask: Do the research subjects represent a normal cross-section of the population being studied? Many psychological research studies using university students are flawed because their subjects are not representative of the normal population since they are all W.E.I.R.D. (White, Educated, Intelligent, Rich, and living in a Democracy).

    • Single Blind Trial:
      Ask: Was the treatment allocation concealed? It is essential that the research subjects are kept "blind" as to whether they are in the experimental or control group (in order to control for any placebo effects).

    • Double Blind Trial (Better Than Single Blind Trial):
      Ask: Were blind outcome assessments conducted? In a double blind study, neither the research subjects nor the outcome assessors know if the research subject is in the experimental or control group. This controls for both the placebo effect and assessor bias.

    • Baseline Comparability:
      Ask: Were groups similar at baseline on prognostic indicators? The experimental and control groups must be shown to be comparable at the beginning of the study.

    • Confounding Factors:
      Ask: Were there factors, that weren't controlled for, that could have seriously distorted the study's results? For example, research studies on the effectiveness of mindfulness cognitive therapy in preventing depressive relapse forgot to control for whether the research subjects were also simultaneously receiving antidepressant medication or other psychological treatments for depression.

    • Intervention Integrity:
      Ask: Was the research study protocal strictly followed? The research subjects must be shown to be compliant (e.g., taking their pills, attending therapy) and the therapists must be shown to be reliably delivering the intervention (e.g., staying on the research protocol).

    • Statistical analysis:
      Ask: Was a statistical power calculation described? The study should discuss its statistical power analysis; that is whether the study size is large enough to statistically detect a difference between the experimental and control group (should it occur) and usually this requires at least 50 research subjects in the study.

      Ask: Are the results both statistically significant and clinically significant? Many medical research findings are statistically significant (with a p-value <0.05), but they are not clinically significant because the difference between the experimental and control groups is too small to be clinically relevant.

      For example, the effect of a new drug may be found to be 2% better than placebo. Statistically (if the sample size was large enough) this 2% difference could be statistically significant (with a p-value <0.05). However, clinicians would say that this 2% difference is not clinically significant (i.e., that it was too small to really make any difference).

      Statistically, the best way to test for clinical significance is to test for effect size (i.e., the size of the difference between two groups rather than confounding this with statistical probability).

      When the outcome of interest is a dichotomous variable, the commonly used measures of effect size include the odds ratio (OR), the relative risk (RR), and the risk difference (RD).

      When the outcome is a continuous variable, then the effect size is commonly represented as either the mean difference (MD) or the standardised mean difference (SMD) .

      The MD is the difference in the means of the treatment group and the control group, while the SMD is the MD divided by the standard deviation (SD), derived from either or both of the groups. Depending on how this SD is calculated, the SMD has several versions such, as Cohen's d, Glass's Δ, and Hedges' g.

        Clinical Significance: With Standard Mean Difference, the general rule of thumb is that a score of 0 to 0.25 indicates small to no effect, 0.25-0.50 a mild benefit, 0.5-1 a moderate to large benefit, and above 1.0 a huge benefit. It is a convention that a SMD of 0.5 or larger is a standard threshold for clinically meaningful benefit.

      The statistical summary should report what percentage of the total variance of the dependent variable (e.g., outcome) can be explained by the independent variable (e.g., intervention).

      In clinical studies, the study should report the number needed to treat for an additional beneficial outcome (NNTB), and the number needed to treat for an additional harmful outcome (NNTH).

        Number Needed To Benefit (NNTB): This is defined as the number of patients that need to be treated for one of them to benefit compared with a control in a clinical trial. (It is defined as the inverse of the absolute risk reduction.) Note: Statistically, the NNTB depends on which control group is used for comparison - e.g., active treatment vs. placebo treatment, or active treatment vs. no treatment.

        Number Needed To Harm (NNTH): This is defined as the number of patients that need to be treated for one of them to be harmed compared with a control in a clinical trial. (It is defined as the inverse of the absolute increase in risk of harm.)

        Tomlinson found “an NNTB of 5 or less was probably associated with a meaningful health benefit,” while “an NNTB of 15 or more was quite certain to be associated with at most a small net health benefit.”

      Ask: Does the researcher accept full responsibility for the study's statistical analysis? The researcher should not just hand over the study's raw data to a corporation (that may have $1,000 million invested in the study) to do the statistical analysis.

    • Completeness of follow-up data:
      Ask: Was the number of withdrawals or dropouts in each group mentioned, and were reasons given for these withdrawals or dropouts? Less than 20% of the research subjects should drop out of the study. The intervention effect should persist over an adequate length of time.

    • Handling of missing data:
      Ask: Was the statistical analysis conducted on the intention-to-treat sample? There must be use of intention-to-treat analysis (as opposed to a completers-only analysis). In this way, all of the research subjects that started the study are included in the final statistical analysis. A completers-only analysis would disregard those research subjects that dropped out.

    • Replication of Findings:
      Ask: Can other researchers replicate this study's results? The research study's methodology should be clearly described so that the study can be easily replicated. The researcher's raw data should be available to other researchers to review (in order to detect errors or fraud).

    • Fraud:
      Ask: Is there a suspicion of fraud? In a research study, examine the independent and dependent variables that are always measured as a positive whole number (e.g., a variable measured on a 5-point Likert-type scale ranging from "1 = definitely false to 5 = definitely true" etc.). For each of these variables, look at their sample size ( n ), mean ( M ) and standard deviation ( SD ) before they undergo statistical analysis. There is a high suspicion of fraud in a study's statistics:

      • If the M is mathematically impossible (online calculator): This is one of the easiest ways to mathematically detect fraud. The mean ( M ) is defined as "the sum ( Sum ) of the values of each observation divided by the total number ( n ) of observations". So: M = Sum / n . Thus: ( Sum ) = ( M ) multiplied by ( n ). We know that, if a variable is always measured as a positive whole number, the sum of these observations always has to be a whole number. For these variables to test for fraud: calculate ( M ) multiplied by ( n ). This calculates the Sum which MUST be a positive whole number. If the calculated Sum isn't a positive whole number; the reported mean ( M ) is mathematically impossible - thus the researcher either cooked the data or made a mistake. A recent study of 260 research papers published in highly reputable psychological journals found that 1 in 2 of these research papers reported at least one impossible value , and 1 in 5 of these research papers reported multiple impossible values. When the authors of the 21 worst offending research papers were asked for their raw data (so that its reliability could be checked) - 57% angrily refused. Yet such release of raw data to other researchers is required by most scientific journals. (Here is an example of a research paper filled with mathematically impossible means.)

      • If the SD is mathematically impossible (online calculator): When researchers fraudulently "cook" their data, they may accidently give their data a mean and standard deviation that is mathematically impossible.

      • If the SD/M is very small (i.e., the variable's standard deviation is very small compared to the mean suggesting data smoothing).

      • If the SD's are almost identical (i.e., the variables have different means but almost identical standard deviations).

      • If the 4th digit of the values of the variables aren't uniformly distributed - since each should occur 10% of the time (Benford's Law).

      • If the researcher is legally prevented from publishing negative findings about a drug or therapy because that would violate the "nondisclosure of trade secrets" clause in the research contract (i.e., it is a "trade secret" that the drug or therapy is ineffective - hence this can not be "disclosed"). Approximately half of all registered clinical trials fail to publish their results.

      • If the researcher refuses to release his raw data to fellow researchers (so that they can check its validity). In order to be published in most scientific journals, a researcher must promise to share his raw data with fellow researchers. Thus a researcher's refusal to do so is almost a sure indicator of fraud.

      • If the research study's data contradicts the study's own conclusions - surprisingly, this often occurs.

  • Calling Bullshit In The Age of Big Data - "Bullshit is language, statistical figures, data graphics, and other forms of presentation intended to persuade by impressing and overwhelming a reader or listener, with a blatant disregard for truth and logical coherence." Reading the syllabus of this university course should be required reading for every student of mental health. This syllabus is absolutely fantastic!

  • Statistical Methods in Psychology Journals: Guidelines and Explanations - American Psychologist 1999

  • Not All Scientific Studies Are Created Equal - video

  • The efficacy of psychological, educational, and behavioral treatment

  • Estimating the reproducibility of psychological science

  • Psychologists grapple with validity of research

  • Industry sponsorship and research outcome (Review) - Cochrane Library

  • 'We've been deceived': Many clinical trial results are never published - (text and video)

  • Junk science misleading doctors and researchers

  • Junk science under spotlight after controversial firm buys Canadian journals

  • Medicine with a side of mysticism: Top hospitals promote unproven therapies - Are some doctors becoming modern witchdoctors?

  • When Evidence Says No, But Doctors Say Yes

  • Major pharmaceutical company fined $3 billion US for making false claims - (text and video) [Editor: This is an example of how a major pharmaceutical company purposely produced fraudulant research in order to increase its sales.] In 2001, GlaxoSmithKline, the manufacturer of the antidepressant Paxil, published research that falsely claimed that Paxil was effective in the treatment of adolescent depression. This claim and others were found to be fraudulant, and in 2012 GlaxoSmithKline was fined $3 billion US in court settlements. Subsequent independent reanalysis of the original Paxil research data clearly proved that the original study was fraudulant. This fraudulant research paper was published in a top psychiatric journal, and has never been retracted or corrected.

  • Cochrane Collaboration - the best evidence-based, standardized reviews available

Research Topics:

Persistent Depressive Disorder - Core Clinical Journals

Persistent Depressive Disorder - All Journals

Persistent Depressive Disorder - Review Articles - Core Clinical Journals

Persistent Depressive Disorder - Review Articles - All Journals

Persistent Depressive Disorder - Treatment - Core Clinical Journals

Persistent Depressive Disorder - Treatment - All Journals

Cochrane Review (The best evidence-based, standardized reviews available)

Strong evidence of effectiveness: Some evidence of effectiveness: No evidence of effectiveness:

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Normal Distribution Of Human Attributes

Regression to the Mean (Or Why Scientific Experiments Require A Control Group)

The "Big 6" Dimensions of Mental Health

Research has shown that there are 5 major dimensions (the "Big 5 Factors" or Five-Factor Model) of personality disorders and other mental disorders. There are two free online personality tests that assess your personality in terms of the "Five Factor Model of Personality". Although not computerized online, the Big Five Inventory (BFI) is a 44-item test often used in personality research.

This website uses these 5 major dimensions of human behavior to describe all mental disorders. (This website adds one more dimension, "Physical Health", to create the "Big 6" dimensions of mental health.)

The behaviors of the "Five Factor Model of Personality" represent five adaptive functions that are vital to human survival. For example, when one individual approaches another, the individual must: (1) decide whether the other individual is friend or foe [ "Agreeableness" ], (2) decide if this represents safety or danger [ "Emotional Stability" ], (3) decide whether to approach or avoid the other individual [ "Extraversion/Sociability" ], (4) decide whether to proceed in a cautious or impulsive manner [ "Conscientiousness" ], and (5) learn from this experience [ "Openness/Intellect" ].

    Which "Big 6" Dimensions of Mental Health are Impaired in Persistent Depressive Disorder?

    THE POSITIVE SIDE OF THE "BIG 6" DIMENSIONS OF MENTAL HEALTH THE NEGATIVE SIDE OF THE "BIG 6" DIMENSIONS OF MENTAL HEALTH THIS DISORDER
    Agreeableness
    Being kind and honest.    		 Antagonism
    Being unkind or dishonest.
    Conscientiousness
    Being diligent and self-disciplined.    		 Disinhibition
    Being distractible, impulsive, or undisciplined.
    Openness/Intellect
    Showing good creativity, problem-solving, and learning ability    		 Impaired Intellect
    Showing decreased creativity, problem-solving, or learning ability.
    Extraversion
    Being gregarious, assertive and enthusiastic.    		 Detachment
    Being detached, unassertive, and unenthusiastic.
    Emotional Stability
    Being emotionally stable and calm.    		 Emotional Distress
    Being emotionally unstable/distressed.    		       Emotional Distress
    Physical Health
    Being physically fit and healthy.    		 Physical Symptoms
    Being physically unfit or ill.    		       Physical Symptoms





    The Following Will Only Discuss The Dimensions of Mental Illness That Are Abnormal In This Disorder

    The problems that are characteristic of this disorder are highlighted with this pink background color.


    EMOTIONAL STABILITY VS. EMOTIONAL DISTRESS

    EMOTIONAL STABILITY (Stability)
    Description: Emotional Stability is synonymous with stability and calm. The Emotional Stability dimension measures the behaviors that are central to the concept of COURAGE - having calm composure and endurance when confronting adversity. Individuals with high Emotional Stability are relatively tough, brave, and insensitive to physical pain, feel little worry even in stressful situations, and have little need to share their concerns with others. High Emotional Stability is associated with better: longevity, leadership, job [team] performance, and marital success. (This dimension appears to measure the behaviors that differentiate safety from danger.)
    Descriptors: Calm, rarely angry, rarely depressed or moody, rarely anxious or embarrassed.
    • From Between facets and domains: 10 aspects of the Big Five
      • Stability:
        • Rarely get irritated
        • Keep my emotions under control
        • Rarely lose my composure
        • Am not easily annoyed
      • Calm:
        • Relaxed, handle stress well
        • Feel comfortable with myself
        • Am not embarrassed easily
        • Seldom feel blue
        • Rarely feel depressed
    • From International Personality Item Pool:
      • Remain calm under pressure
      • Rarely get irritated
      • Feel comfortable with myself
      • Relaxed most of the time
      • Am not embarrassed easily
    Language Characteristics: Pleasure talk, agreement, compliment, low verbal productivity, few repetitions, neutral content, calm, few self-references, many short silent pauses, few long silent pauses, many tentative words, few aquiescence, little exaggeration, less frustration, low concreteness.
    "I am relaxed, and I handle stress well."
    "I am emotionally stable, and not easily upset."
    "I remain calm in tense situations."
    "I rarely get irritated."
    "I keep my emotions under control."
    "I rarely lose my composure."
    "I am not easily annoyed."
    "I seldom feel blue."
    "I feel comfortable with myself."
    "I rarely feel depressed."
    "I am not embarrassed easily."
    EMOTIONAL DISTRESS (Impaired Stability)
    Description: Emotional Distress is synonymous with emotional volatility and negative emotion. Individuals with high emotional volatility are easily upset or angered. They often are very moody and emotionally labile. Individuals that have high negative emotion exhibit over-sensitivity to threat or stress. They exhibit excessive fear, anxiety, depression, or irritability.
    ICD-11 Description: The core feature of the Emotional Distress (or Negative Affectivity) trait domain is the tendency to experience a broad range of negative emotions. Common manifestations of Emotional Distress include: experiencing a broad range of negative emotions with a frequency and intensity out of proportion to the situation; emotional lability and poor emotion regulation; negativistic attitudes; low self-esteem and self-confidence; and mistrustfulness.
    Descriptors: Easily upset, angry, depressed, moody, anxious, embarrassed.
    • From Between facets and domains: 10 aspects of the Big Five
      • Emotional Instability:
        • Get angry or upset easily
        • Change my mood a lot
        • Am a person whose moods go up and down easily
        • Get easily agitated
        • Can be stirred up easily
      • Negative Emotion:
        • Worry a lot
        • Get nervous easily
        • Am filled with doubts about things
        • Feel threatened easily
        • Am easily discouraged
        • Become overwhelmed by events
        • Am afraid of many things
    • From International Personality Item Pool:
      • Panic easily
      • Get angry easily
      • Often feel blue
      • Worry about things
      • Am easily intimidated
    Evolution: All animals have evolved a "fight or flight" response to threat to ensure their survival. Mammals went one step further and evolved a "fight, flight, or freeze" response to threat. In humans, this mammalian "freeze" response to threat involves inhibition of behavior in response to threat, punishment, and emotional distress. This threat response of "freezing", shutting down or passively avoiding is commonly seen in human anxiety or depression (e.g., freezing with fear or being immobilized by indecision, worry or depression).
    Language Characteristics: Problem talk, dissatisfaction, high verbal productivity, many repetitions, polarised content, stressed, many self-references, few short silent pauses, many long silent pauses, few tentative words, more aquiescence, many self references, exaggeration, frustration, high concreteness.
    Screening Questions:
    • "I worry about almost everything."
    • "I get emotional easily, often for very little reason."
    • "I fear being alone in life more than anything else."
    • "I get stuck on one way of doing things, even when it’s clear it won’t work."
    • "I get irritated easily by all sorts of things."
    Research: Lower scores on Emotional Stability are associated with unhappiness, dysfunctional relationships, and mental health problems. *MRI research found that Low Emotional Stability (= Emotional Distress or Neuroticism) was associated with increased volume of brain regions associated with threat, punishment, and emotional distress.
    * Depressed Mood:
    "I have no worth as a person."
    "Everything seems pointless to me."
    "I often feel like a failure."
    "The world would be better off if I were dead."
    "The future looks really hopeless to me."
    "I often feel just miserable."
    "I'm very dissatisfied with myself."
    "I often feel like nothing I do really matters."
    "I know I'll commit suicide sooner or later."
    "I talk about suicide a lot."
    "I feel guilty much of the time."
    "I'm so ashamed by how I've let people down in lots of little ways."
    "I am easily discouraged."
    "I become overwhelmed by events."
    ("Emotional Stability vs. Emotional Distress" modified from "PID-5" by Kreuger RF, Derringer J, Markon KE, Watson D, Skodol AE and Between facets and domains: 10 aspects of the Big Five) [More Information]
    *MRI Research:     Testing predictions from personality neuroscience. Brain structure and the big five.



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