Chronic depression has received less attention than its acute variant, but research suggests that it should be taken seriously. Dysthymic disorder is prevalent, affecting about 3 percent of the adult population, with women twice as likely to be affected as men ( Weissman et al., 1988; Kessler et al., 1994). It has high morbidity and comorbidity. The Rand Medical Outcomes Study found dysthymic disorder had a more debilitating course than acute major depressive disorder ( Wells et al., 1992). Dysthymic patients by definition ( American Psychiatric Association, 1994) suffer for at least two years, more days than not, without lasting relief. By the time many present for treatment they have suffered for decades.
Dysthymic patients suffer quietly. They feel guilty, hopeless, and worthless. Because dysthymic disorder often begins early in life, patients often recall having had these symptoms all of their lives and accept them as part of their personalities. Dysthymic individuals tend to work hard out of a sense of guilt and need to justify their existence; yet they have little energy, have difficulty concentrating, and even when they achieve things they tend to think of themselves as frauds. Interpersonal difficulties are a hallmark of the disorder ( Kocsis et al., 1988a; Stewart et al., 1988; Cassano et al., 1990). Dysthymic patients are reluctant to let people get close to them lest people dis