Sie sind auf Seite 1von 13

DEPRESSION

AND

ANXIETY 25:207217 (2008)

Research Article
DEPRESSIVE PERSONALITY DISORDER, DYSTHYMIA,
AND THEIR RELATIONSHIP TO PERFECTIONISMy
Steven K. Huprich, Ph.D.,1 John Porcerelli, Ph.D.,2 Rachel Keaschuk, Psy.D.,3 Juliann Binienda, M.S.,2
and Benjamin Engle, B.A.4

This paper reports the results of two studies in a nonclinical (n 5 105) and
primary care outpatient sample (n 5 110), in which Depressive Personality
Disorder (DPD), Dysthymia, and depression were assessed for their distinctive
relationship with perfectionism. Results from both studies found that selfreported DPD, Dysthymia, and depressive symptoms were all intercorrelated,
and that DPD, Dysthymia, and depressive symptoms were correlated with three
dimensions of perfectionismConcern over Mistakes, Doubts about Actions,
and Parental Criticism. In the nonclinical sample, variance in measures of
DPD was predicted by measures of perfectionism after controlling for depression
and Dysthymia symptoms. A similar pattern of findings was observed in the
primary care sample. This relationship with perfectionism did not occur when
Dysthymia or depressive symptoms were predicted. Nevertheless, much of the
variance in measures of DPD, Dysthymia, and depressive symptoms is
associated with each other and not perfectionism. It is concluded that a common
factor or set of factors underlies these disorders, but that DPD may be more
strongly related to perfectionism than Dysthymia and depression. As a common
factor(s) is identified, measures of DPD and Dysthymia may be refined, thereby
increasing the discriminant validity of their measures. Depression and Anxiety
25:207217, 2008.
& 2008 Wiley-Liss, Inc.
Key words: depressive personality; perfectionism; dysthymia

INTRODUCTION

Some concerns have been expressed about the DSM-

IV [American Psychiatric Association, 1994] proposal


of Depressive Personality Disorder (DPD). In particular, some have leveled that DPD is hard to
distinguish from Dysthymia [Clark and Watson,
1999; Ryder and Bagby, 1999; Ryder et al., 2002,
2006]. Specifically, this concern has centered on the
idea that DPD and Dysthymia may be slight variants of
an underlying predisposition to chronic affective
illness. This idea is not new [Akiskal, 1983], and
research on this topic has provided strong evidence for
a shared biological underpinning to both disorders. For
example, Klein [1990, 1999] and colleagues [Hayden
and Klein, 2001] found high rates of major depression
in patients with DPD and their first degree relatives.
Upon reviewing the research, Ryder, Bagby, and
colleagues [Bagby and Ryder, 1999; Ryder et al.,

r 2008 Wiley-Liss, Inc.

Department of Psychology, Eastern Michigan University,


Ypsilanti, Michigan
2
Department of Family Medicine, Wayne State University
School of Medicine, Detroit, Michigan
3
Stallery Childrens Hospital, Capital Health, Edmonton,
Alberta, Canada
4
Department of Psychology and Neuroscience, Baylor
University, Waco, Texas
Correspondence to: Steven K. Huprich, Ph.D., Department of
Psychology, Eastern Michigan University, 501 Mark Jefferson
Building, Ypsilanti, MI 48197. E-mail: shuprich@emich.edu

Received for publication 22 February 2006; Revised 18 July 2006;


Accepted 13 September 2006
y

Portions of this manuscript were presented at the 2003 and 2004


Annual Meetings of the Society for Personality Assessment
(Miami, FL and Chicago, IL, respectively).

DOI 10.1002/da.20290
Published online 12 March 2007 in Wiley InterScience (www.
interscience.wiley.com).

208

Huprich et al.

2001, 2002] argued that DPD should be subsumed


within Dysthymia, given the degree of overlap of DPD
and Dysthymia in their sample. Their position reflects
the idea that both disorders are variants of a common
affective illness. Most recently, Kreuger [2005] suggested that the DPD-Dysthymia issue will be resolved
once biological underpinnings of the mood-anxiety
personality (p 245) are better understood, as the
classification system can become more empirically
driven and organized.
Although it appears as if DPD and Dysthymia may
share a common biological predisposition, studies on
the overlap of DPD and Dysthymia have found that,
while the two disorders overlap, they are not redundant. In a review of studies conducted to date, Huprich
[2001] reported that the rate of overlap between the
two disorders ranged from 19 to 80%. The lowest rate
was found in a nonclinical sample of college students,
in which 19% of those diagnosed with DPD met
criteria for Dysthymia. In the same sample, however,
78% of those with Dysthymia also met DPD criteria
[Klein and Miller, 1993]. Rates of overlap have also
been reported by Klein and Shih [1998] and Hirschfeld
and Holzer [1994], with the average degree of overlap
between the two being around 50%.
As Huprich [2001] summary was published, other
data on diagnostic overlap has been reported. One of
the largest samples evaluated for DPD and Dysthymia
was described by McDermut et al. [2003]. In a study of
900 adult psychiatric outpatients, McDermut et al.
found that 18% of those with a DPD diagnosis also
met Dysthymia diagnostic criteria, whereas 48% of
those meeting Dysthymia criteria also met criteria for
DPD. In contrast, Bagby and Ryder [1999] found that
95% of the sample meeting DPD criteria also met
criteria for Dysthymic Disorder.
There are some important ways in which DPD and
Dysthymia have been differentiated in clinical and
nonclincal studies. McDermut et al. [2003] found that,
compared to those diagnosed with Dysthymia, individuals with DPD were more likely to have a current
diagnosis of major depression and higher lifetime rates
of social phobia, a specific phobia, obsessivecompulsive disorder, and generalized anxiety disorder. They
also were twice as likely to be diagnosed with another
Axis II disorder, were more suicidal at the time of their
assessment, and more likely to have had a previous
suicide attempt. Bagby and Ryder [1999] attempted to
differentiate the two disorders by creating DPD and
Dysthymia scales from the Beck Depression Inventory
(BDI) [Beck et al., 1961], revised Depressive Experiences Questionnaire [Bagby et al., 1994], the Personal
Styles inventory [Robins et al., 1994], the NEO
Personality Inventory Revised [Costa and McCrae,
1992], and the Symptom Checklist 90 [Derogatis,
1992]. For each DPD and Dysthymia criterion, they
created a scale of three to 11 items. Cronbach as for
each scale were good, ranging from .53 to .82. Cluster
analysis yielded two clusters. One cluster consisted of
Depression and Anxiety

five of the six DPD trait scales and one of the


Dysthymia scales, whereas the other cluster consisted
of five of the six Dysthymia scales and two of the five
DPD trait scales. A subsequent factor analysis yielded a
two-factor solution, again with a majority of the
scales falling on their respective DPD or Dysthymia
factor.
One study has examined the five factor model in the
context of DPD and Dysthymia. Huprich [2000]
identified a nonclinical sample of those classified as
either DPD or Dysthymia and asked them to complete
the NEO Personality InventoryRevised [Costa and
McCrae, 1992]. Compared to those in the Dysthymia
group, individuals assigned to the DPD group were
significantly higher in self-consciousness, neuroticism,
angry hostility, and depression, and significantly lower
in gregariousness, openness, agreeableness, and positive emotions. Despite the limitation of a nonclinical
sample and the small sample size, the results for DPD
appear to generalize to clinical samples of those
diagnosed with DPD [Bagby et al., 2004; Dyce and
OConnor, 1998; Huprich, 2003a; Reynolds and Clark,
2001].
In a review of the historical concept of depressive
personality, Huprich [1998] found that DPD was
hypothesized to be associated with experiences of early
childhood loss, self-criticism, and negativity. The latter
two were believed to originate early in life as a
compensatory mechanism by which the individual
seeks to be perfect so that s/he would not experience
loss, disappointment, or rejection from others. Obviously, such attempts are eventually self-defeating.
Interestingly, some studies have provided support for
these ideas. Huprich [2003b] found that outpatients
diagnosed with DPD felt more alienated and insecure
in the context of interpersonal relationships and
reported less support from family members. Such
findings suggest that those with DPD may have a
heightened sensitivity to loss and feel detached, which
may have resulted from inconsistent parenting. Huprich [2003b] also found that those with DPD were had
higher levels of perfectionism, greater concerns about
making a mistake, and more reports of parental
criticism than psychiatric controls.
Other studies have found those with DPD to have
high levels of perfectionism and self-criticism. Hartlage
et al. [1998] assessed for DPD in 90 outpatients
who were in treatment for depression. Then, controlling for state-like aspects of depression, they
evaluated those criteria of DPD that were most
resistant to state-depression. They found that selfcriticism was most associated with DPD and independent of a depressed mood. Similarly, Klein [1990]
found in a sample of 53 outpatients meeting DPD
criteria that those with DPD were more likely to be
self-critical and harbor negative attributions than
psychiatric controls. Huprich and Frisch [2004] also
found that a measure of DPD was negatively correlated
with optimism and that those meeting criteria for DPD

Research Article: DPD, Dysthymia, and Perfectionism

had significantly lower levels of optimism than those


who did not. However, these studies did not compare
individuals with DPD directly with those diagnosed
with Dysthymia.
Upon reviewing these studies, it appears that DPD
may be characterized by personality features that we
will broadly characterize as perfectionism when
compared to Dysthymia. However, it is not clear that
perfectionism is more distinctive for DPD than
Dysthymia or depression. Perfectionism has been
found to be a predisposing variable to many psychiatric
conditions [Blatt, 1995; Flett and Hewitt, 2002].
For instance, Hewitt and Flett [1993] and Hewitt
et al. [1996] found that self-oriented perfectionism
(having high, self-imposed unrealistic standards, and
intensive self-scrutiny) interacted with achievement
stress to predict depression in depressed and nondepressed psychiatric patients and nonpatients. Hewitt
et al. [1998] also found that self-oriented perfectionism
was uniquely associated with chronic unipolar depressive symptoms, even after controlling for current state
depression, whereas socially oriented perfectionism was
uniquely associated with current depressive symptoms.
In an earlier study, Huprich [2003b] assessed
perfectionism with the Frost Multidimensional Perfectionism Scale [FMPS; Frost et al., 1990]. This scale is
ideally suited to assess perfectionism in the context of
DPD, as the subscales capture defining features of
perfectionism (concerns about making mistakes, high
personal standards, doubting or questioning ones
actions before acting, and high levels of organization)
as well as development antecedents believed to account
for perfectionistic qualities (high parental expectations
and high levels of parental criticism). Frost et al. [1993]
found that self-oriented perfectionism correlated most
highly with the Concern over Mistakes subscale of the
FMPS. Thus, this scale may be particularly relevant to
understanding the perfectionistic qualities and attitudes
found in those with DPD.
Given past empirical findings and conceptualizations
of DPD, and concerns about the degree of overlap
between DPD and Dysthymia, it was of interest to
determine whether DPD and Dysthymia may be
differentiated by their association with perfectionism.
It was hypothesized that individuals with DPD would
have significantly higher levels of perfectionism than
controls. No hypotheses were generated about the
differentiation of DPD and Dysthymia via levels of
perfectionism. However, if the two disorders could be
differentiated in this manner, such findings may
provide further evidence about clinically and empirically meaningful ways in which the two disorders could
be differentiated.
The first study reported below is a pilot study in
which a nonclinical sample was evaluated for DPD and
Dysthymia symptoms, as well as assessed on multiple
dimensions of perfectionism. The second study utilizes a
female, primary care outpatient sample, in which rates of
depressive disorders were expected to be higher.

209

STUDY 1
METHOD
Participants. Individuals were recruited for participation from a private, Southern university, whereby
they received extra course credit as part of their
enrollment in an introductory psychology course. All
subjects who signed the informed consent document
completed the study. One hundred and five students
participated. The resulting sample had a mean age of
19.64 (1.67) years, ranging between 18 and 27. Forty
percent were male, and a majority of the sample was
Caucasian (59%). The remainder consisted of AsianAmerican (20%), Hispanic (10.5%), and AfricanAmerican (10.5%). As other measures were provided
to this sample [Huprich and Keaschuk, 2004], only
those measures relevant to this study are reported here.
Measures
Depressive Personality Disorder Inventory. The
Depressive Personality Disorder Inventory (DPDI)
is a 41-item, 7-point Likert questionnaire that assesses
thoughts, feelings, and beliefs associated with DPD.
Items for this measure were created from the
DSM-IV description of this disorder. This measure was
shown to have preliminary evidence of acceptable
reliability and validity in an undergraduate sample:
Cronbachs a was .94, and the DPDI correlated
positively with the Automatic Thoughts Questionnaire
Revised (r 5 .85; 21) and the Dysfunctional Attitudes
Scale (r 5 .57; 22). Huprich et al. [2002] reported a
Cronbachs a of .95 in a sample of outpatients and
provided further evidence to support the measures
convergent, construct, and discriminant validity. Huprich et al. derived a cutoff score and provided
satisfactory diagnostic efficiency statistics. In this study,
Cronbachs a for the DPDI was computed to be .95
[Huprich et al., 1996].
Beck Depression Inventory-II. The BDI-II is a
21-item, 4-point Likert questionnaire that assesses
thoughts, feelings, behaviors, and physical symptoms
associated with major depressive disorder in individuals
age 13 or older [Beck et al., 1996]. Each item has four
responses, ranging from 0 to 3, in which 0 indicates the
absence of a depressive symptom, whereas a 3 indicates
the presence of the symptom in its most severe form.
In this study, this measure was included because past
studies have found elevated rates of depressive symptoms in both DPD and Dysthymia [e.g., Klein, 1999;
Klein and Shih, 1998; Skodol et al., 1999]. The
reliability and validity of the BDI-II is well documented [Beck et al., 1996]. In this study, Cronbachs a was
computed to be .88.
Depressive Personality-Dysthymia Checklist. This
is a multi-part measure that measures DPD, Dysthymia, and Major Depressive Disorder [Bagby and Ryder,
1999; Ryder et al., 2001]. Parts 1 and 2 consist of
15 items in a yesno format that assesses the presence
of absence of DSM-IV criteria for DPD and Dysthymia. Items for DPD were derived from the seven
Depression and Anxiety

210

Huprich et al.

DSM-IV [APA, 1994] criteria for DPD. The seven


criteria each had two questions, and for an individual to
meet the threshold for that criterion, both questions for
that criterion had to be answered in the affirmative.
Directions asked participants to indicate whether the
specific feature had been present since early adulthood.
Another seven questions assessed seven criteria for
Dysthymia which were reported as present for most of
the time over the past 2 years. However, one of the
criteria had two questions associated with it, although
to meet the threshold for that criterion, only one
question had to be answered yes. To meet the
diagnostic threshold for DPD, we required individuals
to answer yes to both parts of five of the seven
questions, and to endorse the item asking if these
criteria were viewed as being a part of the individuals
personality. To meet the diagnostic threshold for
Dysthymia, we required the individual to endorse the
item asking about being sad or depressed most of the
time over the past 2 years, along with endorsing at least
two other symptoms. Thus, the scoring algorithms for
DPD and Dysthymia were consistent with DSM-IV
guidelines for assigning a diagnosis. In this study,
Cronbachs a for DPD symptoms was .84, and for
Dysthymia symptoms was .80.
Frost Multidimensional Perfectionism Scale. The
Frost Multidimensional Perfectionism Scale [FMPS;
Frost et al., 1990] is a 35-item Likert questionnaire that
is designed to measure six components of perfectionism. The six subscales are Concern over Mistakes,
Personal Standards, Parental Expectations, Parental
Criticism, Doubts about Actions, and Organization. A
total score also is computed that assesses ones global
level of perfectionism. This measure was selected due
to its ability to assess various elements of perfectionism,
including individual traits and influences of parents on
perfectionism. The FMPS has been used in previous
studies and has successfully differentiated DPD from
psychiatric controls [Huprich, 2003b]. Reliability and
validity are reported by Frost et al. [1990]. In this study,
Cronbachs a for each scale was .85 (Concern over
Mistakes), .73 (Personal Standards), .78 Parental

Expectations, .87 (Parental Criticism), .76 (Doubts


about Actions), and .93 (Organization).
RESULTS
On the Depressive Personality-Dysthymia Checklist,
12 individuals met criteria for DPD and 15 met criteria
for Dysthymia. On the DPDI, one individual met the
criteria for DPD. Five individuals met criteria for both
DPD and Dysthymia, which led to overlap rates of
42 and 33%, respectively. The individual meeting
criteria for DPD on the DPDI met criteria for
Dysthymia and DPD using the Depressive Personality-Dysthymia Checklist.
Measures of DPD, Dysthymia, and the BDI-II were
highly intercorrelated. DSM-IV DPD scores were
positively correlated with DSM-IV Dysthymia symptoms (r 5 .60), BDI-II scores (r 5 .64), and the DPDI
(r 5 .65). The DPDI was positively and significantly
correlated with DSM-IV Dysthymia symptoms
(r 5 .60), and BDI-II scores (r 5 .64). DSM-IV Dysthymia symptoms were positively and significantly
correlated with BDI-II scores (r 5 .67).
Means, standard deviations, and ranges for all
variables are reported in Table 1. Pearson correlations
are presented in Table 2 for measures of DPD,
Dysthymia, and the BDI-II with perfectionism.
To minimize the possibility of a Type I error, only
correlations significant at Po.01 are reported. In
general, the patterns of correlations of DPD, Dysthymia, and the BDI-II with dimensions of perfectionism
were rather similar and ranged between .26 and .69.
All four depressive scales were positively correlated
with Concern over Mistakes, Parental Criticism, and
Doubts about Action. DPD and the BDI-II were
positively correlated with Parental Expectations.
Due to the degree of overlap among the constructs
of interest, and the desire to determine the relationship of
perfectionism to DPD and Dysthymia, hierarchical
regressions were conducted, in which the DPDI, DPD,
Dysthymia, and BDI-II scores were predicted by the entry
of all remaining depressive measures followed
by the perfectionism scales into the equation. This

TABLE 1. Means, standard deviations, and range of variables from nonclinical sample
Variable

Mean

SD

Range

DPDI
DPD traits
Dysthymia
BDI-II
Concern over mistakes
Personal standards
Parental expectations
Parental criticism
Doubts about actions
Organization

119.40
1.65
2.62
7.80
24.14
25.13
17.07
9.22
10.05
24.23

32.46
1.70
2.20
7.33
7.36
4.19
4.46
4.24
3.36
5.20

56206
07
07
034
1142
1635
625
420
419
630

Depression and Anxiety

Research Article: DPD, Dysthymia, and Perfectionism

211

TABLE 2. Pearson correlations among measures of depressive personality disorder, dysthymia, depressive symptoms,
and perfectionism in nonclinical sample

Concern over mistakes


Personal standards
Parental expectations
Parental criticism
Doubts about actions
Organization

DPDI

DPD

Dysthymia

BDI-II

.64
.04
.15
.47
.69
.16

.39
.09
.28
.48
.48
.09

.51
.11
.20
.42
.54
.03

.47
.03
.26
.52
.56
.09

DPD, Depressive Personality Disorder score from DSM-IV checklist; DPDI, Depressive Personality Disorder Inventory total score; Dysthymia,
Dysthymia total score from DSM-IV checklist; BDI-II, Beck Depression Inventory-II.
Po.01.

TABLE 3. Hierarchical regression analyses of the DPDI, DSM-IV depressive personality, dysthymia, major depression
symptoms and perfectionism in a nonclinical sample
Criterion
DPDI

DPD traits

Dysthymia

BDI-II

Sig. predictors
Step 1: BDI-II
Step 2: BDI-II
Dysthymia symptoms
Step 3: BDI-II
Dysthymia symptoms
Concern mistakes
Personal standards
Parental expectations
Parental criticism
Doubts actions
Organization
Step 1: BDI-II
Step 2: BDI-II
Dysthymia symptoms
Step 3: BDI-II
Dysthymia symptoms
Concern mistakes
Personal standards
Parental expectations
Parental criticism
Doubts actions
Organization
Step 1: BDI-II
Step 2: BDI-II
DPD traits
DPDI
Step 3: BDI-II
DPD traits
DPDI
Concern mistakes
Personal standards
Parental expectations
Parental criticism
Doubts actions
Organization
Step 1: DPD traits
DPDI
Step 2: DPD traits
DPDI
Dysthymia
Step 3: DPD traits
DPDI
Dysthymia

Std. b

Sig.

Adj. R2

DF

Sig.

.44
.20
.46
.05
.23
.35
.10
.08
.03
.35
.16
.47
.15
.62
.07
.52
.02
.05
.08
.07
.19
.13
.51
.21
.54
.09
.19
.53
.02
.13
.02
.03
.08
.06
.13
.30
.25
.10
.21
.32
.06
.11
.28

.00
.03
.00
.52
.00
.00
.15
.32
.79
.00
.02
.00
.06
.00
.40
.00
.87
.48
.39
.54
.04
.11
.00
.00
.00
.37
.03
.00
.89
.23
.77
.72
.47
.55
.11
.02
.04
.46
.08
.01
.69
.49
.03

.19
.34

24.35
24.72

.00
.02

.63

13.83

.00

.21
.50

28.84
59.27

.00
.00

.53

2.14

.06

.25
.52

35.28
30.00

.00
.00

.53

0.04

.26

.24

.00

.28

.00

.30

.19

Depression and Anxiety

212

Huprich et al.

TABLE 3. Continued
Criterion

Sig. predictors
Concern mistakes
Personal standards
Parental expectations
Parental criticism
Doubts actions
Organization

Std. b

Sig.

.17
.03
.06
.29
.19
.02

.19
.75
.56
.03
.12
.84

Adj. R2

DF

Sig.

DPD traits, Depressive Personality Disorder score from DSM-IV checklist; DPDI, Depressive Personality Disorder Inventory total score;
Dysthymia, Dysthymia total score from DSM-IV checklist; BDI-II, Beck Depression Inventory-II.

procedure allowed us to determine which of these


constructs were most predictive of the respective construct. Results are presented in Table 3. In general, the
DPDI and DPD measures had a significant or marginally
significant increase (respectively) in the amount of
variance explained in them by the addition of the
perfectionism scales. However, Dysthymia and the BDIII measures did not have a significant increase in the
amount of variance explained by the perfectionism scales.
Across all four regression analyses, however, DPDI, DPD,
Dysthymia, and BDI-II scores were accounted for unique
variance in their respective predictions.
Because this sample consisted of nonclinical undergraduates, it was of interest to evaluate these constructs
in a sample in which depressive symptoms would be
commonly observed. Thus, a primary care outpatient
female sample was selected for the second study.

STUDY 2
METHOD
Participants. Participants were recruited from two
primary care outpatient locations. The first was from a
primary healthcare clinic affiliated with the Department of Family Medicine, Wayne State University
School of Medicine. Because the population at this
clinic was predominantly African-American and
female, it was decided only to recruit such individuals.
One hundred and ten of 135 consecutive female patients
(84%) agreed to participate, signed an informed consent
document, and completed the measures. Their mean age
was 34.30 (11.97) years and ranged between 18 and 65
years old. The majority had at least a high school
education. Twenty-nine percent reported completing high
school, 41% reported completing some undergraduate
education, and 13% reported having received a college
degree. Data from this sample are also reported in Huprich
et al. [2005]. However, only measures collected from this
sample that are relevant to this study are reported here.
The second source for participant recruitment was in
a primary care physicians office in the southern United
States. Participants completed the questionnaires in a
private area near the physicians office and were
provided with $20 when they returned in the quesDepression and Anxiety

tionnaires. The first author monitored the progress


of the data collection with the office staff. All data were
kept in a confidential location in the physicians office.
Measures
Depressive Personality Disorder Inventory.
Described above. In this study, Cronbachs a for the
DPDI was computed to be .93 [Huprich et al., 1996].
Depressive Personality-DysthymiaMajor Depression Checklist. Questions for DPD and Dysthymia
are described above [Ryder et al., 2001]. However, the
final part of the checklist was created specifically for
this study. This is a 9-item, yesno format questionnaire that assesses the presence of absence of DSM-IV
criteria for Major Depressive Disorder over the past
2 weeks. A complete listing of this checklist is
presented in Huprich et al. [2005]. Each of the criteria
included from 1 to 4 questions. A yes response to any
of the items indicated that the symptom was present.
The only exception was the agitation/psychomotor
retardation item in which two yes responses are
needed for the symptom to be considered present. Also,
one of the items assessing an individuals weight loss
was not counted as a symptom of depression when the
individual indicated that she was dieting. To determine
the presence of MDD, the DSM-IV algorithm was
used. In this study, Cronbachs a was .88.
Frost Multidimensional Perfectionism Scale.
Described above. In this study, Cronbachs a for each
scale was as follows: .88 (Concern over Mistakes), .74
(Personal Standards), .72 (Parental Expectations), .71
(Parental Criticism), .81 (Doubts about Actions), and
.86 (Organization).
Procedure. Potential participants were approached during one afternoon per week for 4 weeks by
a research assistant before an appointment a family
practice clinic and told briefly about a study involving
questions about mood and health. If they were
interested in participating, they signed an informed
consent document and completed questionnaires in
a separate location from the general waiting area. For
their participation, individuals received a $15 gift card
to a local department store. Questionnaires were
administered in random order by a master-level
research assistant, although some measures that were
not part of this study were administered last.

Research Article: DPD, Dysthymia, and Perfectionism

RESULTS

213

Patterns of correlations between the depressive


measures and perfectionism measures are reported in
Table 5. To minimize the likelihood of a Type I error,
only correlations that were significant at Pr.01 are
reported. Correlations ranged between .24 and .54 in
magnitude. All four depressive measures were significantly correlated with Doubts about Actions. All
depressive measures but Dysthymia were positively
correlated with Parental Criticism and Concern over
Mistakes.
Like above, regression analyses were performed in
which DPD, DPDI, Dysthymia, and Major Depression
scores were predicted by the hierarchical entry of the
remaining variables followed by the perfectionism
variables. Results are presented in Table 6. DPDI and
DPD scores had a significant or marginally significant
increase in the amount of variance accounted for by
the addition of perfectionism subscales. This was not
the case when Dysthymia and Major Depression scales
were predicted by perfectionism scales.

Using the scoring paradigms associated with each


measure, individuals were classified as meeting diagnostic criteria for DPD, Dysthymia, or Major Depressive Disorder. Although eight individuals met criteria
for DPD from the DSM-IV checklist and the DPDI,
only three of these were diagnosed from both
measures. Thus, 75% of those with a DPD diagnosis
received it from only one measure. Fourteen of the
individuals meeting criteria for Dysthymia did so on
one or both of the DPD measures, which produced an
overlap rate of 48%. Six of eight diagnosed with DPD
on the DSM-IV checklist met criteria for Dysthymia
(75%), whereas seven out of eight diagnosed with DPD
on the DPDI met criteria for Dysthymia (88%).
Means, standard deviations, and ranges for the
variables of interest are presented in Table 4. Measures
of DPD, Dysthymia, and Major Depressive Disorder
were highly intercorrelated. DSM-IV DPD scores
were positively correlated with DSM-IV Dysthymia
symptoms (r 5 .53), DSM-IV Major Depressive Disorder symptoms (r 5 .68), and the DPDI (r 5 .51). The
DPDI was positively and significantly correlated with
DSM-IV Dysthymia symptoms (r 5 .53), and DSM-IV
Major Depressive Disorder symptoms (r 5 .62). DSMIV Dysthymia symptoms were positively and significantly correlated with DSM-IV Major Depressive
Disorder symptoms (r 5 .62).

DISCUSSION
In both samples, the results indicated that DPD,
Dysthymia, and Major Depression were strongly
intercorrelated and predictive of each other. Furthermore, measures of these disorders were all correlated
with factors of perfectionismthe Concern over

TABLE 4. Means, standard deviations, and range of variables in primary care sample
Variable

Mean

SD

Range

DPDI
DPD traits
Dysthymia
Major depression
Concern over mistakes
Personal standards
Parental expectations
Parental criticism
Doubts about actions
Organization

115.57
1.58
3.11
1.61
18.79
21.32
15.52
8.00
8.45
22.82

41.29
1.74
2.66
1.34
8.55
5.39
4.40
3.52
3.90
5.29

38258
07
07
04
945
935
525
420
420
830

TABLE 5. Pearson correlations among measures of depressive personality disorder, dysthymia, depressive symptoms,
and perfectionism in a primary care sample

Concern over mistakes


Personal standards
Parental expectations
Parental criticism
Doubts about actions
Organization

DPDI

DPD

Dysthymia

MDD

.52
.11
.13
.47
.54
.20

.37
.18
.06
.37
.24
.13

.20
.01
.00
.22
.24
.13

.36
.12
.00
.32
.36
.23

DPD, Depressive Personality Disorder score from DSM-IV checklist; DPDI, Depressive Personality Disorder Inventory total score; DYST,
Dysthymia total score from DSM-IV checklist; MDD, Major Depressive Disorder total score from DSM-IV checklist.
Pr.01.
Depression and Anxiety

214

Huprich et al.

TABLE 6. Regression analyses of the DPDI, DSM-IV depressive personality, dysthymia, major depression symptoms
and perfectionism in a primary care sample
Criterion

Sig. predictors

Std. b

Sig.

Adj. R2

DF

Sig.

DPDI

Step 1: MDD
Step 2: MDD
Dysthymia
Step 3: MDD
Dysthymia
Concern mistakes
Personal standards
Parental expectations
Parental criticism
Doubts actions
Organization
Step 1: MDD
Step 2: MDD
Dysthymia
Step 3: MDD
Dysthymia
Concern mistakes
Personal standards
Parental expectations
Parental criticism
Doubts actions
Organization
Step 1: MDD
Step 2: MDD
DPD traits
DPDI
Step 3: MDD
DPD traits
DPDI
Concern mistakes
Personal standards
Parental expectations
Parental criticism
Doubts actions
Organization
Step 1: Dysthymia
Step 2: Dysthymia
DPD traits
DPDI
Step 3: Dysthymia
DPD traits
DPDI
Concern mistakes
Personal standards
Parental expectations
Parental criticism
Doubts actions
Organization

.65
.56
.14
.41
.13
.22
.13
.02
.12
.14
.06
.57
.35
.33
.25
.35
.18
.02
.03
.21
.08
.00
.65
.47
.27
.04
.47
.31
.07
.07
.12
.02
.08
.07
.04
.65
.38
.12
.39
.39
.11
.38
.10
.18
.04
.00
.06
.11

.00
.00
.14
.00
.15
.11
.17
.75
.21
.22
.42
.00
.00
.00
.02
.00
.24
.87
.76
.07
.52
.98
.00
.00
.00
.71
.00
.00
.55
.64
.22
.80
.44
.59
.62
.00
.00
.18
.00
.00
.23
.00
.46
.06
.57
.99
.58
.18

.43
.44

76.73
2.18

.00
.14

.56

5.63

.00

.32
.39

48.09
10.61

.00
.00

.46

2.14

.06

.42
.46

72.50
5.33

.00
.00

.45

0.86

.53

.42
.57

72.45
17.68

.00
.00

.59

0.74

.62

DPD traits

Dysthymia

BDI-II

DPD, Depressive Personality Disorder score from DSM-IV checklist; DPDI, Depressive Personality Disorder Inventory total score; DYST,
Dysthymia total score from DSM-IV checklist; MDD, Major Depressive Disorder total score from DSM-IV checklist.

Mistakes, Doubts about Actions, and Parental Criticism scales (except in one case). Thus, it appears that
there is a common component shared by all of the
depressive measures and some of the perfectionism
scales. Such findings support the idea that a common,
biological mechanism may account for the relationship
Depression and Anxiety

among three similar psychological disorders [Kreuger


and Tackett, 2003; Livesley, 2005; Ryder et al., 2002;
Widiger and Simonsen, 2005]. Accordingly, these
results may support the idea of a depressive-anxious
personality dimension [Mineka et al., 1998], and that
such a dimension may predispose one to be preoccu-

Research Article: DPD, Dysthymia, and Perfectionism

pied about ones actions and criticism from parental


figures about ones actions.
It should be noted that Huprich [2003b] sample
consisted of primarily Caucasian males in a psychiatric
outpatient sample, whereas the current sample was
African-American females in a primary care outpatient
sample. Collectively, these studies demonstrate that
DPD as assessed on the DPDI with psychiatric and
primary care samples may be characterized by certain
aspects of perfectionism and appears to generalize
across gender and race. Nevertheless, DPD, as
currently assessed, appears to overlap substantially
with measures of Dysthymia and major depressive
symptoms.
Although the results support the idea of a common
factor underlying Depressive Personality Disorder,
Dysthymia, and depressive symptoms, results also
testify to what has been a regular limitation to the
comparison of studies on DPDnamely, different
measures of the construct do not always provide
convergent results [Huprich, 2001, 2004]. Klein and
colleagues have regularly assessed DPD with Akiskal
[1983] criteria [Hayden and Klein, 2001; Klein, 1990,
1999; Klein and Miller, 1993; Klein and Shih, 1998].
Huprich and colleagues [Huprich, 2000, 2003a,b,
2004; Huprich, 2005; Huprich and Frisch, 2004;
Huprich et al., 2005] often used the DPDI [Huprich
et al., 1996], the Diagnostic Interview for Depressive
Personality [Gunderson et al., 1994], and SCID-II
Self-Report [First et al., 1997]. Bagby and Ryder [1999]
and Ryder et al. [2001] have used their own self-report
measure which was included in this study. Despite
evidence of their construct validity across studies
[Huprich, 2001], there is no observed gold standard
for assessing DPD, and when multiple measures of
DPD are used with the same sample, there is poor
evidence of convergence within the sample [Huprich,
2004]. In some ways, it is no surprise that this problem
exists, given the disagreement that existed in the
committees that formed DPD and Dysthymia diagnoses for DSM-IV-Text Revision [APA, 2001; Widiger,
2003]. Therefore, continued examination of these
constructs must take into account the difficulties in
assessment. It may be that a dimensional analysis of
underlying, genetically based personality dimensions
could assist in this problem of differentiating two
similar disorders. Specifically, as common biological
dimensions are identified, ongoing evaluation of the
two constructs for discriminant validity could occur
and evaluated in the context of what criteria define a
personality disorder [Hirschfeld and Holzer, 1994;
Robins and Guze, 1970].
This study is limited in at least three ways. First, selfreport measures were used to assess DPD, Dysthymia,
and Major Depression symptoms. Because a negative
mood state has been shown to influence self-reports
of personality traits [Hirschfeld et al., 1983; Ouimette
et al., 1996], and due to potential problems in selfpresentation bias that are found in patients with

215

personality disorders [Huprich and Ganellen, 2006;


Klein, 2003], the validity of these measures is limited.
Second, because a nonclinical and primary care outpatient sample were used, it is not clear to what extent
these findings would generalize to a psychiatric
population. However, the pattern of similarity in the
results across such diverse samples, as well as their
degree of convergence with studies from nonclinical
and psychiatric samples, lessens this concern. Third,
the sample sizes were somewhat modest. Increased
sample size may allow for a more finely tuned analysis
of the items of the self reports, which could provide a
more sophisticated way to differentiate these similar
constructs.
In conclusion, results from both studies found that
self-reported DPD, Dysthymia, and depressive symptoms were all intercorrelated, and that DPD, Dysthymia, and depressive symptoms were correlated with
three dimensions of perfectionismConcern over
Mistakes, Doubts about Actions, and Parental Criticism. Dysthymia and Major Depression were predicted
by measures of each other and measures of DPD.
Variance in measures of DPD was uniquely predicted
by Concern over Mistakes, Doubts about Actions,
and Parental Expectations in a nonclinical sample, but
not in a primary care sample. It is concluded that a
common factor or set of factors underlies these
disorders, but that DPD may be more related to
perfectionism than Dysthymia and depression. It also is
evident that research on the DPD construct is limited,
in part, by the differing types of measures used to assess
it. As the common factor(s) is identified that underlies
DPD, Dysthymia, and depression, the discriminant
validity of assessment tools may be refined, as well
as ones understanding of the components of each
disorder.

REFERENCES
Akiskal HS. 1983. Dysthymic disorder: psychopathology of proposed
chronic depressive subtypes. Am J Psychiatry 140:1120.
American Psychiatric Association. 1994. Diagnostic and statistical
manual of mental disorders. (4th ed.). Washington, DC: Author.
American Psychiatric Association. 2001. Diagnostic and statistical
manual of mental disorders. (4th ed. Text Revision). Washington,
DC: Author.
Bagby RM, Ryder AG. 1999. Diagnostic discriminability of
dysthymia and depressive personality disorder. Depression Anxiety 10:
4149.
Bagby RM, Parker JDA, Joffe RT, Buis T. 1994. Reconstruction and
validation of the Depressive Experiences Questionnaire. Assessment 1:5968.
Bagby RM, Schuller DR, Marshall MB, Ryder AG. 2004. Depressive
personality disorder: rates of comorbidity with personality
disorders and relations to the five-factor model of personality.
J Personality Disorders 18:542554.
Beck AT, Steer RA, Brown GK. 1996. Beck Depression Inventory II
Manual. San Antonio, TX: Psychological Corporation.
Beck AT, Ward CH, Mendelson M, Erbaugh J. 1961. An
inventory for measuring depression. Arch General Psychiatry 4:
561571.
Depression and Anxiety

216

Huprich et al.

Blatt SJ. 1995. The destructiveness of perfectionism: implications for


the treatment of depression. Am Psychol 50:10031020.
Clark LA, Watson D. 1999. Personality disorder, and personality
disorder: Towards a more rational conceptualization. J Pers
Disorders 13:142151.
Costa PT Jr, McCrae RR. 1992. The NEO PI-R professional
manual. Odessa, FL: Psychological Assessment Resources.
Derogatis LR. 1992. SCL-90-R administration, scoring, and
procedures manual-II for the revised version and other instruments
of the psychopathology rating scale series. (2nd edn.). Townsend,
MD: Clinical Psychometric Research.
Dyce JA, OConnor BP. 1998. Personality disorders and the fivefactor model: a test of facet-level predictions. J Pers Disorders
12:3145.
First MB, Gibbon M, Spitzer RL, Williams JBW, Benjamin LS.
1997. Structured Clinical Interview for DSM-IV Axis II Personality Disorders. New York, NY: Biometrics Department, New York
State Psychiatric Institute.
Flett GL, Hewitt PL. 2002. Perfectionism: theory, research, and
treatment. Washington, DC: American Psychological Association.
Frost RO, Heimberg RG, Holt CS, Mattia JI, Neubauer AL. 1993.
A comparison of two measures of perfectionism. Pers Individual
Diff 14:119126.
Frost RO, Martin P, Lahart C, Rosenblate R. 1990. The dimensions
of perfectionism. Cogn Therapy Res 14:449468.
Gunderson JG, Phillips KA, Triebwasser J, Hirschfeld RMA. 1994.
The diagnostic interview for depressive personality. Am
J Psychiatry 151:13001304.
Hartlage D, Arduino K, Alloy LB. 1998. Depressive personality
characteristics: state dependent concomitants of depressive disorder and traits independent of current depression. J Abnormal
Psychol 107:349354.
Hayden EP, Klein DN. 2001. Outcome of dysthymic disorder at
5-year follow-up: the effect of familial psychopathology, early
adversity, personality, comorbidity, and chronic stress. Am
J Psychiatry 158:18641870.
Hewitt PL, Flett GL. 1993. Dimensions of perfectionism, daily
stress, and depression: a test of the specific vulnerability hypothesis. J Abnormal Psychol 102:5865.
Hewitt PL, Flett GL, Ediger E. 1996. Perfectionism and depression:
longitudinal assessment of a specific vulnerability hypothesis.
J Abnormal Psychol 105:276280.
Hewitt PL, Flett GL, Ediger E, Norton GR, Flynn CA. 1998.
Perfectionism in chronic and state symptoms of depression. Can
J Behav Sci Special Issue: Canadian perspectives on research in
depression 30:234242.
Hirschfeld RMA, Holzer CE. 1994. Depressive personality disorder:
clinical implications. J Clin Psychiatry 55(supplement):1017.
Hirschfeld RMA, Klerman GL, Clayton PJ, Keller MB, McDonaldScott P, Larkin BH. 1983. Assessing personality: effects of the
depressive state on trait measurement. Am J Psychiatry 140:695699.
Huprich SK. 1998. Depressive personality disorder: theoretical
issues, clinical findings, and future research questions. Clin Psychol
Rev 18:477500.
Huprich SK. 2000. Describing depressive personality analogues and
dysthymics on the NEO-Personality Inventory-Revised.
J Clin Psychol 56:15211534.
Huprich SK. 2001. The overlap of depressive personality disorder
and dysthymia, reconsidered. Harvard Rev Psychiatry 9:158168.
Huprich SK. 2003a. Evaluating facet-level predictions and construct
validity of depressive personality disorder. J Pers Disorders 17:
219232.
Huprich SK. 2003b. Depressive personality and its relationship to
depressed mood, interpersonal loss, negative parental perceptions
and perfectionism. J Nervous Mental Disease 191:7379.
Depression and Anxiety

Huprich SK. 2004. Convergent and divergent validity of three measures


of depressive personality disorder. J Pers Assess 82:321328.
Huprich SK. 2005. Differentiating avoidant and depressive personalities. J Personality Disorders 19:659673.
Huprich SK, Frisch MB. 2004. Depressive personality and its relationship to quality of life, hope, and optimism. J Pers Assess 83:2228.
Huprich SK, Ganellen RJ. 2005. The advantages of using the
Rorschach to assess personality disorders. In: Huprich SK, editor.
Rorschach assessment of the personality disorders. Mahwah, NJ:
Erlbaum Publishers. p 2753.
Huprich SK, Keaschuk R. 2004. Depressive personality and its relationship to anaclitic and introjective depression. In: The Midwinter
Meeting of the Society for Personality Assessment, Miami, FL.
Huprich SK, Margrett JE, Barthelemy KJ, Fine MA. 1996. The
Depressive Personality Inventory: an initial investigation of its
psychometric properties. J Clin Psychol 52:153159.
Huprich SK, Porcerelli J, Binienda J, Karana D. 2005. Functional
health status and its relationship to depressive personality,
dysthymia, and major depression symptoms: Preliminary findings.
Depression Anxiety 22:168176.
Huprich SK, Sanford K, Smith M. 2002. Further psychometric
evaluation of the Depressive Personality Disorder Inventory. J Pers
Disorders 16:255269.
Klein DN. 1990. Depressive personality: reliability, validity, and
relation to dysthymia. J Abnormal Psychol 99:412421.
Klein DN. 1999. Depressive personality in the relatives of outpatients
with dysthymic disorder and episodic major depressive disorder
and normal controls. J Affective Disorders 55:1927.
Klein DN. 2003. Patients versus informants reports of personality
disorders in predicting 7.5-year outcome in outpatients with
depressive disorder. Psychol Assess 15:216222.
Klein DN, Miller GA. 1993. Depressive personality in a nonclinical
sample. Am J Psychiatry 150:17181724.
Klein DN, Shih JH. 1998. Depressive personality: associations with
DSM-III-R mood and personality disorders and negative and
positive affectivity, 30-month stability, and prediction of course of
Axis I depressive disorders. J Abnormal Psychol 107:319327.
Kreuger RF. 2005. Continuity of Axes I and II: toward a unified
model of personality, personality disorders, and clinical disorders.
J Pers Disorders 19:233261.
Kreuger RF, Tackett JL. 2003. Personality and psychopathology:
working toward the bigger picture. J Pers Disorders 17:109128.
Livesley WJ. 2005. Behavioral and molecular genetic contributions
to a dimensional classification of personality disorder. J Pers
Disorders 19:131155.
McDermut W, Zimmerman M, Chelminski I. 2003. The construct validity of depressive personality disorder. J Abnormal Psychol 112:4960.
Mineka S, Watson D, Clark LA. 1998. Comorbidity of anxiety and
unipolar mood disorders. Annu Rev Psychol 49:377412.
Ouimette PC, Klein DN, Pepper CM. 1996. Personality traits in the
first degree relatives of outpatients with depressive disorders.
J Affective Disorders 39:4353.
Reynolds SK, Clark LA. 2001. Predicting dimensions of personality
disorder from domains and facets of the five-factor model. J Pers
69:199222.
Robins E, Guze SB. 1970. Establishment of diagnostic validity in
psychiatric illness: its application to schizophrenia. Am J Psychiatry
126:983987.
Robins CJ, Ladd JS, Welkowitz J, Blaney PH, Dize R, Kutcher G.
1994. The Personal Style Inventory: preliminary validation studies
of new measures of sociotropy and autonomy. J Psychopathol
Behav Assess 16:277300.
Ryder AG, Bagby RM. 1999. Diagnostic viability of the depressive
personality disorder: theoretical and conceptual issues. J Pers
Disorders 13:99117.

Research Article: DPD, Dysthymia, and Perfectionism

Ryder AG, Bagby RM, Dion KL. 2001. Chronic low-grade


depression in a nonclinical sample: depressive personality or
dysthymia? J Pers Disorders 15:8493.
Ryder AG, Bagby RM, Schuller DR. 2002. The overlap of
depressive personality disorder and dysthymia: a categorical
problem with a dimensional solution. Harvard Rev Psychiatry 10:
337352.
Ryder AG, Schuller DR, Bagby MR. 2006. Depressive personality
and dysthymia: evaluating symptom and syndrome overlap.
J Affective Disorders 91:217227.

217

Skodol AE, Stout RL, McGlashan TH, Grilo CM, Gunderson JG,
Shea MT, et al. 1999. Co-occurrence of mood and personality
disorders: a report from the collaborative longitudinal personality
disorders study (CLPS). Depression Anxiety 10:175182.
Widiger TA. 2003. Personality disorder and Axis I psychopathology:
the problematic boundary of Axis I and Axis II. J Pers Disorders
17:90108.
Widiger TA, Simonsen E. 2005. Alternative dimensional models of
personality disorder: Finding a common ground. J Pers Disorders
19:110130.

Depression and Anxiety