So, where is the line for the ones that have been in hell for years?

On Diagnosis changes, the inadequate classification of depression, ranting and DULL blog posts.

On the side bar I’ve written that I suffer from “Chronic Depressive Disorder”, but the truth is that the exact diagnosis doesn’t really exist as such.  In my medical files I’m either:

  • F32 (in the ICD-10), classified as an EPISODE, that according to the DSM-IV-TR, can be considered so if the symptoms persist for over TWO WEEKS.   It can be mild, moderate and severe.  When I was still at school it was considered moderate, and since I became unable to work or do anything else afterwards, I achieved the SEVERE tittle (yay me! )(¬¬)

or,

  • F33, classified as RECURRENT, or having at least 2 Major Depressive Episodes  (each with a minimum duration of 2 weeks).   In my case the severity described in the same way as F32.

Well, since a month or so ago, courtesy of my new psychiatrist, I’m

  • F34, classified as PERSISTENT mood disorder, more specifically, Dysthymia.

Part of the definition for persistent mood disorders is:  “Persistent and usually fluctuating disorders of mood in which the majority of the individual episodes are not sufficiently severe to warrant being described as hypomanic or mild depressive episodes.”

Not Sufficiently Severe.

I appreciate that the psychiatrist may have wanted to acknowledge that I not only have been struggling with whatever this is for over two weeks but for several years.  BUT instead he changed the severity description to being something that is not severe enough to even warrant a MILD depressive episode diagnosis.

This is not a medal I want to have, a token of how horrible my life has been in the shape of a diagnosis, but my “mood disorder” is not going to get any milder just because the criteria say so.   It does send me into a fit of rage of “How much more fucking severe does it have to get?” and “Why do I even care about a diagnosis if the treatment may not even change?”.

It matters to me anyway, perhaps for validation, or even for academic purposes.    If I were to choose though, I’d stick with Major Depressive Disorder as my AXIS I diagnosis, as it doesn’t have a true upper boundary in terms of  duration, and it even has a MINI specifier of “Chronic”, that in my eyes is more appropriate than being classified as dysthymic and having a clear boundary of “has not been sufficiently severe”.

Course if I push I may end up with a dreary vague “Mood Disorder NOS” or “Unspecified Case of Weird Brains”

This has been bothering me for a while even before being diagnosed as Dysthymic.   The disparity of severity and time, causing cases like mine to become lost in the diagnosis criteria of different disorders.   The majority of depressive disorders, even untreated only last a few moths with complete remission of symptoms afterwards.

Unlucky me and a lot of blog friends and loved ones who got stuck with the other end of the spectrum.  Long term and severe at the same time.

High Five

We’ll see how this whole diagnosis issue resolves when The DSM – 5 gets published in 2013.  According to the APA site, they want to get rid of the severity boundary for Dysthymia, also renaming the illness as Chronic Depressive Disorder.

So, lets just say that the diagnosis on my sidebar comes from the future.

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  1. #1 by Pandora on June 21, 2010 - 9:14 pm

    I agree that it’s not some sort of medal, but it’s hideously frustrating to feel like they’re not taking your pain sufficiently seriously, as this would denote. I would be furious.

    I’ve actually had a few run-ins about the importance of accurate diagnoses recently. I believe that they’re imperative to the correct treatment and ergo prognosis. Others talk about treating the symptoms which of course is exactly what should be done – but a diagnosis conceptualises those symptoms into cluster, in order that the most effective treatments be allocated directly. Seems sensible to me.

    Anyway, take care of yourself 🙂

    Pandora x

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