Hi! I believe I can be of help with this issue.
300.40 is the diagnostic code (both in ICD-9, which is what insurance companies have us report the diagnoses in, and DSM-IV which is the psychiatric diagnostic coding system) for dysthymic disorder. What is that?
Well, without getting too technical, dysthymic disorder is one of the depressive disorders.
In order to truly understand the diagnosis, though, I will have to explain that a clear difference between Dysthymia and Major Depressive Disorder (MDD) doesn't exist. Functionally, I can tell you that the difference is a matter of how long the problem has manifested. If it's lasted without abating longer than a few months, it's going to be Dysthymic Disorder. Otherwise it will be MDD. Here's how the Diagnostic and Statistical Manual classifies them so you can see for yourself and get a better idea. Let's look at it and then I'll continue. Here's the entry for MDD:
Major Depressive Episode
A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
Note: Do note include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.
(1) depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.
(2) markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)
(3) significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.
(4) insomnia or hypersomnia nearly every day
(5) psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
(6) fatigue or loss of energy nearly every day
(7) feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
(8) diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
(9) recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
B. The symptoms do not meet criteria for a Mixed Episode.
C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
E. The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.
Major Depressive Disorder
A. Presence of a single Major Depressive Episode
B. The Major Depressive Episode is not better accounted for by Schizoaffective Disorder and is not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
C. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode. Note: This exclusion does not apply if all the manic-like, mixed-like, or hypomanic-like episodes are substance or treatment induced or are due to the direct physiological effects of a general medical condition.
A. Presence of two or more Major Depressive Episodes.
Note: To be considered separate episodes, there must be an interval of at least 2 consecutive months in which criteria are not met for a Major Depressive Episode.
B. The Major Depressive Episodes are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
C. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode. Note: This exclusion does not apply if all the manic-like, mixed-like, or hypomanic-like episodes are substance or treatment induced or are due to the direct physiological effects or a general medical condition.
Now, let’s look at the criteria for Dysthymic disorder:
According to the DSM-IV, dysthymia is characterized by an overwhelming yet chronic state of depression, exhibited by a depressed mood for most of the days, for more days than not, for at least 2 years. (In children and adolescents, mood can be irritable and duration must be at least 1 year.) The person who suffers from this disorder must not have gone for more than 2 months without experiencing two or more of the following symptoms:
- poor appetite or overeating
- insomnia or hypersomnia
- low energy or fatigue
- low self-esteem
- poor concentration or difficulty making decisions
- feelings of hopelessness
In addition, no Major Depressive Episode has been present during the first two years (or one year in children and adolescents) and there has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode, and criteria have never been met for Cyclothymic Disorder. Further, the symptoms cannot be due to the direct physiological effects of a the use or abuse of a substance such as alcohol, drugs or medication or a general medical condition. The symptoms must also cause significant distress or impairment in social, occupational, educational or other important areas of functioning.
So you see she's been diagnosed with dysthymic disorder probably because the depressive symptoms have been going on for a long while and there wasn't a specific event that triggered them. Your description of her, though, doesn't seem to match the diagnosis very well. So, she may not have told her doctors and psychologists much of what you told me here.
I wish you the very best!
Please remember to click the green accept button. Feel free to continue the discussion; my goal is to get you the best answers possible. Bonuses are always appreciated! If I can be of further help with any issue, just put "for Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, XXXXX XXXXX