Internet Mental Health


Internet Mental Health Quality of Life Scale (Client Version)

Internet Mental Health Quality of Life Scale (Therapist Version)

Big 5 Factors Of Mental Illness And Code For This Disorder
(The "6th Big Factor" of Mental Health, "Physical Health", Is Coded Normal or Green)


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: disinhibition (distractibility), negative emotion (depressed mood, low self-esteem), and physical symptoms (fatigue, altered sleep and appetite).


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.


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.


Occupational-Economic Problems:

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

Negative Emotions (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

Back to top

Click Here For Free Diagnosis

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".

Back to top

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.

Back to top

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.


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.


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.


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.


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.


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.

A Dangerous Cult

Back to top


General Information


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 Skills That Are Lacking During Persistent Depressive Disorder

    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
    Sociability Social withdrawal Friendly; interested in social contacts and activities

Back to top

Treatment Is Identical To That Of Major Depressive Disorder

World Health Organization Depression Treatment Guidelines

Treatment Guidelines


Back to top

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.

  • Sociability 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.

Improving Positive Behavior

Philosophers for the past 2,500 years have taught that it is very beneficial to start the day with goal-setting, and end the day with a brief review.

This habit of planning your day in the morning, and reviewing your day in the evening, is a time-proven technique for more successful living.

Note: When each of the following videos finishes; you must exit YouTube (by manually closing the window) in order to return to this webpage.

Morning Meditation (5-Minute Video)

Afternoon Meditation (Learn How To Have Healthy Relationships)

Evening Meditation (5-Minute Video)

Life Satisfaction Scale (Video)

Healthy Social Behavior Scale (Video)

Mental Health Scale (Video)

Click Here For More Self-Help

Back to top

    "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!

  • Canadian researchers who commit scientific fraud are protected by privacy laws: There are criminals in every community - even in the scientific research community (especially if a lot of money is at stake). Criminal researchers can hide their fraud behind outdated privacy laws.

  • 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? The results should be both statistically significant (with a p-value <0.05) and clinically significant using some measure of Effect Size such as Standardized Mean Difference (e.g., Cohen's d >= 0.33). The summary statistics 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 - Latest Research (2016-2017)

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

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

Back to top

Which Behavioral Dimensions Are Involved?

Research has shown that there are 5 major dimensions (the "Big 5 Factors") of personality disorders and other mental disorders. There are two free online personality tests that assess your personality in terms of the "Big 5 dimensions 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", but our discussion will focus on the first 5 major dimensions.)

These major dimensions of human behavior seem to represent the major dimensions whereby our early evolutionary ancestors chose their hunting companions or spouse. To maximize their chance for survival, our ancestors wanted companions who were agreeable, conscientious, intelligent, sociable, emotionally stable, and physically healthy.

    Which Dimensions of Human Behavior are Impaired in Adjustment Disorder?

    Agreeableness Antagonism       Agreeableness
    Conscientiousness Disinhibition       Disinhibition
    Intellect Decreased Intellect       Intellect
    Sociability (Extraversion) Detachment       Sociability (Extraversion)
    Emotional Stability Negative Emotion       Negative Emotion

The 5 Major Dimensions of Mental Illness

The Big 5 Factors or dimensions of mental illness each has a healthy side and an unhealthy side. Thus the Big 5 Factors are: (1) Agreeableness vs. Antagonism, (2) Conscientiousness vs. Disinhibition, (3) Intellect vs. Decreased Intellect, (4) Sociability (Extraversion) vs. Detachment (Introversion), and (5) Emotional Stability vs. Negative Emotion.

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

The problems that are diagnostic of this disorder are highlighted in   Pink  . Other problems that are often seen in this disorder are highlighted in   Yellow  .

Treatment Goals for Individuals With Disinhibition

Description: Conscientiousness is synonymous with being self-disciplined, industrious and orderly. The Conscientiousness dimension measures the behaviors that are central to the concept of SELF-CONTROL - organizing and controlling one's behavior in order to achieve one's goals. This involves traits like paying attention, controlling impulses, and delaying gratification. High conscientiousness is associated with better: longevity, health, school and job performance. (This dimension appears to measure the behaviors that differentiate behavioral order and inhibition from chaos and disinhibition.)
Descriptors: Industrious, self-disciplined, rule-abiding, organized
Language Characteristics: Many positive emotion words (e.g. happy, good), few negative emotion words (e.g. hate, bad), more perspective, careful to check that information is conveyed correctly, straight to the point, formal, few negations, few swear words, few references to friends, few disfluencies or filler words, many insight words, not impulsive.
Research: Higher scores on Conscientiousness predict greater success in school and at work. *MRI research found that Conscientiousness was associated with increased volume in the lateral prefrontal cortex, a region involved in planning and the voluntary control of behavior.
"I do a thorough job. I want everything to be 'just right'. I want every detail taken care of."
"I am careful."
"I am a reliable hard-worker."
"I am organized. I follow a schedule and always know what I am doing."
"I like order. I keep things tidy."
"I see that rules are observed."
"I do things efficiently. I get things done quickly."
"I carry out my plans and finish what I start."
"I am not easily distracted."
Rigid Perfectionism
"Even though it drives other people crazy, I insist on absolute perfection in everything I do."
"I simply won't put up with things being out of their proper places."
"People complain about my need to have everything all arranged."
"People tell me that I focus too much on minor details."
"I have a strict way of doing things."
"I postpone decisions."
Description: Disinhibition is synonymous with being distractible, impulsive and disorganized.
Descriptors: Distractible, impulsive, irresponsible, disorganised, unreliable, careless, forgetful
Language Characteristics: Few positive emotion words, many negative emotion words, less perspective, less careful, more vague, informal, many negations, many swear words, many references to friends (e.g. pal, buddy), many disfluencies or filler words, few insight words, impulsive.
* Irresponsibility:
"I've skipped town to avoid responsibilities."
"I just skip appointments or meetings if I'm not in the mood."
"I'm often pretty careless with my own and others' things."
"Others see me as irresponsible."
"I make promises that I don't really intend to keep."
"I often forget to pay my bills."
* Impulsivity:
"I usually do things on impulse without thinking about what might happen as a result."
"Even though I know better, I can't stop making rash decisions."
"I feel like I act totally on impulse."
"I'm not good at planning ahead."
* Distractibility:
"I can't focus on things for very long."
"I am easily distracted."
"I have trouble pursuing specific goals even for short periods of time."
"I can't achieve goals because other things capture my attention."
"I often make mistakes because I don't pay close attention."
"I waste my time ."
"I find it difficult to get down to work."
"I mess things up."
"I don't put my mind on the task at hand."
* Reckless Risk Taking:
"I like to take risks."
"I have no limits when it comes to doing dangerous things."
"People would describe me as reckless."
"I don't think about getting hurt when I'm doing things that might be dangerous."
* Hyperactivity:
"I move excessively (e.g., can't sit still; restless; always on the go)."
"I'm starting lots more projects than usual or doing more risky things than usual."
* Over-Talkativeness:
"I talk excessively (e.g., I butt into conversations; I complete people's sentences)."
"Often I talk constantly and cannot be interrupted."
* Elation:
"I feel very happy or exhilarated."
"I'm feeling a rush of good feelings."
("Conscientiousness vs. Disinhibition" 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)
*MRI Research: Testing predictions from personality neuroscience. Brain structure and the big five.

Treatment Goals for Individuals With Negative Emotion

Description: Emotional Stability is synonymous with being calm and emotionally stable. The Emotional Stability dimension measures the behaviors that are central to the concept of COURAGE - having calm composure and endurance when confronting adversity. 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, even-tempered, peaceful, confident
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."
Description: Degree to which people experience persistent anxiety or depression and are easily upset. (This could be thought of as high threat sensitivity or low stress tolerance.)
Descriptors: Emotionally unstable, anxious, separation-insecure, depressed, self-conscious, oversensitive, vulnerable.
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.
Research: Lower scores on Emotional Stability are associated with unhappiness, dysfunctional relationships, and mental health problems. *MRI research found that Low Emotional Stability (= Negative Emotion or Neuroticism) was associated with increased volume of brain regions associated with threat, punishment, and negative emotions.
* Emotional Instability:
"I get emotional easily, often for very little reason."
"I get emotional over every little thing."
"My emotions are unpredictable."
"I never know where my emotions will go from moment to moment."
"I am a highly emotional person."
"I have much stronger emotional reactions than almost everyone else."
"My emotions sometimes change for no good reason."
"I get angry easily."
"I get upset easily."
"I change my mood a lot."
"I am a person whose moods go up and down easily."
"I get easily agitated."
"I can be stirred up easily."
* Anxiety:
"I worry about almost everything."
"I'm always fearful or on edge about bad things that might happen."
"I always expect the worst to happen."
"I am a very anxious person."
"I get very nervous when I think about the future."
"I often worry that something bad will happen due to mistakes I made in the past."
"I am filled with doubts about things."
"I feel threatened easily."
"I am afraid of many things."
* Separation Insecurity:
"I fear being alone in life more than anything else."
"I can't stand being left alone, even for a few hours."
"I’d rather be in a bad relationship than be alone."
"I'll do just about anything to keep someone from abandoning me."
"I dread being without someone to love me."
* Submissiveness:
"I usually do what others think I should do."
"I do what other people tell me to do."
"I change what I do depending on what others want."
* Perseveration:
"I get stuck on one way of doing things, even when it's clear it won't work."
"I get stuck on things a lot."
"It is hard for me to shift from one activity to another."
"I get fixated on certain things and can’t stop."
"I feel compelled to go on with things even when it makes little sense to do so."
"I keep approaching things the same way, even when it isn’t working."
* 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. Negative Emotion" 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)
*MRI Research: Testing predictions from personality neuroscience. Brain structure and the big five.

Back to top

Internet Mental Health © 1995-2018 Phillip W. Long, M.D.