THE SUBAFFECTIVE-CHARACTER SPECTRUM SUBTYPING DISTINCTION IN PRIMARY EARLY-ONSET DYSTHYMIA - A CLINICAL AND FAMILY STUDY

In 1983, Akiskal proposed that primary early-onset dysthymia should be divided into two subtypes: subaffective dysthymia, which is a subsynd romal form of major mood disorder; and character spectrum disorder, wh ich is a form of personality disorder with secondary dysphoria. The pr esent study attempted to validate this distinction. Akiskal's (1983) c riteria were applied to a sample of 97 early-onset dysthymic outpatien ts, yielding groups of 41 subaffective and 56 character spectrum patie nts. Patients were evaluated using structured interviews for Axis I an d II disorders, family history of psychopathology, and the early home environment, and a comprehensive battery of questionnaires. In additio n, direct and family history interviews were conducted with their firs t-degree relatives. There was mixed support for Akiskal's typology. Co nsistent with the model, subaffectives exhibited higher rates of major depression, depressive symptoms, and a number of depressive personali ty and cognitive features. In addition, there was a higher rate of alc oholism among the relatives of character spectrum patients. However, c ontrary to Akiskal's model, the groups did not differ on gender, unsta ble, personality disorders, family history of mood disorders, or the e arly home environment.