Conversely, where there is a smaller genetic contribution greater life stress is required to produce the particular result. Even so, someone with a diathesis towards a disorder does not necessarily mean they will ever develop the disorder. Both the diathesis and the stress are required for this to happen.
The diathesis-stress model has been reformulated in the last 20 years as the stress-vulnerability-protective factors model, particularly by Dr. Robert P. Liberman and his colleagues in the field of psychiatric rehabilitation. This model has had profound benefits for people with severe and persistent mental illnesses.
It has stimulated research on the common stressors that people with disorders such as such as schizophrenia experience. More importantly, it has stimulated research and treatment on how to mitigate this stress, and therefore reduce the expression of the diathesis, by developing protective factors.
Protective factors include rigorous and nuanced psychopharmacology, skill building (especially problem solving and basic communication skills) and the development of support systems for individuals with these illnesses.
Even more importantly, the stress-vulnerability-protective factors model has allowed mental health workers, family members, and clients to create a sophisticated personal profile of what happens when the person is doing poorly (the diathesis), what hurts (the stressors), and what helps (the protective factors). This has resulted in more humane, effective, efficient, and empowering treatment interventions
People who have Dysthymic disorder will often report that they don’t recall ever not feeling depressed, but they may be relatively functional in managing their life, although the symptoms are severe enough to cause distress and interference with important life role responsibilities. It is important to have a complete physical to rule out any physical illnesses that might be causing the depression.
Also, if the person has a chronic medical condition that appears to be the cause for the depression (such as any chronic debilitating condition), then the correct diagnosis might be a Mood Disorder due to a general Medical Condition, even if all the criteria for Dysthymic disorder are met. The question is whether the medical condition is physically causing the depression, rather than creating chronic psychological distress that is causing the depression.
Despite the long term nature of this type of depression, psychotherapy is effective in reducing the symptoms of depression, and assisting the person in managing his/her life better. Some individuals with Dysthymic disorder respond well to antidepressant medication, in addition to psychotherapy, so an evaluation for medication may be appropriate.
Two groups of mood disorders are broadly recognized; the division is based on whether the person has ever had a manic or hypomanic episode. Thus, there are depressive disorders, of which the best known and most researched is major depressive disorder (MDD) commonly called clinical depression or major depression, and bipolar disorder (BD), formerly known as “manic depression” and described by intermittent periods of manic and depressed episodes.