hood at a time of vulnerability in personal devel-
opment of sense of self. The various personalities
may know of each other or be unaware that the
others exist. Dissociative identity disorder is highly
debilitating.
Treatment may combine ANTIPSYCHOTIC MEDICA-
TIONSand intensive PSYCHOTHERAPY. The extent to
which treatment succeeds depends on multiple
factors, which are difficult to predict at the onset
of treatment. RECURRENCE and relapse are com-
mon.
See also ACUTE STRESS DISORDER; BRIEF REACTIVE
PSYCHOSIS.
dysthymic disorder Low-intensity, long-term or
chronic DEPRESSION. A key characteristic of dys-
thymic disorder, also called dysthymia, is that the
person is generally able to function in the world
though does not feel much joy or pleasure. Irri-
tability, tiredness, and disinterest in most activities
are other hallmark symptoms. Treatment that
combines therapy (such as COGNITIVE THERAPYor
BEHAVIORAL MODIFICATION THERAPY) and ANTIDEPRES-
SANT MEDICATIONSis often effective in diminishing
symptoms and helping affected people learn pro-
ductive COPING MECHANISMS to accommodate
aspects of their lives that cause stress. Alternative
and complementary methods such as BIOFEEDBACK,
HYPNOSIS, MEDITATION, and VISUALIZATIONare often
helpful for reducing symptoms as well as restoring
a sense of control about the person’s life circum-
stances.
See also ST. JOHN’S WORT; STRESS AND STRESS MAN-
AGEMENT.dysthymic disorder 373