Eeyore: Dysthymic Disorder

Client: Eeyore

Background Information: Eeyore is an older grey donkey from the Winnie the Pooh Series by A. A. Milne.  There is no documentation on Eeyore's exact age or demographic information.  Eeyore is not currently employed.  Eeyore lives in the southeast corner of the Hundred Acre Wood in "Eeyore's Gloomy Place: Rather Boggy and Sad".  His housing is stable, but in poor condition as it regularly gets knocked down.  Eeyore is in general good health, but appears slightly underweight and often loses his tail.  Eeyore's posture is frequently in a slumped position and his eyes appear downcast and droopy.

Description of Problem: Eeyore has indicated that he has felt depressed for as long as he can remember. Eeyore has reported feeling a lack of interest in the activities his friends are engaging in.  Eeyore has low self esteem and is often tired or fatigued.  Eeyore often makes self-deprecating comments about his unimportance.  For example Eeyore is frequently saying "Thanks for noticing me".  Eeyore has a relatively hopeless outlook on life.  As reported by Pooh, after Pooh said good morning to Eeyore,  Eeyore gloomily responded by saying, "Good morning Pooh Bear.  If it is a good morning, which I doubt".  Eeyore has reported feeling that his close friends do not need him.

Diagnosis: Dysthymic Disorder 300.4

A.  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.  

B. Presence, while depressed, of two (or more) of the following:
 1.  poor appetite or overeating
 2.  insomnia or hypersomnia
 3.  low energy or fatigue
 4.  low self-esteem
 5.  poor concentration or difficulty making deciions
 6. feelings of hopelessness

C. During the 2-year period of the disturbance, the person has never been without the symptoms in Criteria A and B for more than 2 months at a time.
 Eeyore has reported always feeling sad or in a depressed mood.  For example, Eeyore stated that he tries to force a smile, a real smile has not existed in a long time.  Per Eeyore and observations by his friends, Eeyore has never been without symptoms for more than a 2 month period.  

D. No Major Depressive Episode has been present during the first 2 years of the disturbance i.e., the disturbance is not better accounted for by Chronic Major Depressive Disorder, Major Depressive Disorder or in Partial Remission.
 The criteria of Dysthymia are met due to the amount of time that Eeyore has experienced these depressed symptoms.

E. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode, and criteria have never been met for Cyclothymic Disorder.
Eeyore has never had a Manic Episode, a Mixed Episode, or a Hypomanic Episode, and criteria have never been met for Cyclothymic Disorder.
 
F.  The disturbance does not occur exclusively during the course of a chronic Psychotic Disorder, such as Schizophrenia or Delusional Disorder.
Eeyore shows no symptoms of chronic Psychotic Disorder such as Schizophrenia or Delusional Disorder. 

G.  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.
Eeyore is not currently taking any medications or drugs.  

H.  The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.  
Eeyore's symptoms have significantly impaired his social relationships with his peers and friends.  Eeyore shows little interest in social engagements and isolates himself for long periods of time. 

Strengths:  A strength of Eeyore's is that he continually tries to find some form of pleasure in life. Additionally, Eeyore has shown previous resiliency in past incidences when he has lost his tail or been in a conflict with his friends.  A coping mechanism of Eeyore's is to sit by himself and "cloud paint" or to be in the company of his friends.  Eeyore has a good support system in his friends who live in his neighborhood, in particular Pooh, Christopher Robin, Owl, and Piglet.