Primary affective disorder: delineation of a unipolar depressive subtype.

Abstract

Summary.-A small group of 4 atypical unipolar depressed Ss who exhibited characteristics consistent with Woodruff, et al.'s genetically based description of a chronic, unremitting subtype of primary unipolar disorder were identified on the basis of the following MMPI differences: (a) significantly higher Sc scores and, (b) non-peak D scores which, however, were not significantly different from those of the other unipolar Ss. While many subtypes of depressed Ss were described in the late nineteenth century, the studies of Kraepelin (1921) yielded a unitary approach which described all Ss with affective disorders as having manic-depressive insanity. Recently, investigation~ by Leonhard ( 1959), Perris ( 1966, 1972 ), and Winokor and Clayton ( 1967 ) have provided evidence that primary affective disorders, i.e., a previous episode of mania or depression unassociated with another psychological disorder, are separable into two distinct groups. The absence of mania is essential to the primary unipolar disorder whereas its presence defines the primary bipolar disorder. Support of this diagnostic distinction has expanded along several dimensions including the biological, genetic, psychopharmacologica1, and psychological. Two subtypes of unipolar primary disorder have been suggested by Winokur, Cadoret, Dorzab, and Baker (1971) and still another subtype has been described by Woodruff, Guze, and Clayton (1971), both on the basis of different genetic patterns: (a) female Ss with an onset prior to age 40 whose families show more depression in the female relatives than males, while the males show high rates of alcoholism and sociopathy; (b) male Ss whose disorder starts after age 40, with equal amounts of depression in both male and female relatives and no significant incidence of alcoholism or sociopathy in the males; and (c) Ss with chronic, unremitting depression over a period of many years. It is the objective of the present study to determine if psychological findings yield evidence suggestive of the existence of these subtypes among unipolar Ss.