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Chronic depression and dysthymia are even more likely to co-exist with anxiety disorders; indeed, some authors argue that dysthymic disorder (DD) is less common in a pure form than in a mixed depression, anxiety co-morbidity, for which the term cothymia has been proposed. Attention deficit hyperactivity disorder (ADHD) is an under-recognized problem in adults and is a common complicating factor in depression. People with depression have more Axis II disorders (most commonly dependent, avoidant, histrionic, or borderline personality disorder) than the general population. Individuals with chronic depression have more co-morbid Axis II disorders than do individuals with episodic major depression. Chronic depression, regardless of severity level, is associated with considerable functional impairment and morbidity. Chronic low-grade depression causes significant impairment and suffering. Dysthymia can be conceptualized as a prodromal disorder, since nearly all individuals with DD will at some point experience a full-blown major depressive episode.
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