Dysthymic Disorder

Name: Bill Dauterive, born Gillaume Fontaine de la Tour D'Haute Rive

Source: King of the Hill (Television series, 1997-2010)
Background Information
Bill Dauterive is a Caucasian male around the age of 42. This age estimate is based on his friends,
including Hank Hill, who has been stated to be 42 years old, and that he was in the same school grade as
his friends. Bill is from an upper-class family in Louisiana, around New Orleans. His family is not present
very often and the only remaining relative he has is a male cousin. His self-reports of childhood hardships
caused by his father could be fictitious because there is no way to verify this. He has almost no family so
genetic factors are hard to account for. His cousin is in good shape and healthy. Bill is the opposite. He
was told by a doctor that he would become diabetic if he did not change his lifestyle.
He was a high school athlete, nicknamed the Billdozer. He was very popular, had many friends and
even held the school touchdown record. He was drafted into the military his senior year of high school
and never graduated. He has remained in the Army and is now a Sergeant barber. He is not particularly
poor or wealthy. He is a simple person and does not have any extravagant tastes or interests that he has
reported.
He met his wife, Lenore, at a concert. She cheated on him and subsequently they divorced. This is
reportedly when the depressive symptoms began appearing. He could not heal from the divorce and
claims he still loves her. He became overweight and started losing his hair. His friends Dale Gribble, Jeff
Boomhauer, and Hank Hill constantly comment on his depression and try to help him. He has had this
core group of friends from a young age. They all live on the same street and get together in the alley to
have a beer often. Bill is obsessed with Hanks wife and believes she is the perfect picture of a woman.
She is the complete opposite of Bills ex-wife. Even though he has a core group of these 3 friends, they
often make fun of him and sometimes exclude him. He has a very poor sense of hygiene and his house is
often very dirty. His friends and their wives often make remarks about this.
He is in a depressive state most of the time. The only time he is out of a depressive state is when he is
with a woman (who always later rejects him) or gets very involved in a project, such as an instance where
he turned his home into a halfway house. He enjoyed the company and enjoyed being needed, but the
occupants took advantage of him and he missed so many days at work the Army almost reported him
Absent Without Leave, or AWOL. He clings to women he gets into relationships with very quickly. He will
be overly dedicated to the women but they always end up taking advantage of him and ending the
relationship. He perceives relationships to be more serious than they are in reality. This behavior
inevitably drives them away.
Description of the Problem
Bill often states that he is depressed. This depression has lasted since his divorce, which is estimated to
be 7-9 years ago. He is in a depressed state most of the time. Others describe him as very depressed
and down. He has some periods of normality, but usually he is just depressed. He believes no one loves
him or will love him and gets into relationships in which he is very likely to be rejected. He overeats and
does not take care of himself very well. He has a very poor image of himself but does not seem to care
enough to attempt to better himself.
He often speaks of his ex-wife and the divorce and of still loving her. If he is not working, he is at home
eating and watching TV or in the alley having a beer with his friends. He does not do much else. His
friends often remark on his bringing up of his divorce and try to set him up with women, but the women
usually reject him. There have been a few relationships he has ended himself, but the majority are not his
choice His friends attempt to tell him he is too good for his ex-wife and that she is not coming back.
Bill gets particularly depressed around the holidays. He usually spends Thanksgiving with Hank Hills
family, which is very intrusive to them. He went through a period of suicidal actions and thoughts but
never completed or repeated these behaviors. His friends were constantly watching him.

Diagnosis
The disorder Bill Dauterive most accurately can be diagnosed as having is 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.
Bill is self-described as being depressed a lot of the time. His friends also state that he is depressed all of
the time and it has been going on for longer than 2 years. In fact, it is closer to 7 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 decisions

6.

feelings of hopelessness
Bill experiences overeating, low energy and fatigue, low self-esteem, and feelings of hopelessness.
Occasionally he experiences insomnia and poor concentration. Quite often his despair will lead him to
overeat which leads to further low self-esteem. The symptoms seem to compound themselves. Bills
friend Hank is usually the one who makes a lot of Bills decisions because he has difficulty doing so
himself, whether everyday decisions or more meaningful decisions.
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.
Bill fits this and does not seem to reach the 2 month mark for absence of symptoms. Bills symptoms of
depression seem to be chronic. He is never out of his depressed state for longer than a few days and this
is usually because he has found someone to be in a relationship with for a short time.
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, or Major Depressive
Disorder, In Partial Remission.
This is hard to account for because Bill is being seen 7 years after the onset. Since it has lasted so long,
however, Dysthymic Disorder accounts for it very well.
E. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode, and criteria have
never been met for Cyclothymic Disorder.
There has been no evidence of a hypomanic episode. The closest period would be when Bill experiences
some type of normalcy does not last very long. He does not have manic episodes or even hypomanic
episodes. Sometimes he is obsessive but that does not last very long and he slips back into depression,
no period of normalcy is seen. He does not qualify for Cyclothymic Disorder because he does not have
periods of hypomanic or manic symptoms.
F. The disturbance does not occur exclusively during the course of a chronic Psychotic Disorder, such as

Schizophrenia or Delusional Disorder.

Bill does not have symptoms of a Psychotic 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 (e.g., hypothyroidism).
Bill does not present with any substance abuse or other medical conditions. Before the onset of
Dysthymic Disorder, he was happy, popular, and content with his life. He does drink a beer in the alley
with his friends nearly everyday, but it is usually just one beer. If he is feeling extremely depressed, he will
drink to excess, but this is a result of his depression, not a cause.
H. The symptoms cause clinically significant distress or impairment in social, occupational, or other
important areas of functioning.
This disorder impacts every portion of Bills life. He needs to be needed, and when he is, for short periods
of time, it makes him miss work; he was almost listed as AWOL on more than one occasion. In his social
life, his depression causes major impairment. All his friends state that he is depressed all the time. He
does not take care of himself which leads to low self-esteem. This majorly impacts his attempts at finding
a date. He does not make new friends, and he only has the core group of friends he grew up with. When
he attempts to meet new people, he is usually rejected and thus, he does not try very often.
Regarding etiology, Bills Dysthymia seems to have been caused by his divorce, so the psychosocial
causal factor fits. There is no way to determine if genetic factors are possible as his only living relative is a
male cousin.
Accuracy of Portrayal
An average person watching Bill in King of the Hill would get a very good idea for what Dysthymic
Disorder is. Bill expresses almost all of the symptoms, almost all of the time. The portrayal is accurate in
that Bill exhibits almost all of the symptoms of Dysthymic Disorder, nearly all the time. Saying that Bill is
depressed all of the time is not an exaggeration. In people with Major Depressive Disorder there are
longer periods of normalcy, but in Dysthymic Disorder there are not long periods of normalcy. More often
than not, Bill is depressed. Major Depressive Disorder is more about episodes of depression, but
Dysthymic Disorder is depression nearly all of the time, and Bill exhibits this. The only inaccuracy was his
period of suicidality, but this was a cry for help, not an actual wish of death. It was not repeated.
Treatment
Dysthymia has not been widely studied and this impacts research on treatment. Many findings from Major
Depressive Disorder have been applied to Dysthymic Disorder, since it is often referred to as a milder
form of Major Depressive Disorder.
One could begin by treating Bill with an antidepressant. After the appropriate dosage was found, he would
begin psychotherapy. Bill needs to be taught about the disorder and recognize that he is not in a normal
state of mind and begin to come out of it. Since he does not really have any family to speak of to attend
therapy with him, his friends should accompany him because they are the individuals he sees most often.
They could be shown that their comments to Bill are hurtful and need to end. If Bills core group of friends
were taught about Dysthymic Disorder they could learn ways to help Bill when he was feeling down and
make him feel better about himself and the situations he finds himself in.
A therapist could use cognitive therapy to help Bill change how he sees the world and to think more
optimistically. This would show Bill that not every bad thing that happens is a crisis and which events to
just let go of. He needs help getting over his divorce and gaining his self-esteem back. Other
recommendations that he find a hobby he likes and recommend him to someone to help him with
nutritional skills, such as what to eat and what to cook.