When you think of depression, most likely, you picture someone with a sad look on their face. You might picture them with drooping shoulders, alone and downcast. You look at them and think, “I wonder what happened to them.”
When you think of depression, you think about someone, or yourself, in the middle of a major depressive episode. But there is another kind of depression that is called Persistent Depressive Disorder (PDD). It is sometimes called dysthymia. Unlike Major Depressive Disorder, PDD can be present in people who are high-functioning and seem to be doing well. But inside things are very different.
Some of the diagnostic criteria for PDD are:
· Sadness, emptiness or feeling down.
· Loss of interest in daily activities.
· Tiredness and lack of energy.
· Low self-esteem, self-criticism or feeling you're not capable.
· Trouble focusing clearly and trouble making decisions.
· Problems getting things done well and on time.
· Quickly becoming annoyed, impatient or angry.
· Avoidance of social activities.
· Feelings of guilt and worries over the past.
· Poor appetite or overeating.
· Sleep problems.
· Hopelessness.
High-functioning depression can be difficult to spot. If you look back over the diagnostic criteria, you might say that you’ve had some of those in your life. But PDD is usually chronic, and it doesn’t have a clear trigger. If you are struggling with PDD, you may say to yourself something like this, “Well, I wish I felt better, but I’ve been like this for years. This is just who I am.”
PDD is different from sadness.
Sadness is an honest and real feeling that comes from a precipitating event you can identify (death of a loved one, loss of a relationship, leaving a job you really love). While it doesn’t feel good, the sadness is honest because you know it is connected to something meaningful. If you are willing to embrace and feel the sadness, you get some relief.
But PDD does not offer any relief. In fact, because you can’t identify a precipitating event, you feel lost and clueless about where the feelings come from. You are able to go to work and do your daily activities, but often, there is a heaviness inside because you don’t feel a sense of meaning from your activities. You may feel boredom. You may feel like you are walking around in a cloud that you don’t understand.
It is not unusual to deal with PDD in ways that are not helpful, that do not express who you want to be. You may self-medicate with alcohol or substance abuse. You may stop doing activities you enjoy and isolate yourself. As you might imagine, these attempts to deal with PDD can make it worse, leaving you feeling more empty and void of meaning.
PDD can come from many different places.
One source is trauma. Experiencing a traumatic event doesn’t automatically lead to PDD, but if you do not process it, the thoughts and feelings associated with the trauma go deep inside and are buried, like a scar covering a deep wound. But these thoughts and feelings of trauma do not go away. They can bubble up and resurface in your life with some of the symptoms of PDD.
Another source of PDD is unresolved frustration. Again, all of us experience frustration, but if you do not find a way to deal with it, you push it aside and try to forge ahead. You focus on the tasks that need to be done. But like the thoughts and feelings of trauma, the hurt, the resentment, and the disappointment can resurface as depression.
What are some ways that you can address PDD?
One important way is to be intentional about taking care of yourself. PDD can lead to you living in a state of self-neglect. You stop doing activities that bring you meaning and joy, like exercise and creative expression (music, art, dance). Some part of you knows that doing this activities will make a difference, but you listen to those thoughts that tell you it won’t really matter.
An important way to deal with PDD is to develop a different relationship with the thoughts and feelings of chronic depression. Notice that the word “depression” is related to the word “depress.” It is a word that means to suppress, to deny, to push down or push away. With sadness, you feel and embrace your thoughts and feelings. With depression, you try to push them away.
This effort to avoid these thoughts and feelings may work short-term. But eventually they return, and often are more powerful and present when they do. By developing a stance of mindful acceptance, you are able to let the depression be there AND still choose behaviors that give your life meaning and joy.
You can learn more about how I work with people who struggle with PDD on my depression treatment specialty page.