Dysthymia Is Known As Persistent Depressive Disorder — Here's What It Looks Like

One of the saddest things we do to hurt ourselves is thinking our suffering is not serious enough to warrant attention. We've been conditioned to think that unless we have a full-blown crisis, tick every symptom box, or have a compelling tragedy, our sufferings are not worthy enough.

And if we seem to have a good life on the surface, we think that makes our pain less valid—and then we say, "I'm not that depressed compared to someone who can't get out of bed."

But all this means is we're telling ourselves we aren't good enough to qualify for empathy from ourselves. We suffer, and we cheapen it by pretending, or talking ourselves out of it. And this is especially true when it comes to dysthymia, aka persistent depressive disorder. 

"Dysthymia" is currently known as persistent depressive disorder in the Diagnostic and Statistical Manual (DSM-V). It is more persistent and less severe than depression, meaning that the individual experiencing dysthymia must have had it for at least two years, but without the same intensity of depressive symptoms...but that doesn't tell us much.

In some people, this manifests as anxious dysthymia, where they experience restlessness and low self-esteem. Those who have anergic dysthymia, meanwhile, tend to be unable to experience pleasure, and feel sluggish. 

To be depressed isn't about feeling sad. Sadness is an emotion we can feel and register. In contrast, to be depressed is to be numb. And the longer we carry numbness for, the heavier it feels, and the deeper it becomes etched into how we see ourselves. 

People who are productive perfectionists—otherwise known as type A personalities—tend towards dysthymia1. This is often their "dirty little secret," because they look like they have it all. Someone getting promoted at work or jetting off to exotic locations can't possibly be having that much trouble if they always deliver, right? So we think. 

This is why calling dysthymia "low grade depression" cheapens it, because some people have become so well-adapted to looking like they're functioning well, when they're actually fight tooth-and-nail to keep up that façade. There's often an increasingly complex and perilous house of cards stacked up as well, from lifestyle expenses, to up-keeping loved ones, to the shame of being outed. But keeping up appearances gets increasingly exhausting over time, and the longer this goes on, the bigger the chasm between appearances and reality, which makes it harder to maintain and simultaneously more urgent to maintain. 

Sometimes the numbness from striving and achieving non-stop, but wondering if we can sustain it before the house of cards falls, can contribute to dysthymia. At other times, it is an all-enveloping grief as priorities change, and we realize we've been chasing the wrong things. We mourn the time and energy lost that can never be reclaimed, and wonder how to start over again.

For others, it's hitting a plateau in their very accomplished lives. Will they simply have to maintain at this level, feeling increasingly tired, lest it becomes a downhill ride from here? We're torn between gratitude for the material conditions and tangible blessings in life, and the realization that it cannot go on forever, or is not enough to sustain one's future. 

What ideas fuel the perspective that you shouldn't be depressed? Common ones include, "What do I have in my life to feel depressed about?" or "I should be better already," and even, "Others are suffering more than me."

What makes you feel fearful and/or empty? Common ones include worrying that money or accomplishments or promotions will stop happening. Or, what if your health, energy, or skills are not enough to support the next level of development you are expected to rise to?

These mindsets might include, "If you are that good, why do you feel this way?" or "If you are that good, why haven't you sorted this issue out yet?" You might even feel you're a burden—a belief many perfectionists hold.

This isn't simply about the relationships and material resources you have but rather extends to your internal resources, especially how you've grown. Most of us hold onto a much younger version of ourselves—one who looks like a hot mess. So when you say you cannot create or sustain your future, which version of yourself are you hanging this on, and how old is that self?

My friend and clinical psychologist Karen Pooh, DClinPsy, says that in the journey to address dysthymia, the key lies in understanding the perfectionist within us.

Perhaps, your priorities have changed, and being unused to it, you have doubts about your future. In this case, what are the biggest fears or concerns, and what new ways of being or thinking have you been fighting? Or maybe, the fuel you used to run on no longer matters.

Many of my Type A clients have historically been fueled by earning impressive amounts of money, winning someone's love or approval, or wanting to prove someone wrong. And when they have reached that goal, the blank canvas of What's Next can feel bleak, rather than exciting.

Others who feel they have lost their courage for living also dismiss their old bravery as if their old self ran on a delusional or impulsive motivation. Being cautious and older, bravado no longer applies.

My favorite reflection here would be, if your younger self could see you now, what would they be immensely surprised by? Which wildest dreams have you fulfilled for them? And then what extra bonuses are you enjoying that they wouldn't even have dared to dream of?

Pooh advocates thinking about designing our lives intentionally around values. She says, "Values serve as guiding principles that imbue life with significance and direction."

You can ask yourself, "Beyond the glittering facade of my accomplishments, what kind of person do I authentically aspire to become?" or, "What facets of life hold the utmost importance for me? What do I hope people will remember about me, and what legacy do I wish to leave behind?"

What are the things that preoccupy you the most, and how can we solve them? What are the things that weigh your life down the most—for instance, tasks, expenses, and relationships—that you can take a step back or delete? And what needless sufferings have you been tolerating your whole life, that you can let go of?

This might include beliefs like, "If I shine too brightly, I am betraying my family," or, "If I don't solve others' problems, then I am not a good person."

Lastly, how can you commit to taking care of yourself especially when things are tough? Because as you take on a new lifestyle, you discard old ways of thinking, being, and seeing the world, and that can be painful and awkward. Some days may be harder than others, and some days you may lose your faith in the process.

Growth is a beautiful thing, but it can also be trying. Some days you have to keep going on, breath by breath, and step by step. When things feel challenging, zooming out helps us see how far we have come. We say a silent prayer of thanks to ourselves for showing up for us. That helps.

And as we grow, we shed things that no longer matter, or perhaps have never quite mattered apart from felt like expectations placed squarely upon our shoulders. There is no need to deny or denigrate our history and our story, but rather use our resources to get us towards the life we wish to live. 

Because life is precious—and maybe, consider that in spite of what everyone says, you don't need to live your best life. That means you don't need to prove that you are ticking all the boxes, if they add little value or aren't aligned with who you are.