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Dysthymia or dysthymic disorder is a form of depression that ranges from mild to moderate intensity. The person may also experience bouts of severe depression in between. Additionally, the major feature of dysthymia is that it is high in chronicity. To be considered dysthymia, an individual must be persistently depressed most of the day, for at least two years. Due to this feature, dysthymia is also called persistent depressive disorder.

An individual with dysthymia experiences sadness most of the day, almost every day. Along with persistent sadness, the individual also feels a sense of emptiness, hopelessness, fatigue, lack of concentration, irregular sleeping patterns (either too much or too little sleep), change in appetite (eating too little or overeating), and low self-belief. A person with dysthymia may also have suicidal thoughts.

The specific causes of dysthymia are not yet known properly. It has been suggested that dysthymia has a genetic basis. It has also been suggested that people with dysthymia have a different brain structure or may even have chemical imbalances in the brain. Apart from that, traumatic experiences have also been suggested to be one of the causes of dysthymia.   

An individual who has dysthymia experiences a lot of difficulties in life. The aspect of chronicity associated with dysthymia becomes the main reason for the individual to face a number of challenges in life. The persistent mild/moderate depression completely drains out the person. 

The individual continuously experiences sadness and a lack of enthusiasm, to the extent that the feeling of happiness seems to be a myth. There is a constant struggle to experience positive affect. On the few occasions that the person experiences some positive emotions, it is usually in a half-hearted manner. 

The half-hearted happiness can be found even in moments that are worth celebrating or there might be a feeling of success or a sense of achievement. On such occasions, the sense of happiness and excitement is not truly experienced. The excitement that comes with achieving something does not even last very long. Any kind of happy occasion very soon seems like old news. Due to this continuous lack of enthusiasm, the idea of achieving something or getting success in life seems to have very little meaning.

The continuous lack of enthusiasm leads to experiencing low energy and an inexplicable sense of fatigue. This gets manifested in the person struggling to complete the simplest of tasks like managing daily household chores. It becomes very difficult for the person to start a new task. If somehow the task is started, it becomes almost impossible to complete it.

The constant feeling of tiredness makes the person always want to rest. In order to rest, if the person goes to bed, then getting out of bed seems to be extremely difficult. No matter how much the person rests and no matter how many hours the person sleeps, that constant sense of tiredness never goes away. The person always feels lackadaisical and out of sorts.

The persistent sadness also makes the person to be completely strained. It is like the individual is always under stress and feels a lot of pressure. A lot of times they appear to be sad or disturbed or stressed out. It becomes visible from their body language or facial expressions. 

This further makes the person become vulnerable and highly sensitive. The person easily feels hurt. The slightest of triggers can make the person teary-eyed or even have an emotional breakdown. Crying becomes almost a regular activity. All of this makes it very difficult to do any kind of work. The person lacks focus and has a lot of difficulty in concentrating.

A major challenge associated with experiencing dysthymia is developing a pessimistic view of life. Depression involves having depressogenic schemas - a set of very rigid patterns of reactions that are triggered by stressors. The continuous strain experienced due to the chronicity of dysthymia causes depressogenic schemas to be activated.

The psychiatrist Aaron Beck (founder of cognitive therapy and cognitive behavior therapy), the one who originally introduced this concept, suggests that depressogenic schemas are dysfunctional beliefs that give rise to negative automatic thoughts. These are thoughts that involve unpleasant and pessimistic predictions that often occur beyond awareness.

The negative automatic thoughts, according to Beck, center around three themes (cognitive triad) - negative thoughts about the self, negative thoughts about the surroundings, and negative thoughts about the future. These negative thoughts are maintained by cognitive distortions, which are internal biases that make the individual feel extremely miserable about themselves.

Dysthymia being chronic, the depressogenic schemas distort the thinking of the individual consistently. This, in turn, creates a very grim picture of the world. The individual, therefore, develops a sense of complete hopelessness and feels that nothing much can be done about the negativities in life that are going on.

Even though depression involves cognitive distortions, research shows that people with mild to moderate depression have a realistic, rationalistic, and accurate view of the world. This is known as depressive realism. This idea was proposed by the psychologists Lauren Alloy and Lyn Yvonne Ambrason. In contrast to this, non-depressed individuals tend to have positive illusions of the world. These positive illusions work well to shield people from the harsh realities of life and often give a rose-tinted view of the world.

However, this is not possible for a person with dysthymia. Dysthymia, involving mild to moderate depression, is associated with depressive realism. The negative aspects of society or the harsh realities of life, which are often overlooked or ignored by non-depressed people, are actually very minutely noticed by individuals with dysthymia. They often become sensitive about it and may start thinking that the world is not a very good place to be. In such instances, it becomes very difficult for a person with dysthymia to experience positive affect. It makes their life gloomy and melancholic.      

The prolonged depression, apart from daily activities, severely affects the social and interpersonal interactions of the individual. With the continuous feeling of sadness, a lot of times, the person with dysthymia does not even feel like meeting other people. Due to the chronicity of dysthymia, the person is quite often in a low mood. Meeting people requires being upbeat and friendly. However, a prolonged low mood does not allow that to happen. 

Quite often people also do not understand what is actually going on with the individual. Explaining to them about it seems to be futile, and pretending to be completely fine, including faking to be happy, seems to be too much of a task. The person, therefore, prefers not to meet people.

People with dysthymia, usually, do not want to reveal their vulnerable side to others. They feel that they might make the situation awkward. They also might feel that others will not understand it and might end up feeling embarrassed about it. Thus, they prefer to stay away from people.

Many-a-times, a lack of energy does not allow the individual with dysthymia to go out and interact with people. The constant fatigue makes them to just want to stay at home and not go out at all. Due to this, they have very limited social interactions.

Dysthymia, therefore, severely limits social and interpersonal interactions. The person with dysthymia often ends up living a reclusive and isolated life. They experience very little social support, which makes them feel more miserable and helpless. They end up feeling extremely lonely and even very alone in life.

It is not always that a person with dysthymia experiences a completely gloomy life. There are phases that come in between when they feel energetic, enthusiastic, and excited about their work, surroundings, and life in general. In such instances, the person might feel to be completely fine, as if nothing has happened. These phases, however, do not last too long. Such phases occur suddenly, and unexpectedly, but are only there for a very short period. It is like within all the gloom there are sometimes small openings of happiness.

When living with dysthymia for years, the person actually starts looking forward to these phases. When such a phase occurs, they try to utilize it as much as possible. In these phases, they will try to be as much productive as possible, they will try to be involved in as many activities as possible that give them joy and pleasure. They try to live life as much as possible before that small opening fades away again. This, perhaps, can be viewed as learning how to live with dysthymia.

Dysthymia does not actually get as much attention as major depressive disorder. Mild to moderate depression involved in dysthymia could be a reason for that. The chronicity involved in dysthymia, however, makes it to be very severe.

Experiencing mild to moderate depression continuously, almost all the time and every day, with the possibility of phases of severe depression in between, and only small, short-lived phases of positive affect, makes dysthymia seem to be almost as severe as major depressive disorder.

Saif Farooqi

A PhD in Psychology (from the University of Delhi). I have been blogging about psychological issues for more than ten years. I am extremely passionate about teaching psychology. I'm a writer, podcaster, and TEDx speaker. I also conduct workshops and awareness programs in schools and colleges. Currently, I'm also working as an Assistant Professor at the Department of Psychology, Faculty of Social Sciences, Jamia Millia Islamia, New Delhi, India


TF said...

Very nicely written with a lot of details about this disorder.

Saif Farooqi said...

Thank you! :)

Brian Arbenz said...

Very informative, and helpful to me. Thank you for posting this.

Saif Farooqi said...

Thank you Brian! Glad to know that