Dysthymia, or chronic depression, is a common symptom of codependency; however, many codependents aren’t aware that they’re depressed. Because the symptoms are mild, most people with chronic depression wait 10 years before seeking treatment.
Dysthymia doesn’t usually impair daily functioning, but it can make life feel empty and joyless. Sufferers have a diminished capacity to experience pleasure and may withdraw from stressful or challenging activities. Their emotions are dulled, though they may feel sad or melancholy or be irritable and anger easily. Unlike with major depression, they’re not incapacitated, yet they may have difficulty trying new things, socializing, and advancing in their career. Some may believe that their lack of drive and negative mood is part of their personality, rather than that they have an illness. Like codependency, dysthymia causes changes in thinking, feelings, behavior, and physical well-being.
Dysthymia was renamed “persistent depressive disorder” in the 2013 edition of the Diagnostic Statistical Manual-V. (I use the terms “dysthymia,” “persistent depressive disorder,” and “chronic depression” interchangeably.) Symptoms must have persisted for at least two years (one year for children and teens) and include at least two of the following:
- Low energy or fatigue
- Sleep disturbances
- Increased or decreased appetite
- Irritable or angered easily (for children and teens)
- Low self-esteem
- Difficulty concentrating or making decisions
- Feeling hopeless or pessimistic
The symptoms must create significant distress or impairment in social, occupational, educational or other important areas of functioning. Although mood remains persistently “down,” it may improve for several weeks of feeling better. Untreated, depression soon returns for longer periods.
People are usually motivated to seek help in order to cope with a relationship or work problem or a major loss that triggers more intense symptoms. When they rise to the level of major depression, which can often occur in people with dysthymia, the diagnosis is “double depression” — major depression on top of dysthymia. Unlike chronic depression, an episode of major depression may only last a few weeks, but it makes a subsequent episode more likely.
Dysthymia affects approximately 5.4 percent of the U.S. population age 18 and older. The numbers may be much higher, since it often goes undiagnosed and untreated. Over half of dysthymic patients have a chronic illness or another psychological diagnosis, such as anxiety or drug or alcohol addiction. Dysthymia is more common in women (as is major depression) and after divorce. There may not be an identifiable trigger; however, in cases of childhood or adolescent onset, research suggests that there is a genetic component.
Although stress can be a factor in depression, some people don’t experience a life event that triggered their depression. There are individuals with chronic depression who blame their mood on their relationship or work, not realizing that their outer circumstances are only exacerbating an internal problem. For example, they may believe that they will feel fine when they achieve a goal or when a loved one changes or returns their love. They’re unaware that the real cause is that they’re striving to prove themselves to compensate for feeling inadequate, or that they have no life of their own, have sacrificed self-care for someone else, or that they feel unlovable and worthy of love. They don’t realize that their depression and emptiness stem from their childhood and codependency.
Codependents, by nature of their addiction to people, substances, or compulsive processes, lose touch with their innate self. This drains their vitality and over time is a source of depression. Denial, the hallmark of addiction, can also lead to depression.