Dysthymia: how to differentiate it from depression?

Depressive disorders have increased after the COVID-19 virus pandemic, even in children and adolescents.

We commonly associate sadness with depression, but it is possible to differentiate between sad states that we can all experience as adaptive and the different depressive disorders that can give yourself. It is important to make visible and know this so frequent problem, since it allows us to identify the symptoms and ask for professional help when it is required.

Dysthymia or persistent depressive disorder is a little known, but very prevalent depressive disorder in society. As the symptoms are less intense than major depression, it is more difficult for the patient to detect it. environment or the person himself, being able to evolve for years without receiving help professional.

However, dysthymia has a negative impact on the quality of life of people, generating health problems, in social relationships and at work.

• Related article: "The 6 types of mood disorders"

What really is dysthymia?

Persistent depressive disorder (dysthymia) is a disorder with a chronic course and less intensity than major depression. Consists in a depressed mood most days for at least two years, Accompanied by sleep disturbances, low energy, low self-esteem, lack of concentration, difficulties in making decisions and / or feelings of hopelessness.

Dysthymia usually has an age of onset prior to major depression, often beginning in adolescence or youth insidiously, this fact being an indicator of a more chronic course. In relation to gender differences, the prevalence is higher in women.

• You may be interested in: "Major Depression: Symptoms, Causes, and Treatment"

How do I know if I have dysthymia?

The symptoms of dysthymia can vary over the years in appearance and intensity. They tend to cause discomfort and affect the proper performance of daily activities. Among the most frequent are the following:

• Loss of interest in daily activities
• Feeling empty or sad
• Hopelessness
• Lack of energy
• Low self-esteem, self-criticism, feelings of worthlessness and guilt
• Difficulties in concentration and decision-making
• Decrease in activity and productivity
• Irritability
• Social isolation
• Alterations in eating habits
• Sleep disturbances

To be diagnosed with persistent depressive disorder the aforementioned symptoms must persist for at least two years in adults or one year in adolescents and children. In the latter, symptoms of dysthymia can include depressed mood and irritability.

• Related article: "Emotional management: 10 keys to master your emotions"

Can dysthymia affect social functioning?

Despite not being a central symptom of depressive disorders, both social functioning and ability to maintain and enjoy relationships are compromised with the symptoms of dysthymia. The most prominent are anhedonia, lack of motivation and loss of interest. As a result, people with persistent depressive disorder often have poorer intimate relationships and less satisfying social interactions.

The main alterations in social functioning are derived from a reduction in the desire to communicate, an increase in sensitivity to rejection or negative evaluation, problems in emotional identification and reduced ability to find effective solutions to problems interpersonal.

Difficulties in interpersonal relationships can contribute to maintaining the disorder and they are one of the main focuses of therapy.

• You may be interested in: "Top 7 Causes of Toxic Relationships"

Can dysthymia occur with other mental disorders?

The literature confirms that comorbidity in this disorder is common, especially with major depressive disorder and other anxiety disorders, as well as with substance use disorder.

Among anxiety disorders, social anxiety disorder and generalized anxiety disorder have been found to be the most commonly associated with dysthymia. Additionally, it is estimated that 10% of people with dysthymia end up developing major depression.

And what are the causes?

The etiology of the disorder is not yet clear, but its multifactorial character has been studiedIn other words, dysthymia can be derived from the interaction of biological, social and psychological factors. At the biological level, affectations have been observed in brain structures such as the amygdala, the hippocampus, the prefrontal cortex and the anterior cingulate cortex; as well as the hypothalamic-pituitary-adrenal axis and the noradrenergic system.

At the psychosocial level It has been seen that the experience of stressful events during childhood or youth can predispose to dysthymia. At the socio-family level, dysthymia has been associated with being without a partner and / or the loss or separation of parents in childhood.

The vulnerability factors that have been observed are: history of depression in first degree relatives, substance use disorder and antisocial personality disorder.

How do you work in therapy?

Treatment for dysthymia is similar to that for major depression, with cognitive-behavioral therapy being the treatment of choice for dysthymia with mild symptoms.

For moderate and severe episodes, the combination of the cognitive behavioral therapy with drug treatment. The psychotherapeutic intervention has the following main objectives:

• The improvement of mood, reducing symptoms such as anhedonia, the inability to experience or perceive positive events and hopelessness, among others.
• Behavioral activation, establishing a series of activities with the intention of recovering the pleasant areas of life.
• The identification of dysfunctional beliefs and behaviors and their subsequent replacement by more adaptive ones.
• Managing stress and learning adequate coping strategies for adaptation to other crises or difficulties.
• Social and communication skills training for the development of satisfying social interactions that reduce isolation.
• Effective and functional problem solving and decision making.

Author: Carla Carulla, child and adolescent psychologist at Elisabet Rodríguez Psicologia i Psicopedagogia.