Persistent Depressive Disorder

You have probably heard of Bipolar Disorder and Major Depression, but perhaps not Persistent Depressive Disorder (PDD). The symptoms in PDD are less severe and dramatic compared to bipolar and major depression. For instance, suicide attempts, psychiatric hospitalization, and the need for anti-depressant medication are much more common with major depression and bipolar disorder.

PDD is largely a cognitive condition, a way of perceiving and thinking about events in your life in a negative way. If you think negative thoughts, especially about yourself, you are going to feel pretty rotten, and can become one of the “silent sufferers” afflicted with PDD. Do you go to work or school, care for your loved ones, and generally function OK, but have a gnawing feeling that others seem to enjoy life more than you do? Are you burdened with pessimism, guilt, lack of interest, low self-esteem, fatigue, social withdrawal, and concentration difficulties? Could be PDD.

The seeds of PDD are usually planted in childhood or adolescence, and can result from poor guidance in developing social skills, optimistic thinking, and a belief that you can deal with challenges. You grow up believing more and more that you are helpless; you dwell on negatives, and experience a steady build-up of stress. Laura is thirty years old and periodically physically abused by her husband. She never knows when she will be hit, slapped, pushed to the floor, or thrown against a wall. She would like to end her marriage but says, “I have no job and nowhere go, but even if I did, he’d find me and beat me. And I’ll never go to the cops because he said he’d kill me. I’m just depressed about it all and feel totally helpless.”

PDD is primarily an avoidance issue. You develop long-standing actions that allow you to avoid facing challenges and maintain your symptoms. You avoid the stressors that helped cause and sustain your life problems, the stressors that you must learn to confront. Your depression robs you of energy, motivation, and positive attitudes. Reggie is sixty-eight and lives in an apartment complex where drugs and gang activity are rampant. His apartment was burglarized, and he was robbed once while walking on the street. Reggie lives in perpetual fear of being attacked and feels totally helpless. In fact, the police captured the street attacker, but when asked to testify Reggie said, “No. What’s the use? He’ll just get off and come after me. I got nothin’ to fight him.”

 PDD drives many to seek psychological help, and frequently a diagnosis of depression results in a prescription for anti-depressant medication. Unfortunately, while medication can be effective with Major Depression and Bipolar Disorder, it is usually ineffective for PDD. If PDD is your problem, do not despair. Usually with the help of professional counseling, you can learn to challenge and face your demons.

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