What is Dysthymia and why high performers need to pay attention to it

“But I don’t have a big sad story like being abandoned by a parent or nearly losing my life”, is something I often hear.

One of the saddest things we do to hurt ourselves is when we think that our sufferings and challenges are not serious enough to warrant attention. We have been conditioned to think that unless we have that full-blown crisis, that constellation of symptoms which ticks all the boxes and we are completely debilitated, or that compelling tragedy, our sufferings are not worthy enough. Part of it comes from being asked to prove that we are suffering, by comments like “What do you have to be depressed about?” or “You are well-dressed, you can’t be depressed.”

Bit-by-bit, we adopt the identity of the sufferer. So if we seem to have a good life on the surface— the things you are thankful for, the glimpses or episodes of fun and meaning— we think it cheapens the suffering and makes our pain less valid. And then we say, “I’m not that depressed compared to someone else who is in bed and unable to get up.”

What this means is, we are telling ourselves we aren’t good enough to qualify to receive empathy from ourselves.

So with no respite from others and ourselves, it compounds the pain because we are conflicted. We suffer, and we cheapen it by pretending or talking ourselves out of it, when we are hurting.

And this is especially true when it comes to dysthymia, otherwise known as Persistent Depressive Disorder.

Here’s something I’ve learnt the hard way.

Pain is pain, and mental health challenges are mental health challenges. And every bit of the good life that you have— and that offers you respite from your pain— you worked towards it.

So let’s stop devaluing the effect of dysthymia on our lives.

What is dysthymia?

Dysthymia is currently known as Persistent Depressive Disorder in the Diagnostic and Statistical Manual (DSM-V), aka the bible of psychiatry. 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 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.

From feeling depressed or having a depressive episode, we call ourselves ‘depressed people’. This makes it hard to imagine a life free from its clutches— is that ever possible. Ditto who we would be if we weren’t depressed, because we’re so used to living that way.

People who are productive perfectionists— otherwise known as Type A personalities— tend towards dysthymia. This is often a dirty little secret. They look like they have it all, and are living their best lives. From the outside looking in, there is professional success, close relationships, status and prestige, and luxuries. Someone going to work and getting promoted, sending their children off to the best universities, and jetting off to exotic locations, can’t possibly be having that much trouble with their mood, memory or relationships, if they always deliver. Or so we think.

And this is why to call dysthymia a ‘low grade depression’ cheapens it. Because some people have learnt to become so well-adapted towards looking like they are functioning well, when they fight tooth and nail to keep up that façade. Often there is an increasingly complex and perilous house of cards stacked up— from lifestyle expenses to upkeeping 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 yet 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 realise we have been chasing the wrong things. Whilst mourning the time and energy lost that can never be reclaimed, and wondering how to start over again.

For others, it’s hitting a plateau in their very accomplished lives. They wonder if that is all life is going to be? And is it simply maintaining at this level, whilst feeling increasingly tired, lest it becomes a downhill ride from here? We are torn between gratitude for the material conditions and tangible blessings in life, and the realisation that this level of blessings cannot go on forever, or is not enough to sustain one’s future.

This really isn’t about believing that one is a special snowflake where the usual solutions to heal and evolve don’t apply– because Type As have always been proactive– but rather being unable to see how they can do it. Because they don’t believe they have the strength anymore. They feel depleted, a shadow of themselves, or that they have lost their nerve.

Common symptoms of dysthymia

According to the DSM-V, these are common symptoms of dysthymia:—

  • Intense sadness or hopelessness
  • Feelings of inadequacy or low self-esteem
  • Lack of interest in usual activities
  • Lack of energy, changes in sleeping patterns
  • Changes in appetite
  • Difficulty functioning at work or school
  • Difficulty concentrating or memory problems
  • Withdrawal from friends and family

 

What to do about it

First, meet the belief that you shouldn’t feel depressed with kindness. What ideas fuel this perspective? Common ones include, “What do I have in my life to feel depressed about?”, “I should be better already” and “Others are suffering more than me”. To be human is to experience some level of suffering and challenges in life, even if there isn’t some big trauma or tragedy that caused it. In fact, you could even reframe that not having that big trauma or tragedy is one less thing to worry about. And, having things to be thankful for in life does not invalidate your suffering; this isn’t a race to the bottom.

Second, consider what about the future weighs you down, that makes you feel fearful and/or empty. Common ones include, what if the money or accomplishments and promotions 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 are in essence, markers of imposter syndrome, which anyone looking to grow will inevitably experience. So acknowledge that you want to be there at the next level, and then ask yourself, how you can close the gap. Because with internal and external resources, most puzzles are solvable.

Third, examine the mindsets that erode your belief in your ability to grow, heal or get things done. These might include “If you are that good, why do you feel this way”, “If you are that good, why haven’t you sorted this issue out yet?”, and “You are a burden”— beliefs that many perfectionists hold. Being aware of these means that you can choose not to listen to them when they pop up, nor get upset with yourself when they do.

Fourth, run an objective audit of your resources. This isn’t simply about the relationships and material resources you have, but rather extends to your internal resources, especially how you have grown. Most of us base our idea of weak, inadequate, crumbling selves on a much younger version of ourselves, who in retrospect look like hot messes. 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? Remember, that younger you did their very best in terms of what they had; hindsight is always 20-20. Then, I invite you to reflect on all the ways you have become stronger and a better human being. You can ask your loved ones for their input, and consider all the objective markers that testify to your resources.

Fifth, consider what perfectionism has been shielding you from. My friend and clinical psychologist Karen Pooh (DClinPsy) says that in the journey to address dysthymia, the key lies in understanding the perfectionism aspect within ourselves. She offers that cultivating a compassionate self-dialogue with our inner self-critic can be healing. For instance, asking what fears perfectionism is trying to shield us from, such as guarding against the fear of negative judgement or rejection, provides insight to how this becomes a vicious cycle that consumes us.

Sixth, reflect on what changes within you contribute to your numbness. 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 fuelled 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. Here’s the deal: You don’t need to denigrate the priorities or fuel that got you to where you are today, even if you think they are silly, small-minded or unspiritual. You do not need to suddenly become all Zen and pretend that accomplishments don’t matter to you, because if that is what your life has always revolved around and you’re fighting it because you think it’s wrong, then you are adding to your own suffering. In essence, perhaps it’s useful to make peace with what got you here.

Seventh, make peace with the time you think you’ve lost, because it can feel as though dysthymia has robbed you of life force and slowed you down. Consider what things you gained in the process, that you weren’t setting out to achieve; or that you worked on as a side project or distraction. Because a gain is a gain, never mind the original motivation behind them.

Eighth, enjoy the view from the plateau. My favourite 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. I am reminded of the saying “Remember that what you have today is what you once prayed fervently for”. And, fears about the future aside, objectively, how would you rate your life right now, as it is?

Ninth, Pooh advocates thinking about designing our lives intentionally around values. She says that “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?”. This way, we can identify concrete steps towards meeting these values, which may include courage, flexibility, sensuality and discipline. Then, ask yourself, how would you know that you are there— for instance, what would your life look like across different departments, and how would you live differently?

Tenth, I advocate simplifying life. These include reflections like, 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”. Another way of thinking could be, what is your new life centred around— what would you maximise, and what would you minimise? For instance, if someone is prioritising their health, then they might maximise sleep and minimise saying yes out of a sense of obligation.

Last, 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. What are the very basic things you need to do to keep yourself mentally healthy? For many people, this might include protocols like getting morning sunlight, deep breathing three breaths to reset their brains when stressed, taking a ten minute walk, hydrating and eating sufficiently well. Keep showing up for yourself.

FAQs

1. What is dysthymia called now?

Dysthymia is called Persistent Depressive Disorder, according to the DSM-V.

2. What are the two types of dysthymia?

Anxious dysthymia is when people experience restlessness and low self-esteem. Those who have anergic dysthymia tend to be unable to experience pleasure, and feel sluggish.

3. Can people with dysthymia ever be happy?

Yes, pursuing a meaningful life, and training oneself to be grateful and not pay attention to the irrelevant depressive thought patterns help.

4. Who is prone to dysthymia?

People who identify as Type A and/or perfectionist personalities, suffering from chronic physical or mental health challenges, or undergoing life changes like ageing and bereavement, tend to be prone to dysthymia. Dysthymia also runs in families.

Takeaway

Growth is a beautiful thing, but it can also be trying. That is why they call it growing pains, especially when you know that the old worlds are dead and the new ones have not been born yet. 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.

So maybe, you just have to live a good life.

Your good life.