Dysthymia

The following piece of writing is a snapshot of a presentation for someone I worked with who has Dysthymia.  Diagnosis is complex and symptoms vary. Please see your GP if you feel you may have the condition or are experiencing similar symptoms.

A couple of years ago I began work with a client who stated her doctor thought she had Dysthymia. I had heard of the condition, however did not know much about it other than its symptoms are similar to that of clinical depression.

I decided to research Dysthymia to ensure I was providing the best possible psychological therapy service I could for my client, taking into account her GP diagnosis.

I discovered that the condition combines a mood disorder with chronic depression and has long lasting symptoms (more than two years for adults). This was true for my client as she stated she had been feeling "low' and '‘moody" for years and was starting to believe this was her personality.

Her parents would say to her “why can’t you be happy and cheerful like your friends?”.  My client, let’s call her Alison, would feel further inhibited by these comments and a spiral of low mood would continue.

It wasn’t until Alison was in her late 20’s that she became fed up with feeling low and sad on a regular basis and wanted to seek help. Colleagues would always ask her “are you alright?” even when Alison thought she was having a ‘good’ day. She visited her doctor who prescribed a low dose of anti depressants and recommended counselling, which is how she came to be a client of mine.

Alison’s symptoms when I first met her included overeating and using food as a comfort. She was slightly overweight and stated she had struggled with her weight since early teens. This factor had contributed to low self esteem and confidence issues, particularly in school and it wasn’t until she was 15/16 that she established a couple of close friends.

Alison seemed like a successful career person however and was beginning to question whether she should just ‘put up with’ how she felt all of the time, seemingly for no reason. Family would tell her to “cheer up”, but then didn’t bother after a while as they became used to Alison seeming down in the dumps thus fuelling a sense of isolation and feeling as though nobody cared.

Aside from symptoms Alison described, I noticed her presentation was, at times, unkempt. Her hair was dishevelled as though she had tied it back before going to bed and hadn’t bothered to redo her hair the following day. She never wore makeup and rarely smiled, although she sometimes gave me a glimpse of her fun, dry sense of humour.  I could certainly see, even early on, the potential I hoped Alison would reach in time.

I quickly noticed that Alison complained a lot about colleagues and management, yet lacked a desire, or perhaps energy, to solve issues she had with them. The counselling was slow work and we spent quite a few weeks building rapport and trust within the therapeutic relationship.  I wanted Alison to feel safe enough to explore her emotions, thoughts and behaviour.  Sure enough, she  began to feel more comfortable within the counselling setting and I saw Alison's personality emerge.

She would smile and at times laugh about something that had happened in her week - this would catch her by surprise the first few times it happened!  After about four months of counselling, Alison began to report social outings she had been on and I noticed subtle changes in presentation, such as a new pair of shoes or a bit of mascara. She complained less, especially about others.  Alison was getting to know herself and as a consequence, her world outside the counselling room was slowly changing, peoples responses to her were more friendly… people began to notice her and were no longer avoiding her in the canteen at work.  She reported feeling more balanced emotionally…less major lows.  

Alison's mood was lifting, however I felt great responsibility to ensure this happened at a slow and manageable pace otherwise Alison was in danger of feeling unsafe, that her world was becoming unfamiliar which could rock the foundations of her coping structure. As an adult she had not known feeling anything other than ‘sad’ for much of the time.

Sure enough, Alison hit a point whereby she just cried for the whole session. She felt as though she didn’t know herself and seemed scared of change. With lots of listening, reassurance and gentle reflections of her achievements in recent weeks, this low point was temporary, however I believe may have been grief in response to the loss of what she had known for so long.  Feeling sad and low much of the time was familiar and in Alison's world, safe.  She knew what to expect and how the 'world' would respond to her.  Transitions, even positive transitions can be a real roller coaster of emotions and the pull to keep us in the default position can be strong.   

A few months later, Alison felt ready to end the counselling. She was still on anti depressants but was attending three monthly reviews with her doctor.  I am confident that Alison had broken away from the strength of her attachment of Dysthymia. She now knew she had the ability and a stronger coping structure, one more free of sabotage, to maintain a sense of positive wellbeing.  Alison was grounded enough, however, to know that there would be challenging days ahead and that she will possibly always be on a journey of learning a more fulfilling way to live with mental health issues.

One thing was for sure, Alison did not directly fall into the specific diagnosis of Dysthymia by the end of her counselling as she had experienced more good days than bad for a substantial period of time.  I really hope this continued for Alison and I also hope her story can offer you hope if you have had a diagnosis of dysthymia, depression or other mental health illness.  Believe that you can feel better.  A diagnosis does not have to define you as a person and with the right support, treatment, time and willing, you too can have more good days.   


See my page on signs of depression for symptoms and treatment options.

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See Dysthymia UK for more information