When the Outside Doesn’t Match the Inside: Persistent Depressive Disorder

You’re the one always smiling…laughing, even, trying to prove to the world (and even to yourself) that you’re having fun in the social setting that you forced yourself to go to. You often feel down in the dumps, worrying that people see through your façade and feeling guilty for possibly pulling them down with you. Maybe joy comes in small waves, but your laughter has been fake for so long that you don’t even know what’s real anymore. You’re hurting on the inside, but no one asks, no one shows concern. No one knows. You stand still on the outside, looking in the window as those around you keep moving forward.

You tell yourself that it isn’t that bad – that you go to work, get things done, that life is generally good. You have felt numb for so long, though, that you don’t feel truly alive – that you’re some zombie robot going through the motions, reaching for a magical cure to revive you. Even on the most exciting of occasions, you feel like your body has a filter, blocking the happiness from fully reaching you.

When we talk about depression, people often think we mean suicidal thoughts, complete and utter hopelessness for the future, and a total inability to get out of bed. Depression takes many forms, though, and Persistent Depressive Disorder can be so easy to miss. He lurks in your life, gently and subtly easing symptoms your way for years – so long that those feelings become a normal way of life and you’ve learned to live with him as your annoying roommate that just won’t leave.

You eventually find routine in your poor or excessive appetite, your sleep problems, irritability, poor concentration, and your low energy. Your quality of life has been greatly reduced, and you attribute it as a personal failure, feeling like your inadequacy is so great that you aren’t capable or even deserving of pure joy. You lack of confidence in decision making, struggling to move from the lonely stepping stone you’re stuck on and wondering if you’re deserving when opportunity arises. You’ve lost your interest in what used to give you passion, and feel hopeless that things will ever change, accepting your depressed mood as fate and isolating yourself in the process.

Persistent Depressive Disorder (PDD) is considered chronic, as symptoms are present for at least two years. While symptoms are more subtle than Major Depressive Disorder, it is not uncommon to experience at least one major depressive episode at some point for those with PDD.


  • Genetic and Physiological:
    • Those with PDD have a higher proportion of relatives with PDD – PDD and severe depression is more likely caused by genetic factors rather than environmental ones
  • Environmental:
    • Traumatic or parental loss / separation are childhood risk factors
  • Temperamental:
    • Higher levels of negative affectivity (a variety of negative emotions, including anger, contempt, disgust, guilt, fear, and nervousness, and poor self-concept), anxiety disorders, or conduct disorder in childhood are factors predictive of poorer long-term outcomes

Finding relief:

To find some relief from feeling numb, overwhelmed with sadness, or disconnected, one thing we can do is to create a comfort box focusing on all five of our senses (touch, sight, smell, taste, sound). When we stimulate all of our senses, it helps us to feel grounded and reconnected with ourselves, bringing us to the present moment when we’re distressed.

If this resonated with you, know that this does not define you, and that you can find further relief through counseling. Your quality of life matters, and life is never “too good” to benefit from counseling. #endthestigma

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