Advice for Coping with Chronic Depression

By Jane Collingwood

What is it?
Chronic depression, also known as dysthymia or dysthymic disorder, is a form of low-grade depression which can last for several years. If you, or someone you are close to, are experiencing dysthymia then you may be on the look-out for more information on coping with the condition.
Briefly, dysthymia is a depression lasting at least two years without any substantial remission. It is said to affect roughly six in every hundred people. In contrast to clinical depression, dysthymia does not prevent a person from functioning normally. It does, however, prevent full enjoyment of life. People with dysthymia feel continuously disheartened and in a state of despair.
The definition of dysthymia also includes at least two of these symptoms: poor appetite or overeating; insomnia or excessive sleep; low energy or fatigue; low self-esteem; poor concentration or indecisiveness; and hopelessness. Dysthymia and major depression can occur together, and this is known as double depression.
So what can be done?
Family doctors often fail to recognize dysthymia, so most sufferers are undertreated. But once it is diagnosed, dysthymia is usually treated with psychotherapy and/or drugs. However, there are many lifestyle changes which can also help.
Is psychotherapy best?
Due to the long-term nature of dysthymia, a non-drug treatment is ideal. Many forms of psychotherapy can be considered, and while the therapist must remain patient, short-term goals should be set in order to improve daily functioning. Cognitive therapy, interpersonal therapy, and solution-focused therapy can be tried, as well as family, couples and group therapy.
How about medication?
Research studies have suggested a significant reduction in dysthymia symptoms with antidepressants. But this is not a straightforward matter – other studies have found no improvement, so the pros and cons must be weighed up on an individual basis.
A review in 2003 found tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) to be equally effective for dysthymia. While cheaper, TCAs such as imipramine (Tofranil) were more likely to cause side-effects than SSRIs like fluoxetine (Prozac) and sertraline (Zoloft).
What alternatives are available?
A range of alternative treatments exist which may benefit dysthymia. Extracts of St John’s wort have been found as effective as antidepressants for treating mild to moderate depression. Overall, though, the evidence is “inconsistent and confusing”, according to a 2005 review.
Some favourable results have been found for omega-3 fatty acids, either consumed as oily fish or as a supplement. It’s possible that future studies will show a definitive benefit, and in the meantime, oily fish has no known side-effects and can certainly be recommended for physical health.
Lifestyle changes
Other dietary supplements which may help include the B vitamins, potassium, and zinc. Of course, a healthy balanced diet is always a good idea, and making food look and smell appealing may encourage a suppressed appetite. Cutting down on, or avoiding, caffeine, alcohol and nicotine is a step in the right direction as they all have a bearing on physical and mental well-being. Seek professional help if necessary.
The herb valerian may be useful to combat the insomnia sometimes caused by dysthymia, and ginseng may benefit low energy levels. Aromatherapy, acupuncture, and other complementary therapies could also be tried.
Regular exercise is important for everyone, but can be particularly beneficial to people with dysthymia. Exercising releases the ‘happy’ chemicals called endorphins, and increases self-esteem. It will also help counteract overeating and promote good sleep.
Social support
For many people, the support of friends and family is invaluable in learning to cope with their dysthymia. Nevertheless, help and support from strangers can sometimes be easier to receive, and this is where support groups come in. Community-based support groups help many people to share their feelings, find friendship, and develop coping skills. Belonging to a dysthymia support group, together with psychotherapy, can substantially improve the chances of recovery.
Can dysthymia affect children?
Dysthymia is present in up to five per cent of children and eight per cent of adolescents. While the main symptom in adults is sadness, children and adolescents often display anger or irritable mood. It can have consequences on children’s social skills and education, later impacting on professional life and setting in place a vicious circle which may later trigger major depression.
As children with dysthymia often have multiple problems, treatment should involve a range of measures together with adequate support for the parents or caregivers.
Hopes for recovery
A full recovery from dysthymia is slow and not guaranteed, but around 70 per cent of patients do recover after four years. Of these, 50 per cent are likely to have a recurrence, so it may be sensible to continue with the successful measures which led to recovery.
A final word
Although depression can be devastating to all areas of a person’s everyday life, many people still believe that they should be able to shake off the symptoms by themselves. Because of this, people with dysthymia may not recognize that they have a treatable disorder or may avoid seeking treatment because of feeling shame or stigma. But, even if it takes several months, the majority of people can be helped to feel better.
Lastly, do call your doctor if your symptoms worsen or don’t improve despite treatment, or if you have thoughts of death or suicide.

Dissociative Identitty Disorder

Most commonly known as multiple personality disorder, dissociative identity disorder (DID) is a condition that can arise when a person suffers severe trauma early in life.  The trauma is typically severe and may involve repeated physical, emotional and sexual abuse. 
The mental illness involves the diagnosed experience at least two personality states which are referred to as alters.  Some sufferers of DID experience more than two alters.  The condition is more easily identified in females than males, which could reveal while more women are documented as suffering from dissociative identity disorder than men.
Dissociative identity disorder is an extreme form daydreaming.  Most people have experienced a minor form of dissociating with reality.  There are times when you may find yourself drifting off into a warm and fuzzy daydream, but DID involves a false sense of reality where there is a lack of connection within the sufferer’s thoughts, feelings and consequently their emotions and actions that result from a traumatic root cause.
The dissociative portion of the identity disorder allows the sufferer cope with the trauma.  The individual actually dissociates themselves from the painful experience that is too severe to deal with.  In order to think about the traumatic experience the person must separate from the pain and assimilate with a false reality.

Common Symptoms of Dissociative Identity Disorder

While dissociative identity disorder is commonly characterized by two or more personality states which control the person’s actions and behavior there are a number of sub-symptoms that sufferers may experience.  The following are some of the most commonly seen symptoms.

• Depression
• Anxiety
• Thoughts of suicide
• Sleep disorders
• Eating disorders
• Alcohol and/or drug abuse

Some sufferers of DID experience severe headaches, time loss and memory loss.  It is not uncommon for people with dissociative identity disorder to encounter times of trance and out of body experiences.  Most people with DID claim to do things during their altered state that they would not normally do.  For example, drinking and driving, visiting a prostitute or stealing money from relatives or close friends.

Who is affected by Dissociative Identity Disorder?

The precise cause of dissociative identity disorder is not known but studies have shown that as many as 98% of all sufferers have experienced a traumatic experience or repetitive abuse at one point or another during their lifetime.  Most individuals who develop this condition recall a history of life threatening abuse and experiences usually before the age of nine years old.
Children who have been emotionally neglected and endured severe abuse may be more prone to develop dissociative identity disorder.  Children who have been raised in a home where the parents were unpredictable and scary often become dissociative in behavior.

How to be Properly Diagnosed?

Time is of the essence when properly diagnosing dissociative identity disorder.  Due to the number of symptoms that accompany this disorder a precise diagnosis can take years to determine.  Secondary diagnoses often cause confusion or provide indicators of false disorders.
According to the DSM-IV there are four sets of criteria to be examined when diagnosing this disorder.  The first is that the individual must exhibit at least two personality states aside from their own.  The second set of criteria involves the personality states taking over the individual’s behavior and causing them to conduct themselves in a manner that is out of character.  The third indicator for diagnosis is that the person has a difficult time remembering anything personal.  The severe forgetfulness is often characterized as amnesia.  The last indicator for diagnosis is that the person suffers from substance abuse but the occasional blackouts or forgetfulness cannot be related to this abuse.
Patients are often seen for years by a psychotherapist or psychiatrist before being properly diagnosed.  People suffering from this disorder may spend years in mental health treatment before finding out that they are victims of this condition.  Once diagnosis is determined the proper treatment plan can be established.  Ongoing care is recommended even after the diagnosis has been made.

Constructing the Best Treatment Plan

There is no cure for dissociative identity disorder but there is at least a light at the end of the tunnel.  The best remedies for treating DID involve long term planning.  According to physicians and psychiatrists at the Mayo Clinic, effective treatment involves lengthy therapy sessions that have proven to be highly successful.
The best treatment plan for DID may include the following:

• Hypnotherapy
• Talk therapy
• Medication
• Movement therapy
• Psychotherapy

Since the condition often accompanies other disorders or issues, oftentimes individuals with DID are treated routinely for depression, anxiety or mood enhancement with much success in curbing the symptoms involved with dissociative identity disorder.  Many times people suffering from this condition benefit by the use of antidepressants or medication to treat anxiety.
Author: njewell
Publish Date: Tue, 03/08/2011 - 12:44
Categories: Dissociative Identity Disorder, Mental Health, Health

Dissociative Identity Disorder (Multiple Personality Disorder)

Dissociative identity disorder (previously known as multiple personality disorder) is a fairly common effect of severe trauma during early childhood, usually extreme, repetitive physical, sexual, and/or emotional abuse.

What Is Dissociative Identity Disorder?

Most of us have experienced mild dissociation, which is like daydreaming or getting lost in the moment while working on a project. However, dissociative identity disorder is a severe form of dissociation, a mental process, which produces a lack of connection in a person's thoughts, memories, feelings, actions, or sense of identity. Dissociative identity disorder is thought to stem from trauma experienced by the person with the disorder. The dissociative aspect is thought to be a coping mechanism -- the person literally dissociates himself from a situation or experience that's too violent, traumatic, or painful to assimilate with his conscious self.

Is Dissociative Identity Disorder Real?

You may wonder if dissociative identity disorder is real. After all, understanding the development of multiple personalities is difficult, even for highly trained experts. But dissociative identity disorder does exist. It is the most severe and chronic manifestation of the dissociative disorders that cause multiple personalities.
Other types of dissociative disorders defined in the DSM-IV, the main psychiatry manual used to classify mental illnesses, include dissociative amnesia, dissociative fugue, and depersonalization disorder.

What Are the Symptoms of Dissociative Identity Disorder?

Dissociative identity disorder is characterized by the presence of two or more distinct or split identities or personality states that continually have power over the person's behavior. With dissociative identity disorder, there's also an inability to recall key personal information that is too far-reaching to be explained as mere forgetfulness. With dissociative identity disorder, there are also highly distinct memory variations, which fluctuate with the person's split personality.
The "alters" or different identities have their own age, sex, or race. Each has his or her own postures, gestures, and distinct way of talking. Sometimes the alters are imaginary people; sometimes they are animals. As each personality reveals itself and controls the individuals' behavior and thoughts, it's called "switching." Switching can take seconds to minutes to days. When under hypnosis, the person's different "alters" or identities may be very responsive to the therapist's requests.
Along with the dissociation and multiple or split personalities, people with dissociative disorders may experience any of the following symptoms:

• Depression
• Mood swings
• Suicidal tendencies
• Sleep disorders (insomnia, night terrors, and sleep walking)
• Anxiety, panic attacks, and phobias (flashbacks, reactions to stimuli or "triggers")
• Alcohol and drug abuse
• Compulsions and rituals
• Psychotic-like symptoms (including auditory and visual hallucinations)
• Eating disorders

Other symptoms of dissociative identity disorder may include headache, amnesia, time loss, trances, and "out of body experiences." Some people with dissociative disorders have a tendency toward self-persecution, self-sabotage, and even violence (both self-inflicted and outwardly directed). As an example, someone with dissociative identity disorder may find themselves doing things they wouldn't normally do such as speeding, reckless driving, or stealing money from their employer or friend, yet they feel they are being compelled to do it. Some describe this feeling as being a passenger in their body rather than the driver. In other words, they truly believe they have no choice.

What's the Difference Between Dissociative Identity Disorder and Schizophrenia?

Schizophrenia and dissociative identity disorder are often confused, but they are very different.
Schizophrenia is a severe mental illness involving chronic (or recurrent) psychosis, characterized mainly by hearing or seeing things that aren't real (hallucinations) and thinking or believing things with no basis in reality (delusions). People with schizophrenia do not have multiple personalities. Delusions are the most common psychotic symptom in schizophrenia; hallucinations, particularly hearing voices, are apparent in about half of people.
Suicide is a risk with both schizophrenia and dissociative identity disorder, although patients with multiple personalities have a history of suicide attempt more often than other psychiatric patients.

How Does Dissociation Change the Way a Person Experiences Life?

There are several main ways in which the psychological processes of dissociative identity disorder change the way a person experiences living, including the following:

• Depersonalization. This is a sense of being detached from one's body and is often referred to as an "out-of-body" experience.
• Derealization. This is the feeling that the world is not real or looking foggy or far away.
• Amnesia. This is the failure to recall significant personal information that is so extensive it cannot be blamed on ordinary forgetfulness. There can also be micro-amnesias where the discussion engaged in is not remembered, or the content of a meaningful conversation is forgotten from one second to the next.
• Identity confusion or identity alteration. Both of these involve a sense of confusion about who a person is. An example of identity confusion is when a person sometimes feels a thrill while engaged in an activity (such as reckless driving, DUI, alcohol or drug abuse) which at other times would be revolting. In addition to these apparent alterations, the person may experience distortions in time, place, and situation.

It is now acknowledged that these dissociated states are not fully-mature personalities, but rather they represent a disjointed sense of identity. With the amnesia typically associated with dissociative identity disorder, different identity states remember different aspects of autobiographical information. There is usually a host personality within the individual, who identifies with the person's real name. Ironically, the host personality is usually unaware of the presence of other personalities.

What Roles Do the Different Personalities Play?

The distinct personalities may serve diverse roles in helping the individual cope with life's dilemmas. For instance, there's an average of two to four personalities present when the patient is initially diagnosed. Then there's an average of 13 to 15 personalities that can become known over the course of treatment. While unusual, there have been instances of dissociative identity disorder with more than 100 personalities. Environmental triggers or life events cause a sudden shift from one alter or personality to another.

Who Gets Dissociative Identity Disorder?

While the causes of dissociative identity disorder are still vague, research indicates that a combination of environmental and biological factors work together to cause it. As many as 98% to 99% of individuals who develop dissociative disorders have recognized personal histories of recurring, overpowering, and often life-threatening disturbances at a sensitive developmental stage of childhood (usually before age 9). Dissociation may also happen when there has been insistent neglect or emotional abuse, even when there has been no overt physical or sexual abuse. Findings show that in families where parents are frightening and unpredictable, the children may become dissociative.

How Is Dissociative Identity Disorder Diagnosed?

Making the diagnosis of dissociative identity disorder takes time. It's estimated that individuals with dissociative disorders have spent seven years in the mental health system prior to accurate diagnosis. This is common, because the list of symptoms that cause a person with a dissociative disorder to seek treatment is very similar to those of many other psychiatric diagnoses. In fact, many people who have dissociative disorders also have secondary diagnoses of depression, anxiety, or panic disorders.
The DSM-IV provides the following criteria to diagnose dissociative identity disorder:

1. Two or more distinct identities or personality states are present, each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self.
2. At least two of these identities or personality states recurrently take control of the person's behavior.
3. The person has an inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.
4. The disturbance is not due to the direct physiological effects of a substance (such as blackouts or chaotic behavior during alcohol intoxication) or a general medical condition (such as complex partial seizures).

Are There Famous People With Dissociative Identity Disorder?

Famous people with dissociative identity disorder include retired NFL star Herschel Walker, who says he's struggled with dissociative identity disorder for years but has only been treated for the past eight years.
Walker recently published a book about his struggles with dissociative identity disorder, along with his suicide attempts. Walker talks about a feeling of disconnect from childhood to the professional leagues. To cope, he developed a tough personality that didn't feel loneliness, one that was fearless and wanted to act out the anger he always suppressed. These "alters" could withstand the abuse he felt; other alters came to help him rise to national fame. Today, Walker realizes that these alternate personalities are part of dissociative identity disorder, which he was diagnosed with in adulthood.

How Common Is Dissociative Identity Disorder?

Statistics show the rate of dissociative identity disorder is .01% to 1% of the general population. Still, more than 1/3 of people say they feel as if they're watching themselves in a movie at times, and 7% percent of the population may have undiagnosed dissociative disorder.

What's the Recommended Treatment Plan for Dissociative Identity Disorder?

While there's no "cure" for dissociative identity disorder, long-term treatment is very successful, if the patient stays committed. Effective treatment includes talk therapy or psychotherapy, medications, hypnotherapy, and adjunctive therapies such as art or movement therapy.
Because oftentimes the symptoms of dissociative disorders occur with other disorders, such as anxiety and depression, dissociative disorder may be treated using the same drugs prescribed for those disorders. A person in treatment for a dissociative disorder might benefit from antidepressants or anti-anxiety medication.

article found on WebMD