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When the Outside Doesn’t Match the Inside: Part One

Persistent Depressive Disorder

You’re the one always smiling and laughing to prove that you’re having fun in the social setting that you forced yourself to go to. You ask yourself, “can people see through my façade?,” and feel guilty for possibly pulling them down with you. Maybe joy comes in small waves. However, 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. Therefore, no one knows. You stand still and look out 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, and life is generally good. However, you’ve felt numb feelings for so long that you don’t feel truly alive. Instead, you’re some zombie robot going through the motions and search for a magical cure to revive you. You feel like your body has a filter that blocks out the happiness – even on the most exciting occasion.

People often think about suicidal thoughts, hopelessness, and an inability to get out of bed when talking about depression. Depression takes many forms, though. As a result, Persistent Depressive Disorder (PDD) can be so easy to miss. PDD lurks in your life by subtly easing symptoms your way for years. The feelings begin to feel normal and you’ve learned to live with them; similar to an annoying roommate that won’t leave.

You eventually find routine in your poor or excessive appetite, sleep problems, irritability, poor concentration, and low energy. Your quality of life has reduced and it feels like a personal failure. Your lack confidence, struggle to move from the lonely stepping stone, and wonder if you’re deserving when opportunity arises. Interest in what used to give you passion is lost. You accept that your depressed mood as fate. The isolation begins.

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. 


  1. Genetic and Physiological

  2. 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.

  3. Environmental

  4. Trauma or parental loss/separation are childhood risk factors.

  5. Temperamental

  6. Higher levels of negative affectivity (a variety of negative emotions, including anger, contempt, disgust, guilt, fear, 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, one thing we can do is to create a comfort box focusing on all five of our senses (touch, sight, smell, taste, sound). We feel grounded, present, and reconnected with ourselves when the senses are stimulated.

If this resonated with you, know that this does not define you. Further relief can be found through counseling. Your quality of life matters. Life is never too good to benefit from counseling. Give Amy Wine Counseling Center a call at 832-421-8714 for more information on our therapeutic services or to schedule an appointment. 


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