Dysthymia, Depression, and Codependency

Dysthymia or chronic depression is a common symptom of codependency; however, many codependents aren’t aware that they’re depressed. Because the symptoms are mild, most people with chronic depression wait ten years before seeking treatment.Dysthymia doesn’t usually impair daily functioning, but it can make life feel empty and joyless. In the Shadow Sufferers have a diminished capacity to experience pleasure and may withdraw from stressful or challenging activities. Their emotions are dulled, though they may feel sad or melancholy or be irritable and anger easily. Unlike with major depression, they’re not incapacitated, yet they may have difficulty trying new things, socializing, and advancing in their career. Some may believe that their lack of drive and negative mood is part of their personality, rather than that they have an illness. Like codependency, dysthymia causes changes in thinking, feelings, behavior, and physical well-being.


Dysthymia was renamed “persistent depressive disorder” in the 2013 edition of the Diagnostic Statistical Manual V. (I use the terms “dysthymia,” “persistent depressive disorder,” and “chronic depression” interchangeably.) Symptoms must have persisted for at least two years (one year for children and teens) and includes at least two of the following:
• Low energy or fatigue
• Sleep disturbances
• Increased or decreased appetite
• Irritable or angered easily (for children and teens)
• Low self-esteem
• Difficulty concentrating or making decisions
• Feeling hopeless or pessimistic

The symptoms must create significant distress or impairment in social, occupational, educational or other important areas of functioning. Although mood remains persistently “down,” it may improve for several weeks of feeling better. Untreated, depression soon returns for longer periods. People are usually motivated to seek help in order to cope with a relationship or work problem or a major loss that triggers more intense symptoms. When they rise to the level of major depression, which can often occur in people with dysthymia (persistent depressive disorder), the diagnosis is “double depression” – major depression on top of dysthymia. Unlike chronic depression, an episode of major depression may only last a few weeks, but it makes a subsequent episode more likely.

Cause of Dysthymia

Persistent depressive disorder affects approximately 5.4 percent of the U.S. population age 18 and older. The numbers may be much higher, since it often goes undiagnosed and untreated. Over half of dysthymic patients have a chronic illness or another psychological diagnosis, such as anxiety or drug or alcohol addiction. Dysthymia is more common in women (as is major depression) and after divorce. There may not be an identifiable trigger; however, in cases of onset in childhood or adolescence, research suggests that there is a genetic component.

Although stress can be a factor in depression, some people don’t experience a life event that triggered their depression. There are individuals with chronic depression who blame their mood on their relationship or work, not realizing that their outer circumstances are only exacerbating an internal problem. For example, they may believe that they will feel fine when they achieve a goal or when a loved one changes or returns their love. They’re unaware that the real cause is that they’re striving to prove themselves to compensate for feeling inadequate, or that they have no life of their own, have sacrificed self-care for someone else, or that they feel unlovable and worthy of love. They don’t realize that their depression and emptiness stem from their childhood and codependency.

Codependents, by nature of their addiction to people, substances, or compulsive processes, lose touch with their innate self. This drains their vitality and over time is a source of depression. Denial, the hallmark of addiction, can also lead to depression. Codependents deny their feelings and needs. They also deny problems and abuse and try to control things that they can’t, which add to feelings of hopelessness about their life circumstances. Other codependent symptoms, such as shame, intimacy issues, and lack of assertiveness contribute to chronic depression. Internalized shame from abuse or emotional abandonment in childhood causes low self-esteem and can lead to depression. Untreated, codependency worsens over time, and feelings of hopelessness and despair deepen.

Codependency and depression can be caused by growing up in a dysfunctional family that’s marked by abuse, control, conflict, emotional abandonment, divorce, or illness. The Ace Study demonstrated that adverse childhood experiences lead to chronic depression in adulthood. All subjects with a score of five or more were taking anti-depressants fifty years later. Other causes of dysthymia are isolation, stress, and lack of social support. (Research shows that people in abusive relationships aren’t likely to disclose it.)


Psychotherapy is the treatment of choice. It is more effective when combined with antidepressant medication. Cognitive therapy has been shown to be effective be eliminating negative thinking to prevent recurrence of depressive symptoms. It may mean healing trauma and PTSD from prior abuse.

In addition, patients need to develop better coping skills, heal the root cause, and change false shame-based beliefs that lead to feelings of inadequacy and unlovability. Goals should be to increase self-esteem and confidence, self-efficacy, assertiveness, and restructuring of dysfunctional thinking and relationship patterns. Group therapy or support groups, such as Codependents Anonymous or other Twelve-Step Program are effective adjuncts to psychotherapy. Lifestyle changes, such as exercise, maintaining healthy sleep habits, and participating in classes or group activities to overcome isolation are also ameliorative.
©Darlene Lancer 2015

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13 thoughts on “Dysthymia, Depression, and Codependency

  1. Every aspect of this article resonates with me. Thank you for writing; I will have to pick up your books. I have never taken medication for depression but I have been considering it. I am in psychotherapy and group therapy at present.

    I am in a codependent relationship that is paired with an insecure attachment (I am fearful-avoidant and he is dismissive-avoidant in attachment style). I have tried to end our 5 year relationship, but he responds with how devastating it would be to lose me and that he’ll change. I cave because of my addiction to him & logistical ease, but our lack of intimacy causes unbearable emotional pain. Any suggestions?

  2. I have v high self efficacy, can’t think of anything I don’t like about myself, assertiveness naturally improving as I age, always been driven and have stable life goals that I have worked on over many years – career goals etc. Successful for my age. Plenty of strong, ling-term friendships. Many interests, which are broad.

    Always feel bored and unsatisfied. Years of therapy, still no idea what’s up except perfectionism that is slowly improving. Can’t imagine a life without it now. Can it get better if this engrained?

    • What you describe may be due to an inner emptiness fueling the striving for perfection and accomplishment. What’s missing is inner connection that may have been lost due to dysfunctional parenting and perhaps internalized shame. Look for my a book on overcoming perfectionism next year. Meanwhile there’s a lot of information on it and on emptiness in Conquering Shame and Codependency.

      • Thanks…actually rethought myself and decided something similar but perhaps opposite…I believe the perfectionism is driving the emptiness rather than vice versa. I was brought up to excel but my focus on excelling means I cannot feel my successes as they are never enough (regardless of what others think…their standards are too low!!) I need to keep envisioning myself as human rather than machine, I think, and get used to “normal” being just as good as “superstar”.

          • Then I would say they are symbiotic 🙂 Perfectionism deepens the emptiness/unworthiness that drives it. In my view, the best thing to do is reduce the perfectionism & tolerate the consequences in order to be more accepting of oneself. Reduce the behaviour driving the emptiness and then accept the emptiness itself (while simultaneously being aware the emptiness is an illusion). If you can accept the emptiness/unworthiness (as a subjective feeling rather than a statement of truth) then you no longer need to run from it.

  3. I’m realizing that I’ve been very codependent in my relationships, including the one I’m currently in where I’ve been feeling extremely high levels of anxiety for most of it (1+ yrs), even though I scaled it back to “friendship.” I find myself feeling “hot and cold” with him, even though he’s incredibly patient with me. I feel irritated and frustrated by unmet expectations I place on him which then leads to me criticizing him and then feeling bad and apologizing later. I plan to purchase your book and am starting therapy tomorrow; however, I don’t know how to be in this relationship in the meantime. I’m sad and scared. What do you recommend?

  4. I am habitually codependent. I left the USA to find myself and release myself from a long line of relationships. Also because I feel that I have a purpose to help others throughout the world.

    As usual.. I’ve met a myriad of wonderful men and one of them invited me to Argentina. The sound of his voice makes me melt and I feel sheer joy when we are together. Yet I left a boyfriend of 3yrs in the USA. I told him about this trip and I’ve told him its over twice but he keeps loving me. Curious where I’m going.

    I don’t want to fee guilt or shame or codependency. This man may be the one for me. I just question my MO; like always. Any thoughts?

  5. I was raised in a very controlling, abusive, emotionally immature, alcoholic home. I know now that I suffered from depression my entire life, until a little over 5 years ago. June of 2010 is when I found Alanon!!! It gave me the sanity I didn’t even realize I needed. It freed me from all the unhealthy thinking I had been programmed with. My brain still wants to go there, the obsessive thinking more, but now I know how to control it. The tools I learned in Alanon have literally given me a new life. No medication needed!

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