Dissociative depression: a psychodynamic view

Abstract

Dissociative depression is a complex and chronic mood disorder characterized by a combination of persistent depressive symptoms and intermittent major depressive episodes. A key feature of dissociative depression is the existence of dissociative symptoms that are linked to prolonged stress experienced during childhood and infancy. Disturbances of sense of self and agency are core indicators of the disorder. Common symptoms include thoughts of guilt and worthlessness, difficulties with concentration and decision-making, changes in appetite and sleep, and suicidal ideation. Additionally, individuals may exhibit various expressive patterns such as borderline phenomena, psychoticism, trauma-related enactments, and attempts at control through somatization, compensatory narcissism, and obsessions. One challenge is that dissociative depression often does not respond well to biological treatments alone. Psychotherapeutic interventions that do not specifically address the dissociative aspect may also be ineffective. The required comprehensive approach involves working through layers of therapeutic reality to reverse the process that led to the status quo. An intensive psychodynamic practice with a renewed theoretical understanding (Dialectical Dynamic Therapy-DDT) is necessary to identify the leverage points that can bring about radical inner change. The aim is to alleviate the barriers that prevent individuals from realizing their full potential assigned in the beginning of life.