Depression is usually evidenced by the presence of one or more deficits in the daily functioning of persons. Identifying these along with other factors help to make the diagnosis of depression.
EMOTIONAL DEFICITS - Chronic Depression is usually associated with an awareness of some strong unpleasant emotions. These may include sadness, feelings of guilt or shame, anxiety, etc. There is a general trend toward dysphoria which can be described as an unpleasant emotional arousal. This "flat affect" is usually associated with a lack of facial expression, a lack of animation or bodily responses, and a general lack of any significant arousal to a normal environment or to any attempts at social stimulation.
THOUGHT DISORDERS - Chronic Depression may also be associated with thought disorders and with difficulty in processing information. Certain thoughts and/or images may occur as rumination. This is common among depressed persons. These intrusive thoughts often contribute to difficulties sleeping, problems in concentrating, and ritualistic behavior patterns.
Another disorder of thinking is indecisiveness. A depressed person is not able to sort out facts in a situation, draw a conclusion, and take decisive action. Commonly, obsessive thinking occurs as a result of the absence of any action. A depressed person might also experience feelings of being overwhelmed with ideas, plans, expectations, and daily events that need to be dealt with. Such feeling of being overwhelmed might be associated with procrastination, indecision, confusion excessive worrying, and frustration. The depressed person may choose to withdraw from people and events in an attempt to reduce the stresses of being overwhelmed. Another form of thought disorder can be seen in self-deprecatory talk and in self-criticism. This self talk aggravates depression and is really self-defeating. It blocks action, decreases hope, and interferes with any potential for problem-solving.
Depressed persons generally organize their experiences rather primitively. They will often make global judgments about events. They are likely to interpret events in extreme, negative, absolute, judgmental, and categorical ways.
A depressed person tends to view the world and his/her experience as a total deprivation or defeat. He/she may also characterize him/herself as a loser and irreversibly doomed.
MOTIVATIONAL DEFICITS - The dysphoria of depression is also associated with inertia and passivity. A depressed person usually finds it very difficult to become active. This results in a lack of action in directions or courses of actionwhich could help resolve the depression. This, in turn, results in the depression becoming more chronic and more intense. It is this very passivity which generally annoys others. It stimulates them to push the depressed person into activities, even against their own wishes. The depressed person feels that things are "too hard", "there is too little time", "there is too little energy", and "too little incentive" to take any action at all. He/she generally complains of being tired and fatigued. Chronic, pervasive fatigue is one of the most telling signs of depression.
PHYSIOLOGICAL DEFICITS - Frequently sleep is disturbed in depression. A person may often have difficulties falling asleep. They may awaken early in the morning. They may experience awakening throughout the night, often reporting generally restless sleep patterns. It is these disturbances of sleep which contribute to fatigue and emotional dysphoria.
A depressed person's eating habits may change drastically. Some people may eat less while others may eat more when depressed. They often display a disregard for a balanced diet during such times.
Sexual activity also tends to diminish during depression, with long periods of abstinence being a common occurence.
Frequently, depressed persons experience mild to moderate headaches, especially in the morning. These headaches are probably related to the anxiety and increased muscle tension which accompanies worry and physical stress. Depression is quite often associated with a dry mouth as well as numerous other kinds of physical disturbances, usually of the gastrointestinal tract. This may contribute to the loss of interest in eating and the loss of weight in some depressed persons.
BEHAVIOR DEFICITS - There are a lot of behavioral changes that occur during depression. Some can be abrupt and severe. A major one is a tendency to avoid everything. This might include social events with family or friends and may also include avoidance of any opportunity to become socially involved. Physical activities, including fun, leisure and recreational events, may become almost nonexistent. Communication skills and style may become impaired or drastically altered. The depressed person may become passive or agitated or even aggressive toward others. Excessive crying can occur. Excessive medication taking and/or alcohol consumption may also occur. Generally speaking, there is a marked change in the rate of a wide variety of behaviors.
Deficient social skills are a major determinate of the presence of depression. Non-depressed people are generally socially skilled. They are active, quick to respond, relatively insensitive to aversive people, do not miss a chance to react, interact fairly evenly with members in group situations, emit to others and elicit from others high rates of positive reinforcement. Communicatively, they are assertive and forthright. This socially skilled behavior pattern of non-depressed people is the goal of treatment and the objective of any preventative effort.
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