Major Depressive Disorder

MAJOR DEPRESSIVE DISORDER has all the signs of clinical depression but on a much higher scale. It can be caused by external factors such as when a loved one passes away, or it can be caused by internal factors, e.g., neurological. This disorder has more severity than Dysthymic Disorder – dysthymic disorder is a mood condition where a client may suffer intense levels of consistent low mood, which often lasts for two years. (See link at the end of this blog.)

Occurrences in major depressive disorder however continue throughout the sufferer’s life to an extent they can become suicidal. Thus self-sabotage might occur when for instance a person does an act to reduce the symptoms of low mood. This might be comfort eating, self-medicating with alcohol, shopping, reassurance seeking and so on. These become problematic when comfort eating becomes bingeing, self-medication becomes addictive, shopping becomes an emotional high (on an overdraft) and reassurance seeking becomes obsessive. These behaviours might occur when the person feels they have no other choice but to dodge their emotions. However, these acts can increase the depths of their already fixed emotional insecurities – worry about weight issues, relationship and/or work problems due to alcohol addiction, debt due to unnecessary shopping trips and doubts about self-esteem when reassurance isn’t helping anymore. The worst scenario is when a person fails to respond to alternative methods to help themselves improve their condition where his or her self-sabotaging behaviours can lead to ill-health, which worsens depression and in some cases may lead to self-harm and either suicidal thoughts, or suicide itself.


THE THERAPIST’S ROLE is much the same as with those with clinical depression. That said, it is important that the therapist ensures the client attends regular medical supervision and encourages them to take the advice of their medical doctor and specialist. The therapist also encourages the depressed person to take and maintain prescribed medication, support him or her in following through with other support and safety mechanisms, e.g., early warning systems (see blog on clinical depression), self-assessment scale, TLC and emergency contacts.

Self-medication is a crucial issue since this can add to an already serious low mood; a GP should monitor, for example, appropriate reduction in terms of withdrawal methods to help guard against the client tipping over the edge. While minor health issues can be complemented by health therapists to help manage client cases, severe mental health issues differ in that these go beyond a therapist’s level of competence. Therefore in the first instance, it is the therapist’s job to support the client during medical supervision only, and to stick to the plan implemented by the medical specialists (since appropriate implementation is extremely hazardous and therefore should not be attempted by the therapist). In the second instance the therapist’s role is to only complement and assist with the consent and knowledge of a specialist, psychiatrist, community health team or mental health social worker, who coordinates and manages the case. DYSTHYMIC DISORDER

 © 2013 Carol Edwards


About Carol Edwards

Hi, I'm a professional CBT Therapist specialising in OCD and related problems. I have lived experience of various OCD subtypes. I'm now in remission and spend much of my time supporting others on the OCD spectrum in person and online. I follow the NICE Guidelines in my practice as a complementary therapist for OCD.
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