6 Signs of Persistent Depressive Disorder

Disclaimer: This article is not meant for a professional diagnosis, instead it aims to bring public awareness to the mental health condition. If you find that you resonate with most of the signs stated below, don’t hesitate to seek professional help from licensed mental health professionals.

Psych2goers, have you always feel “down in the dumps”? You feel sad and unable to “pick yourself up” and it has always been that way, for as long as you can remember. 

If you feel that the above description resonates with you, most probably you are having traits of persistent depressive disorder (PDD). 

According to the latest edition of Diagnostic and Statistical Manual (DSM-5), below are the compulsory symptoms that need to appear in patients with PDD: 

  • Depressed mood for most of the day, for more days than not, as indicated by subjective account or observation by others, for at least 2 years (for adults) or at least 1 year (for children and teens)
  • During the period of the disturbance, the person has never been without symptoms from the two out of six criteria (see below) for more than 2 months at a time.
  • Criteria for MDD may be continuously present for the stated duration, in which case patients should be given comorbid diagnoses of persistent depressive disorder and MDD.
  • There has never been a manic episode, a mixed episode, or a hypomanic episode and the criteria for cyclothymia have never been met. (For more info: Read article https://psych2go.net/what-is-the-difference-between-cyclothymia-and-bipolar-disorder/)
  • The symptoms are not better explained by a psychotic disorder.
  • The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse or a medication) or a general medical condition.
  • The symptoms cause clinically significant distress or impairment in important areas of functioning.

Alright, Psych2goers, maybe you are now intrigued about the additional six criteria. In addition to the compulsory symptoms, patients with PDD need to fulfill at least 2 of the following 6 criteria:  

  1. Poor appetite or overeating

For Claire, eating becomes a chore. It turns into an unnecessary nuisance and worry. She feels as if her stomach has been in a knot and her heart has been in her throat for several months. She feels that she is so stressed that she doesn’t even feel hunger. Even the task of cooking (which she always enjoys before) becomes overwhelming. 

Psych2goers, do you know, one of the signs of PDD is the patient will experience poor appetite or overeating? 

Simmons and colleagues (2016) conducted a study in which the brain activity in unmedicated depressed patients with increased or decreased appetite, and in healthy control subjects were viewed using functional magnetic resonance imaging (fMRI). In both groups, they are told to view photographs of food and non-food objects. The results revealed that depression-related increases in appetite are associated with hyperactivation of putative mesocorticolimbic reward circuitry, while hypoactivation of insular regions that support monitoring the body’s physiological state causes depression-related appetite loss. 

2. Insomnia or hypersomnia

It is 3 am. You toss and turn on your bed. You feel tired, however you are unable to fall asleep. 

One of the cardinal features for patients with PDD is disturbances of circadian rhythms. They will sleep at a time which is out of phase with the body’s biological rhythms. Thus, they are prone to develop either insomnia or hypersomnia, with prolonged sleep episodes at night or increased daytime sleepiness and fatigue (Provini, 2020). 

3. Low energy or fatigue

You wake up from your 8-hour sleep. You notice, you always feel fatigued and low in energy despite having an adequate amount of sleep. 

During medical consultations, fatigue is one of the most common symptoms. However, the definition and conceptualization of fatigue is difficult due to its subjective nature. Therefore, most practitioners consider it to be an extreme and persistent form of mental and/or physical tiredness, weakness, or exhaustion (Dittner, Wessely, & Brown, 2004). 

4. Low self-esteem

Psych2goers, have you ever had a pessimistic view of yourself? Do you feel embarrassed, inept, or clueless in social situations? You look at your own reflection in the mirror, and you realize you don’t like the person, you feel worthless, and useless. You look at your friends’ achievements and suddenly feel inferior.

If your answer is “Yes” to the above questions, you most probably have low self-esteem. 

People with PDD can have this symptom. They may put themselves down, doubting and questioning themselves, regardless of their close friends or family trying to convince them otherwise. This lack of confidence may affect several other areas of a person’s life such as friendships, home, schooling, exams and studies, work performance, or the ability to seek work in the first place. 

5. Poor concentration or difficulty making decisions

Since the pandemic, your 10-year-old son has been attending online classes. You notice that he has a hard time focusing during the classes. He is always distracted and doesn’t want to concentrate on what the teachers are saying. 

Oftentimes, PDD can also cause concentration difficulties that negatively impact their daily function with poorer clinical outcome (Majer et al., 2004). Poor concentration may manifest differently in different people. According to Nall & Biggers (2019), this may include: 

  • being unable to remember things that occurred a short time ago
  • difficulty sitting still
  • difficulty thinking clearly
  • frequently losing things or difficulty remembering where things are
  • inability to make decisions
  • inability to perform complicated tasks
  • lack of focus
  • lacking physical or mental energy to concentrate
  • making careless mistakes

6. Feeling of hopelessness

Recently, you notice a change in your thought patterns. Your brain keeps telling you that things are dreadful, horrible, or awful. It may try to persuade you that you cannot succeed or your future is bleak. 

If you keep having distorted and inaccurate thoughts, there is a high chance that you are experiencing hopelessness. 

Hopelessness is defined as the belief that things aren’t going to improve and you can’t succeed. This can be one of the symptoms of PDD.

Final thoughts 

PDD is a chronic condition and requires treatments and interventions from licensed mental health professionals. If you notice that you or your loved ones have signs stated above, please don’t hesitate to seek the appropriate treatments. 


Dittner AJ, Wessely SC, Brown RG

J Psychosom Res. 2004 Feb; 56(2):157-70.

Majer, M. et al. (2004). Impaired divided attention predicts delayed response and risk to relapse in subjects with depressive disorders. Psychological Med. 34, 1453–1463.

Nall, R., & Biggers, A. (2019, September 6). What Makes You Unable to Concentrate? Healthline. https://www.healthline.com/health/unable-to-concentrate.

Provini, F. (2020, August 31). Sleep and depression. MedLink Neurology. https://www.medlink.com/articles/sleep-and-depression.

Simmons, W. K., Burrows, K., Avery, J. A., Kerr, K. L., Bodurka, J., Savage, C. R., & Drevets, W. C. (2016, April 1). Depression-Related Increases and Decreases in Appetite: Dissociable Patterns of Aberrant Activity in Reward and Interoceptive Neurocircuitry. The American journal of psychiatry. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4818200/.

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