Did you know there are two types of depression? In this article, we will talk about the two types of depression, what depression looks like on the outside, what depression feels like on the inside, and what you can do to recover from either type of depression. 

Diagnosing Depression 

The diagnosis of a major depressive episode includes seven symptoms that have lasted more than two weeks. These include:

1. Depressed/Irritable mood

2. Decreased interest or pleasure in life

3. Difficulty sleeping

4. Eating too much or too little

5. Feeling slowed down

6. Easily fatigued

7. Thoughts of suicide or increased thinking about death

A good example of depression is the character sadness from Inside Out. 

In the movie, Sadness moved slower than the others, focused on the negative aspects of a situation, stayed alone and isolated, and struggled with being assertive. 

Sadness also had the gift of understanding what others were feeling, is deeply sensitive and compassionate, and remained steadfast and patient to achieve her character’s main role–to inform Riley of the importance of losing her childhood home and moving away from her friends. 

When Joy finally allowed sadness to take control of Riley’s emotions, Riley broke down and cried. Her parents responded to her sadness with understanding, comfort, and reassurance.

Sadness or Depression?

Sadness metastasizes into depression when the person either denies sadness’s presence OR there is no one else in the person’s life who understands and comforts. When sadness cannot be processed correctly, it gets internalized and leads to feelings of helplessness, hopelessness, and despair. 

The Two Types of Depression

Did you know that there are two different ways people are vulnerable to depression?

While the outer symptoms of depression can appear similar, how a person thinks and feels about themself can look completely different. These symptoms are on two ends of the spectrum, and can be mixed in with one another. 

In therapy, it’s important to focus on a person’s unique, internal experience, how they are trying to cope with their situation, and their selected goals.

Relational or Anaclitic Depression

The first type of depression is known as relational or anaclitic (means “to lean on” in Greek) depression. Some people love to be a good friend, partner, and family member–and there is nothing inherently wrong with this–however, problems begin to emerge if someone’s self-esteem or sense of purpose relies on others too much. 

People prone to relational depression are often serially in romantic relationships or pursuing romantic relationships. They may even take pride in calling themselves “hopeless romantics'' or “addicted to love.” 

People with relational depression can seem clingy, overly needy, and smothering. Alternatively, they may display the opposite of this and be hyper independent, arrogant, and passive-aggressive. Inside, they often feel empty, lonely, and hopelessly misunderstood. 

When a person with relational depression reaches adulthood, they often struggle with developing their own path because they’ve looked toward others to make them happy. They have difficulty being assertive and setting boundaries. Some people even find themselves in controlling and abusive relationships. They often have difficulty verbalizing their difficult feelings because they don’t want to cause a conflict or burden others.

Relational Depression Defense Mechanisms

Defense mechanisms people on the relational end of the depression spectrum may employ include:

• Regression - People may act and look younger than their age or believe they are helpless or powerless in situations they may actually be able to change. 

• Reversal - This occurs when a person reverses roles. In therapy, people with depression often reverse roles with me causing me to feel helpless after a patient rejects my suggestions or observations.  

• Somatization - If a person does not express their intense thoughts and feelings, they may show up in their body. Their body will manifest their symptoms through illness, fatigue, or even chronic health issues. 

Self-Critical or Introjective Depression

The second type of depression is self-critical or introjective depression. 

Introjection occurs when a person absorbs other people’s unacceptable parts in order to protect against rejection or abandonment. This often occurs when a harsh or critical parent chastises their child for their (real or imagined) mistakes. 

In dysfunctional families, a child may play the role of the scapegoat who constantly gets blamed when something bad happens. In therapy, patients slowly realize part of their parents’ attempts at discipline might have been very damaging. 

But introjection doesn’t have to occur from parents. Sometimes, there is not a strong, guiding presence in the home. Therefore, the child will look toward their community in order to figure out how to gain acceptance and self-esteem. In order to correct their mistakes, they may yell at, insult, or humiliate themselves. When they reach adulthood, they often struggle with burnout due to the unrelenting demands and expectations they have placed on themselves. 

Introjective Depression Defense Mechanisms

Defense mechanisms people with introjective depression employ include:

• Introjection

• Reversal 

• Idealizing others - They focus on others’ amazing qualities and fail to remember they have many flaws as well.

• Devaluing/Putting down oneself - Ironically, they reverse this on themselves. The person will focus on their negatives and dismiss their positive qualities. When asking about five positive qualities, patients tend to struggle to come up with five of them or they qualify or minimize these strengths. 

Understanding Depression and Efficacy

An important aspect of depression is efficacy. Efficacy is one’s ability to exert their influence on the environment. People with low self-efficacy often feel helpless and powerless. They switch between periods of hyperproductivity to spectacular burnout. People can have high expectations of themselves or others, which can be helpful at times. However, if the expectations are unrealistic, it can lead to disappointment, discouragement, and exhaustion. 

Next Steps

Now that you understand how depression can differ within a person, what can you do about it?  

For Relational Depression:

Think of your important relationships and imagine asking them for feedback on yourself.

• What do you think about setting boundaries or being assertive?

  • What standards and expectations do you have?

  • What sort of consequences do you set?

  • How much do you struggle to follow through with?

  • How do you feel when others are mad or disappointed with you?

  • Do you feel happy when others are happy, even though you have a good reason to be upset?

• How close do you feel towards people in your life?

  • Do you wish to be closer? 

  • Are you worried about asking because you don’t want to be seen as clingy or desperate and ultimately be rejected?

• Do you find yourself often helping others, but no one is there to help you?

• What else do you have trouble expressing in your relationships?

• How difficult is it for you to give strong, negative feedback about how their behaviors impact you?

For introjective depression: 

Notice how these beliefs show up in your daily life:

• “If I am perfect, people will like me and won’t have a reason to reject me.”

• “If people really get to know me, they will abandon me.” 

• Identify all the little ways you think you are “bad” 

• How has that “badness” played a role in any of your significant losses?

• What standards and expectations do you have for yourself?

• Think about current important relationships and as you’re thinking about them, imagine asking them for feedback on yourself. 

  • Does the thought of asking this question terrify you? 

  • What sort of messages are you worried the most about hearing? 

Conclusion 

Therapy can quickly help someone struggling with depression. Research shows progress can be seen in less than four sessions. 

In my therapy practice, these are a few of the topics we explore. We focus on helping you regain confidence and calm your thoughts and feelings. We create a happier and healthier life for you and the people you choose to love. Ready to get started? Book an appointment or learn more about the services offered.