Depressive personality grows out of loss nobody helped the person grieve, plus a belief that their suffering is their own fault. These patients usually do well in therapy, but the self-hating kind gets worse with too much support and needs their self-attack named.
What it is
People with depressive personality tend to have had significant loss without being helped to grieve it, and tend to believe it is somehow their fault that they are suffering.
“you tend to have had significant loss and not been helped to grieve that loss. And for reasons that are very common in childhood, you tend to believe it's somehow your fault that you are suffering”
1:01:27Nancy McWilliams on Psychoanalytic Diagnoses, Part 2: Depressive Personality, Histrionic Personality, OCPDNov 2024Guest episode It tends to develop in sensitive, highly related children whose parent is critical, unresponsive or absent and cannot meet the child's need for relatedness.
“People who tend to get into the depressive personality category tend to be sensitive kids who are highly related. And if you have a parent who is critical, non-responsive, absent, not able to meet the needs of the kid for relatedness, then you can get into trouble”
1:08:07Nancy McWilliams on Psychoanalytic Diagnoses, Part 2: Depressive Personality, Histrionic Personality, OCPDNov 2024Guest episode Mania is basically a state of denial of all the sad things depressive people are acutely aware of. The two are opposites, which does not mean they are not the same phenomenon.
“A mania is basically a state of denial. of all the sad things that depressive people are acutely aware of. It's not accidental that they're absolutely opposite. That doesn't mean they're not the same phenomenon”
1:00:17Nancy McWilliams on Psychoanalytic Diagnoses, Part 2: Depressive Personality, Histrionic Personality, OCPDNov 2024Guest episode
Therapy
Depressive patients are usually good psychotherapy patients because they come in believing the problem is them. They are very reactive to separation and tend to equate separation with rejection.
“Usually depressive patients are pretty good patients in psychotherapy because they come in believing the problem is them and they respond They're very reactive to separation. They tend to equate separation with rejection”
1:03:44Nancy McWilliams on Psychoanalytic Diagnoses, Part 2: Depressive Personality, Histrionic Personality, OCPDNov 2024Guest episode Two groups need different things. The more empty, hungry group responds very well just to a relationship in which the other person is interested in them. With the self-hating group, the therapist eventually has to call their attention to their go-to automatic self-talk.
“In the more empty, hungry group, they respond very well just to a relationship in which the other person is interested in them. In the more self-hating versions of depressive personality, the therapist has to eventually find a way to really call their attention to how their go-to automatic self-talk is”
1:04:52Nancy McWilliams on Psychoanalytic Diagnoses, Part 2: Depressive Personality, Histrionic Personality, OCPDNov 2024Guest episode
Pitfalls and myths
Be too supportive with the self-hating kind and they tend to get more depressed. They conclude you are a very nice person who does not get how bad they really are.
“If you're too supportive with the self-hating kind of depressive person, they tend to get more depressed because they think, you're a very nice person, but you don't get how bad I really am”
1:05:35Nancy McWilliams on Psychoanalytic Diagnoses, Part 2: Depressive Personality, Histrionic Personality, OCPDNov 2024Guest episode Depressive personality was the most common personality type in the literature before 1980, the empirical literature included, but the mood disorders task force did not want it in the DSM.
“the most common kind of personality type that existed in the literature, including the empirical literature before 1980, was depressive personality. But people on the mood disorders task force didn't want to have depressive personality in there”
7:09Nancy McWilliams on Psychoanalytic Diagnoses, Part 1: Personality, Defenses, Themes, Paranoid PersonalityNov 2024Guest episode
From these episodes
Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.