Attachment, Loss, Trauma and Personality in Resistant Depression

Abstract

Depression is one of the most common psychiatric disorders worldwide. The World Health Organization ranked it as the leading cause of morbidity, resulting in high utilization of health services and decreased work productivity. The concept of depression throughout history has changed and continues to change, from simplistic notions of single causal factors to more complex etiology. This paper aims to discuss the changing ideas of depression; the importance of attachment, of unresolved grief and loss as traumatic factors contributing to pathologies of personality and the development and maintenance of depression. I will illustrate with a brief case history the need to take into account these factors and the prominent affects experienced in the treatment of resistant depression, rather than resorting to pharmacotherapy alone.