Why is it so hard to shower when |’m depressed?

Q. I find many tasks challenging when I’m depressed, but showering feels especially difficult. Why is that? And what can I do about it?

A: If you have depression, you know how challenging everyday efforts can be.

Cooking, cleaning, socialising — all of these can feel as if you’re trudging through the mud, said Dr Lindsay Standeven, a psychiatrist and professor at Johns Hopkins Medicine.

Difficulties with grooming and hygiene are especially common with depression, she said. But because uncleanliness can be associated with laziness or even immorality, people with depression might be afraid to discuss their symptoms with their doctor. And that shame, combined with the low self-esteem possibly triggered by not bathing, can fuel depressive symptoms even further, Standeven said.

If you’re wrestling with stepping into the shower, or know someone who is, it’s important to give yourself or others grace, experts say.

WHY DOES DEPRESSION MAKE IT HARD TO SHOWER?

Part of it is simply because keeping up with your hygiene — like brushing teeth and washing hands — requires energy, and a common symptom of depression is fatigue. So even if you want to shower, you may not have the energy to do so, said Christine Judd, a psychotherapist and mental health social worker in Australia. But there’s something uniquely challenging about showering. Depression can impair your ability to solve problems, make decisions and set goals, said Dr Patrick Bigaouette, a psychiatrist at the Mayo Clinic. That can make many tasks difficult, but especially those with multiple steps.

“If you break it down, there’s actually so many steps that are involved with showering,” Bigaouette said. A single shower might include undressing, turning on the water, lathering, hair-washing, shaving, rinsing, drying off and choosing what to wear.

For someone without depression, Standeven said, moving through those steps might feel seamless, like watching a flip book animation in which the transitions are nearly invisible. But for someone with depression, the same process may feel like flipping one page at a time, with each additional step making the undertaking seem increasingly daunting.

Feelings of worthlessness, hopelessness or other types of negative thinking — “I don’t deserve to be clean”; “If nothing matters, why bother?” — can also hinder a person’s ability to bathe, Bigaouette said.

The subsequent inability to shower can reinforce the belief that you can’t do anything right, he added. That can cause a feedback loop where poor hygiene actually exacerbates the underlying symptoms that prevented the shower in the first place.

HOW CAN I MAKE SHOWERING EASIER?

If you’re struggling to shower, first remember that your feelings are reasonable, Standeven said.

“Would you be holding yourself, or anybody else, to the same standard if they were walking around ill with some other illness?” she said. If you just had surgery, she added, “you’re not going to wake up and expect yourself to walk a couple kilometres”.

Setting smaller goals can help. Maybe aim to shower once a week instead of every day, or try to stand in the shower for just a few minutes, even if you don’t wash your body or hair.

You can also try breaking the process into smaller steps, Bigaouette said. Perhaps you first tell yourself to turn on the water, then put one foot in the shower, then the other, and so on. These smaller steps may feel more manageable than one larger objective.

Making the shower more enjoyable can help too, the experts said. Treat yourself to pleasant-smelling products or listen to a favourite playlist. Recall when showering felt easier and try to mimic that experience, Bigaouette suggested.

You might also set a reward for completing your goal, like watching a favourite TV show, Standeven said. If your energy is low, consider using a shower seat or taking a bath. Or ask a partner, friend or family member to help with some tasks, like washing your hair, setting out your outfit or providing emotional support by sitting in the bathroom with you.

Knowing that you are cared for can help combat that negative voice in your head, Bigaouette said.

And simply making the effort to practise a healthy behaviour can reinforce the idea that you can accomplish something, research suggests, contradicting any negative thoughts that may say otherwise.

WHEN SHOULD I SEE A DOCTOR?

There is no “correct” frequency for showering. And not everyone with depression struggles to stay clean, Judd said. In fact, some people who are depressed may bathe too much because they may worry that if they seem unkempt, others will notice that they’re depressed.

The question, then, is: “How does this compare to your normal?” Standeven said.

If you’ve noticed a change, talk with a doctor and consider seeking therapy, the experts said. Cognitive behavioural therapy, a form of psychotherapy, can help address some of the bigger underlying problems that make poor hygiene such a hard cycle to break, Bigaouette said.