There are certain diagnoses that may be co-occurring with perfectly hidden depression (PHD) or could be confused with PHD. And the last thing I want is for anyone to label themselves PHD or identify with PHD and stop there – when instead, you may need to recognize that you’re experiencing another type of psychological issue that warrants understanding and even treatment. Those diagnoses are Bipolar II disorder, Obsessive Compulsive disorder, Generalized Anxiety Disorder and Borderline Personality Disorder. We’ll talk today about what traits PHD and these other disorders have in common and what makes them distinct from one another.

The listener email for the week comments on my habit of including research and ideas from other people on SelfWork — and I respond about the “why” of that choice on my part.

Important Links:

The INFJ personality category or the Myers-Briggs

Don’t Panic by Reid Wilson

Understanding the Borderline Mother by Christine Lawson

Bipolar II Disorder
Meets criteria for a current or past hypomanic episode And meets criteria for a current or past depressive episode:
A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least four consecutive days and present most of the day, nearly every day, and including at least three of the following symptoms:

  1. Inflated self-esteem or grandiosity
  2. Decreased need for sleep
  3. More talkative than usual or pressure to keep talking
  4. Flight of ideas or subjective experience of racing thoughts
  5. Distractibility
  6. Increase in goal-directed activity (socially, at work or school, or sexually) or physical agitation. Excessive involvement in activities with high potential for painful consequences (e.g., buying sprees, foolish investments, sexual indiscretions)
Five or more of the following symptoms present during the same two-week period:

  1. Depressed mood most of the day, nearly every day
  2. Markedly diminished interest or pleasure in all or almost all activities
  3. Significant unintended weight loss or change in appetite
  4. Insomnia or hypersomnia
  5. Being physically agitated or listless
  6. Fatigue or loss of energy
  7. Feelings of worthlessness or excessive/inappropriate guilt
  8. Diminished ability to think or concentrate, or indecisiveness
  9. Recurrent thoughts of death, recurrent suicidal ideation, a suicide attempt, or a plan for suicide


At least one of the symptoms is either depressed mood or loss of interest or pleasure.


Generalized Anxiety Disorder
  1. Excessive anxiety or worry, occurring more days than not for at least six months, about a number of events or activities
  2. Difficulty controlling the worry
  3. The anxiety or worry is associated with at least three of the following symptoms:
    1. Restlessness or feeling on edge
    2. Being easily fatigued
    3. Difficulty concentrating or mind going blank
    4. Irritability
    5. Muscle tension
    6. Sleep disturbance


Obsessive-Compulsive Disorder
This disorder is characterized by the presence of obsessions, compulsions, or both. The obsessions or compulsions are time consuming (i.e., take more than one hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

  1. Recurrent and persistent thoughts, urges, or images that are experienced  as intrusive and unwanted and, in most individuals, cause marked anxiety or distress
  2. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion)

  1. Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, silently repeating words) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly
  2. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, they are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive


Borderline Personality Disorder
BPD is characterized by a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five or more of the following symptoms:

  1. Frantic efforts to avoid real or imagined abandonment
  2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
  3. Identity disturbance: markedly and persistently unstable self-image or sense of self
  4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)
  5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
  6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
  7. Chronic feelings of emptiness
  8. Inappropriate, intense anger or difficulty controlling anger
  9. Transient, stress-related paranoid ideation or severe dissociative symptoms


You can hear more about PHD and many other topics by listening to my podcast, SelfWork with Dr. Margaret Rutherford. Subscribe to my website and receive one weekly newsletter including my weekly blog post and podcast! If you’d like to join my FaceBook closed group, then click here and answer the membership questions! Welcome!

My new book entitled Perfectly Hidden Depression has arrived and you can order here! Its message is specifically for those with a struggle with strong perfectionism which acts to mask underlying emotional pain. But the many self-help techniques described can be used by everyone who chooses to begin to address emotions long hidden away that are clouding and sabotaging your current life.

And there’s a new way to send me a message! You can record by clicking below and ask your question or make a comment. You’ll have 90 seconds to do so and that time goes quickly. By recording, you’re giving SelfWork (and me) permission to use your voice on the podcast. I’ll look forward to hearing from you!

Photo by Nathan Cowley from Pexels

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