Depression wears many faces. And far too often, no one can see it, or feel it. Because it’s cloaked beneath a wall of the perfect-looking life. 

Whose faces are these — these hidden faces of depression?

She’s the professionally successful young woman who years ago woke up alone and naked in a hotel room, not remembering how she’d gotten there. She knew she’d been raped, but she’d never told anyone. She grew up in a home where no one talked about anything painful or troubling. 

I put it out of my mind,” she tells me now, smiling. “Plus it was so long ago.”

She makes herself throw up secretly. Sometimes twice a day.

Then there is the impeccably dressed mother and wife who’s very active in the volunteer community; everyone relies on her, respects her, and loves her. They don’t know that most days she doesn’t want to get out of bed and has developed a growing panic that makes her dread social gatherings. She swallows Xanax and drinks wine to cope. I ask her when her depression began and she looks at me, somewhat surprised, ”Oh, I’m not depressed. I don’t cry or anything. I have far too many blessings in my life to be depressed.”

Or he’s the man you can always count on; always willing to go the extra mile for someone else. He’s a divorced and remarried father, a successful lawyer who came into therapy because his wife dragged him into couples counseling, which went well. He called back months later, ”I’d like to talk to you by myself.”

Old hurts had been banished from his psyche. He’d been sexually abused by a grandfather who’d also been his major go-to support, teaching him to fish and hunt. He’d tried to forget that. But he is angry underneath it all.

Who are these folks?

Perfectly hidden depression…

Each one of these people have what I term perfectly hidden depression someone who’s internally despairing while outwardly appearing as if they have the world by the tail. And the most recent research on perfectionism — especially when you feel under intense pressure to look perfect to others — can have devastating consequences.

Does this sound familiar to you? Do you recognize yourself in these stories? And if so, how do you change? How do you stop hiding?

Here are five steps in healing. Five things that can lead you into acknowledging your own vulnerability and finding self-acceptance — the antidote for shame. 

1) Become aware or conscious of how perfectionism is a problem in your life.  

Don’t get me wrong. Striving for excellence isn’t bad in and of itself. But shame doesn’t have to govern your life. 

But if you don’t see how it’s encroaching on your joy, if you don’t recognize that you’re growing lonelier and more despairing, then it’ll be more difficult to address it as something you need and want to change.

You could be escaping your pain in various ways: alcohol, prescription medications, eating problems, or obsessive behaviors are some of the most common. But all of that is kept secret from others, and perhaps even from yourself. You have to bring that into the open, admit it so that you can change the way you deal with stress. Appropriate exercise, journaling, meditation, massage, laughter with friends are all healthy ways to manage stress.

2) Face your fear of letting go of perfectionism. Commit to the change. 

Make a commitment to the change. This is very hard with perfectly hidden depression, since it’s not apparently causing you a lot of pain. No one is worried about you. No one is texting, “Hey are you okay?”  No one. So it’s easy to hide. It’s easy to put out that smiling selfie out and pretend that the gnawing sadness isn’t really there.

But you can do it. And you’ll make mistakes. You’ll relapse into your striving for perfection. And that’s okay.

3) Confront the rigid rules you follow in your life. 

You’ve been following rules for a long time, rules about how and when and where you can act. It’s time to challenge those rules.

For example, one is, “Your needs never come first. That’s selfish.”.Realize that you get tired and used up; you need support yourself. That’s not selfishness, it’s self-awareness and allows you to recharge so that you can put your best foot forward next time.

But you’ve become a much more comfortable “giver” than “receiver.” So you’ve created a world where all you do is give. Give. Give.That has to change; you can learn to say “no” and reveal what you want. This is showing who you really are.

4) Connect with painful feelings, like anger or sadness. 

I’ve had many people tell me, “If I start talking about what I am sad (or angry) about, the pain will never end. It will suck me under.” 

It’s too frightening to emotionally go there. Or you don’t even know how. You’ve been so shut off from your feelings for so long, feeling sad feels impossible.

It takes time. And patience. And self-compassion.  

There is frequently something in your personal history that got all this started. Perhaps this was abuse or a hurtful family dynamic. That original trauma or dynamic that got the hiding started needs to be identified, talked about and worked through gently and compassionately. That may take some time and working with a therapist might be in order. 

5) Grow into change and seek true emotional intimacy. 

You can learn to find your strength in opening up about who you are to others — seeking intimacy through that openness. Those who love you may have been concerned about how much you take on, or how you never seem to flinch. Yet others may have counted on you not to or need to look perfect themselves. The second pattern can be a problem in taking the risks that lead to change. 

So you have to assess your relationships for their safety, and choose to feed those that support you in your newfound openness and vulnerability.

Taking these steps is more than worth it. They may save your life.


You can hear more about mental health 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!


This was originally published on Oct 4, 2014 and was updated on May 4, 2019.

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