Perhaps you, or someone you love, has taken The Beck Depression Inventory.

It’s a very well-known questionnaire that’s often used to determine if someone meets the criteria for depression as it covers its traditional mental, emotional and physical aspects. It’s easy to take, is self-scored, and even quantifies just how depressed you might be, dependent on your score.

Often, if you’re moderately depressed, you don’t realize how slowly the lights have gone down on the joy or satisfaction with your life. You can’t see how much you’re struggling with negativity, irritability, or sadness. You’re blind to the many ways you’re isolating from others, even feeling as if your energy is imploding inward.

Depression has entrenched itself into who you are and how you think. It’s robbed you of the ability to see opportunity, realize options, or focus on others. Perhaps you’re at the point where you barely function. You take your kids to school, but you go back to bed when you go home. You go to work, but can’t focus so you give people excuses why you’re not meeting a deadline. Shame over all this can constantly berate you for what you aren’t, what you haven’t accomplished, or who you could’ve been, if given the chance.

You might even struggle more than that and have surprised yourself with thoughts of your own death or other form of escape from your current life.

The good news is that you can get better. With exercise, therapy, medication, mindfulness, and hard work, you can lift the veil that has cut you off from the enjoyment of life.  As Andrew Solomon wrote, ” The opposite of depression isn’t happiness, it’s vitality.”

So how is perfectly hidden depression different from all of this?

Perfectly hidden depression (PHD) is a term I coined to describe a syndrome, or a set of characteristics and behaviors, that enable you to hide or detach from you emotional pain. That doesn’t mean your pain isn’t there, or that it’s not having an effect. But you’ve learned to automatically and even unconsciously bury it under a mountain of perfectionism.

So what does your PHD life look like? You’re performing to the best of your ability all the time, every day. You push yourself to the limit, putting others before yourself, even believing that any focus on yourself is somehow selfish. You’re living very deliberately, getting things done, accomplishing the seemingly impossible…all while ignoring the memories of how you were deeply hurt in your childhood or abused as an adult.

You avoid revealing too much about yourself, laughing off your fatigue. You don a mask of happiness every day, and you may have even be fooling yourself that the mask is the real you. Others admire you. “You have an awesome family.” “I could only dream of living your life.”  The only choice that feels safe? Maintaining that image.

A man who identified with PHD, once said to me, “The Beck Depression Inventory is asking the wrong question for me. I’d answer a resounding “no” to the statement, ‘I often feel hopeless.’ I wouldn’t admit feeling hopeless,. To anyone. Ever. The question should be, ‘If you could admit feeling hopeless, would you?’ The answer again would be “no,” but it would reveal perfectly hidden depression.”

So in these cases, no depression inventory would ever reveal your depression. Because you greatly fear vulnerability – and even trying to discover what’s been buried.

If you identify with with classic depression, you may struggle to admit it, or fear you’ll be stigmatized if you do. Yet others notice, others see the change in you. You see the change in you. And hopefully, you will seek help.

But if you identify with PHD (here is a questionnaire if you are wondering if you might), no one is concerned about you. You’re alone in whatever awareness you have that something is deeply wrong. And that very loneliness can lead to thoughts of hurting yourself.

Let’s change that.

Know that perfectly hidden depression is real. It is its own type of depression that will not fit classic criteria. At least, at first. It’s just as real as its classic cousin. And perhaps – it can be just as lethal.

Because being invisible hurts.

You don’t need to hide.


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!

Photo by Tim Marshall on Unsplash



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