There’s a kind of depression that we’re missing in mental health.

It’s not easy to detect, because when you have it, you hide it.

You may be aware of what you’re doing. But, more likely, you’ve hidden for so long, you’ve become unaware of what happens, day after day. Your gut knows something’s wrong. And in the quiet of the night, the loneliness that edges into your awareness may come close to plunging you into despair. But you quickly silence the warning signal. Achieving success, smiling, seeming to have a perfect-looking life has been your go-to way of coping for so long, it simply seems like who you are. Or who you have become.

You may not even realize it’s depression. Because how could you be depressed? “I have so many blessings.”

I call it perfectly hidden depression.

You wouldn’t meet criteria for minor depression, or what is called dysthymia, because you look far too confident, too well-connected, too into what you’re doing. Your life is going great and you’re not quite sure what you’d say to some therapist.

You won’t qualify as having major depression, because you’re far from isolated. Tears don’t appear. In fact, tears or any expression of emotional pain is notably absent. No one is approaching you, saying that you “seem different,” or asking you, “Is something wrong?” Far from it. Instead, you’re likely to hear, “I just don’t know how you get all the things done that you do!”  There’s no expressed suicidal ideation. In fact, what a therapist or doctor sees in you is someone who’s successful and well-liked; maybe working too hard, or anxious.

It’s depression all right, underneath all of that accomplishment. Your despair has been stowed underground, and your perfect-seeming life has become a camouflage, protecting you from painful memories that were pushed away years before. After all, how could you be depressed? Sure, you know that you can be high-strung, often not getting enough rest. You’re perfectionistic, but you count on that trait time and time again. Maybe you worry and you try very hard to stay in control, but doesn’t everyone? Isn’t that the right way to live?

This isn’t true contentment nor authenticity. There are “shoulds,” “musts,” and “have to’s” that govern your life. You’re outwardly successful, accomplished, and admired, but deep inside you’re suffering, even if you’re unaware. How do I know this?

  • Because where there are secrets, you can find loneliness.
  • Because where there’s little self-care or lack of self-compassion, you’ll find shame and self-criticism.
  • Because where there’s perfectly hidden pain, you can easily find a sense of being trapped, even enslaved by the very strategy you used to cope.
  • Because where there’s silence, you won’t be able to find vulnerability.

What follows is a questionnaire for you to take, to help you become more clear about identifying with this group, or syndrome, of behaviors. If you do, I hope you will seek out more information. It could literally save your life.

A Checklist For Perfectly Hidden Depression (PHD)

 How do you know if you have perfectly hidden depression? Take this short questionnaire to find out. Try to be honest with yourself. Scoring instructions are at the end. You can also click here to download the questionnaire.

  •  Do you struggle with confiding in others — especially about your real-life difficulties and problems? Yes______ No______
  • Do you obsess about things looking perfect, both for yourself and through others’ eyes? Yes______ No______
  • Do you avoid talking to your partner (or your friends) about feeling hurt by them, or about a growing resentment you might have? Yes______ No______
  • Do you have trouble sleeping or turning your mind off at night? Yes______ No______
  • Do you have trouble admitting when you’re feeling overwhelmed? Yes______ No______
  • Do you push yourself to get the job done, regardless of the cost to you? Yes______ No______
  • Do you respond to the needs of your friends even when it can short-change your own? Yes______ No______
  • Did you grow up in a family where feelings of sadness or pain were avoided, or where you were criticized or punished for expressing them? Yes______ No______
  • Have you ever been hurt emotionally, physically or sexually, and told no one? Or if you did tell someone, you weren’t believed or supported? Yes______ No______
  • Did you grow up in a family (or are you still experiencing a family) where you felt like you had to meet defined expectations rather than being allowed to be yourself? Yes______ No______
  • Do you like to have control of a situation if you’re going to be involved? Yes______ No______
  • Do you have a growing sense that it’s becoming harder to maintain an organized structure in your life? Yes______ No______
  • If so, do you feel anxiety or even panic? Yes______ No______
  • Do you tend to not cry or rarely cry? Yes______ No______
  • Are you considered ultra-responsible, the one that can always be counted on by your co-workers or family and friends? Yes______ No______
  • Do you think that taking time for yourself is selfish? Yes______ No______
  • Do you dislike people considering themselves “victims”—that it’s not their fault when something goes wrong? Yes______ No______
  • Did you grow up being taught that you were supposed to handle painful things on your own? That asking for help reflected weakness? Yes______ No______
  • Do you strongly believe in focusing on the positives in your life, or “counting your blessings”? Yes______ No______
  • Do you have a critical, nagging inner voice telling you you’re not good enough, or that you could have tried harder, even though you accomplished your goal? Yes______ No______
  • Do you outwardly seem hopeful and energetic while, at times, you struggle with a sense of being trapped? Yes______ No______
  • Do you make lists of tasks to get done during the day, and if they are not completed, feel frustrated or like a failure? Yes _______ No_______

Count your positive answers to the questions above. If you answered “yes” to five to eight questions, you’re likely to be a very responsible person, though you may need to consider taking more time for yourself. A “yes” response to eight to eleven questions indicates that your life seems governed by highly perfectionistic standards, which may be detrimental to your well-being. Twelve or more positive responses may reflect the presence of PHD, or a depression that you deny (or are unaware of) – except in your quieter moments where you realize how cut off you are and how lonely you feel.

Lots of driven, accomplished people share these traits, or have these dynamics in their history. Often, they lead to success and happiness — that’s what’s called positive perfectionism.

When too many of them are present, you’re likely to experience PHD.



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 Demeter Attila from Pexels.

This post was originally published on March 26, 2016; updated and republished on March 19, 2023.

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