How To Know If You Experience Perfectly Hidden Depression: A Questionnaire
There’s a different 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 never learned how to experience (let alone express) such unwelcome feelings. Instead, you bury them. Deep in your gut you might know something’s wrong, and in the quiet of the night, loneliness can edge into your awareness and even 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. It is who you have become. You count your blessings, scoff at the idea of having any mental health struggles, and look to the world like you’re at the top of your game.
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 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 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 September 23, 2023.
This is fascinating, especially reading some of the questions that uncover risk factors. I did not have dysfunctional parents but, rather, parents with health issues that put me in a quasi-caretaking role at an early age. I was diagnosed with dysthymia in my 40’s and I suspect my mother had issues with depression, too (she died when I was 12 so I will never know for sure). I have a huge need of feeling in control, also.
I am glad it’s offering another perspective to you Alana. It’s amazing how people don’t recognize that they’re discounting things from the past that shape the way they live today. You can be on automatic. Thanks very much for commenting.
It is shocking to me how many of these were problems of mine….almost all. May I share my testimony that therapy works? That help is available and if you desire to get better it is possible? It took a long time, I had to reprogram my brain practically…but I am so much better.
Oh that’s wonderful to hear! Yes! Your testimony is more than appreciated. I talked to an interviewee today who has experienced this for years, and never sought help. Thanks so much!
I answered yes to eight questions and interestingly enough, have recognized I need to take more time for myself. Yay! I’m doing that in so many ways, and it’s wonderful.
Good for you. Thanks for commenting Brenda.
I just came across this and I have to admit that it has kind of scared me about how many of these I answered yes.
I hope Cassie that your answers might help point you in a direction where you could begin to ask yourself some questions about how your past might be affecting your present choices. There are plenty of posts on PHD here on the website as well, that might be useful to you. Remember, there are many strong things about some of the “symptoms” or characteristics of PHD. It’s only when they’re over-done or they are the sole way someone functions, that there is a problem Good luck to you. You can always email me at askdrmargaret@146.66.99.73 .
I answered yes to 23 out of 25 of these.
Hi Jessica. I’d urge you to continue reading my work on PHD — there are several posts on the website about it, how it can begin, and what are the initial steps of doing something about it. I also have episodes on my podcast about PHD, in which I go into even further detail. The link to the podcast is below. It starts with 003 and 004 then there are others sprinkled around. Good luck to you. Dr. M.
I’m just 16 years old, and I know that people who read this are older than me and experienced tough life but I want to mention that even now, I answered 14 questions yes and I found about PHD yesterday. I was so indescribably bad. Even though, I was never had a depression before, not a minor one. And yesterday I started crying without knowing why, or knowing why. And at this moment, I have to make decisions that are going to change my life. And I seriously don’t know what to do with it. And, well my parents, they can’t help me. I’m so screwed up. Because I think they are one of those reasons.
Hello Layla. Being 16 can be really tough, but that doesn’t mean depression can’t be present. Please find some adult you can talk to about what’s going on, before your depression gets worse. If it’s not your parents, then maybe someone who could help your parents understand. Take very good care. Dr. Margaret
Thank you for sharing this.