What is perfectly hidden depression?
Would you know if you or someone you love were suffering with it?
Perhaps you have a perfect-looking life outwardly, yet inwardly you struggle with a sense of something being wrong, or even more dangerously, you have fleeting thoughts of suicide or escaping your very busy, but very lonely life.
However, you’ve also become an expert at keeping your true feelings from others. You may be aware you’re intentionally hiding pain but it’s also possible that you are now largely unconscious of underlying despair, except for a deep tug in your gut that can whisper to you that something’s terribly wrong.
You may have even searched online, trying to understand what that tug could be. You looked at the criteria for depression and when you didn’t fit into them, you might easily have felt shame at how obviously ungrateful you are for your blessings.
What’s intriguing in the exploration of perfectly hidden depression (PHD) are two questions: If you don’t know how to reveal your pain, how do you figure it out yourself? That’s what this post is for.
But the second question is this: How would anyone else know before it’s become too hard for you to cope?
My recent TEDx talk focuses on this complicated issue – and I’d love for you to watch.
Perhaps in this description of the PHD syndrome, you’ll find yourself. And be relieved that finally, there’s a name for what you’ve been experiencing.
Ten common traits of perfectly hidden depression…
These are the most common I’ve found. You may have a few or almost all.
1. You are highly perfectionistic, with a constant, critical inner voice of intense shame.
Having a perfectionistic streak is one thing. You try to do your best: “If it’s worth doing, it’s worth doing well.” Yet if you silently berate yourself if you’re not at the top at all times, there’s a problem. If an activity or a pursuit is meaningful to you, it needs to appear perfect, especially if it’s going to be evaluated or seen by others. You’re the perfect parent, most accomplished lawyer, head of the class, or the “best” best friend. You consistently measure and evaluate your status, and if you’re not meeting perceived expectations, you ramp up the pressure. Inner shame pummels you every hour of every day; its voice telling you, “You’re not who others think you are.” “You’re a big mess and someone’s going to figure that out.”
2. You demonstrate a heightened or excessive sense of responsibility.
You’re very aware of duty, obligation, and loyalty, and can be counted on in a crunch. But as Dr. Gordon Flett, a renowned researcher in perfectionism, states, you feel that, “The better I do, the better I must do.” “I’ll let you know if I need help,” you’ll say. But you won’t.
3. You have difficulty accepting and expressing painful emotions.
Anger is avoided or denied. Sadness is banished to the back of the closet. Disappointment is for whiners. You may not even have the words to express these emotions. You stay in your head most of the time, rather than connecting with heart — analyzing, decoding, thinking through things. You smile to hide.
4. You worry a great deal, and avoid situations where control isn’t possible.
You aren’t someone who can stay easily in the present, but worry about the future. If you do yoga, you may hate the final position, when the suggestion is to breathe and relax. You may love to cook, but have a very hard time sitting with guests and enjoying the meal.
The need for control is strong, and so a lot of time is spent worrying about the things that might occur to interrupt that control. Ironically, It’s important to hide this worry. So, others may not know it exists.
5. You intensely focus on tasks, using accomplishment as a way to feel valuable.
“You’re only as good as your last success.” You count on activity and accomplishment to distract yourself from any inner insecurities or fears that might try to seep out of hiding.
We all do this to a certain extent. If you’re having a bad day, it feels good to get something done. Or you get a promotion at work. Or someone emails you about how your kindness was so meaningful to them. There’s value in purpose and effort.
But you carry it too far. You may not know what brings you a sense of esteem, except for those accomplishments and tasks. And that’s the problem. Your sense of importance and contribution to the world isn’t coming from who you are inherently, only your most recent success.
6. You have an active and sincere concern about the well-being of others, while allowing few into your inner world.
This isn’t fake concern, and it’s not pretend or insincere. It’s real: Caring for others is what you do very well. However, you don’t let others sense any vulnerability. You don’t reveal pain from your past. Your spouse might know, but it’s not discussed. There’s a wall up against anyone discovering that you’re lonely or fatigued, empty or overwhelmed.
This can be especially frightening when suicidal ideation is present. And you can’t let anyone in. Devastatingly, even if you do, you may not be believed. “What, you? Depressed? You’ve got everything in the world going for you.” And that could lead to horrific consequences.
7. You discount or dismiss hurt or abuse from the past, or the present.
Compartmentalization is a skill. It’s the ability to be hurt, sad, disappointed, afraid, or angry but store those feelings until a time when you can work through them. Healthy people do it all the time.
However, in PHD, you can rigidly over-compartmentalize. You’ve developed very strong boxes where you lock away painful feelings, consciously or unconsciously, shoving them into a dark recess of your mind. This allows you to discount, deny, or dismiss the impact of life experiences that caused pain in the past, or the present.
One woman identifying with perfectly hidden depression emailed me a while back saying she’d been diagnosed with PTSD, and that she has totally dismissed it. “What happened to me was no big deal,” she wrote. “Much worse things have happened to other people.”
8. You have accompanying mental health issues, involving control or escape from anxiety.
You live your life in a very controlled, well-governed fashion. So actual psychiatric diagnoses that might co-exist with PHD might be disorders having to do with control, such as eating disorders and/or obsessive-compulsive traits. Alcohol or sedative medications could be used to escape anxiety as well, albeit secretly.
9. You hold a strong belief in “counting your blessings” as the foundation of well-being.
Counting your blessings is healthy, and can keep anyone optimistic and grateful. However, you may feel guilt or even shame if you’re anything but positive. Expressing compassion toward yourself? That’s out of the question; you’ve got too many blessings in your life. Thus, any suggestion of self-compassion gets designated as whining or complaining.
It’s termed toxic positivity.
10. You have emotional difficulty in personal relationships, but demonstrate significant professional success.
The vulnerability that’s found in true intimacy is hard for you. While driven to be productive and achieve, you aren’t likely to be someone who can easily relate on an intimate level. And you may have chosen a partner, who in fact, doesn’t allow vulnerability either, or doesn’t have that capability. Your relationship may be based primarily on what you do for each other, rather than who you are for each other, with the emphasis staying on the kids, your careers or being the perfect-looking couple.
If you have one or more of these ten traits, you can change. You can begin to practice self-acceptance. And it’s hard work. You’re undoing a lot of things that have protected you in the past.
You can take this questionnaire to see where you might fall in the spectrum of PHD.
If someone you love has these characteristics, please send them this post. They will hopefully feel seen, and loved. It could be the catalyst that would allow them to start a journey that might save their life.
If you’re a therapist, please realize that depression doesn’t always look the same, not always presenting with depressed mood and anhedonia. They can look at you brightly, and say, “You know I don’t know why I’m here.” You have to notice that their smile is a bit forced. Their emotions, tightly tucked away.
And their eyes, carefully masking the pain that they’re terrified to let you see.
You can hear more about perfectly hidden depression 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 is available 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!
This was originally published on May 6, 2017; updated and republished on July 9, 2023.