What is perfectly hidden depression? And how do you know if you’re suffering with it?

You have a perfect-looking life. But you’re inwardly struggling with depression, maybe even having thoughts of suicide or just getting out somehow. But others would never guess that you are.

Why? You’ve become expert at keeping it from others. You may be aware you’re intentionally hiding pain (as in what’ s termed “smiling” or “high-functioning” depression), but it’s also possible that you have no real clue. The dynamic may have entrenched itself so far into your very being that you may be largely unconscious of its presence, except for a deep tug in your gut that tries to whisper to you that something’s terribly wrong. 

You may have even searched online, trying to understand what that tug could be. You look at the criteria for depression and when you don’t fit into them, you may feel shame just for for exploring depression as what’s tugging at you. Then the highly critical, perfectionistic voice inside you gets even louder.

What may be intriguing in the exploration of perfectly hidden depression (PHD) is this question: If you don’t know how to reveal your pain, how are others supposed to identify what’s going on? How do you figure it out yourself? 

So. let’s talk about a set of characteristics that are usually present in perfectly hidden depression. If any of basic information has resonated with you, it’s pretty likely you’re going to find yourself there. Remember, PHD isn’t a diagnosis. You won’t find the term in any other books or magazines. It’s a syndrome (a group of things usually found together) that’s created when a tremendous amount of effort is put into creating a perfect-looking life. And it can lead to desperate loneliness. 

10 commonly shared characteristics of perfectly hidden depression

Following are 10 primary characteristics of PHD. They’re not all present in every person who might recognize themselves in PHD. But they’re fairly consistent.

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 you can silently berate yourself if you’re not at the top, at all times. You may allow yourself one area in which you’re not proficient — for example, laughing and saying you couldn’t skate if your life depended on it. Or you can’t tell a joke. But if it’s an activity or a pursuit that is meaningful to you, it needs to appear perfect, especially if it’s gong to be evaluated or seen by others. You’re the perfect parent, most accomplished lawyer, head of the class, or best friend. You consistently measure and evaluate your status, and if you’re not meeting perceived expectations, you ramp up the pressure. Inner shame governs your choices and your world 

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. You’re the first to notice when something’s going wrong, and look for solutions. You’re a good leader, although not the best delegator. This sense of responsibility can turn painful, as you may readily blame yourself, rather than taking a moment to understand the entire picture. This tendency can leave you vulnerable to manipulation. 

3. You have difficulty accepting and expressing painful emotions.

I know when I’m sitting across from someone who’s smiling brightly at me while simultaneously describing a significant loss or disappointment that I may have tripped over someone else who’s hiding. Not always. But it’s a question I begin to ask myself as a therapist.

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.

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. If you do yoga, you may hate the final position, for which 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 it might not be obvious to others that it exists. People will shake their heads and wonder aloud, “You never seem to have a care in the world. You don’t sweat the small stuff.”

You bet you’ll look as if things move easily for you, and without much effort; your worry is hidden, right under the smile.

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 that perhaps you’ve been putting off. 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.

But if you have perfectly hidden depression you may carry it too far. You may not know how to express what you like about yourself, what brings you a sense of esteem, outside of your external achievements. 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 if any 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 devastating 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 about something and to put those feelings away until a time when you can deal with them better. Healthy people do it all the time. You can even do it with joy or happiness. Sometimes it’s not the time to burst out singing.

However, if you identify with PHD, you rigidly over-compartmentalize. You’ve developed very strong boxes where you lock painful feelings in, 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 PHD emailed recently that she’d been diagnosed with PTSD, and that has totally dismissed it. “What happened to me was no big deal,” she wrote. “Much worse things have happened to other people.” That may or may not be true, but pain is still pain. 

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.

9. You hold a strong belief in “counting your blessings” as the foundation of well-being.

I believe in counting your blessings. You bet: It’s healthy, and it can keep you optimistic and grateful. However, if you’ve read this far and identify with PHD, you may feel guilt or even shame if you are ever anything but rigidly positive. Expressing compassion toward yourself? That’s out of the question; you’ve got too many blessings in your life. And any suggestion of self-compassion gets designated as whining or complaining. And that’s not allowed. 

10. You have emotional difficulty in personal relationships, but demonstrate significant professional success.

The vulnerability that is linked with 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 will 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 and being the perfect-looking couple.

If you have any of these ten characteristics, you don’t have to hide. There’s no shame in being human. You can take this questionnaire to see where you might fall in the spectrum of PHD. You can listen to my podcasts on perfectly hidden depression to find out what to do about it. You can realize that there are many others, like you — who are hiding and keeping secrets.

I’ve been writing for over five years about perfectly hidden depression (PHD) and now, New Harbinger Publishing has published my book on this highly damaging syndrome. 

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, and don’t always present 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 the light in their eyes carefully masks the pain that they are so frightened to show.

My new book entitled Perfectly Hidden Depression is available now! Just click here!  Its message is specifically for those with a struggle with strong perfectionism which acts to mask underlying emotional pain. But the 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. 

You can hear more about depression and many other topics by listening to Dr. Margaret’s podcast, SelfWork with Dr. Margaret Rutherford. Subscribe to this website and receive her weekly blog posts and podcasts, as well as  free downloadable ebook, “Seven Commandments of Good Therapy.”!

If you’d like to join my FaceBook closed group, then click here and answer the membership questions! Welcome!

This was originally published on May 6, 2017 and was updated on May 11, 2019 ,again on October 11, 2019 and finally on November 23, 2019.