Do You Have High-Functioning or Perfectly Hidden Depression?
Why the difference matters.
Posted December 8, 2019 | Reviewed by Gary Drevitch
Sometimes you speak to spark a conversation. Sometimes you speak to express your values or to make someone laugh.
And sometimes you speak because something needs to be said: An overlooked truth is waiting to be understood.
That truth is that depression can wear many faces. And one of those faces can be very hard to see, because it's covered by a mask—what I term perfectly hidden depression (PHD).
Suicide rates are soaring. And some people appear to be dying by suicide before they ever reach out for help, from anyone. They've lived perfect-looking lives...until something shatters within them. And that something could be unexpressed pain and pressure from the weight of the secrets they've been silently carrying for years.
Yet how is this mask of perfectionism different from what some with depression do every day, in what's called "high-functioning" depression?
Maybe you get up in the morning. You're more than aware of a sadness lurking behind your eyes; maybe you suffered abuse that still gives you nightmares; maybe you're grieving the death of your best friend. Maybe most mornings you don't want to get out of bed. But you put a smile on your face, take your kids to school, and do the best you can do. You simply don't talk much about the pain you know is there. You stay busy trying to put your best foot forward. Maybe you go to therapy. Maybe you don't.
But you pull yourself together.
On this note, one woman asked a great question: "Aren't we all hiding to a certain extent? Isn't that a healthy thing to do, rather than another behavior that's a problem?
Using compartmentalization in high-functioning depression
She makes a great point. And you bet it is. We all have our own problems that we cope with on a daily basis, and frequently may not reveal to others.
You carry on. You cope. You make life work, even though you know you're dealing with depression. And it's very hard. Maybe you meet the criteria for classic depression or maybe you don't. But you're struggling and few see it.
Psychologically speaking, people with high-functioning depression are able to use the skill of compartmentalization, where you suppress your own personal feelings for the moment and instead, attend to the needs or expectations of the present. You metaphorically put anger or sadness or fear into a box in your emotion closet and stick it up on a shelf until it's the right time to deal with it. It's an important skill, and one that many people know how to use well and effectively. When the time is right, when you're in a safe space to pull that pain out, you can cry or get angry or whatever you need to feel.
Someone experiencing high-functioning depression still needs help and appropriate treatment however. And they, like someone who identifies with PHD, may not ask for that help. They may battle on alone and without treatment. And then of course, things can become worse.
The difference between high-functioning and perfectly hidden depression
So what's the difference between this and perfectly hidden depression (PHD) ?
In high-functioning depression, you're aware of what you're doing.
But in perfectly hidden depression, you may have grown quite unaware. And you use highly rigid compartmentalization, meaning you immediately deny, discount or avoid emotional pain. Your goal isn't to get those feelings out later and work through them. You push them away out of fear. Out of shame. Or out of the greater need to seem perfect or in control.
This need for control, fueled by shame, can be highly dangerous.
Somewhere in your past, you likely learned that your physical safety or emotional survival depended on that need for control. You learned it was safer to hide or cover up painful emotions. So hide you did. And now you do it without thinking. You do it unconsciously. You firmly believe your life is good.
The unconscious strategy of hiding and staying silent
Let’s use a very real-world example about what is meant by “unconscious": When you step into a dark but well-known room in your home, you don’t have to think where the light switch is. Your hand shoots up automatically, and easily finds its place on the wall as you flick it on. You don’t give it a thought. It’s an automatic, unconscious action. Your body remembers. Your mind remembers, but without thinking about it in that moment. We do unconscious things all the time – things that have become second nature. We could go deeper and talk about unconscious urges and drives, but for the sake of our discussion, that’s not necessary. The more something is old hat or habitual – the more likely that it’s tied into unconscious behavior.
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Perfectly hidden depression may share some traits with high-functioning depression, but it isn't the same. Because you're not necessarily aware. Until you are.
Research is showing us that when rigid perfectionism is present, it can cause other severe psychological problems, as well as deepening depression. And still go unnoticed. Because it's unconscious. And because it masquerades as success.
Here's what Rebecca, a classic example of PHD, had to say:
"Before I read about PHD, I'd never have thought of myself as depressed. Ever. If I even wondered, if I listened to my gut that was whispering something was wrong, I'd feel incredible shame, like I didn't appreciate the good things in my life. I couldn't even imagine allowing myself to think or say some of the things I've said to you since we've been working together. I didn't realize how I was living. Or not living."
Rebecca wasn't suicidal. Yet. She came to therapy because her fear of the thoughts that were entering her mind was greater than her fear of the inevitable emotional vulnerability of getting those boxes down from the recesses of her memory. And working through the feelings that would come with them.
This is the first vital step in healing from PHD: labeling what has been the way you're functioning as destructive and hurtful in the long term, and making what has remained unconscious, conscious.
That can be very difficult. But it also might save your life. Or the life of someone you love.
Any type of depression can be dangerous, lonely, and despairing, whether you appear depressed or not. Call it whatever helps you to call it, but recognize the power of depression's presence. And if your gut is whispering to you that something's not right, please listen.
It's trying to get your attention.
You can identify where you might be on the spectrum of perfectly hidden depression by taking this questionnaire.