Perfectly Hidden Depression
Individuals may hide their depression because they worry about what others will think, they do not want to be a burden or they do not know how to get help. Some may not even realize that they are suffering from a mood disorder. Clinical Psychologist Dr. Margaret Rutherford created the term “Perfectly Hidden Depression” (PHD) to describe a syndrome with ten common traits:
- Perfectionism accompanied by constant internal criticism that causes shame;
- an elevated sense of responsibility;
- difficulty expressing and accepting painful emotions (for instance, believing that crying signifies weakness);
- constant worrying and avoiding situations that cannot be controlled;
- an intense focus on tasks and deriving value from accomplishments;
- allowing few people into your personal life, even as you sincerely care about the well-being of others;
- dismissing or downplaying prior/current abuse or injury;
- other mental health issues, such as anxiety;
- expressing gratitude and/or positivity without practicing self-compassion; and
- significant professional success while experiencing difficulties in emotional relationships.
Individuals with PHD believe they need to appear flawless, especially if an activity or project is going to be seen and evaluated by others. They are intensely loyal, generally have difficulty delegating tasks or responsibilities, and tend to deny or avoid anger and remain analytical. Keeping busy distracts them from their inner fears and insecurities. PHD also causes people to “rigidly over-compartmentalize” their feelings.
Dr. Rutherford developed “A Checklist For PHD”. Questions include: “Do you avoid talking to your partner or friends about feeling hurt by them or about a growing resentment you might have?”; “Do you have trouble admitting when you are feeling overwhelmed?”; “Do you tend not to or rarely cry?”; “Are you considered ultra-responsible and someone on whom your family or friends can always rely?”; “Do you think taking time for yourself is selfish?”; and “Were you taught as a child that asking for help reflected weakness?”
High functioning people with depression can exhibit a variety of behaviors that reveal their inner struggles, appearing cold or unemotional, avoiding eye contact, displaying nervous habits (i.e., chattering or playing with their hair, etc.), feeling intimidated by the future, overthinking, a racing mind, and ruminating and/or dwelling on the negative. Signs of depression in children and adolescents include ‘‘all-or-nothing’’ thinking; catastrophizing; concentration and memory problems; difficulty making decisions; inappropriate responses to events; and being irritable and uncooperative. Youth who believe that others view them as being incompetent are more likely to develop depression and school is often a stressful environment for students who are not successful.
PHD can lead to exhaustion and loneliness. It is important for individuals with depression to manage their time, energy and attention. The Japanese concept of wabi-sabi or “imperfect beauty” in which nothing is ever finished, lasts forever or is truly perfect can be a beneficial starting point. Also consider what you do with the negative emotions you feel like anger or fear.
People with PHD are often viewed as overachievers. In reality, depression diminishes both hope and motivation. In order to recover, it is important to dismiss the belief that focusing on yourself is selfish. Rather than a sign of weakness, asking for help is an act of strength. Change is possible, including in the emotions you express and what you allow others to see.