High-Functioning Depression Is the Hidden Mental Health Issue We Need to Talk About More

Despite being one of the most common mental health conditions, depression can sometimes be hard to spot. It can manifest differently: One person might have trouble getting out of bed while another is high-energy and always smiling.

“Seeing someone who looks like they are going through life with no problems or worries doesn’t mean they’re not hurting on the inside,” says Dr. David Tzall, a licensed psychologist in New York City. It’s an important reminder, he says, that “not all disabilities are visual.”

High-functioning depression is a term used to describe someone who has depression but doesn’t look like it’s impairing their life. Someone affected might be going out socially, maintaining meaningful relationships, and working successfully at a job — all with the added stress of maintaining the facade that everything is fine.

It can be easy to miss the subtle signs of high-functioning depression. Here’s how to recognize if you or someone you care about might be affected.

What is high-functioning depression?

While not a clinical diagnosis, high-functioning depression is a term to describe a type of hidden depression. For a range of reasons, those affected are motivated to mask their symptoms: Perhaps they fear the judgement of other people, don’t want to cause concern among their loved ones, or are even grappling with their own negative views of mental health issues.

High-functioning depression is a way for a person to avoid being stigmatized for being mentally ill than a separate depression diagnosis, explains Dr. Tzall.  “It’s an adaptive form of behavior.”

Because of this, it’s hard to know how many people are affected, though over 8.4 percent of adults have at least one depressive episode annually, according to the National Institute of Mental Health—a prevalence that’s higher in women than men.

While anyone can develop high-functioning depression, some individuals may be more at risk than others. People raised in certain racial or ethnic families where discussing mental health is taboo might be more likely to not want to believe or accept they have depression, explains Dr. Jameca Woody Cooper, a counseling psychologist and trauma and culture specialist. Growing up in a family where talking about feelings was discouraged can make it challenging for someone to recognize their own symptoms and seek help. Personality factors, such as being a perfectionist, can also put people at risk, as those affected try to conceal their symptoms. 

How to recognize high-functioning depression

If you’re unsure whether you or someone you care about has high-functioning depression, consider asking some of these questions: Have you been feeling sad or discouraged recently? Are you not giving yourself grace and being overly self-critical? Are these feelings because of some event or have they showed up without warning? Depression can also manifest as physical symptoms, including headaches, stomach pains, and loss of appetite or sleep.

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