Ep 110: Hidden Depression in Perfectionists

Dr. Margaret Rutherford, author of Perfectly Hidden Depression and psychologist, chats with Andy about the symptoms--some intuitive and some counterintuitive--of depression. According to Dr. Rutherford many young people hide feelings of depression behind a constant state of achieving.

Full show notes

We know our teenagers better than anybody else, so we’d definitely know when they were feeling depressed...right? The basic symptoms of a depressed person are recognizable---withdrawing from social activities, no longer participating in things they used to enjoy, changes in dress and diet. If we saw that our teen exhibited these symptoms or noticed that they seemed anxious or unenthusiastic about life, we’d definitely know something was up.

But what about a teen who’s depression isn’t quite so easily spotted? What if your teen seemed to be doing perfectly--class president, varsity soccer team, prom queen--but deep down, they were hiding a seriously crippling mental health crisis? Teenagers like this exist, and in fact this kind of depression is a lot more common than you might think.

To shed some light on this subject, we’re sitting down with Dr. Margaret Rutherford, author of Perfectly Hidden Depression: How to Break Free From the Perfectionism that Masks your Depression. The book is all about how some people experience depression in a way we may not think of as “traditional” or” conventional”. These people seem as though they’ve got everything together on the surface, but inside, a deep depression is stirring.

Dr. Rutherford began to notice this kind of depression in patients in her 25+ years as a therapist. Patients would come in for other conditions, like eating disorders or insomnia, and were surprised at the suggestion that perhaps they may be suffering from depression. These patients would insist that their life was going well, when it was time to discuss the serious traumas they’ve faced, they smiled through it as though there was no pain at all.

That’s when Margaret realized that perhaps these patients were experiencing depression in a way she hadn’t quite considered before. She coined the term “Perfectly Hidden Depression”, to describe people who’s sadness was so well hidden that even they themselves didn’t realize it was there. They don’t look depressed, don’t act depressed, have an active life with plenty of friends, but then are suddenly discovered attempting suicide or checking themselves into psych hospitals.

In order to help you better understand how this could be possible, Dr. Rutherford dives into the definition of Perfectly Hidden Depression and explains it’s symptoms and signs. In the episode, she describes common habits of people with this condition, which can serve as warning signs that your teen might be experiencing a mental health issue that they can’t or won’t talk about.

10 Signs of Perfectly Hidden Depression

If you’re worried that the description of Perfectly Hidden Depression might sound like your teen, don’t fret. Margaret and I discuss in depth ten common symptoms of people with this condition, so that you can develop a deeper understanding of how it works and how it may be affecting your teen.

Dr. Rutherford explains that one thing people with this kind of depression tend to do is focus intensely on outward accomplishments in order to feel valuable. This may occur as a result of feeling an excessive pressure from family or society to achieve highly. They might feel as though they aren’t valid or worthy of love when they aren’t winning awards or getting promotions. Margaret emphasizes that while ambition is a wonderful attribute, this need to fulfill external measures of success can become irrational or cause intense self criticism, leading to a dangerous decline in mental health.

This leads to another common habit of those with Perfectly Hidden Depression--the tendency to compartmentalize their feelings. While those who are struggling with these feelings may sense that something is off within them, these folks are likely to put this feeling in a box in their mind and pretend it doesn’t exist, or believe it is simply the result of a bad day. Margaret shares a tragic example of an individual who exhibited some depressive behaviors, who, when a worried friend showed concern, insisted it was only a fleeting feeling. Sadly, a few weeks later, he committed suicide.

Oftentimes, people with Perfectly Hidden Depression don’t feel like they can share their negative feelings, or may even suppress them to the point where they don’t let themselves really experience sadness. Dr. Rutherford says that this often occurs because these individuals have a harsh inner critic which might cause them to feel shame over these negative emotions. They’re also often perfectionists, and don’t like to cry, complain, or show that their life is anything less than smooth sailing.

In the episode, Margaret discusses all ten common habits of those with Perfectly Hidden Depression and explains how to spot them. Once we’ve defined the syndrome a little further, we dive into what parents might be doing to worsen this condition in teens, and how they can prevent this condition from developing in their kids.

How Parents Can Hurt And Help

Dr. Rutherford knows that parents would never want to cause their children grief, but she points out some ways parents may be contributing to or worsening the development of Perfectly Hidden Depression in their teens. Oftentimes, the pressure from parents to achieve and perform, whether that’s in school, sports, or other extracurriculars, can be a major contributor to this problem. In the episode, Margaret talks about how we can continue to encourage kids in a healthy way, allowing them to reach their full potential while also allowing them to remain emotionally stable.

In many cases, parents might see their kid performing extremely well, and take this to mean that this kid is happy and thriving. This is not a bad assumption--and it is certainly true in some cases. Margaret suggests, however, checking in with your teenager and making sure they are maintaining healthy habits and considering their own mental well-being. In the episode, she explores this idea further and gives tips for what to do if you suspect your teen might be struggling with Perfectly Hidden Depression.

When it comes to prevention, Dr. Rutherford stresses the importance of being vulnerable with your kid. She stresses how important it is to model emotional vulnerability to allow teens to grow into individuals who know how to handle all of life's ups and downs. If parents make it seem as though expressing sadness, anger and fear is unacceptable, kids may not learn how to let their feelings out.

This means it’s ok to share your disappointments about losing out on a job, your sadness about the death of a loved one. It’s ok to show your teenager that life doesn’t always go as planned. Now of course, it’s not a teenager’s job to help you fix the problem or to be your therapist, but letting them see that failure and negative emotions are a part of life can do wonders for their own emotional health.

In The Episode…

When it comes to Perfectly Hidden Depression, there’s a lot to learn! Dr. Rutherford and I also cover:

• How to spot symptoms of Perfectly Hidden Depression
• Why praising perfectionism can be dangerous
• What is appropriate to share with kids and what is not
• The five stages of overcoming perfectly hidden depression