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.


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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 symp...